This happens sometimes with afrezza corrections. It acts so fast that the cgm sometimes can’t track it. In minor cases that’ll just mean the cgm loses its direction arrow but still displays a number. In other cases we’ll get a situation like this where it gives the ??? For some length of time because it didn’t know what to make of the rapidly correcting bg.
Here tonight I ordered prime rib, mashed potatoes and vegetables. I pre bolused with novolog, but apparently under dosed-- also I was not expecting it to show up with split pea soup and onion rings… so my under dose was significant and my bg relatively quickly shot to the upper end of my target range and my cgm alarmed at 140. I tooted a 4 of afrezza at that point and my bg changed course and corrected so fast the cgm couldn’t track it for a while… and still hasn’t even settled out enough to show me the arrow, but as you can see from the dots it’s pretty steady in the 70s range…
First highlight is pre bolus. Second one at the top is afrezza correction (I call this the turn & burn) This is in real time. I’ll post a new pic soon to show how it settles out— pretty remarkable that it never seems to stack even when combined with novolog.
Amazing. I’m curious to see the CGM data when I try Afrezza corrections, because so far, I’m not seeing much happening with finger sticks (though I could check more often). I’ve used it twice recently with stubborn highs, and things don’t appear to change until I dose (more) Novolog, but I would imagine maybe I’m missing it climbing even higher (eek) and Afrezza bringing it back down to the high number I saw to begin with…
Yeah, I can imagine with the delay it wouldn’t work as great for Afrezza users, in particular, but I think it will help me to get a a quick idea what direction things are going when I need to correct a high/treat a low.
I did eat a little tiny miniature apple with the afrezza to slow down the correction a bit otherwise it would have been a steeper and likely further reduction
That is a pretty big difference from the Humalog where it seems the smallest miscalculation and you are either shooting high or low and then need a further correction of carb or insulin to try and balance out.
Absolutely, the difference is night and day. Liquid insulin operates in a very linear fashion because of how it’s absorbed… and you have to get it almost exactly right to have the desired results. This is different.
Honestly if I was reading this stuff from the marketing department of whoever was distributing it at the time, I flat out would not believe them. (I tend to be just a BIT skeptical when it comes to marketing - lol)
But having so many first hand reports of the way it works can not be dismissed.
Assuming the Afrezza train gets bigger and bigger and assuming the closed-loop systems continue to expand to different systems and more FDA approved solutions, I do wonder how these two will tie together. Would some closed-loop systems allow input of insulin dose (ie - Afrezza) into the algorithm other than from its own pumping device? Just as you would enter # carbs?
Itd be hard for me to grasp how this technology would be integrated with a closed loop system-- it’s just kind of a different approach than that… I’d actually see it as more of a competition to that approach with a completely different concept… and it’d be somewhat self defeating even if it could ever be pulled off because this stuff is faster than the cgm tracking it…
The whole concept is just crazy. I am really glad you all are sharing the information. As mentioned, I highly value first hand information.
Unless something changes, we would be a few years out from using Afrezza but it sounds like something we would almost certainly want to include as part of the overall treatment approach when the change from Ped Endo to Adult Endo happens.
It offers a lot of major advantages… it’s not the 100% grand slam miraculous almost-cure that I thought it was at first, but i certainly wouldn’t want to have to get by without it…
We were all taught to think inside a very confined little box when it comes to how insulin works. We were taught that x amount of insulin will lower your blood sugar y amount or counteract a certain amount of carbohydrates etc… but in reality, in a physiological sense none of those concepts are how insulin actually works inside your body-- they’re conceptual adaptations that we use to make it work and attempt to make a square peg fit in a round hole so to speak… because insulin doesn’t belong injected into your skin, that’s not the natural order of things and we have to come up with all sorts of rules to get it to play along when we play the game by those rules— those are the tools and concepts we need to live by when injecting liquid insulin into our skin-- but this is just a very different mechanism
For me, the “lows” I’ve experienced with Afrezza are completely different from my Novolog lows, and they’re always just little dips into the 60s, they don’t make me feel quite so awful, and they’re easily brought up without having a rebound high. Of course, I’ve only been at this a few weeks, so I’ve only had a couple lows.
The action time is, I think, the hardest part for me, since I eat a diet pretty high in fat, so I usually take Afrezza up front and then Novolog at 1 hr to cover the later rise. Like @Sam, I’ve realized it’s not the miracle drug I thought it might be (and I thought at first it would be something to use all by itself, which is obviously not the case for me), but it’s still really amazing.
@Thomas was it you who was saying you change out sensor rarely more than every 10 days? I’ve been noticing even with novolog the sensors (which I’m generally wearing long past their advertised life) don’t respond very fast at all…
Eg just tonight I ate dinner and Pre bolused with novolog… rose from about 80 to about 110 and was feeing really good about it until 1:15 after the first bolus when all of a sudden the cgm jumped to 128 (I did a finger stick at this time and got a 175) and then the next dot on the cgm was at 145… so clearly here my cgm is so slow that it often says things are hunky dory until long after I’d have liked to know that they weren’t. I’m wondering if I’m just physiologically different than people who have awesome accurate real time cgm readings, or if I’m doing something differently than them. I’ll post a pic of this when the dust settles
