Afrezza doesn't seem to be great for my correction boluses

I find that if my BG begins rising post-meal, Alfrezza seems almost powerless to stop it. I use Novolog in an OmniPod for pre-meal boluses, and I’ve been experimenting with Alfrezza as a quick-response correction bolus. Today, for instance, I pre-bolused 16 units for two pieces of pizza for lunch. My BG was 65 when I began eating and stayed around 100 for an hour after my meal. When it rose to 109 10 minutes later, I inhaled 4 units of Alfrezza. About 35 minutes later, my BG had risen to 146 and 1:10 later it was still at 146. In the interim, I did three small 1-unit boluses of Novolog, which hopefully will help bring things down with no further rise. I know timing is everything with Alfrezza, but I really thought I had bolused enough Novolog pre-meal for the two slices of pizza, so I didn’t use any Alfrezza until my BG got to 109 an hour later. This isn’t the first time Alfrezza has failed to prevent a pretty significant post-meal BG rise for me. Is there a key to success when using Alfrezza for corrections?

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For some reason, pizza seems to be some special kind of bastard to manage with insulin of all types. I’ve had my best results with it by inhaling afrezza around 35 minutes after I start eating it and then a follow up dose at about an hour… Both 8s for me but I don’t have the self restraint to limit myself to two slices. Still even with all these tricks, you’re lucky to keep your bg below 150 at some point

Realistically, you ate pizza and kept your bg below 150 which is actually a success in my book.

I have experimented quite a lot with mixing and matching afrezza with novolog to cover the same meals… Over time I’ve come to generally find it to not be a great idea… And I like to just use one or the other… Too many variables and impossible to actually understand what’s doing what with mixing and matching… I still do it once in a great while but only in the form of adding about 2u of novolog right off the batt for longer digesting meals when I know the afrezza will wear off to fast (like pizza).

Ps if you need 18u of novolog to cover two slices of pizza the 4u cartridges of afrezza might just be way way to weak for you…

I’ve experienced mixed results with using Afrezza for corrections. I’ve been using Afrezza for corrections for the last 9 months or so and primarily use my insulin pump for basal and bolus needs. I was using Afrezaa for as little as a few corrections per week but lately I’ve been using it several times per day.

It’s not been rock-solid consistent for me but with so many other factors involved (holiday treats, the vagaries of site absorption, inconsistent food absorption, etc.) it’s hard to pin the correction failures on Afrezza. I’ve had better, more consistent results with small (<= 2 units) intra-muscular or IM injections.

Perhaps a better test for me will be controlling all the other variables as much as possible and then give an Afrezza correction and see what happens. I had had very good and consistent results correcting a high when I wake up in the morning with the combination of Afrezza and an IM shot.

Terry, is it possible that you need much larger dosage for correction purposes (and possibly larger dose than you have expected)? At least that is what Matt Bendall has observed.

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!

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.