EH has been using Afrezza as a supplement to his current Humalog and Triseba insulin regimen for almost a month now. He’s been on the road for that entire time, so BG has been a bit wacky and we are not in the “testing” phase exactly. Just aiming for “adequately managed” presently.
Anyhow, he had an unfortunate morning today - at a conference with a super carb-a-riffic breakfast option, he decided he’d just eat the pastries and fruit on offer, so he loaded up an 8u Afrezza dose. During/right after inhalation, he coughed and noticed a puff of insulin leaving his mouth. He injected 4u of Humalog to try to correct the course of his BG. But he basically had an unknown amount of Afrezza on board.
I’ve numerous times thought I botched the dose one way or another, by coughing, by thinking it all ended up in my mouth instead of inhaled, etc… but it’s always seemed to have worked as if I’d inhaled it just fine… really can’t explain it… I think even if you think you messed it up most of it ends up where it’s supposed to be in my experience
I’ve experienced the same as @Sam. Even one memorable time I panicked because there was a great amount (to me) of powder still in my inhaler, it still worked as though I took the usual dose. Can’t explain it!
Yes!!! When I first started using I took this huge deep breath and even held it for a few seconds. I soon realized that just a short inhale and no hold was just as effective.
Thanks guys. It’s good to know that you have all experienced success with the dosage even if there’s a malfunction in taking it!
Well, @Michel, it went kinda crummy. He dropped down to around 50, and then skyrocketed back up. He wound up going up to almost 300+, but he’s coming down with something. He’s actually left the last day of the conference and is on a plane on the way home right now. I will be referring to the recent sick day thread. I should’ve snapped a picture of his 24 hour BG track, but I forgot, and the time is already passed – so what I can see in Dexcom share is pretty useless.
So do you think he’s sick or that he just under bolused for the pastries and fruit? Depending on the pastries, the carb load on the back end could have been very high, thus making him skyrocket. Of course, couple that with potentially not getting enough Afrezza and you are bound to trend over 200.
I speak only of second hand knowledge : Afrezza users here often mention needing a second puff because Afrezza runs out faster that heavy, long carb/ food loads.
Very true! Especially if it had a lot of fat. I frequently dose a bit of Novolog (rationing my Afrezza, haha) at the 1-1.5 hr post meal mark to head off the 2nd rise.
These are all good points! I think an all carb breakfast + coming down with what is clearly a cold now is what happened. Poor man was in line at the airport when I first posted, his flight was delayed 3x due to smoke in SFO, and he bailed and took Amtrak home, which took 9 hours.
I think figuring out the equivalent of an extended bolus using MDI and Afrezza is what @Pianoplayer7008 has done. and maybe that’d would work better for carbs + fat. We don’t really do a lot of carbs (we don’t try NOT to do carbs, but I’ve realized we just are a low carb house, in the past it made BG management easier) so when that’s what’s on offer, it’s hard to guess I think. His ratios are off right now too, we are really still working to figure it out. Luckily he’s home for a week! Experimenting will happen when sickness is gone!
Just found out this afternoon that the OmniPod has shipped and so we will be in a whole new arena with that soon too!
Kim, one thought to have in mind, as @docslotnick reminded me recently, is that, when you go over a certain number of carbs, your ratio becomes wildly different and requires a lot more insulin per carb. This is particularly true of low-carbers who always need a couple of days of adaptation when they switch back to medium carbs, as they end up being very carb-sensitive to start with.
If this was an unusually high number of carbs for EH, this may have been an issue.
Yes! That’s brilliant and I read that a while ago, and I think I forwarded it along to Eric. But again, a while ago, and I need frequent reminders. It definitely doesn’t seem to be a linear progression.
I think our original experiment that included a lot more carbs than we normally eat (for glycogen restoration) plus running a lot (for consistency), was probably rocky because of that period of adaptation that needs to occur. And I don’t think I had read about the adaptation period yet.
For “one-off” meals, we find the reverse to be true. A meal with 2~3 times the normal carbs will require us to cut back on the insulin or we will end up with a persistent low later that will take additional carbs to correct. Maybe a 20% ~ 30% cutback on the insulin seems to be somewhat effective. Obviously different from other’s experiences.
Thanks! Once he’s not sick, we will fire it up. Now, we are reading the manual.
@Thomas, for your everyday diet how many grams of carbs are you guys eating? Are the “one-off” meals having an insane amount of carbs (ice cream sundae with banans for instance)?
I will be referring to the recent sick day thread. I should’ve snapped a picture of his 24 hour BG track, but I forgot, and the time is already passed – so what I can see in Dexcom share is pretty useless.
and maybe that’d would work better for carbs + fat. We don’t really do a lot of carbs (we don’t try NOT to do carbs, but I’ve realized we just are a low carb house, in the past it made BG management easier) so when that’s what’s on offer, it’s hard to guess I think. His ratios are off right now too, we are really still working to figure it out. Luckily he’s home for a week! Experimenting will happen when sickness is gone!