Mark, when I am unusually high and decide to take a shot from a syringe, I compute the correction amount on my Ping, then disconnect and shoot that amount out (which serves the secondary purpose of letting me see if the insulin is freely flowing or there is a problem with the set). Then I take my shot. That way I have a record of the IOB I injected on my pump.
Do some googling on reactive hypoglycemia to get an idea of the dynamics of Afrezza. Afrezza is much more like endogenous insulin in its pharmacokinetics. Still way slower, but on a sliding scale its much closer to the real thing than subQ endogenous rapid acting.
There's quite a bit of good material on reactive hypo out there. The behavior of Afrezza is similar to an overeager pancreas that gives too big a phase 1 response.
Some T1s also have impaired alpha cell function, so have a weak glucagon response and don't counter-regulate well. Afrezza could certianly be a problem for these people, although it seems to me given the flexibility the lightspeed response the stuff has, one could stick to the smallest dose and just repeat if necessary.
That's true, Sam.
I think what niccolo is looking for, though, is a physiological explanation for why this is the case. I've contributed what I do know that's different, and contributes to the greater "error bars" in dosing, but he's on to a good question, and I'd like to know in more detail what the kinetics of Afrezza are that make the dosing range as crude as it is.
At this point, I'm inclined to believe that the short halflife of Afrezza is sufficient, but I have the same discomfort as niccolo that that's the entire explanation.
Novo Nordisk are testing a faster version of their rapid acting insulin. It’s currently in phase 3 trials scheduled to complete this summer.
https://clinicaltrials.gov/ct2/show/NCT01831765
Excellent write-up niccolo! (now people are going to tell you and me to get a room :-))
I see Afrezza as just another arrow to add to my quiver, not a replacement for the pump I'm using now. After Terry (and a few others) donate their bodies to science so us bastards can use them to see if it's truly safe, I plan to do my best to get some and try it, and if it works well my whole treatment strategy will probably change to my pump providing corrections and extended meal boluses, with the immediate, carb part of my meal bolus delivered with Afrezza (I TAG).
I'm not familiar with intramuscular injections. Never actually tried it myself. Do you have any experience with and/or do you know any good resources to find out more about it.
That's great advice Zoe, thanks much for sharing. I'm going to start doing that too. The frugal side of me doesn't like wasting that insulin, but that's probably not very rational.
Just curious, when you take a shot with a syringe are you doing it intramuscularly, like mohe0001 mentioned?
Dave and Terry, from page 3, know all about the IM injections. He might not have read the page 4 postings yet. Here's some discussion...https://forum.tudiabetes.org/topics/more-on-no-not-moron-im-inje...
I've come to always IM for big corrections unless there is a confounding circumstance (not practical in the current environment, too much pump IOB).
Just the way of things, usually when I need a big correction (over 150), I just usually don't have IOB, and I'm at home or at work where I have a private office.
I swear by IM. Every parameter is about twice as fast: Onset, peak, rate of action (how fast it lowers BG), and duration (a little more than half of subQ).
The only thing I don't like about it is the long needle :-)
Zoe, its probably the farthest thing from reality for you, but that paragraph made me laugh -- it reads so easily like a heroin junkie wrote it :-)
Just another one of those quirks being a PWD. We sound so much like drug addicts with our lingo!
Great. Thank you!
That is SO SMART! I have been doing IM injections for highs for years - but this is such a great solution to be able to have that added to the rest of the insulin I’ve taken. Simple and smart. So glad I saw this!!!
I want afrezza when BG is 200 or more and I want to eat because now that means I’ll be 200 or more for a few hours. And when I’ve eaten a lot of protein and insulin dose has worn off and Bg is high.
Our endo refuses to prescribe Afrezza. I think the long-term effects of being high for two hours every time you eat causes cumulative damage and asthma drugs are inhaled. So pick your poison. I don't think dosing will be a problem for our teen. She usually eats 50 grams for lunch and dinner. And if snacking, 30 grams, so that would be about four units (her ratio is 1 to 7). Works out perfectly. But she could never correct a high as 4 units could only be used for an extremely high blood sugar. I need 1 or 2 unit cartridges. Where do I find a doctor in New York that can train on its use and prescribe it (presuming the lung test does not preclude her from usage). It doesn't seem to me the endos are even looking at the data, just reacting in a negative manner.
My endo put me off for two weeks regarding prescribing Afrezza while she gets up to speed. She told me in an earlier meeting that she is favorable towards it. When I called after two weeks, she was on vacation for 10 days. I will find out soon if she's really prepared to prescribe it.
As far as locating a doctor willing to prescribe Afrezza, I would contact Sanofi. Their US headquarters is in New Jersey. This large pharmaceutical company will be using their sales reps to contact clinicians. They should be able to identify an endocrinologist in your area willing to prescribe it.
I am hopeful that over time this drug will prove itself and become more accepted. To me, the appeal is that the precise insulin/carb ratios you just described hopefully become LESS important with the ultra fast action. I’m a bit frustrated that the reaction I’ve seen on this forum seems to be one of doubt, and a tendency to want to disprove and discredit this new innovative treatment. That said, I am, by definition, biased because I own several thousand shares of MNKD. However I am a T1 diabetic myself. I am reminded in this discussion that once upon a time all of the smartest, most analytical and scientific people on earth knew without a doubt that the earth was flat.
If you’re concerned about transient post-prandial spikes, you could always bolus earlier and/or super bolus and/or restrict carbs, too. All have trade-offs associated with them, but so does being an Afrezza guinea pig.
That said, I’m glad folks are stepping up to be guinea pigs because it’ll be great to learn about their real-world experiences.
From what I understand, most Type 1s have impaired alpha cell function, in the sense that the beta cells no longer send a "messenger" to the alpha cell telling the alpha cell there is too much insulin in the body. The beta cells are dead. Can't send that "messenger" out to the alpha cell. So there is only counterregulatory response by the liver, which is not guaranteed. For any type 1. So accurate dosing would always matter. In one study, they were dosing Type 1s with partial boluses (just enough to cover the spike) and the pump would do the rest. I also thought dosing for Type 1s was originally going to be half before the meal, half after. Now they are saying you can dose after. It does not behave exactly like injectable insulin. We need more information on how to safely dose, erring on the side of caution. But this insulin is far superior to anything on the market. I can't wait until more is known and we can get it.
Easy solution. Disconnect pump and bolus into the air. then reconnect. That is a waste of insulin. Get an app for your cell phone called RapidCalc. If you enter the bolus information into the app, it will track insulin on board.
Interesting thread . . . I'm one of the guinea pigs :) I'll be taking my first dose of Afrezza tonight for my dinner bolus. Very excited to give it a try and I'll report back.