So what you'll be doing with this tactic is to bring down a high BG quickly with part of the Afrezza dose and then backfill the missing basal due to the temp minus 100% basal with the balance of the Afrezza correction. I'll be curious if you try this. Please post if you do so.
Do you guys feel the afresh hitting your throat when you inhale? I really do and when I feel it more than other times Iām always concerned that it wasnāt an effective inhalationā¦ Iāve never actually seen it turn out that way though. I can actually see the product in my mouth/ throat after I inhale itā¦ Thatās my only complaint so far. That and it outrunning food. I still havenāt taken to splitting doses like most others have-- Ive only had to take 2 corrections doses at 2 hours in 11 days of use.
Yes, I do feel the Afrezza powder hitting the back of my throat. I worried initially that that was somehow diminishing the intended dose, but like you, I haven't observed that in the post-meal BGs.
For a few meals I did take a follow on dose but I haven't done that for the last few days and my control has been very good. One of my goals is to keep my total daily dose on insulin at a minimum. If I can limit my Afrezaa to two meal doses and one correction then I'll be happy with that. Maybe average 2.5 four unit doses average per day.
A sticky BG resists Afrezza correction
Yesterday I took one 4-unit Afrezza doses for for each of my two meals and also added two correction doses. I've seen this resistance before using rapid acting analog insulin, so Afrezza running into the same thing doesn't surprise me.
I can't complain about yesterday's line at all. The green stripe ranges from 65-120 mg/dl, a new narrower goal range for me. My BG ranged from 56-119 mg/dl. I spent 92% of my time in range with only 1% low. My standard deviation was a lean 14 and the average came in at 100 mg/dl. You can see the two hour gap as I had to reset the Dexcom CGM.
Each of the syringe symbols represents a 4-unit Afrezza dose. At 5:55 p.m. I took 4 units of Afrezza and enjoyed a 6-ounce ground chuck hamburger topped with 2 ounces of melted cheese. I added 4-ounces of fried tomatoes and 2 tablespoons of peach mango salsa. My mealtime BG was 105 mg/dl. When it started to climb almost one hour out, at 6:49 p.m., I took another 4-units of Afrezza. The line dropped to about 92 mg/dl at 9:32 p.m. and started to rise yet again.
At 11:55 p.m. my CGM woke me up with a 120 mg/dl high alarm. I took another Afrezza correction and confidently went back to sleep. That correction did drive my BG line down to the upper 60s but did not send me hypo.
Sometimes my BGs get sticky like yesterday for the last 14 hours of the day. It seems like they get into a groove and they don't want to move, even in the face of corrections and exercise. You can see that I went out for two walks at 1:35 p.m. and 3:15 p.m. for 20 and 40 minutes respectively.
Being able to correct a 120 mg/dl while I'm sleeping without worry of going hypo later in the night is a big deal for me.
Correction: My BG ranged from 60-126 mg/dl yesterday.
Thatās tighter than the vast majority of non diabetics in the USA.
Thanks for the comment, Sam. It's fun using something new, like Afrezza.
True (see: Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals, J Diabetes Sci Technol. 2007 Sep; 1(5): 695ā703)
From the numbers in that paper, and similar numbers I've come across at various times addressing this question, I'd say that short spikes (<60min) above 140 are probably inconsequential. Rather, it's the total time at "normal" that is the key.
Non-diabetics come back down very quickly. This is a big part of the promise of Afrezza -- minimizing time at higher levels.
An average of 100 mg/dl corresponds to an a1c of 5.1 -- well below "diabetic"!
Thanks for the link, Dave. You're right about the quick return to normal BG numbers following meals in the non-diabetic person. I found this passage interesting:
In our study, tissue glucose concentrations in nondiabetic subjects were below 140 mg/dl during 99.2% of the total day, whereas other studies investigating continuous glucose profiles in type 1 and type 2 diabetic patients demonstrated that glucose concentrations were above 140 mg/dl during about 60% of the total day or above 180 mg/dl during about 30% of the total day, respectively. Postprandial hyperglycemic excursions are a major problem, and increasing efforts are recommended to reduce postprandial hyperglycemia in diabetic patients. [footnote citation numbers removed for clarity]
Diabetes humbles
Note: The green stripe above ranges from 65-120 mg/dl.
I've had a great run of blood sugar control the last few months, especially since I started on Afrezza. Yesterday serves to remind me that, yes, I still have diabetes!
Right after midnight yesterday morning my blood glucose dropped below 60 and even dipped down to 51. To make matters worse this low event held for about two hours. My CGM woke me up several times and I treated with glucose tablets 3-4 times during that low. I'm always hesitant to overdo treating a low because I don't want to add to any hyperglycemia rebound that can occur.
And that rebound occurred with a vengeance as you can see by that large mountain profile. I gave myself a 1.5 unit pump correction at 4:39 a.m. and that brought the high into range when I woke up. The rest of the day was OK but not as tight as I like it.
So I know that the low caused the high, so what caused the low? Well, the night before I took my usual dose of Afrezza for dinner as well as some pump bolus for protein/fat. Ninety minutes after dinner, a fingerstick revealed a BG of 187, the CGM trace was under-reporting. So I took 8 units of Afrezza and waited an hour. Fingerstick 156. I decided to take another 4 units of Afrezza as a correction and that turned out to be a mistake.
I went to bed about 90 minutes after my last Afrezza correction and though I'd be OK. Well my BG kept trending down into the low I described above. My lesson here is to be careful with Afrezza corrections in the evening. The combination of the Afrezza corrections and my usual basal rate is what drove me low and ultimately caused the multi-hour overnight high. It reminds me that sometimes taking no action is the best course of action when it comes to diabetes.
Anyway, I thought my readers might like to see that all is not smooth sailing for me. I do, after all, still have diabetes!
Glad the day got better Terry. Iāve been sailing along eating low and even moderate carbs without high spikes in my honeymoon but suddenly went over 200 a couple days ago. Didnāt need to correct since my 2nd phase is hanginā in there but it still surprised me. I guess when things are going well wherever we are in the diabetes spectrum we think (hope) things will stay that wayā¦not!
You're right, Lilli. You can never really turn your back on diabetes and trust that things will work out in your favor. It doesn't usually work that way.
Great that you still have 2nd phase insulin. The home-made stuff is always better than the man-made. Thanks for the comment.
I learned how to split cartridges into 2 units each. Itās easy. A 2 unit cartridge takes me down 30-50 mg/dL depending on activity level. Usually I split an 8 unit into 4-2 unit cartridges and it lasts me the day
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