Ask Dr. E: How Do You Avoid the WAD (Wild Ass Guess) When Dosing Mealtime Insulin?

Rapid-Acting Insulin Afrezza Works Differently Than Injected Insulin

The reason why Afrezza works so well for kids (especially unpredictable eaters) is due to the time course of action. Subcutaneous insulin typically starts working in 15-30 minutes, reaches its peak in 1-3 hours, and doesn’t get out of your system for 3-5 hours.

Afrezza starts working in about 12 minutes, reaches its peak in about 45 minutes, and is out of your system in 1.5 to 3 hours. Since it starts working so quickly, you take it when you start eating.

What If You Don’t Know How Much Your Child Is Going to Eat?

That’s the million-dollar question for every parent!

With injected insulin, you have to make a WAD (wild-ass guess) about how much insulin to give your child 20 minutes or so before every meal. Since Afrezza starts working so quickly, you give it to them right when they start eating.

You can also give it to your son after he’s started eating. If you aren’t sure if he’s going to eat all his food, you can wait until he’s halfway through and then give him the dose. That way, you know he’s consumed enough calories to give him rapid-acting insulin without causing a low, and hopefully you have a better sense of how much he’s actually going to eat.

Another option is to give your son a small dose right when he starts eating, and when you know he’s going to finish his meal, you can give him a second dose. You don’t have to worry about stacking because Afrezza gets out of the system so quickly. 

Just make sure you discuss all dosing options and plans with your healthcare provider.

Dosing Afrezza Safely:

One of the biggest mistakes people make when they switch from injected insulin to Afrezza is assuming it’s a one-to-one swap. One unit of Afrezza does not equal one unit of injected insulin. 

Generally speaking, it’s one unit of subcutaneous insulin for every 2 units of Afrezza, but many people find they need a ratio of 1:3. You’ll have to experiment and work with your healthcare provider to find the best ratio for you.

There will be a learning curve, but most people get comfortable using inhaled insulin fairly quickly.

As with most medications, there are some kids who should not use Afrezza, including those with chronic lung conditions like active asthma. Before starting Afrezza, your child’s doctor will order a baseline lung function test called FEV1 to make sure their lungs are healthy and there aren’t any underlying lung conditions. 

The FEV1 test is repeated every six months during the first year of treatment and then once a year after that to monitor lung health over time.

Afrezza Doesn’t Replace Basal Insulin

One important thing to remember is that Afrezza is only a rapid-acting mealtime insulin. It doesn’t replace basal insulin, which is long-acting insulin that covers your “background” insulin between meals and overnight.

Rapid-Acting Insulin Afrezza for Kids: Key Takeaways

Afrezza is a great mealtime insulin option for many kids because it’s needle-free, easy to use, and provides similar glycemic control to subcutaneous insulin. 

Because it enters the bloodstream quickly and gets out quickly, Afrezza gives families flexibility with insulin timing before meals. That means less stress, less guesswork, and fewer worries about insulin stacking or delayed lows.

Afrezza also makes it easier to match insulin to what your child actually eats, instead of gambling on what you think they’ll eat. With the number of times kids change their minds about food, I’d rather gamble on… just about anything else! 

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