The recent release into the wild of the first ultra-rapid acting inhalable insulin, Afrezza, caused quite a stir in the diabetes online community. According to its package insert, once inhaled, it reaches its peak within 12-15 minutes and returns to baseline around 180 minutes. It does something special with liver signaling that moderates post-meal blood glucose (BG).
In other words, it’s way faster than the fastest insulin on the market today. In fact, its speed rivals the normal physiological speed of insulin release in a healthy non-diabetic. Equally important, it finishes more quickly and avoids hypoglycemia common to current rapid acting analog (RAA) insulin, Apidra, Humalog, and Novolog.
Early adopters report far fewer episodes of symptomatic hypoglycemia and no severe hypoglycemia. The insulin appears to act more elastic with regard to the strict insulin to carb (I:C) ratio and insulin sensitivity factor (ISF) used with RAA insulin dosing. Doses come in a 4-unit cartridge that provides equivalent insulin of one to four RAA insulin units. There’s also an 8-unit cartridge intended for when 4-8 equivalent units are needed.
Stack-of-buttery-pancakes dripping-maple-syrup fantasy
As a type I diabetic (T1D), I currently follow a low-carb high-fat, or LCHF, way of eating and target a 30-carbs/day limit. I don’t intend to abandon LCHF but would like to add a few more carbs back into my diet including beans, legumes, carrots, and sweet potatoes. I know, boring! I’d also like to celebrate once in a while and splurge on a milk shake or piece of pie without the hyperglycemia “hangover” or a tiresome ride on the blood glucose rollercoaster.
I understand Afrezza’s appeal to return to the carefree-eating days before diagnosis. It seems like a dream to restore what you once enjoyed and thought lost forever. I get the allure. That’s a tough siren call to resist. I don’t think I’ll follow that path because it’s not best for me. I will kick diabetes’ ■■■ just the same. And hopefully enjoy many more healthy years. Life is good!
I’ve been diabetic for 31 years and have now used a LCHF way of eating for three years. The entire experience has taught me that the way I ate growing up, before my diabetes diagnosis, did not support a healthy future me.
During my high school days I would drink three or four 16-ounce bottles of Coca-Cola every day. My go-to breakfast until age 30 and diabetes diagnosis was a bowl of processed sugar cereal, a banana, and milk. Ugh! Knowing what I know now about glucose metabolism, I cringe when I think about it. I regularly hammered punishing loads of fast-acting quick-to-sugar carbs to my poor metabolism.
Not carb- war II
I don’t think a high-carb processed-food diet (45-60%+ of calories as carbs) is healthy for anyone. I believe it promotes chronic inflammation and risks more serious diseases. I do not want to revert to my old carby ways, even if Afrezza can tame the blood-sugar beast.
I also believe that taking much larger total daily doses of insulin than you actually nutritionally need may itself constitute a long-term health liability. I’ve read in the medical literature that hyperinsulinemia may impair health.
The topic of low-carb versus high carb eating in diabetes fueled long and heated debates on this site and across the diabetes online community. I am not interested in that debate in this thread. Most people have made up their mind and with every meal vote their preferences.
There has already been ample writing about Afrezza and high-carb eating. This thread will tell the story of low to moderate carb intake and the effect of Afrezza. If you want to reignite the carb wars, I’m not interested. Been there, done that. Besides, asking someone to change their way of eating is akin to asking them to change their religion!
Two meals, late breakfast, early dinner
I eat two meals a day plus a snack. Breakfast is often between 10 a.m. and noon. I like to eat dinner between 5-6 p.m. The way that I currently dose is to take a carb bolus 15-45 minutes before I eat. At that time I also start an extended bolus to cover the protein and fat. I count half the protein grams and 10% of the fat grams as equivalent carb grams. I then deliver that bolus at a maximum rate of 1.2 units/hour for however long it takes, usually 2-5 hours.
I’ll use Afrezza to replace my carb bolus typically with a 4-unit cartridge as I start eating. I will still maintain my basal delivery on the pump as well as the protein/fat extended bolus. I don’t find the timing of the extended bolus as critical and it may be started from one hour before eating up until mealtime.
Here’s what I’ll track and post
- What and when I eat, including macronutrient breakdown for meals eaten at home. For restaurant meals I may just describe the food.
- Timing and amount of all nutritional boluses taken, including my extended pump bolus to cover protein/fat as well as the Afrezza carb dose.
- Timing, duration, and intensity of any exercise in the four-hour post-meal period.
- The continuous glucose monitor (CGM) line from mealtime to four hours post-meal or longer.
- 24-hour CGM lines, if interesting.
My post and comments will not include any dramatic before and after graphs. I say this because I have been able to control my BG levels pretty well using existing technology. I use an Animas Ping insulin pump, a Dexcom G4 continuous glucose monitor, and a Roche Accu-Chek Aviva glucose meter.
Current metrics
The following CGM numbers are for the preceding month. I spent 91% of my time in range, 65-140 mg/dl. My time spent in hypoglycemia (< 65 mg/dl) is 5%. Blood glucose variability as measured by the statistical measure, standard deviation, is currently 23 mg/dl. Finally, my average BG is 94 mg/dl. One measure I hope to improve is time spent low. My goal for Afrezza will be to limit the percentage of time less than 65 mg/dl to 1%.
I also look to Afrezza to grant me more mealtime-dosing flexibility while allowing me to add some nutrient dense higher carb foods back into my diet. I am eager to quickly correct high BGs and not be forced to maintain a multi-hour hyper-vigil without over-stacking corrections. The “cherry on top” appeal for me will be the ability to safely add the occasional decadent high-carb treat back into my life.
Note: In the interest of full disclosure, I hold Mannkind (MNKD) stock (long) in my investment portfolio.
***Cross-posted at the TypeOneGrit Facebook Page***
