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Question:

From Brazil:

I hear talk about nasal insulin. Do you have more information about this?

Answer:

The nasal route for administering insulin has an obvious appeal and it does work. There have been a number of clinical trials in patients with both Type 1 and Type 2 Diabetes; but the end results have been disappointing for two main reasons. The first is that even with additives supposed to enhance the absorption of insulin, like lecithin and saponin derivatives, it takes about 20 times as much insulin to achieve the same effect as subcutaneous dosage. The other problem is that absorption is erratic. Even with a well-standardised product like 'Novolin Nasal' about a quarter of the subjects could not maintain control and in nearly all A1c levels increased.

A few years ago there was a resurgence of interest with a nebuliser device that was intended for the management of moderately severe acidosis. Again the results were less predictable that with subcutaneous, intramuscular or intravenous insulin and in any case the need for short term admissions for acidosis has abruptly lessened.

The intranasal route is still however, in common with oral insulin, being considered for 'vaccination'. That is, the giving of small doses of insulin to genetically at risk infants and first degree relatives of Type 1 Diabetics who do not yet have antibodies with the objective of forestalling auto-immunity.

DO'B

Original posting 21 Oct 96

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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