Insulin Clinics / Foundations

Inhaled insulin

Inhaled insulin is a mealtime insulin breathed in as a powder. It acts faster and shorter than injected insulin, does not replace basal insulin, and is not for people with lung disease.

Last updated: October 2026 · Based on ADA Standards of Care, FDA prescribing information, and NIDDK · General information, not medical advice — see our editorial policy

What inhaled insulin is

Inhaled insulin is human insulin made into a dry powder that is breathed in through a small, whistle-sized inhaler. The only inhaled insulin sold in the United States is Afrezza, first approved by the FDA in 2014 for adults, and since May 29, 2026 approved for adults and children 6 years and older with type 1 or type 2 diabetes. (An earlier inhaled insulin, Exubera, was withdrawn from the market in 2007 for commercial reasons.)

The powder is absorbed through the lungs into the bloodstream. Compared with injected rapid-acting insulin, it starts working sooner and wears off sooner — its effect usually lasts about 1.5–3 hours at typical doses (longer with large doses). That makes it a mealtime insulin only: it does not provide background (basal) insulin.

Who it may suit — and who should not use it

• Type 1 diabetes: must always be used together with a long-acting (basal) insulin. Inhaled insulin alone is not enough and could lead to DKA.
• Type 2 diabetes: can be added at meals alongside other treatment, as decided by the prescriber.
• Not for people with chronic lung disease such as asthma or COPD. The product carries an FDA boxed warning because it can cause sudden narrowing of the airways (bronchospasm) in people with these conditions.
• Not recommended for people who smoke or who stopped smoking within the past six months.
• Lung cancer: if you have or have had lung cancer, or are at high risk for it, you and your prescriber should weigh the benefits against a possible risk. A few cases were seen in clinical trials — too few to tell whether the medicine was the cause.
• Children: approved for ages 6 and older (May 2026), with the same lung-function testing and smoking limits as adults. It has not been studied in children under 6. Discuss it with your pediatric diabetes team.

Lung function testing

Before starting, people need a breathing test called spirometry to measure lung function (FEV1). The prescribing information calls for the test to be repeated after the first 6 months and then every year, because inhaled insulin can cause a small decline in lung function. If FEV1 falls by 20% or more from the starting value, the prescribing information says to consider stopping it.

How doses work

Inhaled insulin comes in color-coded single-use cartridges of 4, 8, and 12 units. Larger doses are taken by using more than one cartridge. Inhaled units are not the same as injected units. The prescriber uses a conversion from the labeling (updated in 2026) when switching someone from injected mealtime insulin, and the starting inhaled dose is usually a higher number of units than the injected dose. Do not convert doses yourself.

The fixed cartridge sizes mean doses move in steps of 4 units, which can be a limitation for people who need small, precise adjustments.

Side effects

• Low blood sugar — as with all insulins. The low blood sugar page covers recognition and treatment.
• Cough — the most common side effect, usually mild and often easing over the first weeks; it leads some people to stop.
• Throat irritation or pain.
• Reduced lung function — usually small, which is why monitoring is required.
• Bronchospasm — wheezing or difficulty breathing. Stop using it and seek urgent care.
• DKA — mainly a risk in type 1 diabetes if basal insulin is missed or if illness raises insulin needs. See high blood sugar and DKA.

Tell your prescriber if you develop a respiratory infection or any new lung symptoms.

Practical points

• Storage: unopened packages are refrigerated; cartridges and the inhaler have specific, fairly short room-temperature limits once opened. Check the package insert.
• The inhaler is replaced every 15 days from its first use, according to the instructions that come with it.
• Cost and coverage vary widely between plans; ask about prior authorization and the manufacturer's savings program. See cost and access.
• Needles: there are no needles for mealtime doses, but basal insulin is still injected for anyone who needs it.

What the guidelines say

The American Diabetes Association's Standards of Care list inhaled insulin as an option for mealtime insulin, noting its faster action and its contraindication in chronic lung disease. In plain terms: it is a reasonable choice for some adults who want fewer injections and have healthy lungs, but it is not a replacement for basal insulin and not right for everyone.

Frequently asked questions