# Afrezza: dealing with the 4U minimum **URL:** \ **Category:** Afrezza\ **Tags:** corrections, bolus, type-1, inhalable-insulin, type-2, noninjected-insulin, mealtime\ **Created:** [April 25, 2017, 2:10pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613 "2017-04-25T14:10:55Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![drpepper68](https://avatars.discourse-cdn.com/v4/letter/d/46a35a/32.png) [@drpepper68](https://forum.fudiabetes.org/u/drpepper68)\ **Post date:** [April 27, 2017, 4:01am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/21 "2017-04-27T04:01:11Z")
What tests do they run to determine you have that? ---
**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\ **Post date:** [April 28, 2017, 12:56am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/22 "2017-04-28T00:56:06Z")
I posted a link regarding [autonomic testing](https://forum.fudiabetes.org/t/autonomic-testing-christopher-h-gibbons-md-faan-harvard-joslin/630). ---
**Author:** ![drpepper68](https://avatars.discourse-cdn.com/v4/letter/d/46a35a/32.png) [@drpepper68](https://forum.fudiabetes.org/u/drpepper68)\ **Post date:** [April 28, 2017, 4:29pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/23 "2017-04-28T16:29:42Z")
Thanks ---
**Author:** ![Gus](https://avatars.discourse-cdn.com/v4/letter/g/ecc23a/32.png) [@Gus](https://forum.fudiabetes.org/u/Gus)\ **Post date:** [May 10, 2017, 4:26am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/24 "2017-05-10T04:26:47Z")
![](https://canada1.discourse-cdn.com/flex030/uploads/fudiabetes/original/1X/8b7cb752fe306e32665cbd638ebba223f0d496cd.jpg)When I started with Afrezza I thought exactly the same. What? 4U minimum? I am going to die. Before Afrezza I was on a pump. I switched to a pump to make it easier to deal with post-exercise hyper-sensitivity (I am a triathlete). The picture shows one of my first experiments with Afrezza. I couldn’t believe it. But there are the numbers. 2 years later the current doses make total sense to me. It has NOTHING to do with injected. Accurate titration and micro dosing doesn’t make sense anymore, because Afrezza is fast-in and out. Its still insulin so you can go low. But at least for me, its a lot harder to get a low, and I know that it wont kill me for sure (that was a REAL risk with injected, especially with exercise). I have pics of more experiments I did if anyone is interested. And I posted most of them @guasaman in Twitter. Cheers! ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [May 10, 2017, 4:42am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/25 "2017-05-10T04:42:32Z")
Welcome Gus! I’ve followed some of your stories with afrezza in the past. Happy to have you join here. Please introduce yourself here: [Welcome, introduce yourself here!](https://forum.fudiabetes.org/t/welcome-introduce-yourself-here/145/139) ---
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [May 10, 2017, 4:50am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/26 "2017-05-10T04:50:23Z")
> [@Gus](#): > > I have pics of more experiments I did if anyone is interested. Gus, welcome! I am extremely interested in your experiments. I am looking at your 4U curve right now. What would you normally have taken when you had a 154 BG for injectable insulin, as a comparison? My son, T1D, is an athlete (swimming/soccer/volleyball) also, but he is only 12. He is not taking Afrezza but he and I have been very interested in it. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [May 10, 2017, 5:09am UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/27 "2017-05-10T05:09:03Z")
The whole mental block is that it’s not “4 units” in the same sense that 4 units of injected is… 4 cats are not comparable to 4 dogs… I honestly don’t even think in terms of units when using it whatsoever… I personally would have taken 1 or 2 units of injected if my bg was 154 depending on the variables (food on board, previous bolus on board, anticipated activity, temperature, phase of the moon, fortune cookies, astrology, the LHA of Aries, state of the tide, all that…) then I would have waited over an hour to have any sense if it was going to work, work too much, or not enough With afrezza I’d just puff one and be on my merry way without thinking about virtually anything… ---
**Author:** ![mikep](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/mikep/32/149_2.png) [@mikep](https://forum.fudiabetes.org/u/mikep)\ **Post date:** [May 10, 2017, 1:10pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/28 "2017-05-10T13:10:49Z")
Welcome @Gus this is such great information. Anyone I speak with initially about Afrezza dosing (including the voice inside my head) has trouble understanding it. Completely understandable, but as you mentioned, once you get comfortable and more importantly trust the dosing, it all makes sense!!! ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [May 10, 2017, 2:54pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/29 "2017-05-10T14:54:16Z")
It’s too bad that MannKind is so short on cash and doesn’t have the distribution partners. I doubt they’ll do the trials or gain the numbers needed to show what you’re saying – which is a tremendous benefit. If you virtually eliminate the risk of a deadly hypo, that’s a HUGE! factor in glycemic control. But you’d probably need to have a huge study to show that the risk of serious hypos requiring hospitalization or outside assistance go down dramatically, even if all this anecdotal evidence makes it seem blindingly obvious. I mean, can you imagine an insulin that did not have a huge indication for hypoglycemia? I wish more people would take it or that _someone_ would help partner with them for distribution and marketing for real. Because there are a lot of potential benefits that are, at this point, just word of mouth. And to have it really take off I suspect it would need a stamp of approval from someone. ---
**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\ **Post date:** [May 10, 2017, 2:56pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/30 "2017-05-10T14:56:37Z")
> [@TiaG](#): > > Because there are a lot of potential benefits that are, at this point, just word of mouth. And to have it really take off I suspect it would need a stamp of approval from someone. I think you are right. I am rooting for them. I want them to succeed. This is a product diabetics NEED. It is raging to see how the medical community does not embrace it. It truly shows the large gap between doctors (endocrinologists) and their patients. ---
**Author:** ![CatLady](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/catlady/32/36_2.png) [@CatLady](https://forum.fudiabetes.org/u/CatLady)\ **Post date:** [May 10, 2017, 3:21pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/31 "2017-05-10T15:21:04Z")
The rep I talked to at TCOYD last month said the Mannkind is working on increasing its sales force–there is finally a rep for my region, yay!–and increasing providers’ awareness of Afrezza. They will also help PWDs whose insurance won’t cover Afrezza by working with the insurers (and provide samples to patients during this period). Insurers are a big obstacle, IMO–mine requires me not to do well with covered insulins before they will cover it. The lower risk of hypoglycemia overall is not a primary consideration nor is being able to eat a more typical diet. Ha! I’d like to see them count out 10 taco chips at their favorite Mexican joint and skip that margarita!! 🙀 ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [May 10, 2017, 3:27pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/32 "2017-05-10T15:27:42Z")
I read a Yahoo Finance article that seemed to indicate currently there are fewer than 300 prescriptions written per month for Afrezza? Is this due to the Afrezza trolls? ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [May 10, 2017, 3:40pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/33 "2017-05-10T15:40:20Z")
I think it’s mostly due to the fact that a) it’s not preferred or even an option on most insurance formularies. b) they have fewer “reps” to go out and market the drug so doctors don’t even know to prescribe it c) endo skepticism because the drug trials to initially approve it were not designed in a way to highlight its benefits, while it comes with a black box warning because of its potential for lung issues. They didn’t really figure out the optimal way to take the drug, and so people in the trials did not have lower A1Cs. d) you need a $600 spirometer thingamajigger in the office to test lung function, something most endos don’t have, so there’s an upfront level of cost and bureaucracy to get around before writing even one script. ---
**Author:** ![Chris](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/chris/32/382_2.png) [@Chris](https://forum.fudiabetes.org/u/Chris)\ **Post date:** [May 10, 2017, 3:45pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/34 "2017-05-10T15:45:01Z")
Could also be that most endo’s are fighting the fight to get the majority of their patients to do the minimum correctly, and Affrezza isn’t on their radar as helping those people. At our last diabetes appointment they actually told us to stretch out the appointment time because we obviously knew what we were doing, it was working, and we didn’t need their help… ---
**Author:** ![CatLady](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/catlady/32/36_2.png) [@CatLady](https://forum.fudiabetes.org/u/CatLady)\ **Post date:** [May 10, 2017, 3:46pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/35 "2017-05-10T15:46:38Z")
Will you post the link for that article? Thanks! ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [May 10, 2017, 3:47pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/36 "2017-05-10T15:47:36Z")
[MannKind: Afrezza Sales Still Low As Company Tries To Increase Outreach](https://seekingalpha.com/article/4069746-mannkind-afrezza-sales-still-low-company-tries-increase-outreach) ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [May 10, 2017, 3:49pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/37 "2017-05-10T15:49:00Z")
And this. i’m not a fan of Seeking Alpha but they consistently cover all the MannKind weekly scripts. [https://seekingalpha.com/article/4066772-mannkind-afrezza-scripts-dip-investor-frustration-rises](https://seekingalpha.com/article/4066772-mannkind-afrezza-scripts-dip-investor-frustration-rises) ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [May 10, 2017, 3:51pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/38 "2017-05-10T15:51:53Z")
I think this is an important factor – why are people not continuing with it? Is it because no one is bothering to explain how to use it, they get frustrated and quit? I suspect there are some people out there for whom it’s not a good fit too – maybe they actually digest food pretty slowly and the “fast-acting” insulin action curve works better for them – my son is like this. Or maybe it’s the fact that it might be a great fit for some foods but not a great fit for others, and people don’t want to have two different insulins they use? But still, just getting more sales reps to fill scripts will only work if people continue to use them. ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [May 10, 2017, 3:52pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/39 "2017-05-10T15:52:21Z")
I would like to make a recommendation to all adult T1D’s (as long as you do not have any pulmonary concerns). No matter what your current insulin regimen is, no matter if you are using a pump or MDI, no matter what insulin you are using… If you have a glucagon kit at home for emergency lows, why not have a box of Afrezza cartridges for emergency highs? Even if you don’t want to use it daily, you can use it for those times when you are spiking wildly and want to bring your BG down quickly. I currently do this a different way (it involves the letters I and V), which for me gives me the quick drop. But I know most people don’t want to do this. So get yourself some Af, and give it a try. You don’t need to wait hours for a BG to come down. I’ve tried Af a few times. It’s quick! I am going to experiment with a few other methods of using it also, for people concerned with their lungs. ---
**Author:** ![ClaudnDaye](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/claudndaye/32/5_2.png) [@ClaudnDaye](https://forum.fudiabetes.org/u/ClaudnDaye)\ **Post date:** [May 10, 2017, 3:56pm UTC](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613/40 "2017-05-10T15:56:39Z")
People tend to have reservations about anything “new”…I’m pretty sure Afrezza falls into this same category. It’s new…it’s radical…it’s different…therefore it must be bad (or maybe not bad, but I’m gonna wait until I see more people using it…type of mentality). Maybe? [Previous page](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613.md?page=1) [Next page](https://forum.fudiabetes.org/t/afrezza-dealing-with-the-4u-minimum/613.md?page=3)