I think I do. Which part am I off on? Your answers are very uncharacteristicaly short. @Jenny
I think whole discussion is uncalled for.
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Iāve posted a bit on my foray into Afrezza more than a month ago and now that I have been using it for 3 months I thought it was time for a followup. And rather than start a new thread I decided to post here,
I am a 71 yr old T2 diabetic (diagnosed in 2000- a gift from my Dadās side of the family), 160 lbs, eating 60-100 gm carbs/day. Before going on Afrezza, I took, and still do, 2000 mg Metformin. I started Lantus about 8 months ago and now take 10u at bedtime. I did go Bernstein lo-carb for 6 months and got A1C to 5.8 but couldnāt keep it up, especially with all my traveling. A1Cās have been between 7.8 and 6.4 over the past 4 yrs, depending mostly on how much traveling I do and my will power. I am a retired field geologist and data geek with a decent background in statistics. When I am on a roll I test my BG 6-10 times a day. Iāve been āeating to the meterā since I discovered Dr. Bernstein in 1995 and Jenny Ruhlās blog a little while later.
After getting the first two monthās supply from my doctor in the form of samples, I was pleasantly surprised to find that my Essence Healthcare Medicare Advantage plan had put Afrezza on their formulary as a tier 4 drug at a cost of $64/month. I currently am getting 60 carts of 8u and 30 carts of 4u. Now that I have been on Afrezza for 3 months I can pretty safely say that I needed a few weeks on Afrezza to really see how my system responds. I travelled in Europe for a month in June and July, and found that I needed more than 4u to cover most any meal over 25-30 gm carbs.
I started using the 8u carts (typically for meals of >40 gm carbs) on June 21, the day I left for Europe (Scotland and Ireland). For my month in Europe my before meal BG averaged about 115 and after meal (60-90 min) about 140. Average carbs was around 35 per meal. If I was using a CGM instead of sticks, I would have been able to see a BG rise after a meal of more carbs and do a 4u correction sooner, probably giving me a better after meal BG.
I the last two weeks of my own cooking (25-35 carbs/meal), I have been in Target (<160, >70) 92% of readings and only blew it after eating a large French fry order at a baseball game. What was I thinking! I would estimate that my June-July A1C would be about 6.0, possibly creeping into the high 5ās. I wonāt be getting my next A1C for 2 months.
Overall I am very pleased with my Afrezza experience. I think users are going to have a variety of responses and would guess a typical learning curve of an attentive diabetic to be a month or more. I have had no issues with a cough (I have always keep well hydrated). I probably have not been as aggressive with correction doses and will go that direction soon. It would be nice if the Freestyle Libre CGM were available in the US.
I have enjoyed the āfreedomā of eating some foods that I love and would have fretted over prior to Afrezza, like corn on the cob and the occasional B&Jās vanilla ice cream with peaches. I havenāt tried a pizza yet or Pad Thai and I know that I need to restrain myself to a small portion of French fries. Restaurant eating has become more relaxed and while I still count carbs out of habit, I donāt obsess over them.
I probably only need to group a meal into one of 3 categories:
- <20 gm carbs (no Afrezza)
-
20 and <35 gms carbs (4u Afrezza) - add 4u correction if >140 after 1 hr
-
35 gms (8u Afrezza) - add 4u correction if >140 after 1 hr
For anything over 35 gms carbs, I then need to pay attention to BG at 1 hr to see if a correction dose is required. I will touch base again when I get my next A1C.
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dunewalker,
Thanks for the Afrezza update, exactly what we are looking for in trying to better understand the drug. Iām curious what you would say is the best feature (no shots, fast acting, decreased hypos, etcā¦). After reading through several userās posts, itās still a bit fuzzy on what the biggest benefit to this new insulin is considered to be??
CB
CB,
For me, who only injects a basal insulin once a day, the ability to reduce my post-meal BG spikes by inhaling rather than multiple injections is a big plus. But even bigger is the ultra-fast action of Afrezza and that it leaves my system in about two hours. This means I need to keep an eye on my Bg after an hour or so to make sure Iām staying below 150-160. I think as I get even more experience I will be able to do better.
I forgot to mention that BG lows have not been a problem so far. My lowest BG after Afrezza has been 73. As I said, I have not been aggressive in taking more Afrezza compared to some users. Some of that is due to my not using a CGM.
One other hurdle with Afrezza is the spirometry test. For me it wasnāt needing to find a pulmonologist because my GP had a hand-held spirometer in her office. Her PA had me do a rapid, forceful exhale several times. Each time, I felt I was leaking a little air thru my nose but didnāt say anything because I thought the nurse knew how to perform the test. It turned out that I failed to meet the 70% of predicted normal FEV1 for someone of my age and weight that is apparently necessary to allow a script for Afrezza.
So they sent me to a pulmonologist for a complete pulmonary exam. All the time I protested that something was amiss as I have never had any pulmonary issues. I still freedive to 25 ft and had recently returned from the Andes where I hiked and walked at altitudes above 12,000 ft for days. AND- the full pulmonary tests were all fine, my FEV1 was 87%. The lab tech said the mistake made in my GP office was in not firmly pinching off my nose prior to exhaling. I reported back to my GP and they took the poor FEV1 reading off my record and approved the use of Afrezza. I doubt if I will be the only person to have an issue like this. Diabetics beware- make sure your nose is well clamped before getting any FEV1 testing.
I hope this info helps and that more insurance companies start to cover it and at a Tier 3 level.
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For me itās the dosing itself. For injected bolus insulin to work well you have to take it advance before eating, and you have to get the dose almost exactly right, which is very difficult to do. you also need to be able to anticipate your physical activity level for the next few hoursā¦ It just ends up that a huge amount of your day ends up devoted to or worrying about the insulin youāve injectedā hoping it was enough, hoping not too much, adding a little more insulin or eating a little more in a never ending juggling contest.
With afrezza I eat what I want, when I want (within reason) then I take either a ālarge doseā or a āsmall doseā 20 minutes laterā¦ Just that ability to be spontaneous is a big improvement in quality of life. I donāt spend the next 3 hours worrying about it eitherā¦ Because food digests more slowly than afrezza peaks, the users sugar levels have a tendancy to rise as the afrezza wears off, which is sometimes considered afrezzas shortcoming, but itās also the reason why itās safer and much harder to produce a significant hypo. Overall itās just a lot easier and I am able to devote much less time and energy to the whole thing than with injected insulin alone.
Exactly. Thatās the aspect of it that intrigues me, and has been pretty much buried under the hype about āNo icky needles!!!ā I know thatās a big deal to some PWDs but for me, after 32 years sticking myself with various sharp objects multiple times a day Iām fairly used to it by now. Iād be just as interested if that wasnāt a feature at all. In fact it might even be more attractive to me, because there are still questions about the fact that some of it remains unabsorbed in the lungs and the potential longterm effects of that.
@DrBB I donāt think weād find too many insulin dependent diabetics who have a phobia of needlesā¦ We canāt afford luxuries like that. Anyone whoās excited about it just because they think the appeal is lack of needles just flat out doesnāt get itā¦
When people sheepishly ask me about sticking myself with a needle, I just say, āAfter the first 10,000 times, itās not a big deal!ā
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Iāll chime in here cbennett and my reason wonāt be that surprising. For me, the biggest benefit is how quickly it works. An example - my pump came off during a very very hot and humid day weeks ago while I was running a baseball tryout for my son. I didnāt realize till the end of tryout and by that time I was already over 300. I inhaled 8u Afrezza cartridge and I was in the low 100ās in 40 minutes. Also, the ability to control spikes is a tremendous benefit for me. I see it going over 130 and I know now I can pretty much stop the spike in a very swift way and be back in range.
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Been using Afrezza for 90 days, just got my A1C and it was reduced from 7.0 to 6.4. My GP
was thrilled and so was I. I also lost 10 lbs during the time I have been taking it. I am a Type 2 and my only medication prior to Afrezza was Metformin. I am happy to report no side effects. I use both the 8 unit and 4 unit cartridges. I am a senior so loosing the 10 lbs plus the ease of use and ability to take it at the table makes this drug a winner for me.
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oldeguy - that is awesome. Congratulations.
Hi DrBB,
I got this from the following article. Supposedly there is no residue, the powder is so fine that it is easily passed through your lungs. Thatās the beauty of this Techno-sphere technology that Afrezza is delivered with. If it takes 20 years or more to get lung cancer from Nicotine that stays in your lungs for years and is a carcinogen. How many years would it take a substance that runs naturally in your blood stream to cause cancer in your lungs, and considering it leaves no residue? Just food for thought.
Thanks and good luck.
āBack in 2009, Al Mann told us theyād been following some patients whoād already been using Afrezza for up to 5 years, and saw no change in their lungs. (They did high-definition CT scans on the 600 patients in their study.) That seems encouraging.ā
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Hi @mpg54(guess what heās no longer part of this?) Iāve read the articles youāve referenced. My take away is in the first month, the subject of your first reference, the one that went on about dehydration, there is a reactive cough immediately upon dose delivery. In the second month, the subject of this most recent reference you site there is a constricting cough, as @mikep put it when responding to your explanation for the first type of cough. You have not acknowledged the second type of cough. It appears during the second month of use and worsens with daily use. It is the cough and not concerns about long term effects that matters. It is a hacking deep lung cough that is distracting to company and a physical irritation. The experience of the inhaled insulin is fantastic in every aspect as the sited reference say except for the cough. When the first article delved into it it said inhalation delivery was an unknown of such significance that he was downgrading his investment rating. The person making that recommendation was making a positive spin with so much discussion of dehydration which more experience has shown to be not the cause of the second cough. All the positives of Afrezza are undeniable. Itās a breakthrough game changer. Itās the best therapeutic available. It makes users healthier. Only the cough is a problem.
Hi Aaron.
Great points. I will say that Iām back on Afrezza for all meal and correction boluses and the cough is relatively gone. Every once in a while Iāll cough a bit after an inhalation but the constrictive cough (which worried me so much) has not come back. Iām wondering if the Afrezza combined with bad allergies and maybe a slight cold all contributed to the constrictive nature of the cough. Either way, Iām back using it regularly and it is working very well.
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Hi Aaron,
Iām still here. I understand and appreciate your feedback, Iām just re-posting things Iāve read from others. I canāt claim any personnel experience with Afrezza, nor do I try to tell others how to treat themselves. Itās good to hear that you are still positive about it as a treatment despite the cough. I wonder how often this occurs as you and Mike seem to have a similar experience, yet Sam does not.
Thanks.
Ok glad youāre here I did the @ key and your name didnāt appear so I didnāt know. I took Afrezza doses last night and this morning and coughed a lot. Seem to be trying doses every two weeks. Thatās how often Iām desperate to bring down bg fast. But when I us ed it regularly I found it less predictable for correction as opposed to carb meal boluses. Hesitant to keep at it but cough very well may go away. That seems to be the common experience.
Hi all - just wanted to post a quick follow up. I had my Spirometry FEV-1 test done again after being on Afrezza for a little over 6 months and it came out great. Doc said it actually improved a bit!! This is very refreshing news as Iām using Afrezza exclusively for all meal boluses and corrections.
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Love it! Happy to hear. I need to do my follow up too but unfortunately got hit with w piece of metal in the chest at work so breathing deeply hurtsā¦ Will probably delay a few weeks til I heal
Lol afrezza actually improved your lungs. What a quandary this puts the naysayers in. Use enough And eventually youāll breathe underwater like a fish (kidding)
LOL thanks Sam. You ok? Sorry to hear about getting hit at work.