Afrezza users poll: lets compile what we are discovering works well

Treatment Insulin
1

Hey fellow afrezza users! I know a gaggle of us have been following the various afrezza threads but I feel like there are enough of us that have been using it long enough to try to synthesize our results in a more comprehensive way. The picture that is emerging as more folks use it is different than it appeared back when our sample size was just mikep, I think. I know some of us are tracking all this in spreadsheets trying to really figure this out, so lets share what we've learned!

So I have some questions for afrezza users:

1. Can you inhale just one time per meal and get good, stable results?
2. Timing - how do you time your inhale relative to your first bite of food for best results?
3. For those who answer no to #1 - what is your best solution so far? Multiple inhales or mixing novolog/humalog with your afrezza? How are you adjusting your novolog/humalog dose when you also use afrezza?
4. Follow up BG testing - how are you timing these tests?
5. How low have you gotten when aggressively dosing with afrezza?
6. How do you feel about it? Is it helping?

2

My answers:

1. Nope - I consistently drift higher in hours 2 and 3, regardless of what I am eating.


2. I am finding that inhaling 20 minutes after first bite is the best I have found so far.


3. I have been mixing afrezza with novolog bolusing, generally reducing novolog by 1 unit per 4 unit of afrezza.


4. I test before I eat and then 1, 2, and 3-4 hours after inhale (sometimes not all 3 after the meal, depending on life, but that is the goal and the columns I use in my spreadsheet).


5. The lowest I have gotten using afrezza is 53, and all my under 60 lows have happened when I have been trying to be too slick and correct my pre-meal value with 4u of afrezza and then still do the 8u 20mins after first bite. I have had overlapping afrezza that cause numbers in the 50s one hour after meal inhale, also with novolog on board. The lowest I ever got in my week of using straight afrezza and no novolog with food was 72. It does seem to live up to the no-hypos promise, except when I push it with overlapping afreza and novolog on board. Can't really fault the drug for that, it is on me there.


6. I do think it is helping - my numbers have been more stable than ever and I haven't have a BG over 200 in two straight weeks which is totally a personal record. the afrezza goes a huge way in moderating my post-meal spikes. I have been very disappointed to realize I am not in the yes to question #1 crowd, I can't just set it and forget it but I do feel overall it is very helpful and I never want to be without afrezza corrections, it is a wonder for fast corrections!

3

Ok, here's my take on your questions:

1. Can you inhale just one time per meal and get good, stable results?

Yes, I normally just inhale one 4-unit dose per meal. I do, however, also use my pump to deliver a protein/fat extended bolus for each meal. My pump rakes care of my basal needs as well. My results , so far, have been very good. I have had a few meals that required a second 4-unit Afrezza dose. In that case, I usually take it about one hour after the first one


2. Timing - how do you time your inhale relative to your first bite of food for best results?

I inhale my Afrezza meal dose right before my first bite. I have experienced a few meals where I went low within 30 minutes after the dose. That generally doesn't happen and I'm not sure what to conclude from those limited expereinces.


3. For those who answer no to #1 - what is your best solution so far? Multiple inhales or mixing novolog/humalog with your afrezza? How are you adjusting your novolog/humalog dose when you also use afrezza?

N/A


4. Follow up BG testing - how are you timing these tests?

I use a continuous glucose monitor so I get a BG data point every five minutes.


5. How low have you gotten when aggressively dosing with afrezza?

My lows on Afrezza don't get much lower than 50 mg/dl. I find that the period when I'm even worried about lows has been considerably shortened post-meal. After 60-90 minutes after dosing Afrezza, I'm not worried about lows. With rapid acting analog insulin, I need to stay vigilant for 5-6 hours.


6. How do you feel about it? Is it helping?

Afrezza gets in and gets out in a hurry. As I said above, it has reduced the amount of time I need to be concerned about hypoglycemia. I can even take an Afrezza dose during the night and as long as I'm at 120 mg/dl or above, I am confident that I won't go low. The same is true for corrections when I'm awake. I can assess the performance of any correction and take further action if needed. My attention post-correction is not held hostage with Afrezza like it is with rapid acting analog insulins.

My overall BG control has not markedly improved with Afrezza. That's most probably because my pre-Afrezza control was very good. I do notice that I spend less time in the 120-140 mg/dl range and more time below 120 mg/dl. I has contributed to my quality of life with simplifying my mealtime dosing and requiring less attention post-correction.

4

1) The majority of the time I get away with 1 dose of afrezza.

2) I have settled out at about 25 minutes after starting to eat to inhale the afrezza

3) M?y focus is still largely on dose timing and how long to delay it for slower digesting foods and different physical activity levels... my goal will always be one and done.

4) I test as needed, usually before I eat, right when I dose, at 1 hr, and 2. Have been adding some later tests lately to try to pin down the late spikes

5) I've had some lower than ideal numbers at the 1 hour mark. Nothing symptomatic. This doesn't really matter near as much as it did with novolog, because at 1 hour the afrezza is pretty much done and the food is still digesting... So really there's a lot less concern.

6) I like it, a lot. It isn't perfect or magic, like any other insulin it requires the user to actually be actively involved in figuring out how to best use it if they want to see great results... but its the most effective tool I've ever seen. I had high expectations of it and it is meeting them. I also had pretty much perfect control with novolog, but I think this will ultimately improve my quality of life significantly.

5

Hi Terry, thanks for your reply! When you first started afrezza, did you try to make it work with no pump bolus? How have you adjusted how much you pump bolus with your afrezza? - are you reducing the pump bolus at all? When you do an extended pump bolus - what does that mean? some before you eat, then the pump does more later?

6

No, I never tried to cover all my mealtime insulin needs with Afrezza only. I eat a low carb high fat diet and know I need an extended bolus (x number of units over y number of hours) to metabolize the glucose that results from protein and fat. Afrezza is much too fast to match well with the slower digestion of protein and fat. I've been bolusing this way for three years now. It works well for me.

If I didn't use a pump's extended bolus feature to deliver the protein/fat bolus I would likely try to use a small injection of old fashioned Regular. (I know, this is more complicated, not simpler!)

I count 50% of protein grams and 10% of fat grams, add them together, divide by my insulin to carb ratio and then deliver that bolus over time at the maximum rate of 1.2 units per hour for however long it takes. For this morning's breakfast I delivered 2.0 units over 2 hours to cover the protein and fat.

I use the Afrezza to replace the pump carb bolus that I need with each meal since I do still consume some carbs.

7

1. No.

2. Right at start of meal.

3. I pump bolus at start of meal, subtracting 1 unit for each 4U Afrezza.

4. On Dexcom.

5. 53 with down arrows, so drank juice. But also had IOB from pump, so not all due to Afrezza.

6. I never want to be without it again. It has helped with aftermeal spikes like nothing else I have tried. I expect to have an A1C in the high 5s or low 6s, which will be a dream come true for me.

8

1) Only works three times out of 10 times. I usually need to correct with 0.5 to 1.0u of Humalog after 90 min (1u lower by 100mg/dL).
2) My best results was after I see my numbers getting higher than 120 on my CGM (usually after 20 to 25 min).
3) I still don't know how to deal with this. I'm still afraid of using too much insulin.
4) I use a CGM
5) I've seen 50 at least 3 times (just before it goes up to 170)
6) Not really. I can barely eat more carbs (my usual 1.5U covers 30g and the 4u covers maybe 50) and if I need two insulins and so much care into timing, it won't be useful.

9

Hi all.

1. I'd say about 80% of the time, but really depends on what I eat.
2. I inhale up to 5 minutes after my first bite
3. Keep eye on CGM (high alert set at 130) and if I see it rising quickly within first 45 mins I will inhale 4u cartridge and that typically blunts the spike and brings me back down.
4. Keep eye on CGM. If something looks wacky I'll test 1 hour after meal.
5. 57 mg/dl
6. I'm very happy with it, BUT, it's not perfect and folks are delusional if they think it's for everyone. I use my Omnipod for basal only now. The fast in and out nature has been eye opening for me for sure.