Afrezza: dealing with the 4U minimum

How do you deal with the 4U minimum? Do you plan meals in 4U increments? Do you combine bolus insulin every time you have a meal?

For us, 4U = 200 mg/dl

Anything you would bolus up to 4 units for (when using RAI), you’d use a 4u cartridge. Here the Afrezza dosing guide if you haven’t seen it.


I’m not an Afrezza candidate, but I am curious and very happy for you, @Sam and all the others that are having success with it.

Are you saying that you wouldn’t go low using 4 units if you only needed 0.25 units? Is Afrezza that forgiving?

I will be blatantly honest . . . I’ve never bolused .25 units so I don’t know the answer to that question. However, I’ve inhaled a 4u for 15-20 carbs and not gone low, so it is that forgiving. YDMV as always.


I wouldn’t say that 4u afrezza would really be as gentle as some sort of microdose like .25u injected… but I think the dosing instructions that say the 4u cartridge can replace an injected dose from 1-4u is a pretty reasonable reflection of reality… and it just really behaves differently because it’s gone so fast…


I really cant stress enough that the “units” of afrezza aren’t the same animal as a unit of injected bolus… it just works differently. I wish they’d called them something different but imagine the FDA wouldn’t allow it. Afrezza works by quickly allowing cells to absorb glucose whereas injected works by slowly allowing cells to absorb glucose over a much longer period of time… in one instance you have to get the dosage just right, in the other you really don’t have to be anywhere near as precise…

To be successful using afrezza you have to “unlearn” a lot of the rules you had to learn to play by with injected… in doing so you can find a great deal of freedom


@britt_j, I am curious – why aren’t you an Afrezza candidate?

I’ve messed with the 4u capsules to see if there would be an accurate way to divide the powder and then make my own inhaler.

I was not comfortable with the quantities though, and when doing it, I felt a little like this guy:

But I know it is doable. Here is a 4u pack. Stamps shown to give scale:


Totally unnecessary… this is not injected bolus. This is why afrezza isn’t exactly taking off commercially – because everyone insists that insulin needs to be precisely dosed (and given the history of insulin, that insistence makes a great deal of sense)

But this is different.


Well, I can try a 4u sometime when I am at 110 and see what happens, but I am not super confident it will settle me out at 80…

Then at that case I’d eat something that happens to be laying around, take it, and watch your blood sugar settle out at 80…

I’d take it at 110 if I were inclined to correct a 110… the only instances in which I’d elect to do so would be 110 and rising appreciably, in which case I’d take the 4 without a second thought

I can try it and see what happens. But I took a 4u for a giant glass of chocolate milk, and I saw myself drop down, so at 110 I wouldn’t feel super comfortable with what will happen. But I can give it a try and see.

But the point is the micro-bolus, like 0.10 or 0.20 with humalog or novolog. If you could divide that 4u into something comparable, it would seem to make sense.

I bet snorting it in your nose would work. Have you ever tried that?! It just has to get into the bloodstream, and people do that with the “other” stuff.

Hey, for the record, despite what people may think reading this, the only drug I have ever used is insulin!


@Eric – after you posted the picture above, I started drafting a message to tell you what it looked like you were doing…

I swear, I am probably the cleanest one here. Except for Britt, who makes me look like a convict. :stuck_out_tongue_winking_eye:


You can’t be cleaner than me! I am the only one in the country who believed Bill Clinton when he said he did not inhale: my only one (!) time puffing I didn’t inhale either :slight_smile:


Like with anything else everyone will react uniquely to it… I am as certain as I can be though from my one person perspective that if used appropriately one can both avoid significant hypos while either correcting or covering carbs…

Each individual has to determine what using appropriately means in their unique physiology and situation

First chance I get, I’m snorting some in my nose.

Wouldn’t that be fun to explain to a cop.

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Cardiopulmonary diabetes complications.

(Basically, nerve damage which manifests, among other things, as slightly reduced lung capacity and diffusion issues along with heart rate variability issues.)

My endo will not clear me for it.

Note: I have never been a smoker.

LOL, I’ve often wondered what cops would think if I was pulled over and they saw a bunch of Afrezza cartridges in my car.

Funny thing is I’m very good friends with a Captain in our local police department. I said to him one day, what would you think this is (Afrezza cartridge) if I got pulled over? Note, he had no idea what it was. He looked at me, shrugged his shoulders and said “no big deal, what is it?”

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It’s never occurred to me to wonder…