Afrezza

It seems rather humorous to be asking this after suffering a severe low yesterday, but since I will be asking my doctor for the new nasal glucagon, I would also like to get a prescription for Afrezza I think.

The main reason I haven’t in the past, is that I am worried about developing nasal problems. I don’t want one more thing to have to worry about. If I do try it, for occasional use, could you please tell me how high your glucose reading has to be in order for you to use the product.

Also how quickly does it bring your glucose level down and by how much. Do you often cause yourself to reach a number that requires you to eat?
I would just like to occasionally bring down an unexpectedly high number of over 170+. It rarely happens, but I would love to never see that high of a number. I won’t be using the spray to cover meals, since it will take years on the market before I will fully trust it.

TIA

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As far as I know, you inhale it through your mouth so it reaches your throat, avoiding your nasal passages. The only risk of using Afrezza, from my own research, is if you have a respiratory infection/cold/etc that would interfere with its absorption. Or if you smoke which would also interfere with absorption

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It worked relatively quickly, when I was able to inhale and not have it come out my nose or mouth, before it hit the lungs.

I really, really, really, wanted it to work since I’ve been having general absoprtion problems. I have thoughts of trying it again (I have quite a bit left) and hoping I don’t cough it all out before it has a chance to work!

Having commercial insurance, I was able to obtain a copay card to cover it.

https://afrezza.copaysavingsprogram.com/

Best of luck to you, @Marilyn6!

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Ohhh, through your mouth. Well that make sense. I have read about it making some folks cough. Never smoked, so think I should be ok. Thanks.

Thanks so much Tapestry. Do you think the ability to not cough just takes practice?

When I tried it probably five years ago, it seemed too difficult to tell what dose you were actually getting because some would end up in your mouth. It definitely made me cough here and there and I always had variable results. I don’t use very much insulin so the variability was too much for me.

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I’ve been using Afrezza for four years now and I would not want to live without it. Last evening provided yet another example of how it helps me. I mostly use Afrezza for corrections.

25%20PM

My post dinner glucose level for the first hour was flat but then I noticed that the BG line took off headed for the hyperglycemic stratosphere. I took a 4-unit Afrezza dose (marked by 2U on the graph) at 5:37 pm. The BG level was at 110. By 6:00 pm the lined leveled out and soon started returning to more normal levels. At 90 minutes, my BG was in the mid-70s, going sideways and the Afrezza dose was done working.

The reason I’ve marked the Afrezza dose with a 2-unit notation is because that’s the equivalent dose of liquid insulin for me. Four units of Afrezza = two units of Apidra in my metabolism.

To orient you on this graph, it covers about six hours between 5-11 pm. The two dashed lines that bracket the glucose trace are 65 and 120 mg/dL.

I have successfully taken Afrezza during my sleep time when I wanted to knock down a highish blood sugar like 130. It usually drops me about 30-40 mg/dL and avoids going low. I see Afrezza as a safe insulin to take before or during sleep. Your results will vary and you should do the appropriate self experimentation for your own education.

Taking a drink of water before and after inhaling Afrezza mitigates the urge to cough immediately after dosing that some people experience.

The only way you will be able to judge whether it will work for you or not is to actually try it. It’s definitely worth a trial.

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@Terry4’s description of Afrezza is on point.

I can’t really rant and rave about Afrezza enough. I wouldn’t be surprised if people thought I was a spokeperson :smiley:

All that being said, I believe you’re fairly insulin sensitive if I remember correctly. It’d probably be best to try out on a relatively high number for your first time so that you can get a good gauge on how much it’s going to drop you. As Terry said, a 4 unit cartridge is about the equivalent of 2 units of other fast-acting insulins, so I’d make sure to do the first correction dose with Afrezza at a time when you would’ve done at least 2 units of Humalog/Novolog. Keep in mind that the 2 units will act quickly and be out faster than fast-acting insulins; Afrezza is front-heavy.

I’ve interacted with others online who have split the 4 unit or 8 unit cartridges down to 2 unit cartridges to enable them to essentially dose the equivalent of 1 unit of fast-acting insulin. It seems like the results have been mixed with some people deciding it isn’t worth the hassle and others really benefiting.

A follow-up dose is needed if you eat a high fat meal. If I remember right, I don’t think you eat high fat though so Afrezza may be an even better fit for you than the average person with D.

Anyway, I’d love to hear what you think after you try it!

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You may end up wasting alot of Afrezza due to how it is packaged and it’s shelf life. Unopened supply is refrigerated. Dosage is 4, 8, 12 unit cartridges, packaged in sets of 3.

Once at room temp, needs to be used within certain number of days. This could work for you if you also considered for mealtime use, or willing to throw out many cartridges once at room temp exceeded.

You may find 4 units too much for correction, and could split, but that is additional step, and not easy to get precise dosing. So plan on additional carbs/glucose if go too low.

I use afrezza primarily for higher carb meals to prevent spikes, rather than as correction.

For me, a 4 unit cartridge is about same as 2.5-3.5 units from pump. Having CGM is helpful to figure out dosing.

I use mainly for meals.
With dexcom, I can catch trends sooner, so prefer to do pump bolus correction before getting to high, rather than using afrezza after high. Would need to use caution if 170 high, with injected/pump insulin still working. Afrezza could result in dropping too low very quickly.

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I’m sure hoping so!

Thanks, @Terry4 I’ll keep this in mind when I give it another go!

I tried Afrezza on their savings program and have not found it to be any “faster” to absorb than Fiasp.

My typical “heavy meal” dose of Fiasp is about 16 to 20 units, injected from a 10ml bottle using a 100 unit/ml B&D syringe.

Thus, I used one 8 unit cartridge (taken first) and one 12 unit cartridge (taken second) substituting for my Fiasp dose before my big meal of the day.

I made a purposeful effort to do a hard exhale before inhaling each cartridge and did not find that I coughed.

Fiasp typically takes about 2 hours to work after injection. It then causes a plunge in my blood sugar (I have a Dexcom G6 which gives me plenty of warning) down to the 60 to 70 range (I always eat some carbs such as Glucerna as my Dexcom warns me). Afrezza behaved similarly and took about 2 hours to work after inhalation. My hope was for immediate (within 20 minutes) after inhalation. However, due to my screwed up metabolism (I’ve been a Type I for about 38 years), Afrezza is no better than Fiasp or even Humulin R, Humalog, or Novolog (2 hours to act)…

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Hi @Fred_E

I don’t usually dose in increments that high, so I’m not sure how much Afrezza would be needed. However, in the increments I do dose, I generally need almost 2x as much Afrezza as Humalog for the same meal or high bg.

If you’re still interested in giving it a shot, You may want to try 2 of the 12 unit cartridges.

Have you tried using Afrezza on a less carb-heavy meal?

Thanks katers87. I think would definitely start with two units since I really want to avoid having to play catch up with food. I think I will soon learn whether that is enough insulin. Yes, I am quite insulin sensitive and seldom does my daily intake of daily food include more than 10 to 15 percent of fat. I will be sure to let you know what I think!!

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Terry, I have no problem with my glucose levels going up to 140 after meals since many people without diabetes naturally rise that high. Am I missing something? I am quite serious as I wonder if somehow I could be benefit from a flatter line. I am willing to do anything if it improves my life with type 1.

So, I guess that with a 170 reading I should have no problem at all with Afrezza as long as I drink some water and don’t take much until I figure out how my body will react. I am really looking forward to trying it.
Thanks for your help!

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That’s a great observation katers87… It’s not that Afrezza is not working, it’s just that it’s no better for my bizarre Type I metabolism than Fiasp etc. 20 units of Afrezza does lower my blood sugar drastically, it just takes two hours to do it, just like Fiasp, Humulin R, Novolog, or Humalog…

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You will find a dosing style that suits you. And you will learn more as time goes by.

I’m often influenced by the rate of change in BG as much as I am about the absolute value. In the example I depicted above, my line was jumping more than 1 mg/dL/minute.

It looks like you were having trouble with Afrezza lasting long enough last month. Has your experience changed?

I’ve found that a follow-up dose for higher fat meals can make a big difference. If I expect my food to digest over seveal hours, then i need a follow-up dose around the 2 hour mark when Afrezza is wearing off for me.

@Marilyn6 I’m sorry to hijack your thread!

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I have been known to not hit the deliver Bolus now button on my pump prior to eating a meal with 75 carbs. I get an alarm an hour later that Bolus was not delivered. By this time my BGs are over 180. Even after reinfusing the Bolus, my BGs continue to rise sometimes up to 250. I then start using correction boluses; however, my BGs remain in the 250 range for several hours.

Would Afrezza be of help under these circumstances?

I do the same, which heavily relies on having cgm for trend and pump for accurate iob. (And a mental “exercise on board”).

With your Loop system, you have safety of automated basal insulin reduction with dropping bgs. This allows more aggressive corrections.

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