I use Novolog and an Omnipod pump, in addition to a Dexcom G5 that I have been on for about a month. The CGM makes it easier to really micromanage BG levels. I looked into Afrezza because I read about how quickly it begins to work and how quickly it leaves your system. I thought this would be a great remedy for the occasional BG spike, so I texted my endo yesterday. She said come right over, and I took the spiro lung test and passed. She started me on a sample pack of 4-unit doses, which is really larger doses than I was looking for. She wants me to take four units as a pre-meal bolus and make up the rest with Novolog. While that’s OK, it really isn’t what I was looking for to aid with correction boluses. Are there any plans to release Afrezza in lower dosages or does anyone have a strategy for correction boluses?
Have you tried any of the 4u for corrections yet? It isn’t comparable to 4u novolog… Most of us find it suitable for corrections even when 4u injected bolus would be way to much
Also it’s important to note that “pre-meal” bolus and afrezza is a concept that you might need to keep an eye on. I wait a full 20 minutes at Minimum after I start eating before I take the afrezza.
It’s so fast that if you take it before you eat it’ll be out of your system while your food is just starting do digest… Timing is everything with this stuff. With higher fat foods I’ll wait a full half hour after
Thanks, Sam. I need to figure out what my correction ratio for Afreeza is. For Novolog, it’s 22. I had an opportunity last night, but I was afraid to try before bed. I’ll just have to figure it out. How do you find it compares to Novolog?
I use Afrezza mostly to correct high BGs. With Apidra, I figure one unit will drop my BG by 50 mg/dl. For Afrezza, a 4-unit cartridge will drop me by 50 mg/dl. Your needs will likely vary. As @Sam19 says, there is not a direct equivalent between Afreeza and rapid acting Analog insulins like Apidra and Novolog.
The best thing to do is to experiment when you’re not socially distracted and safety glucose at the ready. Finger-sticks are your friend. Since you’re experimenting, keep some notes for later review.
Afrezza is an amazing tool.
It doesn’t compare at all to novolog in terms of dosing… You will need more “units” of afrezza than any injected bolus but the units really aren’t comparable. With novolog you gotta get the dose just right and dialed in, figure out correction factors and all that… I’d advise you not to even bother with any of that when using afrezza. I just kinda have loose “carb limits” in my my mind that I try not to eat more than… But I really don’t need to carb count at all for the most part with afrezza
If you eat reasonably balanced meals, and figure out how it’s gonna work for you… Timing is really the whole key… The dosing and the units becomes about 90% irrelevant for me… It’s more like taking ibuprofen for a headache in terms of dosing (should I take one or two?) than it is like taking injected bolus.
Just start with the simple dosage guide included with it and fine tune from there…
Very helpful, guys. Thanks.
How often do you replace the “whistle” dispenser? It looks like the recommended is 15 days. What about refrigeration? I ask because sometimes these restrictions are overkill.
That’s a good question… And kind of a poor concept on their part, because a “month supply” box of afrezza is never going to last exactly 30 days… And there’s only two inhalers, so it’s never going to work out just right.
I’ve used the inhalers way, way past the 15 days… They do get a lot of powder residue inside them over time, which can be cleaned up quite a bit just by tapping the inhaler mouthpiece on a hard surface… After you’ve used it a few days you’ll see that doing so knocks loose some powder that’s stuck inside.
From a practical standpoint id recommend just replacing your inhaler when your box is about half empty… And keep a used one as a spare in case you lose or break one.
There’s no good reason I’ve found to replace them every 15 days, I use them well past that.
How about refrigeration, Sam? My endo didn’t say anything about it when she gave me my sample kit. Ha! I remember when insulin used to require refrigeration between injections.
The instructions say to keep the cartridges in the refrigerator until they are opened then discard them (or use them) within 72 hours of opening. They can be kept out of the fridge at room temperature for 10 days if they are unopened “with temperature excursions permitted”
You can store the opened cartridge blister pack in the fridge if you want, but I don’t see the point if they need to be discarded within 72 hours… Also it says to have cartridges and inhaler both out of refrigerator for at least ten minutes before you inhale---- all I can figure on this one is that it’s more likely to make you cough if it’s icy cold.
Did you not get the instructions sheet? It comes in every box… I can jotnot it to you or something if you want to pm me your email address
Thanks, Sam. Yes, I got the instructions, but I wondered if practical experience had proved that strict adherence to the printed instructions was somewhat unnecessary. Kind of like many users of the Dexcom G5 continue using a sensor up to two weeks beyind its expiration.
I generally follow them and don’t find them overly burdensome once you get the hang of it… The only one I’ve decided is pretty unnecessary is the 15 day inhaler replacement…
The one that I spend a lot of time pondering and am not real sure about is if opened blister packs really need to be discarded after 72 hours… My best speculation at this point is that the powder may clump somewhat over time and the answer to that may depend a lot on the humidity, etc of the environment— I am not ready to completely ignore this instruction like I am the 15 day inhaler replacement
Sam, don’t forget the water drinking before and after to reduce any dry cough. 
First things first
So, what is it about the way Alfrezza works that helps people avoid hypo episodes? I realize that there’s not a 1:1 ratio of Alfrezza to injectables like Novolog which I use, but from the reading I have done, people don’t even pay much attention to dosing and yet they still don’t go low but they do stay within a great range. What’s going on with the way Alfrezza works that it is so much less likely to drive you into hypo range? Is it just the rapidity with which it moves through the system or is there some other physiological process involved?
By the way, I’m finding that maybe the 2-unit doses that I wished for originally maybe would be all that great anyway.
One other thing: is it just my imagination, or does Afrezza contribute to better control even when I’m not using it? It seems like some of my CGM lines are more pancake flat, like this morning, even though I haven’t even had a dose of Afrezza today.
Afrezza’s action profile is an earlier onset and peak with the duration much shorter than rapid acting anaolg insulin (Apidra, Humalog, Novolog). This much shorter duration or tail accounts for the lack of hypos it causes. It typically peaks right near the time of your food peak. Many of us that use the rapid acting analog insulin find that the hypos are often felt in the out-hours (2-5 hours post meal) or tail of its action. Afrezza’s lack of a tail is an endearing quality.
Each dose of Afrezza and person will vary but I find for me that most of Afrezza’a glucose lowering action occurs in the 30-75 minute range and it’s mostly gone at 90 minutes.
As far as any multi-day effect goes, I don’t think Afrezza itself can directly take credit for that. But I do find that good control one day will often lead to good or even better control the next. It seems my body has a 24-hour metabolic memory and all things held equal will try to retrace the line of 24 hours before, both good and bad.
I think, and I’m not really an expert but I have used it a lot— that there are several factors at play. @Dave26 actually did a pretty good explanation in this regard… Essentially I think that it’s just allowing the cells throughout your body to absorb the glucose more readily and naturally than injected insulin…
While we have pretty much all learned to think about the insulin / glucose process as linear… A+b = c in terms of “this amount of insulin cancels out this amount of glucose” that’s not really how it actually works in a physiological sense, because the insulin itself isn’t actually playing a direct role in the process like we think it is. Instead it’s allowing the process to occur— the first CDE I had described insulin as “the key to the lock on almost every cel in your body to allow it to absorb glucose” with afrezza— you just have a key that actually fits correctly… Instead of a sledge hammer to knock the door down with like with injectables— by this I mean that injected insulin unlocks the cells glucose receptors for too long, artificially long perhaps… Causing hypoglycemia.
We have to remind ourselves sometimes that the insulin itself is actually a hormone that signals a process in the body to take place instead of actually accomplishes something on its own…
Anyway that’s how I see it… Not exactly scientific but works for me… Glad it’s working well for you
i’ve heard this before from another source. i’m trying to understand what you mean. i don’t take insulin. say i have a high carb meal in the morning; this would be unusual for me. the morning before i had eggs and cheese. since my body is used to a low carb breakfast, i assume it would be used to putting out minimal insulin. so the high carb meal from this morning would drive my blood sugar up quite a bit since my body would be putting out its normal low insulin amount. then i speculate it would catch up to reality and start bringing my bg down after 2 hours or whatever. then, say, the next day i go back to my normal low carb meal, but my body thinks i might have another high carb meal again this morning, so it’s ready with lots of insulin. i’m only eating low carb, so all that insulin might give me much lower numbers than usual. i am using a hypothetical scenario that i guess i could test myself for fun, but is the above situation catching the spirit of what you mean, terry? if not, could you give me an example?
In terms of explaining how Afrezza works to control blood sugar, it appears Matt B’s videos: Time Is Everything and Afrezza Units & Insulin:Card Ratios explain this issue pretty well:
http://afrezzadownunder.com/2015/10/afrezza-timing-is-everything/.
http://afrezzadownunder.com/2015/09/afrezza-units-insulincarb-ratios/
Matt’s other videos on Afrezza (in his website) are also very interesting and worth checking out.