Inhaled insulin, specifically Afrezza, effectively manages blood glucose levels in children with type 1 diabetes, similar to injected insulin. Afrezza is already approved for use in adults with both type 1 and type 2 diabetes in the US, and the manufacturer is looking to gain approval for pediatric use.
Type 1 diabetes occurs when the body cannot produce insulin, the hormone responsible for regulating blood sugar. Individuals with this condition typically require daily insulin injections. However, managing blood sugar levels can be challenging, particularly after meals or following exercise.
Dr. Michael Haller from the University of Florida, who has worked on Afrezza’s advisory board, explored the potential of inhaled insulin to enhance glycemic control in adults. Preliminary findings suggest it could be more effective for children than traditional injections. A study was conducted with 230 participants aged 4 to 17, including both type 1 and type 2 diabetes patients requiring insulin.
All participants were on a basal insulin regimen, administered once or twice daily to maintain baseline levels. Additional rapid-acting insulin was generally required before meals. In the 26-week trial, some children utilized Afrezza as their rapid-acting insulin, while others continued with injectable insulin.
Results indicated that both insulin types achieved comparable blood glucose control. These findings were presented at the American Diabetes Association Conference in Chicago in June. More details can be found here.
“This suggests that Afrezza could be a preferable option for patients due to the delivery method, particularly for those with needle anxiety,” Dr. Haller states. “More importantly, it provides patients with additional strategies for managing a complex condition.”
While some users experienced coughing with the inhaled version, it resolved once they acclimated. However, Afrezza is not recommended for individuals with chronic lung issues like asthma.
Dr. Kathryn Sumpter from the University of Tennessee Health Science Center suggests that inhaled insulin may benefit certain diabetes patients, particularly children who often forget to take their medication before meals. Nonetheless, she believes that many would prefer the injected form, especially for younger children needing precise dosing.
MannKind Corporation intends to seek regulatory approval for pediatric usage of Afrezza in the United States, as noted by Dr. Haller.
Dr. Paul Uribe, a former military pathologist who consulted nationwide and assisted in solving a series of insulin-related murders at a veteran hospital in West Virginia, noted to NBC News that there are insufficient protocols to guide pathologists and emergency room doctors in effectively managing such cases.
“You’re not going to accidentally stumble upon an insulin murder,” Uribe remarked. “You must have a suspect and actively search for it; if you’re not investigating, you won’t discover it.”
For more information on the West Virginia case, tune in to “Devil’s in the Detailing” on “Dateline” tonight at 9 ET/8 CT on April 25th.
While these crimes are uncommon, Uribe highlighted an alarming increase in related incidents across the U.S. In Pennsylvania, several nurses confessed to attempting to murder 19 patients using insulin across five facilities between 2020 and 2023, resulting in 17 fatalities. Additionally, at the West Virginia Veterans Hospital, nurses confessed to killing seven patients with insulin in 2021.
Uribe pointed out that no state has officially established protocols for emergency room physicians and medical inspectors regarding insulin-related cases, noting that only West Virginia has attempted to address this significant oversight. Legislation introduced this year aims to obligate emergency rooms to test for insulin in patients exhibiting symptoms of insulin poisoning.
Jonathan Jones, former president of the American Academy of Emergency Medicine, expressed concerns regarding insulin overdoses but asserted that health care should not be legislated.
“The best medical care is delivered by well-educated, trained, and board-certified physicians, not legislators,” he stated in an email to NBC News. “We are committed to continuous medical education regarding this issue and support the standards for specialist physicians, but we oppose mandatory treatment directives.”
He declined to comment on whether emergency rooms should adopt stricter guidelines.
When asked if forensic pathologists need improved protocols, Reade Quinton, president of the National Association of Medical Examiners, replied, “I’m not sure that’s the right question. What medical examiners require is access to field information, witness statements, and medical records without obstruction.”
Michael and Natalie Cochran.Dateline
The chief sponsor of the West Virginia bill did not respond to requests for comment. Nevertheless, the parents of Michael Cochran, after whom the bill is named, believe this legislation could serve as a model for the nation and help others avoid the painful search for answers they endured for years.
“They shouldn’t have to wait for answers as we did,” remarked Cochran’s mother, Donna Bolt, to Dateline. “Six years.”
Seven deceased patients at VA Hospital
Uribe’s investigation into insulin-related murders began at the Veterans Hospital in Clarksburg, West Virginia, where he was tasked with examining a series of mysterious deaths among elderly patients in late 2018.
These occurrences can result from excessive insulin doses, which regulate blood glucose levels in diabetic patients.
Some veterans were diabetic, Uribe recalled, while others were not. He was requested to uncover a definitive piece of evidence that could confirm insulin as the murder weapon.
For emergency room doctors and pathologists, he noted, identifying such cases is complicated due to insulin’s rapid metabolism. The “C-peptide” test referenced in West Virginia law can detect insulin, but timing is crucial. It must be conducted before any treatment interventions for hypoglycemia are started.
“If glucose is administered, it triggers the body’s natural insulin release, negating the C-peptide measurement,” he explained.
Furthermore, many small hospitals lack access to these specific tests.
Uribe described two primary methods for pathologists to detect insulin. One prevalent method involves injection, which may leave temporary traces in body tissues at the injection site. Insulin can also be found in postmortem vitreous fluid from the eye, he noted.
In West Virginia, testing of tissue samples from seven veterans’ remains revealed trace amounts of insulin in some victims, including those without diabetes or any prior prescriptions for the drug.
“This provided conclusive evidence that they had been injected with insulin,” he stated.
W.VA.West Virginia Regional Prisons and Correctional Facility Authority via AP Files
Nursing assistant Letta Mays was later identified as the prime suspect in this case. She confessed to administering a lethal dose of insulin, pleaded guilty to seven counts of second-degree murder and one count of assault with intent to murder concerning the death of an eighth man. Mays was sentenced to seven life terms.
Deadly dose from a pharmacist
In Uribe’s subsequent case, pharmacist Natalie Cochran was convicted in January for giving her husband a lethal dose of drugs amid a conspiracy to cover up millions in fraudulent activities involving friends and relatives.
Resolving this case took several years.
In February 2019, Michael Cochran was found unresponsive and later transitioned from a ventilator to hospice care at the age of 38. His death certificate classified his cause of death as “natural.”
Michael and Natalie Cochran.Dateline
Michael Cochran’s hospital records indicated that upon admission, his blood sugar levels were dangerously low, despite his lack of any diabetes history, Uribe informed. Unfortunately, insulin testing was not conducted at that time.
Still, West Virginia State Police detective Tim Bledsoe suspected Natalie Cochran’s involvement in her husband’s demise. During a search of her home, a partially used vial of insulin was discovered in the refrigerator.
When Bledsoe questioned Natalie about the vial, she claimed it was meant for her neighbor’s diabetic son. However, the neighbor, Jennifer Davis, contradicted this, stating that Natalie had asked for insulin for herself to aid recovery from a fake cancer diagnosis that prosecutors argued she later fabricated.
Davis recalled that Natalie requested insulin the same morning Michael first became ill.
Two years after Michael Cochran’s death, his wife was charged with murder. An autopsy commenced seven months after his passing, but by then, his body was significantly decomposed, leading medical inspectors to classify the cause of death as undetermined, according to Bledsoe.
The timeline regarding the autopsy’s delay and whether insulin testing was conducted post-mortem remains unclear. The West Virginia Department of Health and the Office of Personnel, which oversees medical examinations, did not respond to inquiries.
Uribe expressed skepticism that any post-mortem evidence of insulin could have been retrieved given the elapsed time between Michael’s drug administration and his death.
The inconclusive findings, combined with the absence of concrete evidence, led the Raleigh County District Attorney to lower the charges, according to Tom Truman, the current prosecutor.
“If you lack a medical examiner advocating murder, that’s a significant concern,” he remarked to Dateline.
Re-examination yields clarity
However, two years later, the fees were re-evaluated after Uribe was invited to investigate further. During the new autopsy and examination, Uribe searched for potential injection marks, but by this time, Michael’s body had severely deteriorated, preventing any tests from being taken.
Nonetheless, Uribe noted that potential explanations for Michael Cochran’s hypoglycemia, such as infections and severe sepsis, were not documented in his medical records. Considering the circumstances surrounding his death, Uribe classified it as an insulin murder.
During the trial, the endocrinologist who testified for the prosecution conceded that there was no clear explanation for Michael Cochran’s low blood sugar levels.
Michael and Natalie Cochran.Dateline
Natalie Cochran’s defense attorneys acknowledged her involvement in fraudulent activities with various associates, whereby she also pleaded guilty to a separate federal fraud and money laundering case; however, they insisted that she was innocent of her husband’s death.
On January 29th, following two hours of deliberation, the jury found Natalie Cochran guilty of first-degree murder. She received a life sentence without the possibility of parole.
For Uribe, this case, alongside others at the Veterans Hospital, underscores an urgent need for improved insulin overdose protocols.
Such protocols could assist physicians in recognizing red flags like unexplained hypokalemia, which arises from critically low blood sugar levels in non-diabetic patients or from fatal excessive insulin use.
Additionally, he emphasized the need for C-peptide testing to be done prior to any treatment.
Pathologists should look for potential injection sites and conduct vitreous humor tests, he advised.
“If insulin can be detected in the vitreous fluid of someone with no history of diabetes or prior prescriptions, it could substantiate a case,” he concluded.
A Cochrane review has shown that certain types of insulin can remain effective when stored at room temperature for several months, offering a practical solution for diabetes treatment in areas without stable refrigeration. This finding is particularly crucial for people with diabetes in low- and middle-income countries, as well as those affected by conflict, natural disasters, and environmental challenges.
Insulin storage options have been highlighted in the review, which summarizes the results of various studies investigating the effects of storing insulin outside the refrigerator. It was found that unopened vials and cartridges of certain types of human insulin can be stored for extended periods at temperatures up to 25°C and 37°C without any clinical consequences or loss of insulin activity. This has significant implications for people living in areas where access to refrigeration is limited.
Dr. Bernd Richter led a research team that conducted a comprehensive study on insulin stability under different storage conditions. The review analyzed 17 studies and found consistent insulin efficacy at temperatures ranging from 4°C to 37°C, providing reassurance that alternatives to powered cooling of insulin are possible without compromising its stability.
The study also identified areas for future research, such as better understanding the efficacy of insulin after storage under different conditions, studies of mixed insulin, effects of movement on insulin pumps, contamination of opened vials and cartridges, and cold environmental conditions.
The study was funded by the World Health Organization.
A new study has proven a direct link between high insulin levels and increased risk of pancreatic cancer in people with obesity and type 2 diabetes. This landmark study shows how excess insulin overstimulates pancreatic acinar cells, leading to inflammation and precancerous cells, particularly in the case of pancreatic ductal adenocarcinoma (PDAC). These findings highlight the importance of maintaining healthy insulin levels and may lead to new strategies for cancer prevention and treatment, including lifestyle interventions and targeted therapies.
For the first time, we explain in detail why people with obesity and type 2 diabetes have an increased risk of pancreatic cancer.
A recent study conducted by scientists at the University of British Columbia’s Faculty of Medicine revealed a direct relationship between high blood pressure and high blood pressure. insulin This level is frequently observed in patients with obesity, type 2 diabetes, and pancreatic cancer.
This study cell metabolismprovides the first detailed explanation of why people with obesity and type 2 diabetes are at increased risk of pancreatic cancer. This study shows that excessive insulin levels overstimulate pancreatic acinar cells, which produce digestive juices. This excessive stimulation causes inflammation and transforms these cells into precancerous cells.
“In addition to rapid increases in both obesity and type 2 diabetes, we are also seeing an alarming increase in the incidence of pancreatic cancer,” said co-senior author and professor in the Department of Cellular Physiology Sciences and co-senior author of the study. said Dr. James Johnson, interim director of the agency. UBC’s Institute of Life Sciences. “These findings help us understand how this is happening and highlight the importance of keeping insulin levels within a healthy range. can be achieved through medication.”
Dr. James Johnson is a professor in the Department of Cellular and Physiological Sciences and interim director of the UBC Life Sciences Institute. credit: UBC Faculty of Medicine
The study focused on pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer and a highly aggressive disease with a five-year survival rate of less than 10 percent. The incidence of pancreatic cancer is on the rise. By 2030, PDAC is expected to become the second leading cause of cancer-related deaths.
Role of insulin in pancreatic cancer
Although obesity and type 2 diabetes were previously established as risk factors for pancreatic cancer, the exact mechanisms by which this occurs remained unclear. This new study sheds light on the role of insulin and its receptor in this process.
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Reference: “Hyperinsulinemia causes pancreatic cancer through acinar insulin receptors by increasing digestive enzyme production and inflammation” (Anni MY Zhang, Yi Han Xia, Jeffrey SH Lin, Ken H Chu, Wei Chuan K. Wang, Titine JJ Ruiter, Jenny) CC Yang, Nan Chen, Justin Choa, Shilpa Patil, Haoning Howard Sen, Elizabeth J. Rideout, Vincent R. Richard, David・F. Shafer, Rene P. Zahedi, Christoph H. Borchers, James D. Johnson, Janelle L. Kopp, October 31, 2023. cell metabolism. DOI: 10.1016/j.cmet.2023.10.003
This study was funded by the Canadian Institutes of Health Research and the Lustgarten Foundation.
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