Just an update. After using the above technique, my 7 day average is now 117 (with no significant hypos.) If I can keep this up, then in 3 months I will have the lowest A1c in my diabetic life! It's like an answer to years of prayers!
Awesome. Happy to hear it I’m having better results with less effort than ever before too.
My DD is no longer on an insulin pump, but if she did use one, this would make perfect sense. She has chosen to use Tresiba for her basal and Afrezza for her bolus insulin. She usually does need two doses of Afrezza, one dose immediately after eating and one dose one hour later. From years of pumping she knows how to bolus for most of her meals. High fat meals or slow digesting meals such as pasta, she inhales for half the carb count of the pasta one half hour after eating. She then will correct 2.5 hours after eating. She was high many times even on the pump with pasta, it’s problematic. Even though she knows how to bolus for the meals she eats, she always had to check blood sugar two hours after eating and correct with more insulin, leave alone or even give a few grams of carbs. Not much has changed, she just inhales one more time for the remainder of the meal. With Afrezza, though, unless the meal is pasta or very high fat, she takes the second dose (a 4 unit cartridge) one hour after the meal. It’s so much faster. The one thing I miss about the pump is the variable basal rates. Yes, she does have to correct highs from 6pm to 1am. These highs have more to do with the flat basal profile of Tresiba (while her basal needs increase 20% during this time period) than the action of Afrezza which, once you get the timing right, does work perfectly. I love how fast Afrezza corrects a high blood sugar. I would say your experience is the norm; most inhale twice for meals unless the meal is fast digesting such as fruit.
Timing is everything
But… this depends on whether you wear a cgms. Our DD won’t wear hers at the moment. So we have to go by what we know regarding the digestion of the types of meals she eats. The only saving grace about dosing with Afrezza without cgms is it is so darned fast, if high, the highs come down quickly. We cannot get the type of control you do because you cannot see the exact moment with blood sugar rises using fingersticks. But results are still very good for most meals dosing immediately after eating with a follow up dose in one hour, after a fingerstick to verify BS. Pasta has always been problematic. And we dose pretty much the same. Dosing for 50 percent of the carbs half hour after eating, and correcting 2.5 hours later. We know from years of testing her blood sugar will be slightly elevated two hours after pasta and high in 2.5 hours. Perhaps we could forestall the high by giving the second dose 2 hours after eating. But without cgms it’s risky. She still loves Afrezza. It gives her freedom. The main benefit is she is not constantly watching, waiting and calculating for insulin on board. She can eat 9pm if out with friends and does not have to stay up babysitting her sugars till 12. Can correct at 10pm, check at 10:30 and can pretty much know where she is, where she is going to be in a half hour and even go to bed at that point.
My DD is Type 1 and Afrezza is a full replacement for injected insulin, with the exception of one shot a day of Tresiba for basal. She does dose twice for each meal, almost always. But it’s no trouble to inhale; very easy for her to take a second dose. If she wore her pump, she could either inhale afrezza right after eating (15 minutes into a meal) and either dose for part of the meal through her pump. At which point she would always test two hours after eating to see where her blood sugar was. Or, she could test her blood sugar one hour after eating and take the second dose of Afrezza. At the two hour postprandial mark, her blood sugar would be normal on Afrezza, slightly higher on Apidra in the pump. So I would vote for dosing both times with Afrezza. But if she doesn’t want to be bothered to dose again use the pump with Afrezza. The dose with the pump would be before eating, though. She does carb count. I do consider the pump optimal for basal use as basal patterns vary throughout the day but it’s her choice.
A 4 unit cartridge drops DD 100 points, sometimes 80 but that is only for correction of a high blood sugar. But if giving a 4 unit cartridge for a meal she needs to eat 20 grams of carbs not to go low. Her insulin to carb ratio is 1 to 7. It seems the ICR is not so different. But she needs a lot more Afrezza for correction. Since it is so fast, working within an hour to 80 minutes, it would help with quick spikes after eating. So it seems like it would be perfect for those who don’t have first phase insulin secretion. If you slowly secrete insulin over the following hours, no second dose of Afrezza would be necessary. But I don’t think they have done studies on MODY. I might wait until they have a two unit cartridge if I was insulin sensitive and test then.
so this it that, insulin u inhaled, very cool, after reading everthing on here about,.