The results of the present study, using the conscious beagle dog, demonstrate that inhaled insulin (INH; Exubera) provides better glycemic control during an intraportal glucose load than identical insulin levels induced by insulin (Humulin) infusion into the inferior vena cava (IVC). In the INH group (n ؍ 13), portal glucose infusion caused arterial plasma glucose to rise transiently (152 ؎ 9 mg/dl), before it returned to baseline (65 min) for the next 2 h. Net hepatic glucose uptake was minimal, whereas nonhepatic uptake rose to 12.5 ؎ 0.5 mg ⅐ kg ؊1 ⅐ min ؊1 (65 min). In the IVC group (n ؍ 9), arterial glucose rose rapidly (172 ؎ 6 mg/dl) and transiently fell to 135 ؎ 13 mg/dl (65 min) before returning to 165 ؎ 15 mg/dl (125 min). Plasma glucose excursions and hepatic glucose uptake were much greater in the IVC group, whereas nonhepatic uptake was markedly less (8.6 ؎ 0.9 mg ⅐ kg ؊1 ⅐ min ؊1 ; 65 min). Insulin kinetics and areas under the curve were identical in both groups. These data suggest that inhalation of Exubera results in a unique action on nonhepatic glucose clearance. Diabetes 54:1164 -1170, 2005 I nsulin delivered by inhalation is an alternative to injected insulin for patients with diabetes. Clinical studies comparing subcutaneous administration of insulin (Humulin) with insulin inhalation (Exubera) suggest that there is a unique glucose-lowering effect associated with inhaled insulin (1). Previous studies in dogs have shown that inhaled insulin has a higher and earlier peak of arterial insulin that clears more rapidly than subcutaneous insulin. Despite the similar arterial and hepatic insulin areas under the curve (AUCs) in the two groups, a 20% greater glucose infusion rate was required to maintain euglycemia in the inhaled insulin group relative to the subcutaneous insulin group (2). This finding was consistent with the unique glucose-lowering effect of inhaled insulin seen in human studies.The difference in glycemic control resulting from inhalation verses subcutaneous administration of insulin could be explained by the different pharmacokinetic insulin profiles resulting from the two routes of administration, or by some unique aspect of insulin delivery by inhalation. To distinguish between these possibilities, we delivered insulin by inhalation (Exubera) or through infusion (Humulin) into the inferior vena cava (IVC) to create an identical pharmacokinetic profile to that resulting from insulin inhalation. We then examined the effects of both routes of insulin delivery on glucose disposal during a simulated oral glucose load. To further clarify the mechanism by which glucose disposal might be enhanced, we compared the role of the liver and nonhepatic tissues in glucose uptake.
RESEARCH DESIGN AND METHODSExperiments were conducted on 22 healthy, conscious, 18-h-fasted, male beagle dogs (weight 8 -10 kg). Before the study, they were fed a standard diet once a day, and water was provided ad libitum. The surgical facility met the standards published by the American Association for the Accredi...