Mealtime dose conversion
Dosage adjustment may be needed when switching from insulin to inhaled insulin
NOTE: Also see starting mealtime conversion instructions below
Up to 4 units SC = 4 units inhaled
5-8 units SC = 8 units inhaled
9-12 units SC = 12 units inhaled
13-16 units SC = 16 units inhaled
17-20 units SC = 20 units inhaled
21-24 units SC = 24 units inhaled
Starting mealtime dose
Insulin naïve: 4 units at each meal initially
Converting from SC mealtime (prandial) insulin: Determine the appropriate inhaled insulin dose for each meal by converting from the injected dose using conversion table (above)
Using SC premixed insulin: Estimate the mealtime injected dose by dividing half of the total daily injected premixed insulin dose equally among the 3 meals of the day; convert each estimated injected mealtime dose to an appropriate inhaled insulin dose (use conversion table above); administer half of the total daily injected premixed dose as an injected basal insulin dose
Yep, we’ll know more when it comes out and some of us actually try it:)
A few years ago, one of the Afrezza trial participants wrote a post here. He was very happy with the results he got from using it. One of his repeated comments was that he just didn't have that much hypoglycemia when using it. He said he suffered frequent hypoglycemia using prandial insulin.
The thread turned a bit testy and combative when members here challenged him about dosing. Afrezza's only coming in doses of 4 or 8 units bothered commenters that were insulin sensitive. My take from this discussion is that Afrezza insulin is not only delivered via a novel route but that the dosing doesn't translate exactly to injectable insulin.
I don't think that poster ever returned here. It's too bad. I'd love to see his continuing comments on Afrezza. I'm hoping we see a release of Afrezza soon.
Interesting, I could see why things might get testy if people felt claims were being made that couldn't be substantiated, though too bad it got personal.
If you look at the action curves, Afrezza absolutely doesn't translate precisely to injectable insulin. It has a super early peak, and then it does have a long, but pretty minimal, tail.
But the claim about dosing isn't so much whether it translates one-to-one--it clearly doesn't--but that somehow dosing just matters a lot less. And that's what I can't get my head around. And I suspect I can't get my head around it because the claim is wrong, or at least more wrong than right, though that's simply my best guess based on the limited data I have for now, and I'm very much open to having my mind changed.
Hopefully we'll find out more in the not-too-distant future!
Oh yeah... like I said, it COMPLETELY solves the problem. No irritation, injury, rash, etc. AT ALL.
The first month I was on the pod I didn't know about Unisolve (or adhesive removers generally). I had a 2-day rash every time I pulled off a finished pod, no matter how careful I was.
I have better results with simply managing bolus timing (pre-bolusing). That way, I bolus exactly what my IC requires, and after the end of the tail my BG's back down where it started (or pretty close). No need to take extra carbs.
By being aggressive with timing, I can usually cap most post-meal spikes at 140-150, dropping back down to the 80s-90s by the end of the 4 hours of action.
By "agressive" I mean timing things so the insulin is peaking at or even a little before BG peaks from the meal. For me this means bolusing 30-45 minutes before eating, then waiting until my BG on the Dexcom is just starting to sniff downward. Then eat.
Of course, this means you've got to be ready with some sugar in case you can't start eating when you'd planned to, for whatever reason. This sort of tight, narrow timing is risky if you're not really on top of it, so it shouldn't be attempted by everyone.
Dave, I do this, too. I've found when I'm insulin resistant in the morning, I'll often delay eating for an hour before the BG starts to trend downward on my Dex. I also walk after my late breakfast to keep the BG from getting too high.
One thing I'd add is that when sick, don't do this. Timing of everything is all messed up. I've been burned by illness delaying digestion of carbs.
Kind of like a "temporary gastoparesis" -- typically when whatever's making you ill also is messing with your stomach enough that you might vomit, carbs from a meal sometimes will not "show" in BG when they usually do.
Paradoxically, avoiding lows when sick can be as much of a challenge as avoiding highs if your GI is involved.
That's a good point. Whenever I prebolus more than 15 minutes or so, I keep close watch on my Dex. Unfortunately, I live with gastroparesis. While my symptoms are mild, it's given me extra motivation to keep my BGs in check.
I use an extended bolus for every meal. I think that has largely minimized the times I go low soon after eating. It also gives me time to change my mind about any "bolus in progress" and pull the plug on it, if needed. Conversely, if my post-meal BG is higher than expected, I can terminate the extended bolus and give an immediate bolus for the balance.
My Dexcom shipped! I was starting to get worried the doctor's office would start blocking calls from me and the Dexcom rep hassling them about the needed paperwork.
Random question: I've had many endocrinologists over the years, and none have ever had a real conversation with me about ketones. I'm a Type 1, either LADA or MODY, who still makes some endogenous insulin, and my highest highs, which don't happen very often, are in the low-200s. My highest high ever was 325, but it happened after foolishly eating a bunch of candy and miscalculating a bolus, and was quickly corrected. So perhaps I'm not really at risk of DKA at this point? Should I get ketone test strips, and if so when would I use them, and what would I do with the information? I believe there are more accurate ketone meters, too? I know very little about this topic, advice welcome!
Most advice online that I have read says to test for ketones when you are above 250. Everyone is different and they may develop ketones at lower or higher levels, or not at all especially if they have long acting insulin on board. I have found that since dka I do not seem to develop ketones while on long acting, even when my bg goes higher. I'm a bit more worried about what may happen on a pump. I always have ketone strips at home, I don't carry them with me so far. I also have a meter which tests for ketones in blood but I don't have the strips to test for that.
I think the time you need to be worried is if you have lack of insulin delivery with your pump, you are dehydrated or sick and so on, all of these can lead to dka. I don't think a spike from food or dp will cause dka. If you have moderate to high levels of ketones and symptoms of dka then you need to get to an er asap.
My best guess is I've never been close to DKA and won't be as long as I continue to have a buffer of endogenously produced insulin, and I don't really ever go over 250 except for a few occasions where I've been really irresponsible in my carb consumption. In fact, during intense physical activity, like alpine climbing, I can go off basal insulin entirely. I guess that's why no doctor has ever had the discussion with me, though I still think it's a bit odd, since they class me as an admittedly unusual Type 1.
I too have my own endogenous insulin (our story seems simalar niccolo) and I do spill ketones when over 230ish. Trace, small, and a few times moderate. I don’t think DKA is real danger either though because of my 2nd phase which still kicks in and brings me down. I’m going to start bolus insulin soon. Interesting side note, when my husband taught high school biology one of his students wrote a paper linking ketone bodies to diabetes and hyperglycemia, this was when docs still thought ketones were just a natural byproduct of digestion. This paper won some science awards but was scoffed at by physicians at first, my husband had to really encourage the student to hang in there and keep presenting it. That student is now a physician himself, Dr. Mark Kay who runs the Kay lab at Stanford!
Dexcom was extremely responsive. And my insurance took no time at all to approve it, but my insurance seems to be very generous in general. My doctor's office took a few weeks to process the needed paperwork. Good luck!
