My endo, who is generally pretty great, said ok to Afrezza! My confirming that I have no history of respiratory problems was sufficient for him to say ok on that front shrug. He said he has very minimal experience with it, but is willing to give it a try, and also I think he knows I’m pretty smart about these things and trusts me to experiment wisely. I’m not sure whether my insurance will cover it—I’m a little concerned they might deny it arguing that my control is good enough and therefore I don’t need any new diabetes toys.
Also, likely many endos, he is definitely pleased with my 6.5ish A1cs, and cautioned against going much lower, but it’s super clear to me that my control could be tighter. I suspect having a better tool to manage carbs and quickly correct highs might get me closer to 6.0, which I’d be happy with (and I think my hypo risk might actually be reduced, since fewer opportunities for rebound hypos).
I was intending to also ask about IM injections (I initially mentioned those, Afrezza, and Fiasp as possible treatment directions), but since he agreed to the Afrezza, the convo ended up going that way, and I didn’t get around to it. If for some reason the Afrezza doesn’t pan out for me, that’s next on my list for strategies to try though
On a side note, he mentioned that he’s had about 7 patients use the Medtronic 670, and he said they’ve all had good experiences and he recommended it. I’m still not interested in it (or any pump) at the moment, since I want to see if this change gets me close enough to where I want to be on MDI. He also agreed with my concern that the Dexcom cgm tech is better.
If you have to fight with your insurance it won’t be on the issue of how good your control already is or isn’t-- they have no way of knowing that. Good luck! You’ll love it, I hope the insurance hoops aren’t too bad
It is either already in their formulary or it is not and if it is not they will have varying layers of hoops to jump through
Congrats! The action time is fast so keep an eye on your BGs while learning to use it. Me, I used Afrezza today to enjoy a KitKat bar for Halloween! Yum!
Thanks guys! Hearing about all of your adventures with it has inspired me
My insurance regularly requests A1cs as part of the approval process for my Dexcom, so they definitely have that info. Hopefully it will work out though, and if this insurer is annoying about it (they’ve been a bit cranky about some things but usually cave in the end), I should be switching to a better one as part of a very likely promotion next spring (part of other exciting recent news!), so hopefully at least they will do it. I’m also going to hunt for vouchers if I need to etc—seems like folks on here have had luck contacting Mannkind.
If you have to go the appeal route, here is a paragraph that can be used or modified a little bit by your endo to his liking:
Afrezza is needed to counter the post meal blood sugar spikes that other rapid acting insulins cannot handle which will help in lowering any future complications and expense due to prolonged high blood sugars. It will also greatly minimize hypoglycemia episodes due to it’s quicker action and clearing out of the system. This provides greater safety and decreased expense by minimizing the possibility of being hospitalized for these issues. Due to all the above benefits and increased quality of life I believe the minimal expense of Afrezza will more than pay for itself due to greatly decreased risk of future complications.
No, my endo will but he wanted to enter his records for the visit and I think preemptively make the case for it before calling it in, bc he’s pretty sure we are going to have to appeal with my insurance.
Thanks @Eric, that’s super helpful, will pass that along to him!
You can go to the Afrezza site, and request a discount card. Mine is not covered, but with discount, I get 90 cartridges for about $120. This lasts about 3 months for me, since it is for corrections and a few meals. Your endo may be able to get free samples. My endo gave me several boxes since none of his other patients were interested.
Ok, so three years after this post, which ended up going nowhere because I hit some walls with insurance coverage and then dropped the ball for a few reasons, my endo was contacted by a Mannkind pharma rep looking to get his patients using Afrezza, and he thought of me as the ideal first one, so just met with the rep and got new FEV1 results (she said it doesn’t matter what your results are in order to get a script, only that you get a baseline to check that it doesn’t go down with use), a demo, and a sample pack! My endo is also submitting a script again, and I’m sure we will need to do a pre-auth, but using the sample pack and finding it effective should provide evidence to help that. Also got the discount card.
Any Afrezza users have words of wisdom before I dive in? I feel pretty informed already thanks to FUD (the rep was impressed at how much I already knew, ha), and I’m planning to try it for the first time as a correction dose sometime in the next couple of days when I don’t have much food or other short-acting insulin in my system, since I think that will be the simplest way to gage its potency for me.
Also the pharma rep said she’s currently not very busy (and imagine that’s true for her colleagues), so if anyone else wants to take advantage of the moment to try Afrezza, might not hurt to contact Mannkind and find out if you’ve got a rep in your area. They are very motivated in making it work out, so they are willing to do a lot of the leg work both to help with your endo and your insurance.
Thanks to @Sam and @kmichel (thanks so much @Sam, @kmichel!) I was able to try Afrezza right before leaving for Europe: it was amazingly fast. But my endo has not allowed me to use it further since (she says there may be an issue with still developing tissue in my lungs). I can’t wait till I am old enough.
So far I tried it twice. Not sure if I dosed inadequately for what was happening with my blood sugars at the time, but I was actually pretty underwhelmed by the response. The second time I did have some coughing with the inhalation though, so might have missed some of the product, and the coughing lasted about 20 minutes. Haven’t tried it again since, since waiting for a good moment to experiment more and a little hesitant because not sure my respiratory system likes it much. But definitely want to try a few more times before concluding that.
@cardamom, your initial experience matches mine. I’ve taken one dose, of 4 units. The problem may have been mine. I was sleepy at two in the morning, trying to read the instructions and set up the inhaler for the first time, may have breathed it in wrong, and probably took too low a dose to bring me down from a sustained 180. I coughed for about half an hour and required a couple of puffs of Ventolin. It did not budge my BG at all. I have not tried it since, but I will when the conditions are right.
I took an 8 to correct from the low 200s (which was the dose the pharma rep suggested for that level correction, and I figured if too much, should be able to treat the low easily since the insulin is so short acting), saw the tiniest dip, but not much. Could be that without the Afrezza I would have gone even higher (still not sure why I was high at the time, so possible, though it was fairly steady in the leadup to the Afrezza, so wasn’t expecting it to keep rising). The second time was a similar situation/result.
Oh btw, the rep suggested tilting your head a little forward/down as you inhale, with the inhaler angled a bit downward (so highest at your lips). And then basically treat it like you are smoking a joint (which is how I summed up her explanation, and she laughed and confirmed they are not allowed to offer that explanation, but yes, that). Slow sustained inhale for 3 seconds, hold for as long as you reasonably can, then exhale.
