Inhaled Insulin Increases Accessibility to Diabetes Care

The management of diabetes in specialized populations, particularly children and pregnant women, is entering a new era as inhaled Technosphere insulin (TI) emerges as a potential solution to long-standing therapeutic barriers. For pharmacists, understanding the unique applications of the inhalation system is becoming increasingly vital, as this "rapid-on, rapid-off" therapy addresses the psychological and physiological challenges that often hinder treatment adherence in gestational diabetes (GDM) and pediatric type 1 diabetes (T1D).¹

Although traditional injectable rapid-acting insulin analogs (RAA) have been the standard of care, they frequently impose a significant psychological burden, including needle-related anxiety and a fear of hypoglycemia, which can lead to suboptimal glycemic control.¹

“Inhaled insulin may provide an effective option for managing diabetes in women with GDM and children and adolescents with T1D,” the authors of a review published in Diabetes Technology and Therapeutics said.¹ “Its unique pharmacokinetic and pharmacodynamic characteristics, combined with noninvasive administration, address many of the challenges associated with injected insulin therapy, such as needle phobia, treatment nonadherence, suboptimal glycemic control, and psychological distress.”

For Gestational Diabetes

In GDM, the diagnosis often requires an immediate and stressful immersion into daily self-management for patients who are otherwise insulin naive. Research indicates that over 40% of women with GDM experience elevated levels of diabetes-related distress, and roughly 43% report a fear of needles.¹

As pregnancy progresses, insulin resistance typically peaks in the third trimester, making postprandial hyperglycemia more difficult to manage with oral agents like metformin, which remain controversial due to potential risks like preeclampsia or small-for-gestational-age infants. Inhaled insulin offers a needle-free alternative that eliminates the need for the rigid 30-to-45-minute pre-bolus timing often required for injections during late pregnancy. Instead, TI can be administered at the very start of a meal, providing a more flexible and less invasive option for achieving pregnancy glycemic targets.¹

For Pediatric and Adolescent Patients

For pediatric and adolescent patients, the benefits of inhaled insulin extend beyond physiology to address the social stigma and emotional strain of managing T1D among peers. Adherence often plummets during adolescence, with adolescents showing the highest HbA1c levels across all age groups. Inhaled insulin provides a discreet delivery method that can be used quickly in school or social settings, reducing the embarrassment often associated with uncovering an injection site.¹

Furthermore, its shorter duration of action—dissipating in approximately 180 to 240 minutes compared to 280 minutes for injectable lispro—significantly lowers the risk of late postprandial hypoglycemia, providing families with greater confidence during exercise or at bedtime.¹

“Despite its potential, the use of inhaled insulin in these populations requires additional investigation,” the authors said. “While current evidence supports its favorable pharmacokinetic/pharmacodynamic profiles and safety, further research is required to establish its efficacy, safety, and optimal dosing in pregnant women and pediatric patients.”

The Role of the Pharmacist

From a clinical and dosing perspective, pharmacists must guide patients through a therapeutic profile that differs substantially from traditional RAAs. Although the FDA label suggests a conservative 1:1.3 conversion ratio, multiple studies suggest that a higher conversion of approximately 1:2 (2 units of inhaled TI for every 1 unit of injectable RAA) is often necessary to achieve bioequivalence.¹

This is supported by the recent INHALE-3 (NCT05904743) multicenter trial, which found that while TI was noninferior to usual care—including automated insulin delivery systems—optimized doses often required a ratio as high as 2.8 to 1 after titration. This discrepancy occurs because cartridge units reflect the powdered insulin content rather than the specific amount absorbed by the lungs.²

Despite its advantages, inhaled insulin requires careful patient screening and strict logistical management. It is strictly contraindicated in patients with chronic lung diseases such as asthma or chronic obstructive pulmonary disease, active smokers, and those with a history of lung cancer.³

Pharmacists must ensure that patients undergo a forced expiratory volume assessment before initiation and at regular intervals to monitor pulmonary safety. Additionally, the medication has specific storage requirements, such as unopened foil packages should be refrigerated, but once a blister card is opened, the cartridges must be used within 3 days.^2,3

The inhaler device itself must also be replaced every 15 days. By bridging the gap between clinical data and patient education, pharmacists can help these vulnerable populations leverage inhaled insulin to achieve tighter glycemic control with reduced psychological distress.^2,3

READ MORE: Diabetes Resource Center

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REFERENCES

1. Laffel LM, Valent AM. Potential Role of Inhaled Insulin in the Management of Gestational Diabetes Mellitus and Pediatric Type 1 Diabetes. Diabetes Technol Ther. 2026;28(1_suppl):43S-54S. doi:10.1177/15209156251403591

2. Hirsch IB, Beck RW, Marak MC, et al. A Randomized Trial Comparing Inhaled Insulin Plus Basal Insulin Versus Usual Care in Adults With Type 1 Diabetes. Diabetes Care. 2025;48(3):353-360. doi:10.2337/dc24-1832

3. Cleveland Clinic. Insulin inhaled powder. Accessed February 3, 2026. https://my.clevelandclinic.org/health/drugs/20389-insulin-inhaled-powder