NPH insulin + inhaled human insulin

The combination of NPH insulin and inhaled human insulin represents a treatment approach for diabetes mellitus that pairs an intermediate-acting injectable insulin with a rapid-acting inhaled insulin formulation.\n\nNPH insulin (Neutral Protamine Hagedorn) serves as the basal insulin component, providing background insulin coverage for 12-18 hours. It typically peaks at 4-12 hours after injection and helps control blood glucose between meals and overnight[4].\n\nThe inhaled human insulin component (brand name Afrezza, formerly Exubera) is a dry powder form of rapid-acting insulin delivered by oral inhalation[2]. It starts working within 10-15 minutes, peaks at 35-45 minutes, and has a duration of 1.5-3 hours[4]. This rapid action makes it suitable for controlling mealtime blood glucose spikes.\n\n## Clinical Evidence\n\nClinical trials have demonstrated that this combination can provide effective glycemic control. In patients with type 1 diabetes, studies showed that inhaled insulin before meals plus ultralente insulin at night provided comparable glycemic control to conventional insulin regimens[3]. Similarly, in type 2 diabetes, the combination of inhaled insulin with basal insulin has shown effectiveness in controlling blood glucose levels[5].\n\n## Administration\n\nThe NPH insulin is administered subcutaneously, typically once or twice daily. The inhaled insulin is administered at the beginning of meals using a specialized inhaler device[1]. This combination reduces, but does not eliminate, the need for injections in patients with diabetes.\n\n## Safety Considerations\n\nCommon side effects of inhaled insulin include hypoglycemia, cough, throat pain, and potential decreases in pulmonary function[2][6]. Pulmonary function should be monitored during treatment, with baseline spirometry followed by repeat testing at six months and one year, with yearly follow-up thereafter[2]. Inhaled insulin is contraindicated in patients with chronic pulmonary diseases such as asthma and COPD[5].

Brand names

AfrezzaExubera