I started using Afrezza in March 2015, as soon as it was available in the US and I still use it almost every day. I started with using it as a substitute for pump delivered meal dosing. It generally worked OK for me but I found that I actually had better control with my pump. I likely could have become proficient with the Afrezza dose size and timing but I found my pump regimen dependable and it produced very good post-meal glucose results. I use a Dexcom CGM to follow my glucose.
In the last four years I continued to use Afrezza for correcting highs and trending, but not yet high, glucose levels. It has worked well in that role. I will often “correct” levels < 120 mg/dL (6.7) if the rate of climb is higher (CGM arrows) than I would like.
Afrezza is forgiving in that it has a short tail of action. I’ve found that it’s generally done working in my body at about 80 minutes. This makes it ideal to correct glucose levels during the night. I don’t have to worry about the long-tail of pump delivered corrections driving me too low.
I try Tresiba for several months and found it worked well for me, but again, not as well as my pump program. I cut my trial of Tresiba short when I started using an automated insulin dosing system. If I chose to adopt a multiple daily injection program, I would restart Tresiba and experiment with using it 2x/day. I’ve also read good things about the long-acting Levemir and might experiment with that if needed.
One unexpected advantage with Tresiba is that glucose control seems unaffected by when you give it. I sometimes forgot my night-time dose and I simply added the missed dose the next morning and suffered no glucose aberrations. The only rule that seemed to matter with Tresiba timing is that you always separate doses by 8 hours and that you average at least one dose per day.
I think Tresiba + Afrezza is a great combination. The biggest drawback that I found with using a long-acting insulin like Tresiba is sometimes forgetting to dose and not having access to the dose evidence/record like a pump supplies. If you’ve forgotten a long-acting dose and are not completely sure whether you took it or not, you’re faced with completely missing or double dosing, not a good choice.
Good luck with your decision. Please report back what you experience.