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!
This is an inspiring model. I’ve just started experimenting with Afrezza today. It’s going to take some time before I’m ready for the pizza challenge! The fuzzy dosing and the rapid pharmacodynamics are quite an adjustment. It’s like being a novice diabetic all over again. I realize that at only 3 years in I’m still a novice in many ways, but I haven’t kept detailed data logs on each meal for a long time. Hoping that it will give me a lot more flexibility around eating out and exercise, though. Will report in if I have any useful observations along the way.
I love Afrezza! But it does play some games with me, especially when I use it a lot. I love to have the freedom to decide to eat something and not prebolus. Especially it is useful for potlucks I go too!
One thing I have to watch for is when it wears off. 2-3 hours later my BG will easily shoot up. I have taken to doing a dose of my regular with my Afrezza to try to compensate, but timing and amount can be a trick! And a lot of the time I need a small dose 3 hours after my Afrezza or another Afrezza dose. Adaptability is the key!
@needlesandmath and @Marie Thanks for both your comments on Afrezza! I talked with my Endo about it two weeks ago as military pharmacy now has it available with Prior Auth. My Endo wasn’t sold on it, but didn’t have that much experience either (only had one patient using it). Would appreciate your further comments on good/bad points and tips for using it! Like @Marie I really dislike having to plan meals further out than my hunger drive and pre bolus; I chalk it up dx late in life, living most my life on the run, and catching meals as I go. Think Afrezza’s quick in/quick out might be helpful. Thanks again!
I got some Afrezza samples from my PCP a few years ago and really appreciated out fast it corrected a high BG! This really helped when I was still on MDIs and had difficulty fine-tuning a meal dose. I didn’t use it long enough to figure out a meal-time dosing strategy but may reconsider asking for an RX if it’s now available on the Tricare formulary.
@TomH I absolutely love it. That’s the thing as a type 1 and a vegan, I have a tendency to wait until my food is being made to dose for restaurant food to make sure it’s available to get. Afrezza allows me to order and then dose or get my food and dose. Potlucks, it’s been a life saver. I have even forgotten to take it before I eat and then realized it and taken it after and still be okay! Although I increase the dose if I take it after.
A 4 unit cartridge isn’t really 4 units. It’s more like 2 1/2 to 3 units. And just like it takes more insulin to deal with a high, it takes more Afrezza too.
And it wears off. Even though I am a vegan, all my food isn’t going through and hitting my system by 2 hours. So you have to watch for the increases that might happen later. Personally using both a fast acting injectable and Afrezza is what works best for me. If I try to use just Afrezza my system does some weird adjustments.
It has to be refrigerated. The small 3 packs can be out for 3 days. I get 9 boxes at a time for $100 through my mail order plan for my 90 day supply. Very economical for me but it takes up room in the refrigerator.
You can cough when you first inhale it. You usually get used to it and don’t cough all the time, but sometimes you still do. Drinking some water right after helps stop that if it’s a problem. When I see the white dust in the air because I coughed almost immediately when I started to inhale it and it probably is from blowing into the inhaler when coughing versus sucking in the Afrezza, how much did I inhale??? Luckily it seems more forgiving about dosing than an injectable.
But I do love it, it has been a game changer in making life a little easier. That is always a huge plus in my book! I am a huge fan!
I sometimes carry it around for a lot longer than that waiting for a stubborn high that needs correcting. I find that it’s not that fast acting or powerful but it does seem to help. But, maybe my experience has to do with using it only for high highs rather than for food and possibly the fact that I leave it unrefrigerated. Even fresh out of the fridge, though, the effect isn’t as dramatic as I expected. Not sure if my expectations are off or if I use it wrong.
@TTnyc I use it similar to you, mostly for a correction bolus. If I can catch a rising post meal high before it gets too bad the Affrezza seems to work for me as: 4u to knock down a high of 140-180 and 8u for a high above 180. But for the “other kind of high” that lingers and seems immune to a normal correction bolus the Affrezza seems pretty weak and sometimes it is tempting to stack doses to attempt to make something happen.
As for dosing, when I use Affrezza for a meal bolus, the ratio seems to be a smallish meal 8u and a medium carb meal 12u. Those seem to work the same for me as 6u syringe insulin for a small meal and 8u for the large meal (with pre bolus). For something with carbs+fat+protein such as Italian food I will also bolus 3 units or so of syringe insulin or pod bolus. And hit the Affrezza post meal also.
@Tomh To sum it up, Affrezza dosing varies by the situation. For meals, I think it’s possible to come up with your own formula the same way we all do with injected insulin. But for correcting a rising or high BG the secret code is elusive. The hard part to deal with for corrections is the short duration, which makes stacking doses seem necessary…but one is never sure how much of the prior dose is still on board after a while. I try to stick with 90 minutes duration with Affrezza to avoid stacking but am not very confident in that number.
So far my experiences track with others in the thread:
The onset is fast enough that for some meals (e.g., high fiber ones) it’s best to take it in the middle of or after eating.
The dose for me seems to roughly follow the 1.5x formula, so 4u Afrezza=2.6u injected, 8u=5.3u, 12u=8u. I’ve only tried 4u so far, though, since I’ve barely ever eaten anything that needs 5+ units (I’m not very adventurous).
The duration is 90-120 minutes, which agrees with what’s on the label.
I did find this chart which notes how duration changes with higher doses. This is useful if you want to get a rough idea of when and how much you’re stacking:
I’m positive that for meals that digest longer than the small lunches I’ve tried it with I would need another dose or to combine it with Novolog.
I haven’t had a cough yet; in fact, I couldn’t feel anything when I inhaled it.
I’m a lot less hungry after using it, which I chalk up to the insulin working its way out so quickly. A surprising but nice benefit.
The main use cases for me, I think, will be eating out in general, lunch on days when I have a packed schedule and not enough downtime for a prebolus, days when I want to work out more flexibly, and correcting highs. But that covers a lot of situations! Will comment again if I figure out any more detailed tricks.
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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).
