I started using Afrezza in March 2015. My initial idea was to replace most of my mealtime insulin. You see, I take two doses of insulin for almost every meal. I take an immediate bolus to cover carbs and then an extended bolus to cover the slower digesting protein and fat. I am a long time pump user.
When I started with Afrezza, I decided to stay on the pump and let it provide the basal coverage as welll as the extended meal bolus. For me, all insulin treatments and tactics are about improved data performance. I use a CGM and closely follow time in range, time low, blood glucose variability as measured by stanadard deviation, and BG average.
I did not see a marked improvement in my numbers when I started Afrezza. The numbers were slightly degraded. After a month or two, I decided to limit my Afrezza use for corrections. So for the last year + I’ve used Afrezza primarily for corrections. It has performed this task very well. In extreme conditions I’ve taken a 250 mg/dl glucose level down to under 140 mg/dl in about an hour. In that case I’ll usually combine the Afrezza with an intra-muscular injection. It’s a great one-two punch.
I am waiting for latest shipment of Afrezza to deliver today. I had let my stock dwindle too low and I only have a few doses of my supply left. My order was delayed a few days and I was starting to worry about running out. Afrezza has earned an important place in my diabets toolkit and I don’t want to live without it.
I still use it a lot… it hasn’t 100% replaced injected bolus for me, but I’d say it’s at least 50% of my program. I’m not sure which I’d chose if I had to chose between it and injected basal for the rest of my life. I’d probably lean towards afrezza because frankly I achieve about the same results with only a fraction of the effort and lifestyle modification that tight control with injected bolus requires for me.
What upsets me, and is the reason I’ve stopped posting in detailed explanations of how I’ve found such great success with it, is that every time a conversation starts amongst people who are actually using it or interested in using it, all of a sudden internet trolls appear to just crawl out of the woodwork and start talking trash. Then admin shuts down threads, and has several times even scolded me instead of the instigators who a) don’t use it. b) don’t have diabetes and c) don’t have a clue what they’re talking about. I’d like to see admin intervening to keep our forum troll-free instead of to shut down legitimate and helpful conversations between the people who stand to benefit from them.
The only complaint I have had with it is that it struggles with higher fat slower digesting meals, which is easily overcome by taking two small doses instead of one large and adjusting the timing accordingly. I’ve turned several people in real life onto it and watched them enjoy phenomenal results as well. Glad to hear its working well for you.
I hope to make it to one or two of these diabetes gatherings over the next couple years there and hope to get a chance to eat something nice with you without having to worry excessively about how to manage the situation. Afrezza will no doubt be my go-to when that happens.
Please keep on posting @Sam19 & @Terry4! It is thoughtful, detailed and life-experienced comments like yours that keep this forum so valuable for all of us. It is a public forum, so there’s no getting around the trolling, but I think this forum has one of the highest signal to noise ratios for any online forum of its type.
I have been using Afrezza about 1 year, but somewhat limited since it is not covered by my insurance. I use it mostly while dining out and corrections. If the discount card was not available, I would likely stop.
Primary benefit for me is corrections, and flexibility for more meal choices/timing, especially when eating out and traveling.
You’re right about that, @truenorth. I think this whole anonymous posting thing allows trolling. I’m wondering if we should ever consider this issue again.
Afrezza is a potent tool, @MM1. It’s allowed me the occasional decadent treat, like a slice of pie, on occasion. Not having to decide in advance puts a tax on my willpower – kind of like non-D’s!
Thank-you, @mpg54. That is a nice introductory article on Afrezza. Since it’s published on the the Cleveland Clinic website, it stands as an authoritative and credible source.
Edit: fixed typo in first sentence; changed “not” to “nice.”
Sam - your comments on posting detailed experience regarding Afrezza are spot on so it’s good to hear updates from real users.
I’m still using as well. Mostly for bolus/corrections but not 100% of the time. Still the best insulin out there IMHO. I use it in combination with my OmniPod and Humalog.
Mike, I think what you have observed is normal and consistent with Matt B’s observation and comment:
"It is worth remembering that much, much more Afrezza is needed to correct high glucose levels than to cover meals. As the video details, if I wait too long to dose, the dose required may be four times higher!
"This video explains why the labelling on the box is unhelpful and confusing. The units just can’t be compared, and it takes a while to work out that Afrezza has two independent effects.
The first phase begins immediately but it doesn’t lower blood glucose, instead it temporarily stops it rising. This effect seems to be responsible for all the weird and wonderful properties of Afrezza, the first phase does not happen with previous insulins.
The second phase, however, works like a small dose of injectable insulin. It lowers blood glucose, and takes longer to start working. This is the only phase of Humalog or Apidra.
Previous treatments work by flooding the body with an unnaturally high level of insulin for hours, in order to slowly lower high blood glucose levels. Afrezza stops blood glucose rising in the first place using the natural first phase signal to the liver instead. This means that for the first time much lower, more natural levels of insulin can now be used in Type 1 diabetics.
I am not a scientist. But, based on my rudimentary understanding, I think Matt’s observation and comment (the second comment quoted above) explained it. As Matt explained it, Afrezza functions as both a first phase insulin and a second phase insulin. It appears Afrezza performs the first phase function exceptionally well. While on the other hand, it performs the second phase function not on the same high level. (Matt noted that the RAAs only function as the second phase insulin).
Here is some discussion of this first phase and second phase release:
First Phase Insulin Release
When a health person starts to eat a meal, the beta-cells kick into high gear. Their stored insulin is released immediately. Then, if the blood sugar concentration rises over 100 mg/dl, (5.5 mmol/L) the beta-cells start secreting more insulin into the blood stream. This early release of stored insulin after a meal is called “First Phase Insulin Release.” In a healthy person it keeps the blood sugar from rising very high because it is available to meet most of the glucose that comes from the digestion of the current meal.
The amount of insulin secreted in the first phase response to a meal is usually determined by the amount of glucose encountered in the previous meal. In a healthy person, this first phase response peaks a few minutes after you’ve started your a meal. The blood sugar rise caused by the meal peaks about half an hour after you start eating.
Second Phase Insulin Release
After completing the first phase insulin release, the beta-cells pause. Then, if blood sugar is still not back under 100 mg/dl (5.5 mmol/L) ten to twenty minutes later, they push out another, smaller second phase insulin response which, in a healthy person, brings the blood sugar back down to its starting level, usually within an hour to an hour and a half after the start of a meal.
It is this combination of a robust first phase insulin response followed by a functional second phase insulin response that keeps the blood sugar of a normal person from ever rising over 140 mg/dl(7.8 mmol/L) even after a high carbohydrate meal. When first phase insulin response is completely functional, the blood sugar level at two hours should be back to the normal fasting blood sugar level which is somewhere in the mid 80 mg/dl range (4.5 mmol/L).
When first phase release fails, or when second phase insulin response is sluggish, blood sugars start to rise to higher levels after a meal and take longer to return to normal. This condition is called “impaired glucose tolerance.” If the blood sugar rises over 200 mg/dl (11 mmol/L) after a meal the same condition is called “Diabetes.”
I’m not a scientist either, or one to link to other blogs or users… But I can tell you from experience that “units” of afrezza are really not comparable to “units” of any other insulin. It works completely differently. It’s really apples and oranges… So no, 4u of afrezza really isn’t comparable to 4u of lispro.
I don’t experience what others have stated about needing to take larger amounts for corrections than for prandial. A 4u dose of afrezza would drop me from 200 to less than 100 in less than an hour. It would also drop me from 130 to less than 100 in the same timeframe without causing hypos. That sort of flexibility and elasticity does not exist for me with injected insulin.
Hi Twill - I think that sometimes when my high tends to need more Afrezza than I expect it’s because of the high carb, high fat nature of the meal and the extended release of the carbs. Should have been more detailed with my comments. I’m not sure what Matt is experiencing as mentioned by @Charles5
I almost wonder if sometimes he’s getting the full dose or not during inhalation.
right on point. I’ve experienced the same. I don’t really worry about a hypo with Afrezza. Elasticity as described by @Sam19 paints a perfect picture.
I am not a scientist. But, based on my rudimentary understanding, I think Matt’s observation and comment (the second comment quoted above) explained it. As Matt explained it, Afrezza functions as both a first phase insulin and a second phase insulin. It appears Afrezza performs the first phase function exceptionally well. While on the other hand, it performs the second phase function not on the same high level. (Matt noted that the RAAs only function as the second phase insulin).