INSULIN INHL,ORAL
Clinical Criteria Summary
Pre-Considerations & Prerequisites
- • Patient training with a VA Diabetes Educator
- • Offer a trial of insulin pens, smaller gauge needles, and other assistive devices
- • Patient must demonstrate competency with and agree to self-monitoring of blood glucose
- • If basal insulin is required, conversion from pre-meal inhaled to injectable insulin should occur once the patient is stabilized on basal insulin and comfortable with administering injections
Exclusion Criteria
- • COPD, asthma, or other chronic lung disorders
- • Patients who smoke or have recently quit smoking within the last six months
- • Active lung cancer, prior history of lung cancer, or risk factors (other than smoking) for lung cancer
- • History of a serious hypersensitivity reaction to regular human insulin or excipients of Afrezza
- • Treatment of diabetic ketoacidosis
Inclusion Criteria
- • Patient has diabetes and requires insulin (inhaled insulin must be used in combination with long-acting insulin in patients with type 1 diabetes)
- • Provider is experienced in managing insulin therapy in patients with diabetes (e.g., endocrinologists, diabetologists, practices in a diabetes management team)
- • Patient must have baseline spirometry (FEV1) within the last 6 months to identify potential underlying lung disease
- • AND at least one of the following:
- Severe persistent injection site reactions (e.g., lipohypertrophy)
- Works in an environment that does not allow needles
Special Circumstances
- • Psychological aversion to needles may warrant case-by-case consideration for inhaled insulin use