Do you mind sharing what HMO you use? We can notify Mr Castagna COO at Mannkind of this importune change in formulary.
Been trying to get Afrezza for my T1D son. Have wondered how well Afrezza meets increased insulin demands of the flu altered body. Would you say it can normalize glucose about as easily as a non-flu altered body or do you have to substantially increase doses?
So Iām really new at using Afrezza and still finding my way. In hindsight, I realize I needed to increase my basal dose 1 unit (or maybe 2 at most). Sighā¦Anyway, my husband and I had been on a road trip to visit to far-flung relatives and toward the end of the trip I felt like I was starting a UTI. Turns out, I was passing a kidney stone!! 
I found that my usual bolus was not enough very quickly and that evening had to use 2 4-unit cartridges about an hour apart before my BG budged from the 200-225 rangeā¦and then I only dropped to about 150. For the next couple of days, I ate fewer carbs but still needed to correct, once with Afrezza and once with exercise (for a Big Blue test). In contrast, today I used 1 4-unit cartridge to correct a bolus timing error and dropped from 180 to 75-ish in an hour!
Iām not sure I answered your question, exactly, but hoped to convey how differently 1 dose can affect BG. Thereās also a bit of a learning curve for inhaling the dose efficiently: the first few times I either coughed or was unable to hold my breath very long so I didnāt get the full dose. I am sure there are other members who can provide more/better responses to your question.
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That is odd but definitely good to know. Do you think the 8 unit cartidge corresponds to 5 or 6 units of Humalog? I donāt generally use that much (!!) but am thinkingā¦a slice of apple or pumpkin pie for Thanksgiving dinnerā¦ 
I donāt think āunitsā of Afrezza compare in any way to units of humalog. After using it for as long as I have your question seems to me like āis 8 apples comparable to 5-6 orangesā
Like Iāve said before I really wish theyād called them something other than āunitsā in my observations that term has caused more confusion and apprehension than anything else
Time is the fundamental variable with afrezza, much more so than amountā¦ that said, you have to take enough or it wonāt be effectiveā¦
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Hmm, I see your point. Um, I guess Iām trying to figure out when Iād use the higher dose cartridges (and what to ask my doc for when I request more samples).
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Yeah thatās the real conflict is that thereās only so many large vs small doses in the boxā¦ so you do end up utilizing it differently depending on which box you getā¦
Iāve gotten the 30/60s in both 4/8 and in 8/4ā¦ I was really concerned about getting the quantity that best fit me at first, in hindsight I think I just utilize it a little differently when I have a different ratio of cartridges and it ends up not making that much differenceā¦
I definitely need at least 30 8s per boxā¦ a box of all 4s would not be a good fit for me
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Sam, they not only call them units, they specifically say that each unit is equivalent to a unit of traditional insulin. I canāt remember the specific verbiage, but I saw it on my package today.
The FDA dictates packaging and labeling requirements. Their package instructions indicate to use a ā4u cartridgeā to replace anywhere from 1-4u of injected bolus, 8u cartridge = 5-8u of injected bolus, and so onā¦
By convention insulin is measured in standardized āunitsā
Afrezza is anything but conventional though and I wish the policy makers would have been willing to think outside the box with itā¦ unfortunately thatās not how the world always works, particularly in medicine. This shortcoming in conventional wisdom has been a major obstacle for it IMO.
They include the following dosage guide
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The reason @sam19 says he can eat like a āfree manā is that he uses the amount of Afrezza he needs to counteract what heās eaten. Itās not a defensive move, like pre-bolusing, but an offensive strategy (dealing with the result of eating). Light bulb went off for me: that why he says:
ETA: This would be a great topic for a DiabetesTalks chat, @cynthia_rogers.
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Yeah you pretty much hit the nail on the head. I crouch in hiding behind the door with my afrezza golf club and as soon as I know the blood sugar bogey man is about to sneak through I bash it over the head with afrezza. Whether I hit it 4 times or 8 is less important than timing the first swing. Good analogy.
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One 8 unit cartridge is equal to about 3 units of humalog for me! And the 8 units drops me much more quickly than a 4. I try to eat low carb and a 4 unit can often do the trickā¦ but if not puff again with no worry! 
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Absolutely! Iām going to wrangle some willing participants!
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I havenāt taken Afrezza in a long time, due to lung irritation. Yesterday, I decided to try a dose around 12:40, as I had been running high and several bumps of Novolog from my Omnipod werenāt having much effect. I inhaled 8 units (the only size I have on hand) at 12:43 with my CGM showing 143. By 1:00, I was at 116 (probably helped some by the Novolog). By 1:30, I was at 110, and was at 100 at 2:00. I stayed in the 90ās for the remainder of the afternoon, bottoming out at 90 at 4:00. I love the effect, but my lungs were irritated until I went to bed. Is that something that subsides over time?
Iāve never felt it in my lungs but have felt it in my throat quite a bit-- which did subside over time, and with treatment of an underlying issue (reflux). I suspect it would subside in most casesā¦
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Seems a little overkill to limit packagingā¦Do you think it would make sense to offer Afrezza boxes of 30 or 60 doses, each box containing a single concentration of 4, 8 or 12? That way you are managing a home supply by dosing level:
"oh, Iām running low on 4s. Use those the most so I will order three boxes of 4ās at 60count. better get a 30 count of 12ās even though I donāt use those much, Holidays coming up and I havenāt ordered a box of 12s since just before Valentines day 2 years ago"
Wonder too whether they are still tweaking concentration. Perhaps the tissue irritation issue (the tissue issue? - gezunthite?) could be tackled by using more or less DKP carrier? more or less flocculationā¦
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Yeah that would work in theory, except itās a prescription medication so your prescribed quantity has to be written up by a doctor such that X units = 30 or 90 day supplyā¦ or X+Y units = 30 or 90 day supply ā they canāt really just give you a blanket authorization to order whatever you want and expect your insurer to just offer a blank check for itā¦
This is the one true sense in which itās not as āliquidā as liquid insulin
I get it about the insurance: canāt have people staking up āsurplusā at wholesale prices and selling retail out the back door.
On the other hand Afrezza is square peg physiologically adept insulin and delivery system that they are trying to force into the round liguid insulin hole.
We order different amounts of liquid insulin strips and pens on an as needed basis, get only the occasional guff. Type 1 diabetes on insulin is not like Type 2 on metformin- one pill a day. Insulin can get exposed to heat. You need more during flu season. Less when youāre hitting the gym dailyā¦Seems like the healthcare system should be as flexible with Afrezza as it is with liquid. JMHO 
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I originally started by getting sample box that included 4s and 8s. I think it was 60 4s and 30 8s.
My total daily bolus from pump, prior to Afrezza, averaged 10 U daily for bolus, and eat relatively low carb.
The problem was that I used the 8s less frequently and often made meal choices just to āuse upā the 8s once opened.
The cartridges come in foil-sealed 3-packs, and they recommend being used within 3 days of āstripā being opened. So it worked better for me to just use 2 4s for the meals that required more, and with flexibility to time them 15-30 apart if necessary.
So now I only get 90 4s per box.
Yes but the liquid insulin prescription and test strip prescription are still written as X units = y days and you order and refill within those parametersā¦ itās not just a blanket authorization. They canāt write a novolog prescription for āas much as you need, whenever you need itā or anything like that either.
Itās usually written as exactly e.g. āinject 15 units dailyā. Or if you have a flexible pharmacy you might get away with āinject UP TO 15 units dailyā but even that modicum of flexibility in dispensing meds is often too much it seemsā¦