Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Diabetes burnout identification and the role of Inhaled Insulin in the dynamic management of Type 1 Diabetes and well-being in a young adult  (#334)

Gnanagurudasan Prakasam 1 2 , Carly Haaland 2 , Kevin Kaiserman 3 , Joanne Rinker 3
  1. SUTTER MEDICAL CENTER, SACRAMENTO, SACRAMENTO, CA, United States
  2. Pediatric Endocrinology, Center of Excellence In Diabetes and Endocrinology, Sacramento, CA, USA
  3. Medical Affairs and Safety, Endocrine Business Unit, Mannkind Corporation, Westlake Village, CA, USA

19 year-old female (diagnosed at 2years) with Type 1 diabetes, initially on injections (basal/bolus regimen), transitioned to insulin-pump at 5, recently on Medtronic 770G. Historical HbA1c was <8%. June 2022, A1c was 8.7%.

Person expressed significant diabetes burnout, especially concerned with transition to college. She disliked insulin pump for aesthetic reasons and expressed fear of hypoglycemia leading to skipping boluses. Pump data revealed 35% in auto-mode and 65% in manual-mode due to sensor failure. Time in range was 67% with 4% hypoglycemia. Wide glycemic excursions (3.3-19.4 mmol/l) noted. After discussing all treatment options, we decided on Afrezza, Technosphere® Insulin(TI) (insulin human inhalation powder)1,2, powder form of bolus insulin taken by oral inhalation and basal insulin combination. With her fluctuating activity and eating habits, inhaled insulin would potentially give her better flexibility without the burden of the insulin pump3 . She started on TI in October 2022 with bolus instructions 4-12 units depending on meal size (4,8 or 12 units for small, medium or large meals with no carb counting). Additional 4 units were prescribed 1 hour post-initial dose, for blood glucose(BG) greater than 8.3mmol/l. She also started on basal insulin, glargine 34 units everyday.   

Three months after initiating TI her A1C improved to 8.2%. Her recent CGM report (February-2023) 'best day' shows average BG of 10mmol/l with 55% time 'in-range' and 0% hypoglycemia. In addition, we reviewed the well-being of the patient using the WHO -5 well-being index4  and asked her to complete this before initiation of TI and 3 months after TI initiation. She reported improvements in both cheerful good spirits and felt calmer and more relaxed since initiation.

Diabetes management is a combination of glucose management and the patient's well-being. Diabetes management should be individualized and inhaled insulin2  could be an integral part of this patient-centered approach.  

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  1. Rendell M. (2014). Technosphere inhaled insulin (Afrezza). Drugs of today (Barcelona, Spain: 1998), 50(12), 813–827. https://doi.org/10.1358/dot.2014.50.12.2233894
  2. Mikhail N. (2016). Place of technosphere inhaled insulin in treatment of diabetes. World journal of diabetes, 7(20), 599–604. https://doi.org/10.4239/wjd.v7.i20.599
  3. Chan, J., & Cheng-Lai, A. (2017). Inhaled Insulin: A Clinical and Historical Review. Cardiology in review, 25(3), 140–146. https://doi.org/10.1097/CRD.0000000000000143
  4. Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: a systematic review of the literature. Psychotherapy and psychosomatics, 84(3), 167–176. https:// doi.org/10.1159/000376585