Ep 88: Inhaled Insulin (Afrezza): Dosing, Timing & The Power of Inhaled Insulin
In this episode you will explore:
- The Dosing Fix: Why you often need a higher Afrezza dosage compared to subcutaneous insulin.
- Speed & Kinetics: How inhaled insulin mimics the body’s natural beta cells to clear glucose fast.
- Lifestyle Benefits: Managing “sticky highs,” exercise without crashing, and dietary freedom.
- Safety & Screening: Spirometry requirements and who should (and shouldn’t) use Afrezza.
- Pediatric Updates: The latest on clinical trials and potential approval for children.
- Whether you are managing Type 1 or Type 2 diabetes, this episode provides the practical “tips and tricks” you need to determine if Afrezza is the missing tool in your diabetes management kit
LISTEN TO THE EPISODE
Get a practical breakdown of Afrezza, the ultra-rapid inhaled insulin, with this comprehensive guide to efficacy, timing, and real-world application. Join Drs. Jeremy Pettus and Steve Edelman—endocrinologists living with Type 1 diabetes—as they reveal why this unique tool is often misunderstood and how to use it effectively to flatten post-meal spikes.
In this episode, we move beyond the basics to correct the biggest mistake users make regarding Afrezza dosage. If you’ve tried this therapy before and felt it “didn’t work,” the issue often lies in the conversion ratio. We review data from Afrezza MannKind studies (such as INHALE-3) to explain the shift from the old 1:1 ratio to the more effective 1:3 ratio. We also cover why this “rapid-on, rapid-off” insulin is the ultimate solution for exercise and how to navigate insurance coverage and prior authorizations.
Thanks for this video. Waiting for my first prescription and learned more here. Does it have to be kept cold, like insulin?
Just keep the Afrezza you are not using in the fridge and the packets you plan on using at room temperature. It is for sure more durable than liquid insulin. Congrats on getting it.
I’m a type 1 for 30+ year and use the mobi pump with control IQ. I also hate the pre bolusing and often end up getting low.
I asked my doctor to prescribe affrezza so I could try using it gradually and see how I like it. She says she doesn’t prescribe it. She said there was a recent study to that showed reduced lung function after long term use. She also said it is more widely used for type 2 patients.
Any comments/suggestions for me. Thanks and love your podcasts!
Your doctor isn’t educated. There’s no data at all of reducing lung function over the long term, however there is a slight reduction in FEV-1, but when you stop Afrezza it goes right back to normal, so it does nothing permanent to your lungs. This drug has been available for 10 years, and it’s primarily used in people with type 1 diabetes. It is approved and used widely in type 2 as well. You should watch this video here: https://www.youtube.com/watch?v=WXCwK2_NdT4&t=222s
I have been using Afrezza for over seven years and I learned some new ideas as I watched your podcast. My experience has been very positive and I think Affrezza has very much helped me lower my Ha1c. I think that your dosing ratios are low for me, my guess is that my personal ratio is more like 4 to 1. I also think that we should be able to sell those extra inhalers back to Mankind to help lower the cost of Affrezza. I hope you are at least smiling!
Rob Coe
Rockport Texas
Yes…smiling indeed! Glad you get educated from TCOYD, and Jeremy and I learn from all of you as well.
Does Medicare cover the cost?
Afrezza is covered by Medicare, but you might want to check with your plan or on the Mannkind website here to confirm: https://afrezza.com/paying-for-afrezza/
What is the minimum amount one can take?
A 4-unit cartridge, which is kind of similar to 2 units of injected insulin, but not quite the same. Afrezza is rapid on and rapid off.
I’ve been wanting to try Afrezza for years and will talk with my endocrinologist at my next appointment. Don’t think it will be covered under my insurance though.
Keep pushing, and there is a $99 cost payment. Depending on your usage, it may last you a long time.
I first used Afrezza when it was approved and was very impressed with how it worked, but struggled with coughing for hours after using. I still used it on and off as it was so effective, but gradually less, but still had it in my fridge. I have started using it again after reading comments to stop the coughing. Drinking water before and after helped a bit, but inhaling like a regular breath inhale worked the best, I used to inhale too quickly. I am currently using it without the cough and the ones I am using expired in 2022. I have used them after being in my purse for a couple of weeks and they still work great, lowering highs that won’t go down. I use Omnipod 5 and have never had any lows from using Afrezza, an amazing tool.
Thanks so much for your comments. I sometimes cough, and inhaling too quickly made me cough as well. Jeremy really relies on Afrezza and does take an inhalation of an asthma inhaler just before, which takes care of it completely. Something like an Albuterol inhaler.
Not really sure if its for me. I have type 2 diabetes. & only take Lantus overnight insulin injections.
I would prefer not having to stick myself daily. Will inquire from my doctor.Thanks for your info!
The question is, what happens to your blood sugars after eating? If they consistently get above 180 and 200 mg/dL, Afrezza might really be helpful for you, but of course it’s something you need to discuss with your doctor. I would also suggest getting a CGM. Even if you only use it for two weeks, you’ll know right away if you bounce up too high after eating.
Awesome trove of information! I recently started using Afrezza after seeing you promote it elsewhere. My provider reacted EXACTLY as you demonstrated, “What’s that? How do I prescribe it?” But she was very cooperative and worked with the specialty pharmacist to get it for me. A few months of trial and error and I’ve got it mostly figured out. Dosing is hard because I usually use less than 2 units of pump insulin at a time. The most useful nugget for me from this podcast is using the Loop system with it. Good to know it has an input for Alfrezza! I may actually start using AID someday.
A detail some users may appreciate: Medicare pays for pumped insulin through Part B, durable medical. Affrezza goes through Part D, Pharmacy Benefits. The two systems do not talk to each other, so you can get pump insulin AND Alfrezza without conflict.
And finally, like you I was diagnosed at age 15 in 1970. It’s an elite club!
That’s really great info about Medicare – thanks! It sounds like you’re doing well. Remember that Afrezza gets out of your system so fast, it’s not totally comparable to subcutaneous insulin, so you just need to experiment with it. Thanks again for your comment!
Question if endo practices do the pulmonary function tests or are patients required to go to a pulmonologist?
Your podcast was super informative. Do you think with the AID pumps they can react fast enough to not give corrective bolus if BG is high and you take Afrezza?
Question # 1) No. The pulmonary function test is a formal two hour test. However, the requirement before starting Afrezza is an FEV-1 (forced expiratory volume in 1 second) test, and it’s a very small device that you blow into that measures the force after one second and then you get a percentage. That’s all you need. Endos can do it in their office. My suggestion is that you do not need a full pulmonary function test, but check with your own doctor first who knows your full health history.
Question # 2) That is a great question. It really depends on how aggressive the hybrid closed-loop system is that you’re using, as some are more aggressive than others. Dr. Pettus and I have found that you can take Afrezza with any system, and you do not end up having hypoglycemia. So I would experiment if I were you, and get your own level of confidence on using it to correct, even though your system may have tried to give you some insulin to compensate.
After a nearly year-long fight, and multiple “automatic” denials, my last appeal via a Medicare Administrative Judge granted me access to Afrezza on my Humana Medicare Advantage plan. I had been using it since 2021 while on my employer’s medical plan, which approved it without even a Prior Authorization. But once retirement kicked in, it wasn’t so easy. Thanks for all you do to educate and promote Afrezza.
Wow, it’s too bad you had to go through all of that, but way to go for sticking with it! Thank you for sharing your experience. Hopefully it will get easier for people on all Medicare plans to get the medications they need, including Afrezza.