Type 2 - Started Afrezza Last Week

I know there are two other T1s here that are taking Afrezza, but I thought for those of you who don't frequent Reddit, Mnkd boards, or Twitter where I post most often that I would make a thread here. Note, that I do not have a CGM :(.

My history is this. Age 28, 5-11, 198lbs. Diagnosed at age 13ish after taking Prednisone for many years for a chronic liver disease. Started insulin therapy due to contradictions for liver disease with the oral meds. I used insulin 1-2 years. Once I stopped the Prednisone, I lost a lot of weight, and no longer needed treatment until last year when typical diabetes symptoms started to show. Against my doctors advice when I was a teen, I started Janumet and Glimepiride for a few months, then stopped due to a hypersensitivity reaction. I am now using Lantus, Humalog, and Afrezza.

My first issue with Afrezza was the cough. I did suffer asthma as a child/teen, but I grew out of it, so to speak. I passed my FEV1 fine, and was prescribed Afrezza the day after. Upon my first inhalation, I coughed quite a few times intermittently over 15 minutes or so. It also made my airway feel slightly constricted, but it wasn't bad enough to need my inhaler that I keep around, that I haven't used in 7+ years.

This issue continued until about 3 days ago. Since then I have had no problems, even after taking 5 cartridges at once.

I am very insulin resistant. I haven't been on insulin long, but my Dr. was comfortable letting me dose myself and report back to him due to my diabetes knowledge, so I discovered that my I:C is 1:4 on average. This number holds true on Afrezza as well. In fact, it might be 1:3 on afrezza, just depending on the meal.

I find that Afrezza controls my levels well the first 2 hours, but at hour 3 I always get a spike. I assume that this is the fat/protein breaking down into glucose at this point that is causing the spike. I will be trying a technique of dosing 15 mins post meal, then again at 2 hours to see if I can mitigate the spike going forward.

If any of you would like to follow my progress, feel free to check my blog https://afrezzapat.wordpress.com, or my twitter @PatOppa. I will also be posting in this thread obviously :).

I hope to be able to provide as much insightful information that I can for you all regarding someone who is very insulin resistant and T2, who eats a moderate carb diet (even though the last week doesn't show that bc I've been testing a lot to see what I can get away with ;))

Disclaimer: I am not a MNKD or SNY investor, but I may throw $500 of MNKD in my pitiful RothIRA before April 15.

I saw someone in Mike's thread ask about the Spriometry cost. This is what is on my Health Insurance website regarding it.

58-spiro.jpg (88.4 KB)


Hi pat, welcome. 2 questions–

Is the 3rd hour spike new with afrezza? Did you have this trend with humalog?

Can you describe some of the typical meals you are seeing this trend with?

I ask because I’m concerned I’ll have the same patterns when I start next week but am confident an effective approach can be found.

Well, I can't give you any real accuracy with the Humalog question I just restarted insulin therapy 10 days ago, after being off it for nearly 10 years. What I can tell you from limited data is that I haven't seen this issue as often on either Novolog or Humalog which I have used at some meals while getting my Rx's straight over the last 10 days.

I also can't be fully accurate on whether it happens every meal with Afrezza or not, due to the fact, that again I was getting my Rx dosing straight, and my Dr. only gave me a single 4U box to start. So, I was conserving Afrezza for more tricky situations like a Double Cheeseburger and fries, or something that in the past would shoot me up really fast. Afrezza took care of that spike I would normally get in the first hour or so with no issue whatsoever.

Today I'm getting 2 boxes of 4&8U, so I'll be able to use the product more often and try to figure out what works best for me to stop that spike at 3 hours.

I'd like to add (nothing you haven't thought about, Sam, I'm sure) that the issue here is quite manageable.

We're dealing with a protocol issue here, not something inherently unworkable about Afrezza. The initial labeling is very simplistic.

Think about it like this: Replacing your pump, and the way you used to use it, with Afrezza. Don't know about you all, but I'm giving myself corrections all the time -- what I mean is, it's not unusual at all to be administering insulin in between meals.

The protocol with Afrezza looks to be similar, it's just not currently a part of the "official" use model. Or more accurately, not a part of the official bolus model. However, corrections are a part of the protocol, which are off-meal, so in large part we're really getting lost in a semantic discussion with little practical differences.

To illustrate: Following Mannkind's labeled protocol, I dose at mealtime, based on the carbs. Works pretty good, but 2 hours out my BG starts rising, and peaks around 3 hours out. I issue a correction according to the labeled protocol. BG comes down, all is good.

Now, take the same scenario, but add that I've eaten this mix of food and quantity many times before, and I know that 3 hour peak is coming AFTER the carbs have been covered. So, instead of waiting until I peak at 180 or something, I go ahead and toot a cartridge at the 2 1/2 mark to get ahead of it. I cap the peak at 130-140, and all is good. I play my harmonica.

So what's the difference in these two scenarios? Insofar as Afrezza is concerned, nothing. Same total amount, delivered with very similar timing. The only difference is that I engaged my brain and administered it smarter, rather than being a robot saluting Mannkind and following their instructions to the letter. In the end, the drug administration, and end result, is almost the same -- just that the brain-engaged approach yeilds superior results.

Yeah you're right dave... one thing I actually did when I was first learning was to draw out my own post prandial glucose graphs and overlay them to an inverted graph of the novolog absorption rates... then try to tweak them "fore and aft" until they cancel out to as close as possible to a flat line--- It's remarkably effective when evaluating timing.

I have to eat A LOT of protein and fat in order to get enough calories. Reading Terry's post about what he ate... well he eats like a squirrel compared to me. I'd starve to death eating like that. Mike seems to eat a lot less protein/fat and substantially more simple carbs than I do. I'm 6'2 and 170 lbs and even eating like a horse have a hard time keeping weight on without a buttload of carbs.... So I think I may have to tweak the timing protocol, and maybe my diet in general, for myself. I'm still striving for simplicity. Simple doesn't have to mean limited, it just means I don't want to have to play by 100 different rules.

I said earlier to Terry that he wants one more club in his golf bag, while I want to play the whole game, and play it well, with just a 4 and an 8 iron...

I thought some here might be interested in Afrezza's pricing, so I'll post this here. It's also on my twitter.

I too think this is a great point. Being that I haven't done prandial injections until recently, I was unaware of the need to constantly correct. This is one reason that I need a Dexcom, and I am seriously considering paying out of pocket for it because I know my insurance won't for a Type 2 with very few hypo issues.

Since I got my 4&8U boxes today, i will be testing over the weekend to see if this 15 mins after, then 2-2.5 hours after moderate carb/higer protein fat meals will work best for me. I will certainly report back with results.

I just ate roughly 2 cups of cooked spaghetti in meat sauce, and a cutie (hybrid mandarin orange). I took 16U of Afrezza 15 minutes after the last bite.

Start: 103
30 mins: 144
1hr: 114

It's pasta, so I'm expecting a rise at some point. So I'm gonna take another 8U at 2hrs in to try to mitigate it.

1.5hr - 109.

I know it's going to rise. It always does.. I think I'm going to dose again in 30 minutes even if I'm at 100.

2hr - 117

Took 8U more of Afrezza.

be careful making assumptions based on past experience with different insulins....

this is based on my experience with Afrezza over the last week.

If it was Humalog, I wouldn't be concerned with the rise because it hasn't happened with pasta.

2.5 hours, after the 8U more of Afrezza I'm at 104 :D

This is my graph after eating 2cups of whole grain spaghetti and meat sauce, with a cutie after. I dosed 16U 15 mins after the last bite, and another 8U at the 2hr after last bite mark.

Hard to argue with results like that

yeah, just takes like 4x the insulin for me than it does for Sprio, and some the other T1s, but that's ok. It might help my resistance in the long run. We shall see.

Re any insulin lowering insulin resistance, this is actually a well-understood phenomenon, not actually caused by the specific insulin used or even by using insulin.

It turns out there are two kinds of insulin resistance. One is genetic. It can be inborn and inherited, or caused by exposure to many environmental toxins like some plastics, PCBs, or drugs like SSRI antidepressants, The other is caused by having high blood sugars. If a person can drop their blood sugars below a certain threshold, all the time, they will lose that second kind of insulin resistance.

You can do this simply by cutting carbs until your blood sugars after meals are always under 140 mg/dl. I hear from lots of people who have done this and it works beautifully. I do it myself.

But if you let your blood sugar go over some level, somewhere between 170 and 200 mg/dl, you will develop that secondary insulin resistance.

There is no magic in Afrezza that is lowering insulin resistance for Sam Finta, who has been posting about this on twitter, it is just that he is no longer way out of control the way he was before.

People who are using pumps, diet, and MDI in ways that are giving them very tight control don't have that secondary insulin resistance and probably won't see a change in their insulin resistance.

People who have genetic insulin resistance probably won't see a dramatic decline in their fundamental IR either, though they will lose that second level IR that is caused by the high blood sugars.

Jenny, I've read many places (but have no peer-reviewed research, although I confess I haven't looked hard) that there is a growing belief that mild insulinemia -- the kind T2's with insulin resistance have all the time with the long tail of fast-actings -- contributes to IR as well.

Then there is the hunger/weight gain issue with chronic high insulin levels.

Afrezza has the potential to eliminate both of these problems with its fast clearance. The hunger issue is one of the reasons I'm excited about giving it a try... I'm soooooooo tired of feeling hungry 3 hours after eating, and still feeling full. Only have a problem with this about 20% of the time, but it's a real stressor to have bolused properly, eaten, watch BG go from 80 to 130, then have hunger picking at you feeling full, staring at the 130, knowing you can't really eat anything nor need to, but your body's insisting.

I never give in, so that's not the issue. Rather, it's just the unpleasantness and stress of the situation that will be so nice to have gone -- if it does go away.