Switching from a pump to Afreeza and long acting insulin

I am thinking of switching from a pump to a daily shot of a long acting insulin for my basal and using Afreeza for my meal bolus. I generally bolus for about 2.5 units of insulin for each meal which according the estimates I’ve seen would be 4 units of Afreeza. Is anyone else using Afreeza for their bolus insulin? Anyone with any experience with Afreeza you’d like to share? Thanks.

I used for awhile when they had discounted price for those with insurance that didn’t cover it.

I used for meals, mostly 4 unit was similar to 2-2.5 units novolog. But for meals with higher fat, I would also do extended bolus from pump. So you may want to still have injected insulin on hand to cover some meals, in addition to afrezza or plan additional Afrezza dose after meal.

Currently I do most bolus from Tandem X2 pump, and Afrezza only for correcting high BGs.

I think @sam19 and @Terry4 are still using.

I’ve been using Afrezza for five years now. I primarily use it for corrections most every day. I use the 4-unit cartridges and I find it equivalent to 2 units of Apidra.

I recently found out that my Medicare Part D Rx plan no longer covers Afrezza but I did find an option to buy it for $99 for a box of 90 doses. It still requires a prescription but no insurance is involved. I’ve not done this yet but will when my supply gets low. Using Afrezza improves my glucose management and I would not want to live without it.

Thanks for link. I used that option a couple years ago, thought it ended. I stocked up and almost out of my supply so will check it out again.

@MM1 and @Terry4 Thanks for the feedback. I was/am hoping to simplify my life by eliminating the pump but maybe its too much to ask if you’re T1. I was wondering about those meals that go a bit over what the 4 unit dose would cover, and even those that are smaller. Go for a long walk maybe.

For meals that would normally need more than what one 4 unit dose would cover, you would either take a second dose at the same time as the first (Afrezza is out of your system so quickly that lows are less likely) or take another dose in an hour to an hour and a half (this tactic is especially good for meals with higher protein or fat).

I was on Afrezza and Tresiba for 2 1/2 years. It worked fantastically for the first six months but after an extended illness all of my insulins stopped being very effective. I went onto a pump (T-slim with Control-IQ) 2 months ago to take advantage of the closed loop technology. I’ve taken a few doses of Afrezza since then for unexpected highs but mostly give the pump time to bring my BG’s down.

I used afrezza in 2016-2017 with a Dexcom g4 which helped a lot. I had a pump, but never liked it, and even tried exubera for about a year. It was nice to take a break from shots, but you’ll still get strange people staring and asking questions. I would overestimate how much you’ll think you’ll use…like terry4 said, 4 units of afrezza will feel like 2 or 2.5 units of subcutaneous insulin…I had trouble trying to get 12u, 8u, and 4u, and finally settled on 8u and 4u combo boxes… I also ended up with a lot of expired boxes, and insurance excuses about how the only boxes they have access to expire next month, etc. If its not too expensive for you, it’ll be nice for about a year…after a year of consistent afrezza only use, you’ll probably develop a cough like I did and most of the users in the trials, but it does work very fast and usually is done in around an hour… which is why the Cgm is crucial.

I use afrezza, primarily for corrections, and love it (No cough here). Like others said, it works quickly and is out quickly, so I tend not to use it alone for meal bolus. :slight_smile:

I have talked with many long time pumpers who made this switch. Just tired of wearing the pump all day everyday. And most had good success with this treatment plan.

I have been pumping since 1990 and have never taken a break. But I did add Afreeza to the mix to help with my highs. I found a 4 unit cartridge was more than enough (sometimes too much). But since using the Tandem Control IQ, I haven’t had highs high enough to use Afreeza.

But as with everything dealing with diabetes, try it out and see how it goes. Worse thing you end up with extra supplies you won’t use. Happens a lot, doesn’t it?! Give it a try and let us know. It’s always great to hear peoples successes and sometimes failures to a new treatment plan. Always learning and growing.

I also wanted to add that I used afrezza exclusively for the year, as my insurance company refused to fill insulin cartridges and afrezza, it was either or…which probably expedited my cough, but it was nice to abstain from cargo pants for a year, and like most others, if you use it as an extra tool, it is nice to have…I miss treating highs while I’m driving

I take Afrezza almost exclusively with my meals. I usually get one box per 4unit and 8unit each month. 4 unit only works for very low carb meals AND works better if I include movement/exercise. 8 unit can handle most any meal except like someone else mentioned here, high fat will cause problems - but it’s easy to watch my blood sugar and catch it later when it starts to go up again. I take Tresiba at night as my long acting.

Re: Afreeza, I’m about to switch from Fiasp to this because of poor absorption/scar tissue. I understand that 4 units Afreeza equals 2 units Fiasp/ Humalog. Really dumb question: You just apply your ratios to this absolute amount and everything is fine?
I take small doses of insulin, including half units - small person.

It’s not exact because Afrezza is so different from other insulins. Afrezza begins working immediately and is out of your system supposedly within 2 hours but in my experience it’s more like 1 hour. My suggestion would be to take a dose and eat a pure carb meal/snack to see how it affects you. Have fast acting carbs ready in case it hits you a little too hard. Afrezza has actually been tested on non diabetics which is never done with other insulins because of how dangerous that is. None of the patients went severely hypoglycemic.

Afrezza really shines if you are eating a carby meal or for corrections, it doesn’t do as well with high fat but you can get through that by taking another dose or 2 later as the fatty meal digests. Also if the smallest dose is in fact too much for you, you can split the doses by carefully opening a cartridge and dumping half of the cartridge into a used cartridge. Good luck!

Thank you, Firenza! I wonder why it was designed with such a large minimum dose.

It was not made for micro dosing. At lower levels the dosing is less accurate, a limitation of the delivery device.

I did a 2 year exubera study and it was a similar situation. But now the insulin is faster and the inhaler is better, but still there are a lot of variables.
How deeply you inhale, if you cough if you have a little cold. These things affect how you absorb it and it’s impossible to tell how much you got.
I would still use it for those times that I go high for no real reason and I want to bring it down faster, it’s expensive and my doctor is not really wanting to prescribe it since I’m on a pump.

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Well, the majority of diabetics require at least 2 units of insulin for meals…the percentage of diabetics who use very little insulin like yourself is minuscule :grin:, I even know of kids who use Afrezza (off label because it’s not approved for children) and they are able to use it without going low. Even when I was a kid I took at least 8 units of Humalog per meal. But it’s seriously not as hard hitting as injected insulins because it’s out of your system so fast.

I once made a big oopsie while at a fair, I ate a chili dog and a piece of cake and completely forgot to take any insulin. I didn’t have a CGM at the time so of course an hour or two later my BG was over 500 mg/dl. Afrezza handled that situation incredibly. I took the amount of Afrezza that I should have taken with that meal and one or two more 4 unit doses and my BG came back into range within maybe 2 hours. With injected insulin I would have gone to sleep that night with a high BG. For problems like that alone I think every diabetic should have some Afrezza around for emergencies.

The only reason Afrezza isn’t my primary mealtime insulin is because I had too many problems with long acting insulins which is why I’m on a pump and getting insurance to pay for Afrezza and a pump is a magic trick that I haven’t been able to pull off.

I use an Omnipod and Afrezza. I love Afrezza, but I also have some issues with it.

Afrezza 4 unit dose is equal to 3 units or 2/12 as an aggressive dose. You can manually pull apart the tiny cartridge and divide it in half for smaller doses although you won’t be exact. You save used cartridges to do that and there’s videos done online by people to show you how. Afrezza is supposed to be more forgiving on dosing. But I know I ate a cookie once with a dose and I started dropping before the cookie hit. Most of the time it’s been fine but I believe some people even take it after they eat because it works so fast on them.

Honestly I would get some to start experimenting with how it works on you so you know before you totally switch.

I love it because I can use it when I eat. So going to potlucks, spontaneously getting something to eat and it works great. More of it works faster too, so that’s great. But if I took a lot for a higher carb meal, it’s almost like I have to retake a third/half the amount in a bolus later. About 2 hours later my BG starts to climb. Even if it’s not a higher fat meal. It’s possible I have a slower digestive system, but that doesn’t explain that it’s extra insulin than if I just took my regular insulin through a pump. But it does go through the system and is gone faster than other insulins.

I react to all sorts of drugs and have allergies, I am the only one I know of that has had this happen. If I start using it a lot, it starts to change my system, I need less insulin at night and then get a larger DP effect in the am and it doesn’t work as well. So if I just use it off and on and make sure I skip days, I’m fine.

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I like Afreeza too. I use Tresiba and Novolog, but will use Afreeza if my BG starts to climb for some unknown reason and I want to bring it down quickly. I have only used the 4 unit dose which acts like about 2 1/2 units of Novolog. One package of Afrezza lasts me several months, but I would hate to be without it.

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