Educational content related to inhaled insulin is made possible with support from MannKind, and editorial control rests solely on TCOYD. Please consult your healthcare team before making any changes to your diabetes care regimen.
If there was a magic pill to combat post-meal blood sugar spikes, I’d be first in line to buy it. Unfortunately, we don’t have magic pills, but we do have a variety of tools we can use to help mitigate post-meal spikes. For people living with type 2 diabetes, healthcare providers (myself included) often recommend taking a walk after a meal if your numbers are stubbornly high, but that’s just not always possible or realistic (especially if you live in North Dakota in January). However, there’s an underutilized, injection-free way for adults to combat high blood sugars quickly and efficiently – with an inhaled insulin called Afrezza (insulin human) Inhalation Powder.
What Is Afrezza?
Afrezza is a man-made rapid-acting inhaled insulin powder you breathe in through your lungs through a small inhaling device, almost like an asthma inhaler. Afrezza can be a valuable and convenient addition to many type 1 and type 2 diabetes regimens, as it is used to control high blood sugar in adults living with diabetes. People who have chronic lung disease–such as asthma or COPD – shouldn’t use Afrezza, and it’s not for use by smokers.
How Is Inhaled Insulin Beneficial for People with Type 2?
A lot of people with type 2 diabetes have concerns about using insulin. Some don’t like the idea of injections, others are concerned about hypoglycemia (low blood sugar), and some people think they’ve “failed” if they have to start insulin. Inhaled insulin is a convenient option, and it gets out of your system quickly (within 1.5-3 hours, for the 4- and 12- unit cartridges, respectively). So depending on your dose, you may be less likely to go too low.
As with all insulins though, Afrezza does have a risk of hypoglycemia, which can be serious. It is important to recognize the symptoms and know what to do if it occurs. Cough and sore throat are other common side effects, and I find that if you take a sip a water before and after your dose, this can help.
Also, (this is important!) transitioning to insulin does not represent a failure on your part! (Read that sentence twice if you need to). Diabetes is a progressive disease, and at least one-third of people with type 2 will eventually need insulin. Insulin helps you to control your blood sugars better, which is a good thing. If you have type 2 and you just found out you need insulin, welcome to the club!
How Does Inhaled Insulin work?
A small insulin cartridge is loaded into the inhaler device, and you breathe the insulin in through your mouth. The insulin kicks in within about 12 minutes, has its peak effect in about 45 minutes, and is out of your system within 1.5 to 3 hours, for the 4- and 12-unit cartridges respectively. Because Afrezza starts working quickly and wears off quickly, you can take it when you start eating. The rapid on/rapid off effects help control blood sugar, and can potentially help keep you within your target range.
How Do You Dose with Afrezza?
Afrezza comes in color-coded single dose cartridges containing either 4 units (blue), 8 units (green), or 12 units (yellow) of inhaled insulin. It should be noted that the units of inhaled insulin may not correlate exactly with the units of traditional injectable insulin. If you are prescribed inhaled insulin, you should work closely with your doctor to determine which dose is right for you. A very helpful step-by-step guide on dosing guide can be found here.
When Should You Take Afrezza?
Afrezza should be taken immediately before a meal since it works so quickly. Depending on the macronutrient content of the meal, you may need a follow-on dose if, after an hour and a half, your blood sugars are still high. Using a continuous glucose monitor can make tracking your blood sugar a lot easier. If you’re not on a CGM, you should test frequently when first trying Afrezza to learn how it affects you.
Is Inhaled Insulin safe?
With Afrezza, the most common side effects are hypoglycemia, cough, and sore throat. In the clinical studies, the cough was mild and typically declined with continued use after 1-4 weeks. If you develop a persistent or recurring cough, or have breathing difficulties while using Afrezza, contact your doctor.
As with most medications, there are some people who should not use Afrezza, including anyone with long-term, chronic lung problems such as asthma or COPD. And Afrezza is also not recommended for people who smoke or have recently stopped smoking.
According to clinical trial data, a small decrease in lung function was reported in some patients. Your doctor should order a baseline test called spirometry to check your lung function before you start this medication, six months after you start using it, and yearly after that.
How to Get Afrezza
If your healthcare provider determines that you are a good candidate for Afrezza, he or she will write you a prescription.
Afrezza is available at your local retail pharmacy, as well as specialty and mail-order pharmacies. However, MannKind partners closely with UBC pharmacy, so the Afrezza Assist team can help navigate insurance benefits and provide support if you have your doctor’s office send your prescription there.
UBC Pharmacy in St Louis, MO (UBC Pharmacy LLC)
4700 N Hanley Rd Ste B
Saint Louis, MO 63134
Work with the pharmacy and/or insurance company to determine your coverage and what your out-of-pocket costs will be. You can also contact MannKind’s support team at afrezzaassist.com, and they will help you navigate coverage and costs. You can learn more about getting Afrezza here.
Although it has been a century since insulin was discovered, inhaled insulin is still relatively new. Afrezza is a great option for people who want a faster-acting mealtime insulin with less injections. In my opinion, Afrezza is underutilized in type 2 diabetes. A lot of doctors don’t know even about it, so you may want to bring this article with you to your next appointment!
Important Safety Information
What is the most important information I should know about AFREZZA?
AFREZZA can cause serious side effects, including:
- Sudden lung problems (bronchospasms). Do not use AFREZZA if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting AFREZZA, your healthcare provider will give you a breathing test to check how your lungs are working.
What is AFREZZA?
- AFREZZA is a man-made insulin that is breathed- in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus.
- AFREZZA is not for use in place of long-acting insulin. AFREZZA must be used with long-acting insulin in people who have type 1 diabetes mellitus.
- AFREZZA is not for use to treat diabetic ketoacidosis.
- It is not known if AFREZZA is safe and effective for use in people who smoke. AFREZZA is not for use in people who smoke or have recently stopped smoking (less than 6 months).
- It is not known if AFREZZA is safe and effective in children under 18 years of age.
What should I tell my healthcare provider before using AFREZZA?
Before using AFREZZA, tell your healthcare provider about all your medical conditions, including if you:
- Have lung problems such as asthma or COPD
- Have or have had lung cancer
- Are using any inhaled medications
- Smoke or have recently stopped smoking
- Have kidney or liver problems
- Are pregnant, planning to become pregnant, or are breastfeeding. AFREZZA may harm your unborn or breastfeeding baby.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements.
Before you start using AFREZZA, talk to your healthcare provider about low blood sugar and how to manage it.
What should I avoid while using AFREZZA?
While using AFREZZA do not:
- Drive or operate heavy machinery, until you know how AFREZZA affects you
- Drink alcohol or use over-the-counter medicines that contain alcohol
Do not use AFREZZA if you:
- Have chronic lung problems such as asthma or COPD
- Are allergic to regular human insulin or any of the ingredients in AFREZZA.
What are the possible side effects of AFREZZA?
AFREZZA may cause serious side effects that can lead to death, including:
See “What is the most important information I should know about AFREZZA?”
Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:
- Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.
Decreased lung function. Your healthcare provider should check how your lungs are working before you start using AFREZZA, 6 months after you start using it, and yearly after that.
Lung cancer. In studies of AFREZZA in people with diabetes, lung cancer occurred in a few more people who were taking AFREZZA than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to AFREZZA. If you have lung cancer, you and your healthcare provider should decide if you should use AFREZZA.
Diabetic ketoacidosis. Talk to your healthcare provider if you have an illness. Your AFREZZA dose or how often you check your blood sugar may need to be changed.
Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:
- A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.
Low potassium in your blood (hypokalemia).
Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with AFREZZA may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with AFREZZA. Your healthcare provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your healthcare provider if you have any new or worse symptoms of heart failure including:
- Shortness of breath, swelling of your ankles or feet, sudden weight gain.
Get emergency medical help if you have:
- Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.
The most common side effects of AFREZZA include:
- Low blood sugar (hypoglycemia), cough, sore throat
These are not all the possible side effects of AFREZZA. Call your doctor for medical advice about side effects.