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Diabetics who have to inject themselves with insulin must have been delighted when insulin by inhalation through the lungs was developed. However, Britain's National Institute for Clinical Excellence has recommended against the routine prescription of the inhalation route, except for those diabetics with a needle phobia.
An article in the New England Journal of Medicine this month reviews the advantages and disadvantages of the new method of delivering insulin.
In fact, neither the clinical advantages nor disadvantages are very great. It does not relieve insulin-dependent diabetics of all necessity to inject; it only reduces the frequency of injections, and should not be used in those with pre-existing lung disease, who smoke or who work in very smoky environments. It seems that it
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neither improves nor worsens the control of the blood sugar of diabetics. The main advantage seems to be that diabetics prefer by a wide margin to inhale rather than inject insulin. The corresponding problem is that insulin by inhalation is more expensive than insulin by injection.
Should the NHS provide the preferred and more expensive, though not necessarily more efficacious, treatment at public expense? One way to establish how much importance diabetics place on inhalation rather than injection would be to let them pay the difference in cost.
If the policy recommended by NICE is followed, I predict that there will be a sharp rise in the number of diabetics with needle phobias certified authentic by doctors. Distress rises to meet the means available for its alleviation. 
FIRST POSTED FEBRUARY 15, 2007
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