title: The lung as an alternative route of delivery for insulin in controlling postprandial glucose levels in patients with diabetes.
abstract: OBJECTIVE
  To determine the efficacy of the lung as an alternative route of delivery for insulin in controlling glucose below diabetic levels (11.2 mmol/L) 2 h after the ingestion of a meal in patients with type 2 diabetes mellitus.
  
  
  METHODS
  Single-blinded, nonrandomized, placebo-controlled pilot study consisting of two visits.
  
  
  METHODS
  A primary care facility.
  
  
  METHODS
  Seven patients with type 2 diabetes mellitus.
  
  
  METHODS
  On the first study visit, fasting glucose levels were normalized. Then, patients inhaled 1.5 U/kg insulin by aerosol into the lungs 5 min before ingesting a test meal. On the second visit, patients inhaled placebo aerosol 5 min before ingesting the same meal. On both visits, plasma samples were collected and analyzed for glucose levels for 3 h during the postprandial state.
  
  
  RESULTS
  No one coughed after inhalation of insulin aerosol or demonstrated hypoglycemia. During the postprandial period, glucose levels were significantly lower at 20 min (5.12+/-1.08 mmol/L), 1 h (7.87+/-0.73 mmol/L), 2 h (8.05+/-1.24 mmol/L) and 3 h (7.50+/-1.43 mmol/L) following inhalation of insulin than when the placebo was used. Data for the placebo were 10.36+/-1.23 mmol/L at 20 min, 14.0+/-1.68 mmol/L at 1 h, 16.18+/-1.45 mmol/L at 2 h, and 14.37+/-2.11 mmol/L at 3h (for all comparisons, p < 0.05). On the insulin visit, glucose levels were < 11.2 mmol/L 2 h after the meal in six of seven patients. None attained this level at the placebo visit. In addition, glucose levels were within the normal postprandial range of < 7.84 mmol/L in four of seven patients 2 h after eating on the insulin visit.
  
  
  CONCLUSIONS
  These results suggest that, once plasma glucose levels are normalized, postprandial glucose levels can be maintained below diabetic levels by delivering 1.5 U/kg insulin into the lungs 5 min before the ingestion of a meal.
authors.affiliation: Division of Radiation Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA. blaube@welchlink.welch.jhu.edu
authors.forename: B L
authors.initials: BL
authors.lastname: Laube
authors.forename: G W
authors.initials: GW
authors.lastname: Benedict
authors.forename: A S
authors.initials: AS
authors.lastname: Dobs
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010865:Pilot Projects; D019518:Postprandial Period
chemical_list: D000336:Aerosols; D001786:Blood Glucose; D007328:Insulin