At the risk of overdoing topics about Afrezza, I want to share some real world experience using Afrezza to correct hyperglycemia. @Jen mentioned in another thread that she likes reading about blood glucose problems and successful solutions. I offer this topic in that spirit.
I’ve been using Afrezza since March 2015. I tried it as my main nutrition insulin for a few months. I decided that I could produce better results more consistently using my pump for bolus insulin. But I never stopped using Afrezza.
I found that it was an excellent way to correct high blood glucose. It acts quickly and its lack of tail action is an endearing quality.
I’ve been struggling with overnight hyperglycemia lately. Here’s one example from my CGM:
I know what’s causing this, evening snacking. But I thought I could get away with it. Sometimes I’m a slow learner.
Two nights ago my CGM woke me up at 1:00 a.m. with a 200 mg/dL hyper. I decided to take one 4-unit cartridge of Afrezza combined with 2 units of Apidra injected intra-muscular. I slept well the rest of the night and woke up to a BG of about 130 mg/dL – not ideal but still in range with no hypo.
Last night, I did better with avoiding evening snacks but my Dexcom woke me up at 3:40 a.m. when it announced a 140 mg/dL alarm. I did the same correction as the night before, one 4-unit cartridge of Afrezza and 2 units of Apidra given IM. Looking back at this trace, you may think that my correction was a little too aggressive, but I factored in my sense that I’ve been a little insulin resistant overnight. As you can see below, my one-two punch correction performed well. I woke up at 7:00 a.m. at 86 mg/dL – and no over-correction hypo!
For me, I find that the peak of Afrezza activity occurs 45-75 minutes after I take it and its gone at about 90 minutes. To me, Afrezza is an ideal correction tool.
Well, that is interesting. Those timings aren’t radically different from my Apidra. The peak is about the same and the tail is maybe 30-40 minutes shorter. But that’s anecdotal, of course. No predicting how either one would behave for another individual.
Over the weekend I posted on Twitter a test that I did with Afrezza. Unexpectedly, I had a pump site issue which ballooned me to 296 and in turn was a nice test for Afrezza to see how quickly I could bring it down. I inhaled 12u of Afrezza and the two screenshots speak for themselves.
That ought to draw out some naysayers. The beauty of this is that it probably didn’t even derail your whole day. You probably went on with your business like there was never a hiccup… whereas if you tried to inject a big pile of insulin to solve that prob you’d likely have been on a roller coaster all day.
This is exactly right. Being able to look at my CGM an hour after I took the Afrezza and see that I was dropping so rapidly made it almost an afterthought for me. I was able to sit and continue to enjoy watching my son’s soccer game with no worries of a low and almost certain I’d be back in range very soon.
Sam, I’ve found that Afrezza only corrections during the night don’t have the follow-through that the Afrezza + Apidra IM delivers. I think I’m more resistant to insulin over night. What I haven’t tried is a larger dose of Afrezza, like 12 units instead of 4.
I have had successful Afrezza only corrections during the daytime.
I know you’re interested in isolating each factor in order to draw a firm conclusion. The problem with that is that there’e no way to run a scientific control since there’s only one of me. I could do consecutive night comparisons but I wouldn’t volunteer to make myself hyperglycemic.
For me using a pump there’s also the pump site absorption sensitivity change from day to day that affects some sites and not others.
So much of what we do suffers from anecdotal criticism. It’s just the nature of the beast.
No, I don’t ask these kinds of questions to medical professionals. I find they lack the time and experience to really understand things beyond textbook explanations. I’m sure there are exceptions to this. I do well enough figuring out my own solutions. Plus I can ask other patients here.
Do you have a good working relationship with medical support people?
Since it was a site issue, did you change your site in addition to correcting with Afrezza? Or is that correction Afrezza alone (still with a site issue or no basal)? If it is just Afrezza alone (with no basal), would it have been different or driven you lower with a new stie and proper basal coverage?
Not only don’t they live it, but it’s not possible to ask a diabetes professional about every high and low that happens. We’d be living in hospitals if we had to consult with a diabetes professional every time we went high or low. Instead, we need to learn to adjust our insulin ourselves (and diabetes professionals should be teaching this). Consulting a doctor is usually left for emergency situatiosn (like impending DKA or multiple severe lows) where things are dangerously out of control. This is a difficult concept for a lot of people without diabetes to understand, since there aren’t many other medical conditions where the patient makes most of the treatment decisions without consulting a doctor.
The thing is, as he describes it, the problem is chronic and recurring. Such problems should always be discussed with the endo or diabetic nurse before the patient takes off self-diagnosing and self-treating. If he wants to maintain a good relationship, he shouldn’t put the endo and/or nurse in the position of possibly having clean up whatever mess might result from his self-management.
In his particular case, he opines “they lack the time and experience to really understand things beyond textbook explanations.” But who will he and/or his family turn to if whatever he chooses to do ends up putting him in the hospital? Perhaps more important, what will the health professional think of the patient? Perhaps something along the line of, “why should I bother to waste time worrying about a patient who doesn’t want to take my advice”?
Most people with tight control who use insulin don’t ask their endocrinologist every single time they need to make a dosage adjustment or have a high or low blood sugar. We’d be calling them every single day if that were the case… The endocrinologists I’ve worked with over the past 25 years have encouraged me to learn to make my own adjustments. There are half a dozen books written by diabetes professionals encouraging patients to learn to make their own adjustments. It’s totally unrealistic for a doctor to expect a diabetes patient to contact them every time they want to make a change—they’ve be getting many, many phone calls a day if that were the case.
If anyone with diabetes is worried that a situation might end up in needing to go to the hospital (like I said above, DKA or severe lows), then yes they should contact their doctor, but probably not until they go to the hospital first and the emergency has passed. But going into the low 200s overnight, even if it’s for weeks on end, is not going to result in the need for a hospital visit…
Definitely, but, as I thought I made clear, the OP makes this sound like a chronic, recurring problem and not a simple one or two time adjustment. I still maintain that when a situation becomes recurring and/or chronic, it should be discussed with the endo and/or diabetic nurse before self-diagnosing and self-managing.
And while “going into the low 200s overnight” may not need a hospital visit, it MAY indicate something ELSE going on that needs attending to, perhaps something that has nothing to do with his diabetes.
When does a problem become “recurring and chronic”? Most people with Type 1 diabetes have excursions outside their target range, sometimes very far outside their target range, multiple times a day. That is every day, not just on occasion. These patients are not told to contact their diabetes team for every single little decision or adjustment that has to be made. And, in fact, many times these patients are told to look for patterns over an extended period of time before making any chnages to their insulin. I have never met an endocrinologist who has gotten mad or asked me why on earth I’ve gone above their authority when I’ve changed my insulin pump settings between appointments, because that’s what’s expected and needed with managing Type 1 diabetes.
…but he indicated in his original post that the source of the problem is evening snacking. A lot of times highs and lows just have no cause that anyone, doctor or otherwise, can figure out. Why would anyone jump to the conclusion that a modest high with a known cause could be due to something besides diabetes?! That is diabetes. What you see above is an average day for someone with Type 1 diabetes. Not dangerous, not alarming, not exceptional, not something to freak out over. A problem to solve. And, yeah, sometimes it takes a few weeks to get dosages re-adjusted and a period of going high smoothed out. And then, instead of trying to tame a high at night, it’s on to trying to prevent a low mid-afternoon, or stopping a rapid rise after dinner, or figuring out how to bike to work without going low. Every day is a balancing act between high and low.
I’m still very curious to know whether you have any actual experience living with diabetes. From what you are posting, I would guess that the answer is no. But maybe I’m wrong.
