Afrezza for boluses and corrections

So share your experiences. I just started a trial of Afrezza to supplement basal from my Tandem 2 pump. Amazing how quick it works and gives me a flat post-prandial CGM curve. Have also found the problems w/ my basals but, finally getting them fine tuned. One thing I noticed is that I need about 2x the amount of Afrezza per gram of CHO. I follow low CHO (20-30 g/d) and moderate protein and fats…trying to shed some pounds. Using 4u Afrezza for 6 gm snack and 8u Afrezza for 12 gm meal. In the past I used corrections for protein (50%) and fat (10%) - do you guys do this using Afrezza …do you give yourself a second hit at about 6-8 hrs if eating more protein or fat? Also, Cigna is my insurer and they declined authorization today. What have others experienced with coverage? I was given a discount card by the pharaceutical rep that can be used pre-authorization which may help. My Endo and Afrezza are offering me 1 mo of supplies to show improvement in BGs and then we are going back to Cigna on appeal.

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I asked my endo to prescribe Afrezza for when I go high. He advised that it could intensify any existing complications so recommended not taking a chance.

Afrezza dosage amounts are very different than typical fast-acting insulindosage amounts.

A 4 unit cartridge of Afrezza roughly equates to 2 units of humalog/novolog. The action times are obviously different too of course. So it makes sense that you would need 2x as much Afrezza as Humalog.

Afrezza is just a completely different animal. I love how it levels off around 70-80. afrezza allowed me to safely lower my average bg level without increasing my low %. I really can’t express how much it has improved my control and quality of life.

I dose if needed for protein, but I don’t eat a very low carb diet so I may not be as sensitive to protein.

I think the biggest benefit of Afrezza is being able to correct highs very quickly. If you only are able to get a limited amount, then I would use it for corrections.

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Do you know what specific existing complications he is referring to? Related to lungs?

Having high bgs will also intensify existing diabetes complications.

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I agree. It’s a fantastic tool and.I use it regularly for that purpose.

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I recently got my Afrezza covered by insurance with mannkinds help. They are fantastic! Their program that provides Afrezza while working through the appeal process is amazing.

One reason insurance claimed they were denying coverage was “not enough information” in my medical records. As if the almost 2 years of previous full time use of Afrezza and concurrent lowering of a1c didn’t exist. So my Dr added to my file ALL of the ways I dose with Afrezza and the reduction of serious hypos.

My a1c before starting Afrezza was 8.9 and my most recent a1c is 6.2. I can’t give any more glowing recommendation than that.

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I wish Health Canada would approve Affreza for sale here :canada:

Is the product sold in 4 Unit doses? I’m wondering what it cost in the USA for a months supply?

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Afrezza comes in 4 unit, 8 unit, and 12 unit cartridges. You can get a box of 90 cartridges of one size or you can get a combo pack of 180 cartridges of 2 sizes. There may be other combinations, but those are the only ones I’ve gotten.

I get the 4 unit and 8 unit combo packs with a total of 180 cartridges. My insurance plan has a non-formulary benefit, so Afrezza is covered for me (with a co-pay). Afrezza is expensive right now. My understanding is that they need more people to use it in order to lower the production costs. They’ve not had as much success in their first few years as they’d hoped for various reasons- none of which are due to any issues with the actual product. My last explanation of benefits showed that the insurance company paid around $3,000 for 4 combo packs (180 cartridges each). That will last me around 4 months, using Afrezza for almost all boluses. I do use Humalog occasionally as well. I assume that once Afrezza is on an insurance company’s formulary (if that ever occurs), the insurance company could negotiate a lower price with Mannkind.

Right now, Mannkind has every incentive to work with people like @Firenza to get it covered. That’s the only way they’ll eventually get onto the formularies.

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IMHO the biggest product issue holding them back is the limited number of dosages available. My boluses and corrections are typically from 0.25-10 units. There is no way to dose 1, 2,3,5,6,7,9 or 10 units with Afrezza. I know there are ways to make your own dosages by taking cartridges apart and refilling with a different amount, but that’s a lot of work if you routinely need non-standard doses. I’ve mentioned this to MannKind a few times over the past two years. I know they recognize the issue. Either I’m a very atypical user or there’s something else holding them back. I like the product but can’t use it for anything other than corrections.

I agree on the 1 unit dose (e.g. 1 unit of humalog would equal 2 units of Afrezza).

However, Afrezza works very, very differently than other fast acting insulins. In general, I can take an 8 unit cartridge to cover food that i would normally take 3-4 units of Humalog. One of the best things about Afrezza is that you DON’T need precise dosing.

And, if you didn’t dose enough, you can follow up with a 4 unit cartridge awhile later. It starts kicking in within 15 minutes, so a mistake doesn’t result in major consequences.

Afrezza tends to level me off around 70-80 mg/dl unless I take way too much, so the risk of hypos is so much lower than with other fast acting insulins. You don’t need the precise dose, and it levels off before a low. It’s amazing stuff.

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I’ve been using Afrezza for four years now, almost always for corrections. I use the 4 unit doses and find that the equivalent effect to my Apidra is about 2-2.5 units.

What I really like about it is it’s quick action and short tail. I can count on it to stop lowering my glucose at 80 minutes. This makes it ideal for correcting highs and returning to sleep in the night.

I also use Afrezza for meals when I’m faced with an unexpected meal or I forget to prebolus and want to prevent the inevitable glucose rise. I consider Afrezza as another tool in my kit and wouldn’t choose to live without it. I average about three doses per day. I rarely take more than four units at a time.

I’m currently on a two week holiday and Afrezza has helped me enjoy foods I don’t usually eat. It has enhanced my quality of life.

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I’m not sure I agree with this. Everyone is different of course, but It hasn’t been my experience and wasn’t the guidance I received from my endo. It may depend on the amount of injected bolus insulin you use. Here’s an excerpt from a recent article about Afrezza that discusses people using small injectable insulin doses, such as myself (link to the full article at the bottom)

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People who eat low-carb or have low insulin doses may have difficulty with Afrezza, as the lowest dose increment – currently four units – may be too much. It is important to know that each unit of injected insulin is equal to 1.5 units of Afrezza. That means that the smallest dose of Afrezza is equal to just over 2.5 units of injected insulin, which may be difficult for people on lower doses of insulin (see chart below). Mr. Harmel has used DIY videos that teach people how cut the four-unit dose to two units, though this not FDA approved or recommended by the company.

Don’t get me wrong. I like Afrezza, but it’s not a drop in replacement for injectable insulin for everyone. If more dosages were available, I would use Afrezza more frequently. At present, I can only use it for situations where I would use more injectable insulin than normal. When I do - it’s absolutely fantastic for the reasons you mentioned!

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I think the 2 unit cartridges would be helpful when I want to dose the equivalent of 1 unit of humalog. Once I get past the point where I need the equivalent of 2 units (4 unit Afrezza cartridge), the amounts no longer need to be precise.

That is my experience- having used 4 unit and 8 unit cartridges for most meals and corrections over the last year.

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Since I stick to a strict diet and exercise schedule in my older age, I don’t take much insulin. Sure I get unexpected highs, but have never tried this. Is Afrezza inhaled? Has it been around long enough to be sure it isn’t harmful?

We are going to Europe for our 50th and I am wondering what in the world I will be able to eat. Last night we went out with our son to a pub, and I ordered a large green salad with apples. I added a cup of garbanzo beans out of a container in my purse. I am becoming a very weird old lady.

Lowered my fat intake again and my insulin needs have dropped again. Today I am taking 20 units total to cover close to 300 very healthy carbs.

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It is. Works well once in good control - 4 units like 2 units other insulin so depending on your correction could drop you 20-50 mg/dl on average. So - probably enough. In my limited experience, the 8u Afrezza doesn’t work as 2x the 4u but, could be that my basals are still off. Cost - expensive, I think. I have insurance and I am at out of pocket max so if approved, mine would be free. Insulin in general is way too expensive! I heard it was about what Humulog or Novolog runs - $300/400 per vial equivalent. Using it to lower high BGs could allow you to use just a little but, in my experience, once you see the benefit of really fast acting insulin - you will want to use it for meals too! Currently my insulin costs $9,600 per year - although we all know that is “funny” money quoted by insurance companies. I remember when a vial of Novolog was $19.97/vial over the counter. Thought when it went up to $50-60 that was a lot! Well, welcome to 2019.

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Afrezza lowers BG beginning at 12 mins and peaks at 35mins (4u inhalation). It is fast on and fast off so good for carbs and anyone w/ post-prandial high BG bump (all of us!). It is the only truly very fast acting insulin - we may have ultra fast insulin in a few years or one that can react in the blood to changing BG needs. This is the only one that delivers, right now. It is inhaled and that is weird but, convenient. I have allergies and junky lungs this time of year so cannot tell if the inhalation is making that worse but, I feel it in my lungs. Giving this a 1 month trial to see how it goes - both BG lowering (time at target and decreased variability - later is harder if on typical fast acting because cannot cover the up front bump and rarely the late rise from protein and fat). For so long we have tried to follow diets that accommodate insulin. This one accommodates us. I eat immediately after inhalation and I have not seen an increase in BG post-pradially at all. Sometimes need a second hit at about 25-30 minutes – still figuring that all out. I also may need some about 6-8 hrs after eating. Currently cover that with my pump because usually “drift” up and my Humulog can catch it. I may actually set my basal a little higher at 4 hrs after each meal. I currently follow low CHO so protein and fat thing more of an issue for me…although I never consume the numbers that are listed in the literature for adjusting insulin because I am on a low calorie diet as well. Going to try to up my pump basal by 0.1 at 2 hrs before presumed bump and see what happens :slight_smile: I agree w/ other posters - that there is a much lower risk of hypoglycemia w/ this insulin. Add to that, I have a Tandem 2 pump that turns off if it thinks I will go below 70 mg/dl and corrects.

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I was one of those who was a control freak! Everything had to be precise. And being kinda sensitive to insulin, Afrezza worried me. But after hearing so much about it at different diabetes conferences and workshops, I decided to try it. And while the dosing is much different than what I would do with my pump, I must say, I love it! I use it like many here, mainly to correct a high. And it works fast, scary two arrows down fast but than levels out and is gone quickly. I don’t usually use it for meals but like @Terry4 if I forgot to prebolus, it fits in perfectly. And this is also someone who has some slight breathing issues but have cleared all tests before and during. I don’t really think about what it is doing to my lungs because, inhaled insulin has been on the market since 2006 and my lung function hasn’t changed in the few years I have been using it.

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I am in Scotland now and I decided to relax my usual eating habits of “no grains and no added sugars.” I just figured that vacation is an exception and I will return to my usual eating style soon enough.

I did eat some bread and a few desserts. I resisted the ubiquitous shortbread cookies found in every hotel room. I’m glad I did it as it affirmed that I can be flexible under unusual circumstances.

I think your biggest challenge will be keeping your fat consumption low. There are plenty of good fruit and veggie options so you should be able to keep intact your essential food values.

My blood sugar control hasn’t been as good as back at home but it’s been good enough. I’m glad I had the Afrezza to bring my highs back into range. Enjoy your European visit and don’t let any food exceptions impair your enjoyment.

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We spent a week in Scotland 30 yrs ago and loved it! Hope that you are loving it too.

Yes, I imagine I will have trouble with fat more than anything else. I too will most likely change my way of eating somewhat for the trip in June of 2020. The next time I see my doctor I will ask him to write a prescription for Afrezza.

Hope you are having decent weather and tons of fun.

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I am an Afrezza user and LOVE it. Yes, still take long acting insulin (1x per day) but Afrezza is only other medicine I have to use for meals and maintenance.

I used small amounts of Humalog and the 4 works fine for me at meals. I use Tresiba so I am covered throughout the day. And a 4 unit is good if I eat something of higher than norm carb and my blood sugar goes up.

I really have a flat line on my Dexcom and the ease of using, traveling, taking, managing blood sugar with Afrezza is worth it. I don’t have anything hooked up to me (except the Dexcom which continues to get smaller and improved).

I can exercise as hard as I want without the worry of “uh oh I’m gonna drop with 2 arrows going down due to lag effect of Humalog”.

I can easily administer anywhere and it is predictable.

Can’t say enough good things about using Afrezza to help me live with diabetes (type 1 for 35 years).

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