Afrezza and Tresiba opinion

Hey friends! LADA for almost 1 year (Age 41). My insulin needs seem to change weekly. Like some days my pancreas is happy other days, not so much.

I am on Tresiba 5 units every morning and I’m equipped with a Fiasp pen for meals. I still mess around with the Tresiba when I’m working out a lot. I still get lows but not too many stubborn highs. I’m also on day 20 of using Dexcom G6. Love the G6! It’s spot on!

I am interested in hearing from anyone who takes afrezza? Pros/cons …I am going to my endo in 2 weeks and I would like some opinions. @Firenza are you still taking it? If so for how long?

I use both. For a long time I used afrezza for almost every meal. Now I find that my digestion isn’t as fast as it was years ago and it is better suited to corrections or when I eat simpler carbohydrates. It’s phenomenal stuff though, a real game changer

Tresiba is great too, imo light years ahead of anything else for basal including pumps

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Thank you! I make myself crazy with the fiasp and counting. Often I don’t give enough because I’m afraid of lows. I think afrezza might help that! Is it a pain to store or take with you? What do you correct with in addition to afrezza?

No it’s not a pain to store or cary at all…

I also use novolog for my bolus, lately pretty much primarily… but afrezza is super helpful still because I can dose conservatively with novolog and if I end up high I take afrezza to knock it back down… it doesn’t really seem to stack with the novolog to any meaningful degree.


Yes I’m still on Afrezza and have been for a year and a half. It’s my primary fast acting insulin and I still think it’s the best diabetes related decision I’ve made.

I used to only need the 4 unit cartridges but in December of 2017 I got a cold that just would not go away and it seemed to permanently change my insulin needs. Now I use the titration packs and those are working great and I finally got my insurance to cover it. BTW, Mannkind cares was a godsend whilst going through the prior authorization process.

My Tresiba dosage changes frequently due to hormones and can sometimes cause me issues but still much better for me than Lantus was. I usually keep the Afrezza I’ll need for the day inside my meter bag and since I carry a purse I don’t find it to be inconvenient to take with me.

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Thank you!!! Do you worry about “inhaling” a drug? Like side effects or long term issues?

Also interesting that you brought up hormones. Sorry if this is TMI, but I stopped getting my monthly cycle while on birth control (41yrs old) so I stopped taking it 3 weeks ago to see what is going on. Wondering if that is playing into my numbers and sometimes for a few days at a clip I will battle lows. I had a mini low 70 at work today and I was a mess after.

Hi Laurie,

I’ve been using Afrezza the past 2-1/2 years for correcting stubborn high blood sugars.

For me…


  1. Works almost immediately. Onset in 15 minutes or less for me. Then my BG drops very swiftly. A 4u cartridge will generally drop my BG by 150 points in about 30-60 minutes.

  2. Clears my system very quickly and stops on a dime. There’s a steep decrease in BG and then it drops to zero. No worry about lingering in my system and causing the unintended lows hours later from ‘chasing the high’ with a large bolus of Humalog or Fiasp.

  3. It’s really great if you’re having a big meal followed by a period of low activity (dinner and a movie for example)


  1. For me it’s not suitable as a replacement for Humalog/Fiasp for routine use. Even the smallest cartridge (4u) is too much for me most of the time. Doses have to be in 4u increments so there’s no way to dose 5u, 6u, etc. Sometimes I’ll use it if I’m having pizza or another ‘bad’ food. It stops my post prandial BG increases dead in their tracks, but I need to bolus later with Humalog/Fiasp to cover BG increases from fat/protein.

  2. The inhalation technique is tricky. As long as I’m careful I have no problems. But on occasion I don’t get it right and end up with some or all of the dose on my tongue or throat. I’d recommend training from a MannKind rep or your CDE before you start using it.

  3. On occasion I get a dry cough after taking a dose. Not a big deal, but very irritating. If you use it regularly over a long period of time, decrease in lung capacity is one of the potential side effects. I’m using it only occasionally so I’m not concerned about it.

Overall I think it’s a great tool for high blood sugar corrections. But I won’t use it unless my BG is over 250 and not responding well to a normal bolus. When that happens I’m really glad I have Afrezza in my diabetes ‘tool kit’

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Thank you!! I never seem to go above 220 and my numbers stay between 80-170 for most of the time if I count everything right (and so on). I wonder if afrezza would drop me to low, but you said they come in 2 u so maybe enough. I never take more that 3-4 units of fiasp, but I am hesitant all the time because I’m afraid of the crash. Still new at this and learning! I keep low carb so I don’t have to worry and count. I hate that part of it and then what gets me crazy is when I give myself a few units then have a after dinner snack… I can never get it right and I don’t want to stick myself again for 30 points or so.

I didn’t realize Afrezza was available in doses smaller than 4u. It would have more utility for me. My CDE is holding an ‘open house’ for her patients next week and will have the reps from most of the device and insulin manufacturers. I’ll have to seek out the MannKind rep and see the latest!

I think I read the info incorrectly, 4 u like you said is the standard. Sorry:( there is a titration pack, but I have no clue what it means! Thank you for your help. I would love to hear what new info is out too.

The titration packs are just boxes of the different doses, 4,8, and 12. They also come in other combinations like 4 and 8 or 8 and 12. Since you take small doses of Fiasp you probably only need the 4 unit cartridges. I’m not worried about lung function at all but my insurance requires a test to cover it so I had one done last month and I got a 98 so all’s good there although I don’t actually have another test to compare it to.

I used to not take enough humalog since I was so afraid of the crash and consequently my bg’s suffered terribly. With Afrezza I don’t worry about that at all and my a1c just keeps getting better. Afrezza was developed to work with carbs and that is what it works the easiest with but it can work with low carb it’s just a little more complicated.

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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.

4u of afrezza is nothing like 4u of liquid insulin thouhj… it’s a real shame that the fda made them label their doses as such, as they just behave completely differently. I make no attempt to carb count when I use afrezza. It’s almost more like taking ibuprofen These help a lot for my tresiba… I have no idea how I got by without it for so long

That definitely would help that circumstance. Did you know that Bigfoot Biomedical bought Timesulin and is using that technology to develop pump-based and MDI-based systems that will use their algorithm to auto-dose when using a pump and suggest dosing corrections when using an insulin pen?

From one end of the spectrum to the other, we are thinking of ways to reduce the pain points of managing diabetes. We are designing comprehensive solutions of device + software + service to help people with diabetes administer insulin more safely, whether through injection or infusion, and access our service more cost-effectively.


I have no relationship with Bigfoot other than as an interested observer of a company who seems to have their values informed by the patient perspective. I look forward to the products they are working on and this might be attractive to me when they release them.

Interesting. I didn’t know that. I don’t keep near as up to date with tech as I used to


I tried Affrezza and I wasn’t impressed as much as the most people. The main point everybody is talking about - it is super-fast acting. Not for me (and not per Affrezza insulin curve chart). Humalog starts acting in my body in about an hour (time when it reaches its peak), Affrezza - in 45 minutes (its peak as well). It is not that much of a difference and certainly not a game changer. I like that Affrezza’s lifespan is 3 hours compared to 4 hours of Humalog, but I still couldn’t use it as inhaling caused immediate cough and half a dose flied out in a dust cloud.

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Thank you! It’s goid to hear everyone’s experiences. Thank you for taking the time to answer my question. I am going to see if I can at least try it. Not sure if my endo even knows much about it.

Hi @Laurie_S,
Just to add my experience:
I too am LADA. Using Tresiba, humalog, afrezza and G6.

  1. Love Tresiba (was previously on Lantus); much flatter line on Tresiba for me
  2. Use humalog for protein/fat/meals. I’m a small person so I use the Jr. pen w/ 1/2 unit dose increments
  3. Use afrezza daily to correct highs or if I eat a little too many veggie or nut carbs (I’m low carb but even larger amt of low carb veggies can do me wrong as well as too many nuts, also weird restaurant sauces on proteins or veggies).
    AFREZZA hints:
    I was lucky enough to run into a very kind afrezza rep at my endo’s office. Rep is also a type 1. I had been having trouble sometimes with afrezza being too strong for me. He showed me:
  4. To drink a sip of water right before you inhale and right after–cuts down on any cough due to powder just bothering throat;
  5. To split cartridges: “off-label” how to split 4U cartridges in half (making them 2U) which has been wonderful for me. Since I am small and eat low carb, often one 4U cartridge would drop me too fast or too low. Open a 4U cartridge and shake half the contents (by eyeball) into an empty or used cartridge (no need for exact split because as others mentioned on here, afrezza doesn’t require exact dosing). Even when I think I might need 4U Afrezza, i will still split, as sometimes the 4U action is too swift for me. I’ll do a 2U and then another 2U 15 or 20 minutes later, which seems to blunt any real fast drop for me.

Things I like about afrezza:

  1. it’s out of my system fast (hour and a half) so i can move on w/ exercise/life, etc. If i need more, I can just take another dose.
  2. Fast correction of highs
  3. No pre-bolus; Can take as I’m eating or even after I’m eating depending on meal

Finally, I love my G6.
Hope this is helpful :slight_smile:

Thank you!! I’m small-medium sizes person lol, so knowing how to split them will be useful to me when I can start trying it. I think even though I have an appointment in 2 weeks, I am going to call my endo to see if there is a rep nearby. I’m a little disappointed with my endo’s office right now, not sure what I’m going to do. He has his own practice and when I started there his nurse was also the secretary. She knew everything and was a great go between as I stared out. She is all of a sudden no longer there and the new person is not a nurse, nor does she know the name of any diabete terms. I also called for advice and never got a return phone call. That is unusual for him. So we shall see.

I also feel good about the Tresiba! I’m in the fence with the fiasp:( and I LOVE LOVE my G6. I hadn’t had a full nights sleep prior to getting the G6! Such a game changer with the alarms. I previously started on the Freestyle Libre, but not having alarms and swiping to get info was Annoying especially at night and during exercise. I even bought the Maio Miao and used spike. While I am grateful for the spike app during that time, nothing is as accurate and peaceful as this G6.

I’m on my 3rd sensor and I’m going to try to restart it tonight and see if it’s accur tomorrow. Otherwise, I will change it.

Thank you again so much!!!