I thought it might be helpful to start a thread about different tips and dosing strategies for using Afrezza. To start:
I only get a set number of Afrezza cartridges each month (and only 4s, which don’t cover those higher carb meals), so I often use a combination of dosing Afrezza and Novolog together for higher carb meals (when one 4 isn’t enough) or for meals that have a lot of fat (so Afrezza wears off before that delayed spike). Recently, I’ve been experimenting with dosing Afrezza and Novolog at the same time, right after I eat, for very high carb meals. For me, Afrezza will fizzle out about the 30 minute mark if I don’t use enough to cover that initial rise. Novolog, for me, starts working about the 30 minute mark, so if I dose it along with the Afrezza, it takes over about the time the Afrezza can’t keep up anymore.
You can see where it rose quite a bit by that 30 minute mark and then started to drop as the Novolog took over (and then I dosed Novolog again to cover the delayed spike from the fat). I still need to tweak things a little as I’m still working out the timing, but for pizza (and a lot of it), I was very happy with this. It allows me the freedom to not worry about pre-bolusing with Novolog (I usually pre-bolus 45 mins), but I’m still able to cover those extra carbs the single 4u Afrezza can’t.
What are some strategies you’ve found helpful when using Afrezza?
(And side note: I am planning to talk to my doctor about altering my Afrezza prescription, but it took a lot of work to even get this prescription approved, so I’ve been afraid to mess with it. )
Where are you looking for improvements in the numbers you posted? That seems pretty hard to beat to me…
It seems like you’ve got the basics understood, stretching out the duration with novolog… really the only tool you’re not using, which is doesn’t seem you need, is a basal insulin… but I think you’re all over it with the bolus…
I know; I shouldn’t try to change what’s basically perfection, but I was still experimenting and now I know: try dosing the Novolog a few minutes before the Afrezza, so it matches up more with my 45 min “pre bolus” (I did 30 mins because I was afraid of going low with the combination), and do the 2nd Novolog dose at the 2hr post-meal mark to catch it as it’s rising (I had to wait to see it trending up before I dosed this time because I didn’t know when it would rise).
I used a similar strategy recently with different timing. I bolused with Humalog when I ate and then dosed with a 4 unit Afrezza cartridge when i started trending up. Then I dosed with another 4 unit Afrezza cartridge 5 hours later.
I think dosing with Novolog/Humalog like you did to chase the second spike is a better idea, but I’m not sure I would’ve caught it in time for the Humalog to hit before I went high. I also think dosing with a teensy bit of R around the same time as the Novolog/Humalog would make for a perfect trend throughout the night. I hit my 160 alarm after a very slow upward trend during the night and had to treat that high. I haven’t used R in years, but I’ve been considering buying some for these kinds of occasions. I tend to have excellent trends during the day, but if I eat protein/fat for dinner, I struggle with a high in the middle of the night.
I didn’t record the play-by-play and exact timing, but I’ll give it a shot the next time I have pizza.
Another thing that I and some others find pretty good success with is to just dose pretty conservatively with novolog, humalog, whatever, before eating… then if I end up high at 1 hour after I’ll chase it down with a 4u afrezza. This seems to be pretty effective to both minimize time out of range high, and reduce hypo likelihood for me…
I’d recommend using R instead of Novolog if you’re dosing for fat/protein. It has a much longer duration and kicks in later meaning it better matches the profile of fat/protein digestion than rapid-acting insulin does. I actually use it in combination with Novolog when on MDI, though Novolog usually hits me within 10 minutes or less after injecting, so my situation might be different.
Only when injecting, it takes longer if I am using my pump. Stress/anxiety levels have a lot to do with how fast it works though. On the weekends when I am stress-free it works almost instantly. If I am at work dealing with a stressful situation, I might as well be injecting saline!