The 4s work very well for that… and bring me back down to normal ranges without hypos in as little as 15 minutes or so… sometimes a little longer… kinda depends on if your blood sugar is still climbing or just hanging steady high…
I agree completely with Allan you just gotta forget all the complex crap and be willing to go with the flow… that’s the beauty of it. It works phenomenally well. The complicated ratios, carb counting, all those headaches are a liquid insulins game… not needed here
That’s really great. Congratulations!
Yes I use 4’s for small corrections as well.
What I don’t understand though, is how it works for small amounts of food. For example, I’m about to drink a beer, so I am going to bolus a small bit for that. But how do you use it for something like that? Would a 4 puff not knock you down too much for just a beer?! (maybe I will have to drink a few, that’s not a bad idea…
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The thing is, I don’t actually do any of that now. The bolus calculators seem so elementary. There are so many more things to consider than just what the calculator looks at. I just go with what I know. I’ve been taking insulin so long, I know what I need for any circumstance. I don’t even have to think through it, it’s just instinctive. And it has served me very well. I’ve only been in the 6’s once in the last 15 years. Every other time I’ve been in the 5’s.
I strive to stay below 100. I think usual is maybe 70-120, but I start hitting corrections when I see it get close to 120.
Perhaps I am a bit extreme on corrections. I will correct at 120 if I know I’m going to keep going up. And I’ll even go to the extreme of doing a 1/2 unit intravenous correction if I am in an extreme hurry, or an IM correction if I am in a hurry, but not an extreme one.
Adding to what @Sam19 had already said
I am not recommending you do what Sam Finta had did, but Sam Afrezza user has an excellent blog about his experience with Afrezza. He was a trial participant and had been on Afrezza for many years.
Perhaps you can talk to him. There was an live session with him on here too.
That looks a lot like the way intravenous dosing works for me. It will drop me quickly if I don’t have food already consumed, but it runs out of your system very quickly. The downside of intravenous is trying to get a vein all the time, but you can do it very precisely. I have done as little as 1/2 unit. Anything smaller than that, and I figure it’s just not worth tapping a vein for it.
So I am definitely interested in trying Afrezza, because it seems like an easier version of intravenous. But I am also a little leery of the lung thing.
The other thing is, I don’t take a lot of insulin…but I take insulin a lot. I mean, I take it frequently. So I don’t know how this is covered. Like if I want to puff 10 times a day, I think my insurance company would tell me to “blow”…
Not magic. Just a much faster insulin and out of your body in 80 minutes. So my DD almost always uses two doses. One 15 minutes after eating (maybe she should wait 20 or a half hour) and one an hour after eating. So if she was eating one 30 gram donut, 4 Afrezza then after an hour 4 more. Or nothing. Depends. Now you did say “donuts” plural. Assuming 2 donuts that would need 8 Afrezza and maybe a 4 if high an hour later. DD takes 4 units if 200 and 8 units if 250 to 300. For correction 4 units takes her down 80 or 90 points. You still have to figure out your correction factor for Afrezza, how it reacts with the food you eat. Not sure how long a donut with all that grease takes to digest… But in reality, she no longer analyzes, just tests one hour after or an hour and a half after and corrects if necessary. It’s easy because i’s so fast. No more worrying about insulin on board. I only hope it stays on the market.
It sounds like you already have your sugars under control without too much work so why are you looking for something different? I dont think it would work well if you have to do tiny corrections all day. The lowest dose is a 4. If my suagrs were between 70-120 without carb counting and all that and I had an A1C in the 5-6 region i would stick with what i was doing personally. 
So whats your goal and what do you think Afrezza would buy you that you dont already have?
The reason I am interested in it is for the speed. After I run, I want to restore glycogen. The most efficient way for your body to do that is to take in carbs within 20 minutes of when you finish. So after I run, I immediately dump a bunch of simple carbs into my body, and take insulin.
Even if I don’t take in carbs after a run, my BG will spike anyway. That is a natural result of the exercise causing release of cortisol, epinephrine, and other hormones which trigger your liver to release glucose. The body’s natural response - “I’m being chased by a tiger, I need to supply energy!”
So my post-run spike is twice as bad, both from replacement carbs I am taking in, and glucose the body is dumping in. It seems that Afrezza would be ideal for that.
Also, there are times when I don’t want to wait for insulin to work, so I frequently do an IV injection. It’s super fast, but hitting a vein all the time is terribly inconvenient.
I like to think of all these things as a huge diabetic tool chest. I can pick the right tool for the job, depending on what I need. On a scale of insulin speed, right now I have (slowest to fastest) subcutaneous, intramuscular injection, and IV injection.
Afrezza might be one more tool, possibly between IM and IV for speed.
If speed is what you’re looking for it’s the only tool you’d need
Holy cow you do an I.V. injection? Have to look that up sometime. Needles dont bother me.
Yeah sounds like Afrezza would be perfect for your goal. I take in a lot of simple sugars after working out too but normally my body absorbs it without any insulin.
It’s definitely a great tool to have and once you use it you wont want to be without it so i warn you now.
I got a script from the doctor, but insurance denied it, so I asked my doctor to do a prior authorization to get approval. Any suggestions on things to say for that? Like say it is needed for more rapid absorption, or faster lowering of BG?
The IV thing is great, but you just have to make sure you have food already working. The way the non-diabetic works, BG starts to rise, and insulin is released into the blood. You don’t want to do it before you eat, only after!
If it’s for a correction, it’s great too. But if you think of a normal 4 hour delivery of humalog or novolog, IV is almost all at once. It hits mostly within the first few minutes, and completely done in less than an hour.
Forget about the big syringes they use for drawing blood! I use my 31 gauge 8mm insulin syringes and can always tap one, but I guess it depends on body type and how close your veins are to the surface.
Yes, dont bother with a prescription until you try it. Get some samples, if your Dr doesnt have any, a Mannkind rep can drop some off to his office. @Castagna2011 on here can help get that going if need be.
i didnt want to go through all the trouble of going through the insurance hassle if it didnt even work for me. Luckily my Dr already knew about Afrezza and had samples for me.
Afrezza is needed to counter the post meal blood sugar spikes that regular insulin cannot handle which will help in lowering any future complications and expense due to prolonged high blood sugars. It will also greatly minimize hypoglycemia episodes due to it’s quicker action and clearing out of the system. This provides greater safety and decreased expense by minimizing the possibility of being hospitalized for these issues. Due to all the above benefits and increased quality of life I believe the minimal expense of Afrezza will more than pay for itself due to greatly decreased risk of future complications.
I continue to use Afrezza as well very successfully. Nothing compares to it, nothing.
Nice, Allen3! Thanks. I’ll send that to the doctor!
I will let the doctor do a PA and try to get some. Even if it doesn’t work for me, it’s easier to do it that way than to try to get samples to the doctor. I have had no success getting samples in the past!
Your insurer may send their own PA form to the doctors office and your doc will either be willing to play the game or he won’t…
Mannkind has a customer service program to help with people struggling with insurance called mannkind cares. I don’t know much about it (hanvent had any insurmountable problems with insurance) but others here can tell you about it.
Their coupon card makes it reasonably affordable even without insurance coverage… I believe.
Ok, thanks, I will check it out. I at least want to try it, sounds like the bomb.
I’ve never written a PA for any kind of insulin, but other meds? TNTC.
I get positive results with the following:
"The medications listed above [any other medications that my patient has used that are in the same general class of medications plus medications s/he has taken previously for the same/similar symptoms] have either been ineffective, only partially effective, or have caused intolerable side effects. A trial utilizing samples of _________________ has resulted in significant reduction in the frequency and intensity of this patient’s symptoms."
PAs have a much better chance of getting approved if:
*No blanks are left unpopulated; use “N/A” when appropriate.
*Prior meds tried are listed by their generic names (even if a generic is not yet available for the medication) and the span of dates during which these meds were taken are listed alongside each med.
*Germaine chart notes, including but not limited to lab results, progress notes, medication flow sheets, and/or results of diagnostic and imaging studies are forwarded with the PA.
*No one lies.
Some health insurers play this little game. If a physician actually submits a PA in the manner in which I believe it is intended (the “P” stands for “Prior”), i.e. it is submitted before a patient takes their rx to the pharmacy and coverage is denied, the physician will receive a faxed reply stating that coverage for the medication was denied because it was sent in error due to the fact that the patient is not being prescribed this medication.
Other games health insurers play:
They deny coverage for a medication that is actually on their preferred formulary so the doctor spends a good chunk of “unbillable” time filling out the paperwork. Then a fax arrives that asks the doctor why a PA was submitted because medication X is a covered benefit.
A PA is approved, but the health insurer neglects to tell the physician or patient that it has been approved only at the highest tier possible and that the patient’s copay will be some high percentage of the MSRP or the PBM’s negotiated price du jour. The patient goes to pick up their rx and the pharm tech says “That’ll be 27 bazillion dollars, please.” The patient will not be able to afford it, and will become enraged at the doctor for prescribing something the doctor knew all along they could never afford. We actually don’t know this. Everyone’s plan is different, often for the same insurer. The same insurer will approve this particular med for say 10 patients in a row and then bam, this happens for your eleventh patient. Formularies and levels of coverage are “adjusted” without warning more often than I change my clothes. Websites are always down, navigation to the “special” formulary section for physicians requires a Ph.D. in computer science and a minimum of one hour, and/or the online formulary is not up to date.
A medication that requires a PA is approved. A dosage change is made and coverage for the same medication is denied. Another PA must be submitted before the insurer will cover the cost.
When I have more time I will list the other large handful of games they play.
