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NICE takes right line on insulin

From Dr Matthew Kiln

West Dulwich, London

Professor Kirby's opinion on inhaled insulin (Letters, 18 May) is interesting but misses most of the points.

Yes, NICE does look at evidence, and there is none to encourage any use of inhaled insulin except in a very few patients.

Fear of injections is quite often induced by health care professionals, it is not a problem we see nowadays because needles are so much smaller than they used to be.

I assume that if the professor feels inhaled insulin has a role, then he feels its dose-to-dose variation of insulin delivered is acceptable.

Sometimes, however, this dose-to-dose variation is up to 60 per cent ­ twice that of most injected insulins!

This is not a drug that is ready to be used ­ except in highly observed research study conditions, which is what NICE sensibly recommends.

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