Dang, that’s one nasty low. I usually feel it coming way before it gets that low, and the CGM will alert me as well. With afrezza I did notice that lows feel different than with injected for me. It begins with light headed ness. And that’s usually the sign for me to have a couple of glucose tablets to avoid the low.
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So @Sam, do you always dose Afrezza by watching your CGM for the beginning of the rise? Ive been having trouble with the timing - staying flat/dropping at 1 hr, then spiking at 2 hrs as the Afrezza wears off. There seems to be no rhyme or reason to the type of food that will do this, as I’ve started slowly pushing the timing farther after I start eating, and for some things it’s already working, and for some it’s not. It’s very frustrating, and really making me think I won’t be able to get it to work for me until I have my CGM.
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Have you tried using it along with some inject-able insulin? Since Afrezza runs through so quickly, it is possible your food is outlasting it. So the Novolog/Humalog/Apidra/Fiasp dose would last a little longer and cover the later hours.
For example, dose for 30% of the carbs with an inject-able, eat, wait 20 minutes and cover the remaining 70% with the Afrezza. Something like that.
I am not very experienced with Afrezza, just used it a little bit, so I am not an expert at it by any means…
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I didn’t even think of trying that (where’s the head-desk emoticon when you need it?). That’s a good idea.
The rhyme or reason really has to do with how much fat and protein is in what you’re eating IMO. With fast digesting simple carbs, like if I just had a bowl of cereal or something, I’d dose right away because I know those carbs are going to start unloading very quickly… if you’re eating something with more fat and protein, say, an omelet with meat and cheese and a roll-- I know that the significant portion of fat and protein is going to slow down how long it takes the carbs to start unloading singnificantly so I’ll wait to dose, sometimes quite a while… It’s always a guessing game with any type of insulin, you just pay attention over time and keep learning new tricks… its never an exact science for me…
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And Eric is right, I often will dose for the longer acting trends that I expect with novolog, and the fast carbs with afrezza… or vice versa, dose conservatively with novolog if I’m expecting a spike later on, then hammer it down with afrezza later… It just really gives you a lot of options and flexibility that without it don’t exist
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Yes this is the central thing you have to work around with afrezza… is that many types of foods outlast it… that’s both its greatest benefit and its potential source of frustration… so tricks will need to be adapted to your particular diet and patterns to overcome… whether it’s follow-up dosing with afrezza, or some form of adaptation with what we used to call(until afrezza made that description seem rather silly) “rapid analogs” … such as novolog, Humalog, apidra
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@Sam, thanks for the input. That’s why I was slightly confused - the no rhyme or reason includes the simple carb/fat/protein ratio differences. For example, I had spaghetti, with corn noodles, sugary sauce, etc, which I consider heavy on the carbs, less so on the protein/fat, and I went low before spiking later on (and I took the Afrezza ~10 minutes after I started eating). Tonight, I took Afrezza right as I sat down to a lettuce wrapped burger with French fries, and even though with Novolog I had to split my dose to cover the 2nd spike, I didn’t see a 2nd spike tonight (and I tried this a couple weeks ago, too - same thing - barely a rise, staying mostly flat the 3-4 hours after that I tested). So weird, but hey, I’ll take it for being able to eat a burger and fries! 
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I’ve had goofy things happen with spaghetti and afrezza combo too that I really can’t explain. Try @mikep he’s Italian
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Tried a combo Afrezza/Novolog dose tonight while hosting another family for a meal - started off at 75, dosed Afrezza 15 mins into the meal, ate ice cream at about 50 mins in, was 110 at an hour, dosed 1u Novolog (usually covers 35 carbs), then was 96 at the 2.5 hr mark. I didn’t test as much as I normally would have, but for eating a rice based meal, drinking hard cider, and eating ice cream, I feel like it went pretty well. Thanks again for pointing out combining the two was an option!
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I’d say so! I’d be lucky to eat an apple and have my bg stay that flat even with using all the tricks in the book
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Pasta can be a tough one. I’ve found hitting a cup to a cup and a half up front with 8u and then a 4-8u follow up controls my post meal spike. All about experimentation.
Good luck!!
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