I started on Afrezza last night

Treatment Insulin
1

and I'm here to share my experience with it as, from what I've been told, I'm one of the early users of it. I will do my best to document as much data as possible - good and bad. There will be trial and error and lots of experiments. Happy to answer any questions as well. Here's some background information on me:

-T1 for 20 years. Age 39.
-Currently use Omnipod, Dexcom G4 and OneTouch VerioSync and now, Afrezza.
-Disclaimer - I have no financial interest in Mannkind or Sanofi.
-I'm just a normal PWD who is always looking for the latest and greatest in treating my diabetes.
-Insurance does cover Afrezza for me.

-Normal routine is to bolus right when I begin to eat. Normally I would see a significant spike 30-45 minutes later.
-Subcutaneous Insulin ratios are : I/C = 1/12, Correction 1=40.

Here is my post from another thread outlining my first dose:

First bolus last night with Afrezza and it went very well. No post meal spike at all. I inhaled the Afrezza right as I was taking my first bite of my sandwich. I tried to keep everything as simple as possible for the first dose. I/C ratio on pump is 1/12 and I ate approximately 90 grams of carbs so I inhaled 2 4u cartridges. Blood sugar was 123 pre-meal. Was 91 an hour after I ate (with no spike). At the 2 hour mark I had creeped up to 144, BUT I made a carb mis-calculation which I attribute to causing the rise.

Of note: On my Omnipod I always bolus right as I begin to eat so the time of dose is consistent. Normally, I'd see a pretty big post meal spike in the 30-45 minute range on SubQ insulin. I did not see that with the Afrezza dose, so I can confidently say it works quickly.

I plan to experiment a lot with the Afrezza. One thing I will do in the next day or two is eat the exact same meal both days and one day use Afrezza and the other day use SubQ insulin via my Omnipod and chart the differences using my CGM.

More to come as I took my second dose for my lunch bolus . . .

1 Like
2

How much longer before you can start Sam? I was excited to see Terry’s report.

3

Just started my own thread after my first meal with afrezza

4

If you go look up the activity curve published in the Afrezza Prescribing Information PDF you'll see that when taken at the beginning of the meal it seems to peak at 1 hour. So it really depends on when the person's meals peak. There is quite a bit of variation in this, especially with older people or anyone with gastroparesis. So you would probably want to do some testing at 15 minute intervals to see when the meal peaks in your individual case and then dose it so that you meet up with it.

The concern here is that the people here are seeing the need for corrections at the 2 hour point, but most people with well-established Type 2 who are prescribed this will not understand any of this thinking and will only take it at the beginning of the meal, potentially ending to 2 hour highs. That would probably explain why the clinical trials showed Afrezza as on average producing a .75% A1c improvement (in people with A1cs many of which were 8% and higher over no insulin, but not getting most of them below 7%.

Prescribing it correctly would require doubling the prescribed dose, which given how stingy insurers are will make it very unlikely it ever gets to a tier where most older or poorer Type 2s (the very ones with the terrible control) can afford the copays.

5

It does not peak at 14 minutes in terms of effect. That is the absorption, but the effect on blood sugar, shown in the second chart in the Prescribing Information, shows the peak effect on lowering blood sugar at 1 hour.

6

The trials required them to take afrezza well before eating, at the same time they would have taken novolog— which of course is not s good protocol for afrezza.

7

Sam, this is the important part of the trials that potential users dont get.
Afrezza was allowed to be used as something new and different from all the others, so the outcome was skewed in disfavor for Afrezza true effectiveness. This soft launch by Sanofi will allow early users to prove that very point by using Afrezza to meet the individuals needs by flexible usage as required...around timing with meals. Afezzauser.com has been telling that message from day 1.

8

Yes… It demonstrated “non-inferiority” while being used completely inappropriately in the trials. Just imagine what it can do if used correctly… I took my
My first dose yesterday. See my post.

9

Finally saw my endo Wednesday and got the ball rolling. I'll be having my FEV-1 test with a group allergist. Apparently if the pulmonologist does it, it's quite a bit more expensive, and interestingly, insurance won't pay for the test for some reason (I need to look in to this further, but I'm not going to delay moving forward because of that -- if I can't get insurance to reimburse me, c'est la vie -- the Afrezza is covered).

Also walked out of the office with a Sanofi Afrezza discount card. Apparently (some) of the reps are giving stacks of these to endos when they meet with them.

So, I'm just an appointment scheduling away from getting started.

I plan to start a new thread to post my own results, with Dexcom Studio graphs like Terry. I also will be using the Event feature of the G4 to record every carb quantity I put in my maw, and each Afrezza dose. Like that calibration points that show up on the graph, these recorded events will show too, and hopefully this extra data will help everyone get a better feel for how the whole thing is functioning.

UNRELATED: Talked to my endo for the first time about my IM injection technique I've been using since the fall. I was disappointed that she was "party line" on the whole thing, actually a bit ignorant. However, as always she was open to the issue, I explained what I'd researched before doing it, and her interest peaked when I told her everything works about twice as fast with Humalog. Anyway, she's okay with it -- I'm sending her some links about the whole thing.

Conclusion: IM injection are REALLY REALLY not part of the program, so to speak, in healthcareland. Yet, there's nothing particularly problematic about them. Just that they're not for "lowest common denominator". It just reinforced for me how little support what I call "hardcore" diabetics have, yet we're trying to achieve what is every treating physician's dream: Hyper "compliance", near-normal BG, healthy bodies.

Points out again how â– â– â– â– -poor our society's view is as to what constitutes "treating" diabetes. It's a "good enough" approach -- not a "fix it" approach.

1 Like
10

I believe you can walk into any Rite Aid with a RediClinic and get an FEV1 test.
Should be fairly cheap and no waiting. You might want to call them first, however, to make sure they have a board certified nurse practitioner available. Most do. Not sure about the clinics at CVS or Walgreens.

11

Hello everyone,

I am hesitant to join this discussion because I am new here and I am not diabetic but I have been diagnosed as being pre diabetic for over three years. Diabetes does run in my family. So I have my fingers crossed.

I don't know if any other pre diabetic or recently diagnosed diabetics feel as I do but my message here is for them as much as it is for you guys. Please don't take this the wrong way because I know most of you have been living with injections for ages. I really, really do not want to have to take daily injections.

It's not that I have some sort of a phobia. I am not out of my mind with fear. I just really do not want to put a needle into my body two, three, or more times every day. I don't think that's a phobia. It's just something I would rather not do.

Now, if I had no other choice, of course I would have to take the injections. But, if I can have any other choice, that would be the course I would take.

I have been following this discussion and many other discussions about Afrezza and also the pills that are being sold for diabetic use. It seems to me that the only pill that seems safe is Metformin and since I have no insurance, Metformin would be my first choice because it's free at my pharmacy.

My A1C has been at 5.9 for the last two years. I have to test my fasting BG soon as I just recently learned that that number needs to be under 125. I have never tested it. I like to believe that it is in a non diabetic range. I hope so.

If my diet and exercise are eventually not enough to keep me from becoming diabetic, I will use Metformin first but if the day comes when I have to also use insulin, I will have to figure out a way to afford Afrezza.

But, hopefully, that day will never come and if it does, I really hope it will be many years from now. I wonder if in ten years if the cost of Afrezza will be much lower than it is today. Almost all medication is too expensive for me and so are doctor visits.

Thank you to everyone for this forum and this discussion. I have learned so much.

PS: Can anyone suggest if they think I should start Metformin now or is it OK to continue to wait? And, if it is OK to wait, what A1C number would mean that I should start taking it?
12

Welcome Rob,
I am much in the same situation as you are, and I know there are many others like us that are prediabetic for some time..
I was told im average 6.2 now and its been not improving recently for me..full retired now, and probably not the neessary exercise that i am so accustomed to over the years..proper dieting suffers too for sure.
I will never inject for type2 if that should come;
I am on medicare and expect it to offer my choices when that day comes.
I am not fond of metformin either, even if it is the Gold standard. If you read up it too can offer troubles to our bodies over time. So what doesnt huh?, I am a firm believer that Al Mann has it right with Afrezza. He argues it should be used early on long before we are cointed type 2. He seems to know it will provide the BG levels at mealtime and our body still produces the basal needs for prediabetics...Plenty of folks posting on these sites to learn more from too.
Good Luck.

13

I understand your aversion to injections, and there really isn't anything I can say that will change the way you feel about it at this juncture.

What I can say is that should you arrive at that point, I guarantee 100% that the feelings you have right now will be completely discarded, and you will find injecting yourself multiple times a day to be no more troublesome than taking a pill.

I was wary of injections too when the only ones I ever got were rare, administered by someone else, in the doctor's office.

The first few days of injecting myself were weird, and a bit off-putting. However it's nearly painless these days with 33 gauge 4mm needles, and it quickly becomes just an ordinary part of your life.

14

Rob, I can honestly say that the poke of the needle into my body five times a day is absolutely the least bothersome about my T1. Dealing with the insulin after it's in my body, now that's another story. For me, I think that's the most promising thing about Afrezza -- how it works, not how it's delivered.

15

I'm with Shadow and Dave on the perception versus the reality of needles. I've yet to meet the insulin-using diabetic that thought the reality of injecting was as bad as they feared.

If I had to rate the top 100 things that trouble me about diabetes, injecting insulin would not even make the list!

16

Dave,

Thank you for your reply. And thank you to eddy, Shadow, and Terry too.

Can you guys tell me if you think I should start Metformin now or should I wait? My A1C has been at 5.9 for over two years. I don't have a doctor so I'm going by what I've read on the internet.

Thanks.

17

Hi Mike, Sounds like you are going gung-ho. I will be interested in seeing how you are progressing with it. Several years ago I was on a study with the first inhalable insulin & after several months of coughing after each inhalation, I had to quit the program. I might say at the time of this study I already had asthma which was well controlled with advair diskus, but later on I found out I was not the only one this med was affecting Blood sugars were not great also. Keep posting.

18

we don't 'butt heads', i don't respond back to you. I know what I know, you're entitled to your opinion as well. nothing about me and my autoimmune disease is anything close or similar to that of a type 2 metabolic syndrome diabetic. every endo I've seen has told me this. what I stated is fact. type 1 diabetes is not at epidemic levels, it's RARE! i want people to know the differences. the amount of energy spent on this post by some seems odds, like hourly, doesn't work get in the way, just sayin'?

19

I wouldn't answer that question, no offense intended. That should be a decision made by you, having learned everything you can about it.

What I can say is that it's a very safe drug with no known serious side-effects if you have a healthy liver. It will lower your a1c a bit, and probably prolong your "pre-diabetes" condition if your D is progressing.

However, that can be be achieved for many with lifestyle changes too, so taking a drug instead may not be the best choice.

20

MikeP, Pat, (and Sam Finta) are all quoted in this Seeking Alpha article. http://seekingalpha.com/article/3020586-early-adopters-embrace-afrezza-as-new-inhaled-insulin-enters-market