Afrezza Inhaled Insulin

Have any of you started using insulin with Afrezza? Did you drop all oral meds when switching to or adding Afrezza? What training did you receive?
I just have a GP, now – on metformin and glipizide. Would he have to refer me to an Endocrinologist?

I am a type 1 and I just use insulin, I am not on any other medications.

The training for me was the rep getting on zoom to show me how to take it, a brief run down on storage, to take it after you eat and one 4 unit cartridge replaces about 2 1/2 to 3 units of injected insulin.

But I am already on insulin. (which I never got training really for either) I think it depends on your doctor, your doctors group and what they provide. And I think as a type 2 you are not given as much training as easily. When I was finally diagnosed right I had already been taking insulin for years.

My endo prescribed Afrezza last fall and I was the first one she prescribed it for. Which means she wouldn’t have had a lot of input to be able to give about it. Now she already has several. But I think a lot of doctors are unfamiliar with it and might be hesitant to prescribe it because of that. Who can prescribe it or any insulin is probably up to the doctor or the guidelines of the group they belong to.

It’s tricky I guess I want to say to start using insulin, whatever kind you do. It’s a learning process.

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For training, you can find videos on how to use.

But the harder part is how to work into your treatment plan, and each person is different.

Afrezza is ideal to cover meal time insulin, which I asume you are not currently using. So you may require reduction in your current meds.

Do you have high BGs after meals ? That could be corrected with small Afrezza dose, based on your meal. For example, maybe small meals are ok with current meds, but with larger (higher carb) meals you use Afrezza.

Has your doctor already suggested that adding mealtime insulin would be helpful?

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I use Afrezza if for some reason I reach 160+ so I very seldom use it. My doctor is a GP too. He had never heard of Afrezza when I asked for it, but he ordered it for me. I watched the YouTube videos to learn how to use it. I have been a Type 1 forever, so I am very used to treating myself. I am not on a pump though. Novolog works as fast or faster for me, so I really have no need for Afrezza.

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Thanks, Marie, for all this information. I wonder why Afrezza seems like such a rare thing, after being on the market for several years. I’ll be discussing it with my doc in a couple of weeks. Guess I should see if my Cigna insurance and/or Medicare covers it.

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Thanks, MM1! I did see one video on YouTube, and it looked informative enough on how to use, but of course I have no idea on how much to use, or when – and how much effect it might have on my BG.
I’ve never used insulin before, but feel like I might need to start at least thinking about it. I’m surprised that everyone who’s replied and the woman in the video are all type 1s. Any ideas on why no type 2s?
My numbers are all in a higher range most of the time – not just after meals, but for no apparent reason – they just stay high – more in the 200s than the 100s. My regular daily exercise is not having nearly as much effect as it used to have, and I’m eating very few carbs – very little of anything, really, and all my meals are very small snack-size. My metformin and glipizide aren’t showing much effect. BG goes down a little overnight, but I wake up high with BG still too high, and it stays in a higher range all day – no matter what – especially as soon as I get up, and before and after breakfast. Major Dawn Phenomenon going on. It’ll go down a few points, eventually – but not significantly with physical activity like it used to do the past 24 years. It started going up during the last couple of years, coinciding with the pandemic. The only thing that I can figure is that in spite of exercising at home as always – I haven’t been out “running around” running errands like I used to, and I’m haven’t been able to overcome my insulin resistance like I have in the past. I’ve probably slowed down some, (being 79 years old), and have a few more family demands on my time and energy, too.
Haven’t spoken with my doc since my A1c a year ago, and it was barely acceptable at the time. I’m sure it’s a point or two higher, now. Seeing him week after next.

Thanks, Marilyn! I’ve seen one video, but not sure that’s enough to go on – especially if my doc hasn’t even heard of Afrezza. So that should be interesting to find out! I know absolutely nothing about insulin, really. My main concerns would be having it prevent me from exercising enough (I do moderately brisk), and/or gaining weight (I’ve been pretty normal since losing all 40 excess pounds within the first 6 months of diagnosis thanks to diet and exercise, and would not like gaining it back)!

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My insurance covered Afrezza but they required a spirometry (lung function) test before approving. The reason it’s not more common is because a lot of insurances do not cover it or if they do cover it it will be at a higher tier than other insulins. It is IMO the safest insulin on the market because it leaves your system so fast that you will rarely go low while taking it.

It really sounds like you might need basal insulin though in order to get your fasting BG down and this is most likely what your Dr. is going to be comfortable with prescribing first. If you still need a fast acting or meal time insulin after you are on a basal insulin though I can’t recommend Afrezza enough. When I started Afrezza I wasn’t on this forum but the diabetics on Twitter coached me through the first week or so (both type 1’s and 2’s).

You may or may not need oral drugs after starting insulin and no one will be able to tell you ahead of time if you will be able to stop them because it will be on a case by case basis.

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This article may help.

https://diatribe.org/switching-afrezza-inhaled-insulin-tips-diabetes-educator

If you try it, consider doing more before and after BG checks to see how it changes your BG.
Be prepared with glucose tabs if it causes BG to go too low as you figure out dosage.

But you may need to switch to endo to get better A1C, and learn if injected basal and bolus insulin would give you better results.

Your pancreas can wear out after a long time and then you don’t make enough insulin. 6% of type 2’s have a lack of enough insulin. That can happen after time. You might consider asking for a c-peptide test to find out if that’s the case.

Afrezza didn’t catch on like they thought it would. But a lot of that is it’s very expensive and wasn’t usually covered by insurance. I think Mannkind coming out with savings cards to use has helped it being used more now. My current endo wasn’t sure it would be covered, wasn’t familiar with it, but was open to me trying it. And to add, some things are more easily covered for type 1’s.

In the US they are more likely to start you on a basal insulin at first. If you need insulin for just after meals a bolus insulin fits the bill, but if it’s a all day thing a basal helps or even using both types. They judge a lot by your A1c and if you want insulin I would suggest you keep a log of your numbers to show what your levels are hitting. A CGM would be invaluable especially if you start insulin. I think@Nancy50 finally got approval of a CGM as a type 2. Medicare has some rules for coverage.

Insulin use has to be learned. A type 2 usually needs more than a type 1, but if you end up lacking insulin I’m not sure that’s the case? And you want to start at lower amounts and work your way up to what you need, without it being too much. But if you start insulin, the most important thing is to keep a hypo treatment handy by the bed and everywhere you go.

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Thanks so much, Firenza! Cigna told me today that Afrezza was on their list – in the various 4, 8, and 12 unit dosages. So at least I know that much. Interesting that I did have to spell it for them two times before they could find it!

Thanks again, MM! I’m going to print that article out. I do have glucose tabs, but haven’t really needed them much.

Thanks for those extra tips and your support, Marie ~ I had a C-peptide test a couple of years ago, and it showed that I had a very high amount of insulin, which I guess tells me that I have extreme insulin resistance?

It sounds like bad insulin resistance. But did your higher numbers start sometime after that test? Because it could have changed since then. The other thing is have you tried dropping all fat for a day? Or a fast for a day to see if it makes a difference? Even one day of higher fat foods and I can tell the difference on how I respond to insulin for the next 24 hours.

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Numbers just gradually crept up. Interesting about dropping fat. But I don’t eat much to begin with – just a few bites here and there – at 2 or 3 snack-like “meals” and 2 small snacks a day. I’d say about 50% protein, 25% fat, and 25% carbs – just guessing.

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For the low fat approach to work and make a noticeable difference I believe it is supposed to be under 5%, I think that’s per the Mastering Diabetes program and their guidelines? I know the Mastering Diabetes program is promoted for type 2’s too. @Marilyn6 would know more about the percentage.

I am a type 1, but I generally don’t eat a lot of fat. But I don’t care except to note some of my carbs might be delayed because of it. But fasting or a very low/no fat day and I can tell I respond better to insulin. Eating something higher fat for me and I also notice a difference in that I have to take a some extra insulin.

The only thing I can suggest is I notice the difference in a day. You might try a very very low fat day, under the total 5% or fasting for a day and see if you notice a difference. Your system would be different from mine, so I don’t know if you would notice as fast but if it ends up helping at all, it would give you more information.

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Actually the Mastering Diabetes Plan is less than 10-15 % fat. Fat is in almost everything we eat including some vegetables. Any processed food is going to have fat.

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I’m LADA/Type 1and have only used Afrezza as my source of insulin. I love it. If your insurer doesn’t cover it, appeal it like I did. But also Afrezza partners with Eagle Pharmacy in the US to provide subsized Afrezza based on how much your insurance covers. Maximum OOP is $100/box of 30 cartridges/month.

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@dogramma , my former GP made it clear: several disappointments in the past with inhaled insulin, often as a miracle drug.

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Thanks, Jon! You have all given me confidence in discussing this with my doctor.
I hope that he will be receptive to the idea of at least trying it.