I’ve been using Afrezza for a couple years now for high-carb meal boluses and stubborn corrections. I’m not using it routinely because the 4u cartridges are too much for normal meals or corrections below about 220.
But lately, for reasons I don’t quite understand, overnight correction boluses from my pump do next to nothing unless I get up and move around for 20min or so. I suspect I’m at the age where my metabolism is slowing and I need a ‘bump’ to spur adsorption. I’ll discuss this with my endo at my next appoint in October,
If SQ adsorption via pump is the issue, I wonder if Afrezza would be a good tool. Afrezza users - what’s your experience using Afrezza for overnight corrections? Does it work as quickly as during waking hours? Does the same dose drop BG at night the same amount as during waking hours?
I am actually more insulin sensitive at night but Afrezza is more predictable for me while I’m sleeping than when I’m awake and moving around (I assume this is hormonal).
During the day I could give a dose and it may drop me right where I expected it to or it may practically do nothing. I have decided this is from a combination of factors including food that might still be digesting or simply movement. At night if I am high and I give a dose I can expect a 12 unit cartridge to drop me 100mg/dl while I sleep.
I’m not an Afrezza user (it’s not in my country yet) but I find overnight corrections need to be roughly double, if not triple, a daytime correction. A nighttime correction based on my usual ISF may hold me steady but won’t drop me.
Thanks for the feedback. The answer I needed, but unfortunately not what I was hoping to hear. I really would like to use it for corrections at BGL around 150-180. Unfortunately 4u cartridge drops my BG about 100-120 points during the day. I tried making 2u cartridges two weeks ago with limited success. I may give it a go again.
Thanks for the tip. I haven’t been that aggressive yet. I’ve generally used my normal correction, waited an hour or so, then hit it again if there’s no change or at least a small change with a negative slope. I’ll give your method a try.
I always split the 4U afrezza cartridges into 2U cartridges; perfect for insulin sensitive me. Open a cartridge up, eyeball 1/2 of it (I’ve found accuracy not that important, although you may differ) into an empty cartridge. There you have it: 2U cartridges. Work great for me
That’s great! Couple of questions. What do you use to transfer the powder from one cup to the other? How do you open and close the cartridges without spilling the contents?
Good questions! Splitting is kind of a pain at first, but you get used to doing it and it gets easier. For me it’s been very worth it.
I split one or two of the 4U cartridges in advance so that 2U cartridges are always readily available and at my disposal for necessary corrections;
It’s hard to explain how to split without a visual, so I searched you tube and found one video on splitting afrezza cartridges here:
(He’s rather slow moving in the video but gets the job done. I watched it at 1.5 speed.)
I’m a big picture girl so it’s helpful to me to understand function: The whistle when clicked down onto a cartridge causes a sliding of the powder cup to the middle of the cartridge (where you see the slit opening on the blue top–4U color). When the cup is in the middle position, it is opened–the powder can be inhaled out of the slit through the whistle. (It can also be spilled if tipped, so be careful.) The cups can only be removed from or replaced into the cartridge top when they are slid to the open, middle position. So, in order to open a cartridge, one needs first to slide the cup to the middle of the cartridge: Remove cup. Split. Replace cup. Close by sliding cup away from middle position;
Some things I do differently than the you tuber:
a) Opening: I use the whistle to slide the cartridge to the open, middle position. I find this easier than manually sliding the cup to open;
b) Closing: I don’t press the cup against the table to reassemble the cartridge. To replace the cup, I just place the cup in the middle of the blue cartridge at a 45 degree angle or so. Click one side of the cup in and then press the other side of the cup up and in;
In answer to your Q as to what utensil I use to split the powder? None. Like the you tuber I just kind of tip and tap 1/2 the cup’s contents into another cup. And, YES, I have lost a little bit of powder here and there (doesn’t seem to affect dosing for me too much). And YES, due to clumsy finger dexterity I even annoyingly lost a half cartridge to the floor once.
I was fortunate to have a kind afrezza rep show me how to split. I’m in So Cal. Not sure where you are, but would be happy to meet to pass along the favor of showing how to split. I know it’s hard without SEEING.
Fantastic instructions @Karin7. I have seen the YouTube video before, tried it and failed miserably. Your suggestions on how you modify his methods are very instructive. Probably my biggest problem when I tried this before was splitting the powder visually and inserting the filled cup into the cartridge. My manual dexterity just isn’t what it used to be so manipulating the small parts is a challenge. Of the four supposedly 2u cartridges I made, only one seemed to work.
Your insertion method sounds much more robust and may tackle that issue. As for splitting the material, I tried using the narrow side of a OneTouch test strip as a spatula to move the powder. I ended up losing some powder with this method. Perhaps with a bit of practice I’ll be able to do it reliably.
Amazing that an MannKind rep showed you how
to do this! That’s fantastic. Unfortunately the rep in my region is not the “bright bulb in the string” and probably doesn’t even know people are doing it.
Unfortunately I live in the boring Midwest so a meeting isn’t possible, but thanks for the offer!
I’ll report back on results of my 2nd attempt. Probably is a week or so.
My insulin sensitivity varies over the course of the night. I time my Lantus doses so that I have more IOB in the evening when I fall asleep and less in the morning when I wake up. I just need more/less insulin at those times.
The same patterns hold for Afrezza. It acts faster than other insulin and levels off better though so I think it’s a better insulin to take at night overall. I’m less prone to rage boluses with Afrezza because it starts working so soon. The fast action and leveling off really helps reduce the severe highs and severe lows at night.
My working assumption has been that my issue with nighttime corrections is based on adsorption speed and not insulin sensitivity. My basal rates are almost identical over 24 hours and I haven’t seen any baseline BG level increases at the same time as my boluses become less effective. Still, last night I decided to create a high BGL, take a 4u cartridge, go back to bed and see what happens.
ate crackers and cheese before bed w/o bolus to raise BG to the point where a correction was in order.
At 2am my BGL was 250 and steady. Took 4u of Afrezza
My CGM trace this morning was interesting. My BGL was 135 when I awoke at 6:30AM. The 4u cartridge dropped my BG by about 115 mg/dL - just as it would during the day. But the drop was much slower than during the daytime. It was a very even, gradual decrease over 3 hour starting a 2:30am and leveling off at 5am.
So the total drop remained the same as daytime doses, but over a 3 hour period. About 2X the max I see during the day. I’ll discuss this with my endo next month, but my assumption is my slower nighttime metabolism decreased insulin uptake compared to the day. I still think Afrezza is the answer I’m looking for despite the slower action. It’s still working, which is something I can’t say for SQ boluses.
I still need the 2u cartridges for smaller corrections, and can use the 4u cartridges for the larger corrections, just as I do during the day.
Just tried making 2u cartridges this afternoon. I used your method for removing and reattaching the cup to the cartridge. Worked perfectly! Thanks!
As for my other issue, transferring powder between cups, I made a small fixture from a empty Trader Joe’s Pub Cheese container to hold the cups. I moved the powder using a OneTouch test strip as a scoop.
Of course the proof of the pudding is in the eating. I’ll use the cartridges when an appropriate opportunity presents itself. Hopefully they work.
I’ve been trying to make 2u cartridges for week or so with limited success. They seem to be very inconsistent. Sometimes they work, sometimes no response at all. I think I’ve honed my technique fairly well (I’ve made probably 30 cartridges) and I know there is at least something in each. Any suggestions?
Related to above, I sometimes open the cartridges after use for inspection and on some occasions there is a bit of powder left in the cup. I haven’t changed my inhalation technique so I can’t imagine that’s the cause. Do you ever experience this? I’ve never opened used 4u cartridges so maybe this in normal. Would at least partially explain why some I make are ‘duds’.
Yes, I experience inconsistency. I usually chalk it up to my poor splitting technique: a) losing some of the powder in the splitting, or b) not eyeballing the 1/2 well. OR, I chalk it up to the type of food, timing of day, exercise or not, any other number of things that might make me slightly more IR at the moment. When it happens that the first 2U Afrezza doesn’t work or doesn’t move me much, I just wait shy of a half hour or so and then take another 2U. I prefer to stack and stagger my 2U’s because often a 4 will drop me too much or too fast. In any event, stacking my 2U’s feels safer to me and still has faster onset (for me) than Humalog, making Afrezza a better fit for quick corrections.
Yes. Same. If I see a bit of powder still in the cup or on the underside of the colored part of the cartridge, I’ll often inhale that left over bit straight from the cartridge (no whistle).
I noticed recently that some of the powder is sticky. I’ve been using a toothpick (when splitting) to kind of break up the contents a bit too.
Thanks - very useful. I’ll have to try the sequential 2u doses. How long do you wait before you determine you need another dose? Do you see the characteristic fast Afrezza BG drop but it stops at a higher BG level than you’d like?
I’m not scientific or consistent about the amount of time I wait between doses. It depends on my situation and dosing purpose.
If I am adding a second dose because the first was ineffective and I’m having a slow rise or a stable number that is too high for my liking, I wait about 25 minutes as Afrezza usually starts working on me within 15 minutes. With a slow rise or only slightly high bg, I give it a little extra time before I hit the second 2U dose just in case for whatever reason onset is delayed for me that day.
If I’m rocketing high per my Dexcom at a fast pace, I may not even wait a full 20 minutes btw doses. I know I’ll eventually need a second dose anyway. It all depends on what I see on my Dexcom: How high am I rising? And how fast?
With 2U Afrezza I don’t experience the steep/fast drop that I have experienced with 4U. This is the reason I like to stagger 2U doses even in situations where I know I’ll likely need more than the 2U dose. (But be careful, as stacking 2 U doses has rarely caused me to fall at an alarming rate similar to the 4U.) The only time I use a 4 is if I’ve really blown it and I’m up around 200. Usually however, I start the 2U dosing way before I’m anywhere near that number and keep adding for control as necessary.
