Did you know that inhaled insulin is available in the US for the first time since 2014? ! In my opinion, it is probably one of the most protected secrets in the diabetic community.
Afrezza has been part of the diabetes toolbox for several years, and in this article we’ll give you an overview of what inhaled insulin is, how it works, and why you chose to use it.
What is afrezza?
Afrezza is a rapidly activating insulin similar to the injectable, rapid activating insulin (Apidra, Humanlog, or Novolog), but it is inhaled rather than injected. Like other rapidly acting insulins, it is mealtime insulin (bolus), so another background insulin is required in the form of long acting insulin (basal).
Inhaled insulin passes through the lungs and directly towards the bloodstream. In other words, insulin starts to work much faster than injected insulin. It is very fast so you can see the first measurable effect within 1 minute of inhalation and within about 12 minutes.
It works so fast that it stays in the body for about 90 minutes, compared to 3-5 hours when the rapidly acting insulin stays in the body.
Afrezza administration
Another way Afrezza differs from injected rapidly-acting insulin is to have a set dose of 4, 8, and 12 units. When you receive the afrezza from the pharmacy, it comes with a set of inhalers, which you choose a dose cartridge, load the inhaler, and inhal the entire amount.
The Afrezza unit is not the same as the injected insulin unit. One unit of injected rapidly acting insulin is the same as about 1.5 units of Affresa. In other words, the smallest Afflezza cartridge (4 units) corresponds to about 2.6 units of rapid insulin injected.
Potential side effects
Afrezza has the same potential side effects as injected insulin, but should not be used by people with certain lung problems, such as COPD or asthma, or those who have stopped or stopped smoking in the past six months.
For more information about potential side effects, see here.
I have never experienced a persistent cough from using the product, but the study reports that 27% of people have developed coughing using Afezza.
Why use inhaled insulin?
I’ve used Afflezza for years with basal insulin and injected it with fast acting insulin, but found it great in certain circumstances.
I mainly use Afflezza for my resistant high blood sugar and high carbohydrate diet. We all know of situations where blood sugar levels are “stuck” at high levels. Afrezza is a great solution for that.
If you are stuck at more than 200 mg/dl (~11 mmol/l), reach for a 4-unit Afflezza cartridge and your blood sugar levels drop into range very quickly. The four-unit cartridge drops approximately 100 mg/dL (5.6 mmol/L), but how much it reduces blood glucose levels depends on the correction factor.
Note: I’ve found that Afrezza reduces blood sugar levels a little more aggressively in the first month or so after starting to use it. I’ve heard the same thing from other users, but I haven’t seen the data that supports it, so at this point it’s only anecdote information.
Another situation where I’m truly grateful to have access to Afrezza is to enjoy a high carbohydrate diet or a high blood sugar diet. Afrezza hits the bloodstream quickly, so there’s no need to do a carbohydrate pre-bolus. I also think it’s easier to match the peak of Afflezza to food than injected, rapidly acting insulin.
How it interacts with movement
My body was loose in 90 minutes, so I wanted to use Afezza when eating before doing aerobic exercise. Unfortunately, the fact that Afezza is only a fixed dose means that I rarely access the correct dose and need to stick to the injected insulin.
Another observation I made is that the effects of Afflezza appear to be further strengthened by exercise than with normal rapid insulin. This means I’m very careful when I have to do any kind of exercise in the 90 minute window of inhaled affresa.
My use of Afrezza was to defeat the hyperglycemia just before I took Brunch on my bike. It lowered my blood sugar level more than I expected and I had to stop on the bike in under 10 minutes to treat my rather low blood sugar.
Learn to use new insulin
Learning how to use Afrezza is like learning a new language and, just as you don’t always take it for injected insulin, you won’t get the dosage/timing every time with Afrezza.
It takes time and some trial and error to figure out how much Afezza you should take, when to take it, and when not to take it.
And for full disclosure, I had some of the most frightening hypoglycemia of my life using Afrezza. Afrezza is very effective, so too much on board can significantly reduce blood sugar levels. What I’m trying to say is that this is not insulin you’re “ragebolus.”
There are advantages and disadvantages to using Afrezza, but I recommend using it the right way for you.
Aside from the occasional lows and limited unit sizes, I think it’s a great product. It’s really a very effective way to quickly lower your blood sugar levels
How to get Afrezza
Afrezza was approved by the FDA in 2014 and is currently only available in the US and several other countries. If you live in the US, your doctor can prescribe Afflezza just as you can prescribe other types of insulin.
Your doctor may not know about Afezza. If so, you need to educate and push the prescription. If you don’t feel comfortable with that conversation, you can always refer your doctor to the Afrezza website.
Before prescribing Afrezza, your doctor should perform a FEV (forced exhalation volume) breathing test to understand lung function. This is a very simple test. Simply breathe into the mouthpiece. Doctors should have the test run again every year after six months to ensure there are no changes in lung function.
Once you have your prescription, just like any other insulin, pick up Afrezza at the pharmacy.
If you have private insurance, Afrezza is available for 70% of private insurance plans, so you’re most likely to be covered. Call your insurance company, or read your benefits plan to learn if you’re covered and what your co-payments are, might be an idea. Most people pay a co-pay of about $45 per prescription, but of course it depends on your plan.
We highly recommend using Afrezza joint paycards. For me, that means my co-payments will be reduced to $15 per prescription. This makes Afrezza a very affordable insulin option.
