For weeks I tried to "live on" Afrezza and use my pump for basal only. I eventually gave up. I must burn it up quickly or something because I was constantly giving correction doses. I'd be good for the first hour, then go higher and have to correct, then sometimes even have to correct again at hour two. It was way too much watching the clock, watching the CGM, and inhaling.
I still wanted to use Afrezza for the purpose of keeping my blood sugar low right after I eat instead of spiking like I usually do. So I've been experimenting with various ways of using Afrezza WITH my pump insulin. So far, my most successful technique has been to count my carbs and compute the pump dose that I would normally give, and then subtract from that dose 1 unit for a 4U Afrezza or 2 units for an 8U Afrezza. I give both the Afrezza and the pump dose at the same time (around the start of my meal.) I'm still experimenting, but results have been VERY promising. No early spikes, and maybe a small spike (like 130's) at hour 2 or 3 that goes down quickly on its own.
It seems that by the time the Afrezza is all done working, the "rapid acting" is kicking in.
Just thought I'd share in case someone else is getting frustrated with Afrezza like I was.
Just to add some background, I'm type 1, take 1 unit rapid acting per 15 carbs, and correction factor is 1 unit insulin lowers 100 points. (So pretty insulin sensitive.)
Nice!!! I haven't had the same issues you describe on a regular basis, but everyone is different. Keep us updated on your experimentation and be careful!!!
I went through a week of trying to be on afrezza 100% and use no novolog but my experience has been the same as you describe. Inhaling 10 minutes into meal, then another hour later, and then another one hour later gives me amazing results but that is a lot of maintenance for just one meal! I can get really great numbers but it takes so many alarms in my phone I was starting to think - is this sustainable?
Just yesterday I started to use it as you describe and my results so far have been very good. I was and still am concerned about causing hypo from having both going at once, but so far my one hour after eating results have been in the 80 - 100 range and stabilize nicely. I have struggled with spikes post-meals my whole life so even though I haven't have the wonderful success that other have had I am still very hopeful about using afrezza to improve my control.
Very interesting. So when you used the 4U Afrezza, it acted the way 1u of a bolus would have worked had you given it enough before eating for it to be active within that first hour?
I'm still trying to figure out how this would work for insulin sensitive people with versions of MODY where they don't have any first-phase insulin secretion but might still secrete slowly over the following hours.
Hard to say. I had spikes after eating even when prebolusing as much as 30 minutes. I just couldn't get rid of them! But I can tell you that a 4U inhale drops me 100 points, just like 1 unit of Novolog would. So unless they come up with lower dosages, I won't correct with afrezza unless I'm at least 180.
I haven’t had that problem but have been getting better and better results with afrezza the longer I wait after eating to inhale the afrezza… Timing will vary for everyone but I think it’s the biggest piece of the puzzle with afrezza…
If I took it at the start of meals I don’t think I’d be having good results.
For me, waiting just produces big spikes. I did try it many times. Apparently, I'm very good at making spikes, even in the first 15 minutes after eating. :-)
I'm stilling inhaling Afrezza at the meal start and have not had any early hypos after eating. I am seeing the need to add a second meal dose about 60-90 minutes after eating. Maybe I should consider taking both doses at the start to of the meal.
I also prebolus an extended pump dose based on protein/fat content of the meal. I only intend for Afrezza to deal with the carb metabolism.
I wonder if your high sensitivity is resulting in insulin receptor saturation from the Afrezza so that excess is not metabolically active, but just gets cleared? According to Mannkind's data, 70% of the insulin in Afrezza gets cleared the first time through the liver.
In any case, it's not too surprising that, as a T1, you're encountering some issues with later spikes. As you likely know, fat and protein in a meal won't affect BG for 3-6 hours after eating. Afrezza taken at mealtime won't help with that.
In fact, for a T1 (which IIRC is off-label for Afrezza at present FDA approval) I would be surprised if late rise, requiring correction doses of Afrezza, didn't happen (without some sort of simulation of second phase insulin response).
For T1s, Afrezza probably won't be a full replacement for short-acting unless someone is willing to check/correct several times in between meals.
Still, I can easily see how even this regimen would be preferable to many, vs. MDI or being attached to a pump (tubed or patch).
How many times do you think mikep and I have used injected bolus since starting Afrezza. I know for me it’s zero and it is for him too unless it’s changed since I talked to him last. Also-- I have not required one single post-meal correction thus far.
Yeah, I probably over-reached with the T1 and corrections comment. I had in mind the fact that T1 have no insulin production, so something's got to cover any late glucose well after the 90 minutes that Afrezza is effective.
What do you think is covering protein and fat in your case, since you haven't had to corrected after 3-4 hours postprandial?
All I can figure is I must still have enough natural insulin production to manage the modest load from protein… Or maybe I just don’t concert protein to glucose to the extent that some others do.
Dave, Thanks for your very kind words. I pretty much stopped posting anywhere back in 2009 when I was offered a three book contract by a big publisher. The books were novels and I write very slowly so I spent the next couple years doing nothing but writing. I had to conserve all my writing energy for that, and when the novels were done, I was so in book mode that I rewrote my diabetes book and then wrote the diet book. After that prolonged squawk, I have pretty much been hanging around trying to figure out what I want to do next.
And when I'm doing that, I end up back online, posting to forums.
