An Overview of Inhaled Insulin

Inhaled Insulin

Inhaled insulin is a mealtime insulin option that is breathed in through the mouth and absorbed through the lungs. It gives some people with diabetes another way to take insulin at meals without using a mealtime injection.

Afrezza® is currently the only FDA-approved inhaled insulin available in the United States. In 2026, the FDA expanded Afrezza’s approval to include adults and children ages 6 years and older with diabetes. Afrezza is used to help improve glycemic control in people with diabetes who need rapid-acting insulin around meals.

Inhaled insulin is not appropriate for everyone. It requires lung function screening before use, and it should not be used by people with chronic lung disease such as asthma or chronic obstructive pulmonary disease, also known as COPD.

At a Glance

Afrezza is an inhaled, rapid-acting mealtime insulin for adults and children ages 6 years and older with diabetes.

It may be an option for some people who need mealtime insulin and prefer an alternative to injections.

For people with type 1 diabetes, inhaled insulin must be used with basal insulin. It does not replace the need for background insulin.

Afrezza is not recommended for the treatment of diabetic ketoacidosis, also known as DKA.

Afrezza should not be used by people with chronic lung disease such as asthma or COPD.

Afrezza is not recommended for people who smoke or who have recently stopped smoking.

How Inhaled Insulin Works

Afrezza is taken at the beginning of a meal using a small inhaler and single-use insulin cartridges. The person places a cartridge into the inhaler and breathes the insulin powder in through the mouth. The insulin is absorbed through the lungs and enters the bloodstream. Afrezza starts working quickly after it is inhaled, which is why it is used as a mealtime insulin.

Because inhaled insulin works differently than injected rapid-acting insulin, dosing and timing are not directly interchangeable. People starting inhaled insulin need clear education from their diabetes care team on when to take it, how to use the inhaler, how to monitor glucose, and what to do if a dose is missed.

Who May Be a Candidate?

Inhaled insulin may be considered for some people with type 1 or type 2 diabetes who need rapid-acting insulin at meals and are 6 years of age or older.

It may be an option for people who:

• Prefer a non-injectable mealtime insulin option
• Have difficulty with or concerns about multiple daily mealtime injections
• Can use the inhaler correctly and consistently
• Can recognize and treat hypoglycemia
• Do not have chronic lung disease such as asthma or COPD
• Do not smoke and have not recently stopped smoking

For children and adolescents, the diabetes care team should also consider the child’s age, ability to use the inhaler correctly, caregiver support, mealtime routines, glucose monitoring plan and risk for hypoglycemia. Some children may need caregiver help even if they are old enough to use inhaled insulin.

Important Safety Considerations

Afrezza has a boxed warning for the risk of sudden tightening of the airways in people with chronic lung disease. This can make breathing difficult. Because of this risk, Afrezza should not be used in people with asthma, COPD or other chronic lung disease.

Before starting Afrezza, the prescribing information recommends checking for possible lung disease. This includes a medical history, physical examination and spirometry, which is a breathing test used to measure lung function.

Lung function should also be monitored during treatment according to the prescribing information.

As with all insulin products, hypoglycemia can occur. People using inhaled insulin should know how to recognize, prevent, and treat low glucose. They should also know when to contact their diabetes care team and when to use backup insulin if inhaled insulin is missed, unavailable, or not appropriate.

Pediatric Use

Afrezza is now FDA-approved for children ages 6 years and older with diabetes. This gives clinicians, children and families another option to consider when mealtime insulin is needed. However, pediatric use should be individualized. Approval does not mean inhaled insulin is the best option for every child.

Before using inhaled insulin in a child or adolescent, the diabetes care team should consider lung health, ability to use the inhaler, caregiver involvement, glucose monitoring, hypoglycemia risk and whether the child has a reliable basal insulin plan if they have type 1 diabetes.

The prescribing information notes that patients age 10 and older may self-administer Afrezza after training if the healthcare professional determines it is appropriate.

Clinical study results in children should also be interpreted carefully. Although Afrezza is approved for children ages 6 and older, pediatric study results were mixed when Afrezza was compared with injected rapid-acting insulin for A1C change. This reinforces the importance of careful patient selection, education, and follow-up.

Role in Diabetes Care

Inhaled insulin may help expand mealtime insulin options for some people with diabetes. It may be useful to discuss when a person needs mealtime insulin but has concerns about injections, daily treatment burden, or how insulin fits into their routine.

However, inhaled insulin still requires careful clinical decision-making. It is not simply an easier substitute for injected insulin. It requires lung screening, appropriate patient selection, education on inhaler technique, glucose monitoring, hypoglycemia planning, and follow-up.

For healthcare professionals, the key question is not only whether a person wants an alternative to injections. The key question is whether inhaled insulin is safe, appropriate, and practical for that person’s diabetes care plan.

Key Terms

Mealtime insulin: Insulin taken before or at meals to help manage the rise in glucose after eating.

Basal insulin: Longer-acting background insulin that helps manage glucose between meals and overnight.

Rapid-acting insulin: Insulin that starts working quickly and is commonly used around meals or to correct high glucose.

Hypoglycemia: Low glucose. Symptoms may include shakiness, sweating, confusion, dizziness, hunger, or a fast heartbeat.

COPD: Chronic obstructive pulmonary disease, a long-term lung disease that makes it harder to breathe.

Spirometry: A breathing test used to check lung function.

FEV1: A spirometry measurement showing how much air a person can forcefully breathe out in one second.

DKA: Diabetic ketoacidosis, a serious and potentially life-threatening diabetes emergency.

Related Links

View and compare all insulins and devices

Insulin – biosimilars and interchangeables