A couple of Afrezza questions


#1

I know there are a few people out there who are using Afreeza with great success. And I have a few questions for you. Not saying this is the way everyone should go, but I am always up for trying something that might make my life easier.
I have been using it on and off this past year whenever I am out of a clinical trial (most won’t let me use it due to how hard it is to calculate dosing numbers).
I saw my doctor last week and he said there was some interesting numbers from a trial with it. He said people using it for meal dosing had much better post meal levels. And I am always in on better post meal levels.
So here’s some of my questions.

  1. 8 unit cartridge is about 4 units by my pump and 4 unit cartridge is about 2.5 units by my pump. I am pretty sensitive to insulin so sometimes a 4 unit cartridge might be a little much. Is there a way to try and do a half a cartridge? I am currently putting all the info into my pump (crabs & blood sugar) to see how much I should be taking and than decide which/how many cartridges to use.
  2. Timing, boy this is a huge shift for me. I have been prebolusing for years. Sometimes waiting 45 minutes. My problem right now is the timing here. I was told to use it when I start eating vs before. And the past few days, I have been but than I am crashing. And the darn CGM is alarming but I let it ride knowing the food will hit soon. Sometimes it does and sometimes it doesn’t. So does this mean I need to use it during or after the meal? And if that’s the case, how often do you forget.
  3. I was also told that you may need a second dose later. Isn’t that kinda hard to calculate? And I thought I had it figured out last night but my plan didn’t work. I need 3.6 units per my pump, so I did one 4 unit cartridge and than 1 unit via pump on an extended bolus. Didn’t work, still crashed.
  4. This feels like my Symlin try a few years ago. Had massive lows right after eating followed by highs hours later. Way to much work.
    I must say, I have loved it for those stubborn highs and would love to see it work.
    Thanks for any suggestions.

#2

Sally,
Below is my best exper w/ afrezza:
First, my diet is low carb (not Bernstein low, but low enough) so I typically am eating slower digesting foods like nuts, non-starchy veggies, protein, etc. If your diet has a more carb bent, your timing may be very different.

  1. I do split cartridges because, like you, I am very insulin sensitive. It works for me, but fyi: split is by eyeballing–not exactly precise. However, with afrezza I find precision less necessary. If you like I will walk you through how I was taught (off label of course!) to split cartridges;
  2. I do not use any standard timing for afrezza that applies to all meal situations. Here’s why: What is my pre-meal bs? What am I going to eat–will fat slow it down? Did I engage in hard exercise that day? Etc., etc. My solution is to begin a meal and closely watch my CGM. (Aren’t we lucky to have CGM’S!!!) Food hits my body with different timing depending on too many factors! So here’s how I time afrezza dosing: I do not pre-bolus. I begin meal. I closely watch my CGM waiting to see the numbers start to rise slightly (with trend arrow still straight) and that’s when I dose. I do not wait for the trend arrow to move, but dose when the numbers begin to rise;
  3. I sometimes will need to add a later dose of afrezza or even 2 later doses (especially if I have eaten protein cuz it tends to create sustained highs in me) again all based on watching my CGM. I may also add a small dose if I’ve undercalculated. Here’s where I really like the split cartridges. I use small doses (Stephen Ponder Sugar surfing) to get me back in range.

Sally, I hope the above is helpful.
Karin


#3

I don’t calculate with numbers whatsoever when using afrezza. I don’t consider carb ratios like I do with liquid insulin. I dose either small 4u doses or medium 8u doses—- they do not equate or compare in any way to units of liquid insulin. I agree that timing is everything and that can be the challenge, particularly with fatty foods that digest much slower.

If you use a cgm it’s pretty easy to just eat, wait for it to start climbing, then dose, then glance back again 2 hours later and do a follow up dose of it’s starting to climb. Sometimes it can take a full 45 minutes for me after I eat to start skyrocketing… it varies tremendously with the composition of the meal.

The main challenge is to not overthink it… and to force yourself to set aside all the rules we learned with liquid insulin.

With liquid insulin you’re activating some of the glucose receptors in your bodies cells for an intermediate length of time… this requires you have very nearly the perfect amount of insulin in order to balance it.

With afrezza you’re activating nearly all your cells’ glucose receptors for a short time. This requires mostly timing, and much less the precise amount—-

I’m not sure that the last bit is scientifically valid but it is conceptually spot-on


#4

My Afrezza use is similar to Karin and Sam. Take it when cgm shows rise, or a bit sooner if current BG is high or rising. I use only 4 unit, and supplement with pump bolus for protein, fat, additional carbs if needed.

I have not split dose, since that’s a nice opportunity for a treat!

My insurance doesn’t cover, so I use it sparingly. Found lowest price at Costco, although much higher now than when I first started.


#5

I’m impressed with the sophisticated and observant dosing routines people use with Afrezza.

I don’t often use Afrezza for mealtimes. I do dose 4-units to correct a rising blood sugar in the 100-115 (5.6-6.4) neighborhood. If it’s not rising too hard then I can often pivot after 3-4 five-minute dots appear and then it heads downward. I’m looking to chop-off BG mountain-tops. Almost all the downward action is done in about 80 minutes. If I shelf-off between 100-110 (5.6-6.1), I may make a second 4-unit correction.


#6

Can you tell me what price you’re getting?


#7

Thanks everyone for all the suggestions! I am working it. Everyday is a learning experience. I have really come to realize I need to release my need for control. I have finally realized I will never get this right day in and day out but I can try for better than average. So I M learning now with all these tools, even if I miss, I can quickly fix most of those “mistakes”. So if my Afreeza doesn’t hit it right the first time, just get another dose and learn from it. It will be the same for me when my new Tandem X2 and Dexcom G6 arrives next week. Everyday will be another experiment and learning experience. Can’t wait for all this new stuff to get rolling and I can stop worrying about everything. Knowing that if I miscalculate, the pump will shut down. Technology can be my friend!


#8

Hi I don’t know if you’ve seen Laura’s YouTube video it mentions splitting a 4-unit into roughly 2, 2 unit cartridges.
Good luck.


#9

My experiments were going well and I really like the ease of Afreeza. I love the no pre bolus issues! But as usual, just when I start a new treatment plan, I start a new trial and I have to come off it. They need accurate insulin dosing numbers. So maybe in March I can fire it back up! Thanks for all the help everyone!