I was diagnosed with type 1 diabetes about a month before my junior year of college, and it really shook up my life. Over the last eight years I’ve become much more conscious about my health and fitness, and I’m constantly searching for new tips and tricks about how I can manage my diabetes most effectively.
If you have been following me on Instagram (@icedcoffeeandinsulin), you may have seen me talk about Afrezza. Now, what is inhaled insulin, and how can it become a part of your diabetes routine?
According to their website, Afrezza is “the only ultra rapid-acting inhaled insulin that delivers glucoses management in the moment for adults living with type 1 or type 2 diabetes.” Here’s a brief overview of how it works:
Here Are a Few Key Highlights of the Insulin:
- It’s inhaled, not injected.
- It’s fast-acting insulin (an alternative to Novalog/Humalog).
- It works instantly, so it can be taken immediately at the start of eating a meal/snacks.
- It only comes in 4 unit, 8 unit, and 12 unit cartridges…BUT it’s important to note that these units do not equal what you would dose for Novalog and Humalog. For example: 4 units of Afrezza = 2.5 units of Novalog, 8 units of Afrezza = 4 units of Novalog.
- The cartridges are placed in a chamber within the small inhaler, and then inhaled through the mouth.
How Do I Use Afrezza in My Insulin Regimen?
I used Afrezza when I was on an Omnipod (from February 2018 – November 2018) as well as with [MDI] Multiple Daily Injections (November 2018 – Present).
When I was on a pump, I was using Afrezza in specific situations. If I was eating a high-carb meal or having a stubborn high blood sugar, I would use the Afrezza to complement the Novalog corrections on the Omnipod.
Before Afrezza, I was finding myself stuck in the 200s, and constantly adding more and more Novalog to lower my blood sugar. This was where I was running into problems with correcting with Novalog. It would either…
- Not work AT ALL
- Work slowly, stay in my body for so long that I couldn’t work out/do physical activity for hours without crashing
I would continue to correct and correct, stacking my insulin until I saw some change in blood sugar, and then I would be in a downward spiral of lows, correcting, etc. I was so frustrated, and my endo recommended Afrezza as a solution. From there, Afrezza has changed everything for me.
It worked quickly and efficiently. I had never seen my blood sugar fall so quickly, and it was in and out of my system so fast that I never experienced dangerous lows. The insulin covered what it needed, and it was out of my body soon. It immediately corrected stubborn highs and in instances where I was about to eat a high-carb meal.
Soon I was using Afrezza as my only form of fast-acting insulin. I was only using my pump for the basal settings (constant flow of insulin throughout the day) and relying on Afrezza for my bolus (fast-acting insulin used for meal-time, corrections, etc.).
My success with Afrezza was one of the key reasons that I decided to go off of my insulin pump and return to MDI. Because of how I was using Afrezza, there was no point (in my opinion) to have a pump latched on my arm for strictly basal settings.
Currently, I am on multiple daily injections. I use Afrezza for all of my fast-acting insulin needs, and Lantus (split dosage twice a day) for my long-acting needs. I am currently in the process of changing from Lantus to Tresiba, which I have heard works better (with less insulin).
If you are considering Afrezza as an option within your current insulin regimen, I strongly suggest connecting with your endocrinologist to discuss how it would benefit you and your routine. If you are still wondering more, here are my top pros and cons of Afrezza:
Pros:
- Less injections. I only take two injections per day (two doses of Lantus).
- It looks like an inhaler, so it’s not this daunting needle that you have to pull out.
- The inhaler is so small, the “embarrassment” factor goes away here. People think it’s an inhaler for asthma, and even a type of vape or tobacco pen! Haha!
- It’s FAST. I have never had to “insulin stack” with Afrezza. I take the puff and know that my BS will go down.
Cons:
- It’s expensive. I currently have a copay of $50 for a 3-month supply (which is pennies for other medicines), but it will depend on the type of insurance that you have. Many insurances don’t cover it.
- You have to inhale it properly, or it won’t work. You have to inhale the insulin at a specific angle for the insulin to properly go through your system. If I’m rushing, the insulin doesn’t go into my system and I have to redo it.
- You have to take double dosages for super high-carb meals. Because the insulin works so rapidly and is in and out of the body in a short amount of time, I find myself having to take an initial Afrezza dose, and then taking a second dose 30 minutes to an hour later. This isn’t necessarily a “con” but it’s something to think about.
In conclusion, I would highly recommend Afrezza. If you are experiencing difficulties with stubborn highs and find yourself “stacking” your bolus to correct, Afrezza might be the perfect solution for you. Bring it up at your next endocrinology appointment!
Additional Resources:
Inhaled Insulin: If You’re Too High, Take a Hit of This!
Inhaled Insulin Afrezza: An Underutilized Treatment in the Type 2 Toolbox
Strike the Spike: Controlling Blood Sugars After Eating
Facebook Live: Rapid-Acting Insulins
I am doing essentially the same with Tresiba as my all-day single base.
I have all of your same experiences. (!!)
My Medicare-D plan does not cover Afrezza, so I’m paying about $99/month.
My A1C has dropped from 6.5 to 6.1 with the extra precision I am now getting.
I wish I knew when that extra dose was required- so I could plan for it.
The best way to determine if you need a follow on dose of Afrezza is to have a CGM and set your upper limit at 150, that way you catch it early. If you do not have a CGM, testing your blood sugar two hours after eating may be a less effective substitute, but will help.
I have a CGM. I find that I use lots of 4u doses, and almost never an 8u. I sure wish I could buy them as needed instead of on some allocated monthly basis. I am not sure I need any 8u doses at all because I could use 2 x 4u doses if 8u was needed.
Out of curiosity – have you been type 1 for more than 20 years? Are you using a pump? I find the 4u doesn’t cover much for me – I used one box of 4 and 8 in just one week. The 8 and 12 seem to work best for me – But I have never used Pump and I am only three days into Tresiba for which I am hoping to see more flat lines on my G6 😉 But curious if the 4 vs 12 diff??
On Afrezza now for three months but still finding food combos for which I need to learn how to stack doses. So easy and effective I don’t mind watching G6 rise, then dosing. I have found if I try and pretreat – like with the yummy TJ Falafel balls which have carbs but high protein too- I got too low. When I watched and treated after the rise started I was then able to dial in the right dose. Great idea to set upper limit for 150 not the typical 180. Seems to simple but great ideas often are! Thanks for sharing.
Mmmm falafel! Thanks for sharing what worked for you!
Thank you for sharing this article. I have been wondering about it and I wasn’t sure how it worked. I was curious about precision – such as a fast acting .5 unit due to correction. It seems challenging to inhale a half unit which I often do before bed or in the mornings on my pump. I understand I should speak with my Endocronologist however I was wondering how you manage small adjustments with the inhaler. Thank you again – always good to hear about new products!!
If you are truly that sensitive to half a unit of insulin, then you cannot use Afrezza in those situations. However, if there are situations where your blood sugar is extremely high or you’re going to eat a rapid-acting carb, then Afrezza may be helpful.
So delighted to hear your report of Afrezza and Tresiba. I am on the same journey. Just started first dose of Tresiba today. 39 years T1D – 19 when diagnosed – back in the Bovine Insulin era. Every time my A1C control has improved it came with new therapies. The first game changer was Humalog when my A1C left the teens and came down nines. I was not built to be a good diabetic – my schedule is too erratic. Thankfully I have been blessed with good health. Never in my long crust diabetic injections career have I touch a 6 A1C. Two months ago I left the Humalog inconsistent response trail and am now using Afrezza. I am so happy with my Afrezza response time. My Dexcom doesn’t lie. Amazingly I have dropped my A1C one point! The first time ever 7.2. I expect the A1C to lower with the Tresiba given the Lantus won’t hold my BS level. I am grateful for TCOYD education. None of these therapies were offered to me by my physicians. I have had to do my own research, make connections for co-pay cards and work on appealing insurance. WE have to be trend setters. There is no one therapy the insurances should be able to control therapies for all T1D and I will work hard to be a voice for what is right for my body. Again – a G6 does not lie. Thanks again for your article.
Thank you for sharing your story and experience, Janna!
I have been using Afrezza for several years in conjunction with my pump. I have had Type 1 for 64 years. I primarily use Afrezza for high BG correction but also use it at high carb meals. An important trick I learned was that as soon as you open the cartridge blister 3 pack, Afrezza starts absorbing water. If exposed more than a couple of days, the powder expands making it too large to fit inside your avioli in your lungs where is gets into your bloodstream. Obviously it doesn’t work then. Very dismaying.
My solution was to use an airtight pill container with a small silica-gel pack (3 gram) that will absorb water. These packs are inexpensive, available online, and are re-usable. This extends the Afrezza lifetime considerably and makes its performance much more consistent. Afrezza is my high BG savior. There is nothing else on the market like it for rapid BG recovery. If you are on a CGM, you will be amazed how rapidly you recover then flatten out without IOB effects. Go for it!
I’ve never heard of that theory from Mannkind (the makers of Afrezza) or anyone else. If it works for you, then great.
Hallo Steve,
I actually got corroboration directly from a couple of Mannkind reps who will remain anonymous. Afrezza powder is about 4.5-4.8 microns in diameter. The maximum size of powder that will fit into the avioli is about 5.3 microns. Mannkind sets a 3 day limit on an open blister pack since they know the powder will expand past that limit due to moisture absorption.
I am sure that you have occasionally had an Afrezza dose that simply didn’t seem to work. Expansion might just be the culprit, although there are a plethora of other reasons as well.
I have actually opened a pack, immediately placed it into my silica-gel container, then waited 10 days (their other limit of how long out of the refrigerator). This Afrezza still worked as prescribed!
Many users quickly use their packs up within 3 days thus this wouldn’t affect them. Nevertheless. I consistently use my “dry box” approach and Afrezza performance has been excellent. I can’t argue with success! All the best, Jack
That’s great – so glad it works for you!
Much good info here. I’ve had type 1 for 50 years and see great benefit in using Afr as a “quick correct” medication. As we all know, there are times when we fall asleep, forget our insulin at home, or order a “diet drink” and get a reading in the 300’s after we realize it wasn’t diet. Has happened to me MANY times…
I’ve been insulin dependent for almost 50 years. This sounds like a fantastic therapy. Can anyone tell me how long it takes for you to prep and use this device/system? What’s the protocol in the case of coughing during inhalation?
It’s really easy to use. The Afrezza website (https://afrezza.com) has great instructions and information, and we have two videos on our website that will help you as well:
https://tcoyd.org/edelman-report/
Inhaled Insulin and How to Use Afrezza and Save on Insulin
Also, our next free virtual conference is on May 1st, and you can speak directly with a MannKind/Afrezza rep in our health fair that day if you have more questions.
Hello John, I an a 39 year Type1. LOVE to meet those “carrying on” even longer than I have. I know about heading out with friends to eat and no syringe etc. I do not use a pump. If you are asking about actual breathing in the insulin? Just second. A nice slow suck in and hold to about count of 5, I find lets the “dust” settle. When I have coughed and see a huge cloud of dust – I have taken an additional dose. It is so helpful with the CGM – to see the quick response – I now watch and see what is happening – I don’t try to dose perfectly because it is so easy to dose more. I don’t want to get low but it’s a learning curve for me with different foods. Watching the quick response of my BS to a dose is the most amazing thing I have seen in 39 years of diabetes – I AM IN LOVE with this Insulin which is providing me life 😉 I am using a small tin – about the size for Altoid which holds the inhaler and about a days worth of cartridges – so easy to tuck in my pocket and head out for a busy day! I’d be happy to post a photo on the TCOYD T1 Facebook page if you would like to see my tin. I hope you get to add this to your routine – and honestly – get rid of Humalog and just use Afrezza – I am completely happy with the results. My A1C dropped 1pt after two months of use. For a crusty old diabetic who has never been below an 8 in control – it was EPIC to see!!!
Is it available now?
Yes Afrezza is available. You’ll need to get a prescription from your doctor.
So, is anyone using Tandem IQ control with Afrezza?
Yes, people do use those together.
So happy to have found this forum. I am just getting ready to start using Afrezza but just read that you can not drink alcohol when using Afrezza. I enjoy a glass of wine with my meal or out with friends on the weekend. Can anyone tell me why you can not drink while using? Has anyone found a work around…maybe injecting insulin if I want a glass of wine? Any suggestions would be appreciated.Thanks!
There is absolutely no reason why you can’t drink and take Afrezza, assuming you’re over 21! That is the craziest thing I’ve heard all day! Cheers!
Haha! Great news! I wondered why my MD failed to mention that little tidbit! Thanks! Cheers!
🍻
I am a teetotaler myself but couldn’t imagine an negative interaction. T1 41 years – I have been using Afrezza as my only short acting since November of 2021. I learned about Afrezza at the last live TCOYD conference February of 2020. Washington State did not have a Mannkind Afrezza representative until fall of 2021. I made a connection with the rep through a Zoom TCOYD Healthcare networking chat room. Paul Hansen has been crucial to my getting Afrezza approved by Kaiser WA and educating my Endo as I am the first in the practise to use Afrezza full time. I went from a 9A1c to my latest of 6.6 ;-)) I am also on Ozempic for the past 6 months – per Dr’s E&P wonderful “smack down” I provided for my Endo to watch and other TCOYD vault T1 new meds training. I will note that without my Dexcom G6 it would be difficult to dose with Afrezza, it is so quick. I need to watch arrows carefully. With the Ozempic slowing my digestion, I note that some carbs need dosing up to 1/2 hour after I start eating but the response of Afrezza is predictable and swift. I LOVE it. Make a connection with your local Afrezza rep who can walk you through things like Alcohol interaction myths to making sure your insurance approves you for Afrezza as part of your Diabetes care!! Contact Afrezza Assist for an introduction to your local rep. Often you can meet them at the Mannkind desk during the Zoom TCOYD conference. You will note many reps are T1 and very experienced. Best Wishes!!
Great advice, Janna! Thank you for sharing your personal experience!
Thanks, I get a little wordy – but I am so excited about Afrezza. I pull out my box and show my cache at every medical appointment to spread the word. For example – my Retinal Specialist sees so many diabetics – so I make sure she knows about Afrezza AND TCOYD resources!! I might need to print more marketing materials 😉
Haha! That’s awesome, Janna!
Thanks Janna for all your insight! Have you had any problems with losing potency? How do you store your Afrezza? I had been using Symlin but ran in to BS rise over 2 hours after meals. I will speak with my Dr about possibly adding that back now that I can quickly bring it back down.
Any breathing difficulties? It’s so helpful to connect with people who have some experience with Afrezza because it’s so new.
Much appreciation!
-Michelle