So I got the okay from my pulmonary test to get Afrezza! So I’m looking forward to trying it! So I have some questions!!!
Has anyone had success with it covered under insurance when you are already on a pump? I guess I also want to know if it messes with your other prescriptions for insulin and the pump if it is covered?
If not covered what seems to be the best way to get it?
I remember some people saying it takes double the dose of Afrezza versus other fast acting insulins. What timing seems to work best for you? And do most of you double the dose? Any warnings you have I should know?
I guess I’ll find out soon enough lol, but I’m very excited to try it!!!
It’s super fast, but it’s not really precise. It comes in large doses.
Really good for predictable meals and brings highs down fast.
You really can’t make small corrections with it though.
If you are having large post meal spikes, you doctor can justify it. It depends on your insurance.
I use humalog in my pump, but my doctor gives me a script for Lantus in case my pump fails. So that’s kind of the same thing, where I’m getting different types of insulin.
You should definitely try it to see how it works. Maybe you can get a sample.
I talked to the rep and they will send me a sample first if my insurance doesn’t cover it. I spike when snorkeling a long time or if I try to eat in the am before snorkeling! Or once in a while in a dosing error lol.
But it would be nice to have for the faster correction off and on!!!
The 4 unit cartridge of Afrezza is sort of equivalent to 1.5-2 units of Humalog. That is the smallest dose of Afrezza that you can take.
I was more sensitive to Afrezza at first than I am
now.
I would recommend very cautious dosing at first. I remember the abrupt drops that Afrezza can create made me uncomfortable. By uncomfortable, I mean that it can made me feel low even though I wasn’t. I was just dropping. Now, I tend to use the insulin a little more proactively and am less likely to need to drop my blood glucose level by as much.
One of the primary benefits of Afrezza is that as long as my basal is set right, I’m much less likely to drop low than with other insulins. It sounds illogical, but that is my experience. I’ve also read others have experienced this. If I take way too much, then I’m still going to drop low. But Afrezza just seems more forgiving overall, so the impreciseness is less of an issue.
After having used Afrezza for close to 3 years now, I’d say the biggest drawback for me was the lack of consistency. It seems to be more consistent when my basal is set correctly, when I’m not experiencing insulin resistance due to monthly hormones, and when I’m not using it all the time (eg. only use it for corrections).
These are good uses for Afrezza because of how fast it works and how quickly it wears off. I would urge a little caution in taking it before snorkeling until you’ve worked out the doses a bit more.
Unfortunately, I can’t be of any help on the insurance front except to say that Mannkind will go to bat with your insurance company for you. I was able to get Afrezza covered on my plan until recently. I may try to switch to a different plan next year and submit an appeal. I’m exploring other options right now.
Define “small” please because I correct 20 mg/dl drops with it if I choose to and I’m quite sensitive to insulin.
I use it as my main bolus insulin and honestly I don’t even think about units at this point. There is small, medium, and large. I take the right one right before I begin eating and move on with my meal. 40g carbs vs 45g? Like I care, they’re both medium. 35g? Still medium. 30g? Maybe medium, maybe small, depends how active I was.
I guess I should say I use it to drop my glucose 20 mg/dl. A 4U can drop me 50 mg/dl or 20 mg/dl depending where I’m at. I don’t get the PK of why or how, I just use it. It’s a big mindset shift.
My understanding is that Exubera had a large, rather complicated inhaler. I also read that the dosing was not designed well. It is a different product with larger issues, and I don’t really think it is a good comparison to Afrezza. My understanding is that it was made by a different company who had little/no experience in medications for diabetes.
However, I think there is still a learning curve on Afrezza’s inhaler.
I angle the inhaler just slightly so that when I breathe in, I’m breathing the powder down my throat- rather than it hitting the back of my tongue.
I breathe out deeply before I bring the inhaler to my lips, then I take a long inhale over several seconds. I continue that inhale after I pull the inhaler from my lips.
A very small amount of powder will get stuck in the inhaler (I tap the open inhaler against a hard surface to get it out), and some powder will not make it to the lungs anyway because it hits the back of your throat. For whatever reason, Afrezza’s dosing does not need to be that precise, so I don’t think these small amounts of lost powder are really problematic as long as you’re consistent in your methods.
There should not be any powder left in the cartridge. If there is, then that indicates there is something wrong in the way you’re breathing in.
It really depends on how insulin sensitive you are in terms of the size of the dose. I can’t use Afrezza (even the 4s) just to correct if I’m not over 200 or planning to eat something to keep it from pushing me too far down. I really wish they would make 2s and have given them that feedback. It is great for covering faster acting food though, and also handy if you have an unpredictable timeframe for food resulting in bg rises (you can wait until you see the first sign of an increase and take it then).
I recommend that you do your own personal experimentation with Afrezza timing and dose size. As much as quantifying all things diabetes data appeals to my engineering mind-set, I found that Afrezza has some “soft edges” that make living with it easier.
I found that Afrezza goes to work more quickly than any other insulin or delivery method I use. I wouldn’t worry about the nominal Afrezza dose size – it does not equate with liquid insulin injections. That’s a hard one to cognitively accept when you’ve developed a healthy respect for the power of this hormone.
Do the experiment, pay attention, and, at least in the beginning, keep some records so you can quickly cement that knowledge safely.
I only use Afrezza for BG corrections, so I can’t comment on bolus therapy with it. As far as corrections go, if you are only correcting with Afrezza and not combining it with pump or syringe corrections, I’ve found it to be very forgiving in not driving me hypo. I can correct at bedtime or during the night with a high degree of confidence that I will not over-correct.
I will correct BGs as low as the 100-120 mg/dL as long as my IOB is zero or low. In other words, I don’t correct in that range after a meal when I expect some glucose rise and expect that my pump-delivered bolus dose to cover that meal.
I’ve been using Afrezza since March 2015 and would not choose to willingly live without it. I’ve lost my insurance coverage for Afrezza in the last year and I will pay out of pocket (as luck and privilege allow me) since I think it enhances my glucose control and quality of life.
I used the “direct pay” option offered (w/o insurance) and think is still available. It was $99 per 90/box, $199 180/box mail order, from this pharmacy.
Thanks for the reminder! I phoned that source several months ago and decided I would contact them when my existing supply nears depletion. I did forget the name and you saved me some creative google searching. I appreciate the help, @MM1.
Unfortunately, US Medicare disallows these kind of offers for beneficiaries. That’s ok, it’s an otherwise great program and I can’t give much criticism.
The $99 for a box of 90 doses is valid for even Medicare beneficiaries. I verified that when I called them a few months ago.
Did you have a C-peptide test to determine the amount of insulin (and insulin resistance) you have before the decision to take Afrezza?
Wouldn’t knowing whether you have low insulin or high insulin levels and are just dealing with insulin resistance be important to consider before adding more insulin?
I am a type 1 and had positive antibodies and was making no insulin by the time of my antibody and c-peptide test years ago. I was already on insulin as I was misdiagnosed as a type 2 for years, the drugs they tried all made me sick so I was put on insulin.
I have no idea about insulin resistance. I take a total of about 50 units a day of Humalog in a pump. So while that’s not the least I’ve heard of people taking, it has never seemed bad either,
It wouldn’t be adding “more” insulin. It would be replacing some of my Humalog so I can have a faster acting insulin when I do spike. My spiking isn’t really that bad, my control is great. Lol, I just posted this link somewhere else, but here are my numbers.
I started slowly and fell in love lol!!! I had my endo up my prescription to 6 boxes for a 3 month period. And with my insurance and Medicare it is only costing $100 for a 3 month supply mail order no matter how much I need.
I have been using a blend of Humalog in my pump and the Afrezza. I like the combo as one thing I discovered is I seem to need some insulin when protein hits later. When I just used Afrezza I would stay nice and pretty level for hours and then 4-6 hours later start going up. Maybe some carbs that hit later, but I have a feeling it’s the higher protein meals. I know my Humalog has a slight tail that hits at the 5-6 hour mark and I think that was covering whatever it is that hits me later food wise. So still using some Humalog seems to work best.
I have been having more issues with my pods so I am also going to try Novolog in my pump to see if that helps. My endo thinks I won’t like it as she said it’s a little slower acting than Humalog and I am a control freak (she put it much more diplomatically) .And I really am lol. I will use the Novolog as mostly a basal insulin if it clears up the pod issues but doesn’t work as well as a bolus insulin…
Afrezza is wonderful stuff. I spontaneously eat and then use Afrezza. I’ve almost always prebolused before. There is sometimes a sharp rise, but pretty quickly a sharp drop too. I still think it’s a little scary to see an arrow straight down on my Dexcom when that happens. There is some timing involved probably in the Afrezza too, but it is trickier to figure that out. But I will learn eventually.
But my A1c was 4.9% !!! Woohoo! And I wasn’t even trying! I have said I wanted to be one time under 5%, so I am happy. But I am not going to do anything to try to keep it. That doesn’t matter to me. I just prefer to stay in the low 5’s like I’ve been and would probably accept even high 5’s or even low 6’s if there were reasons for it.
I was also wondering what my endo would say. Not a word, in fact I was the one that brought it up and said I always wanted an A1c under 5% once but didn’t care if I stayed there. And that is was great because I wasn’t even trying so it was easy. She just said she thought it was probably that I had started using Afrezza so much and that’s probably true. Of course she can see my Dexcom Clarity Reports and that I am still 96-98% in range (a few more higher numbers, more pod failures) and an SD of 25.
