This is what I do also. Nothing is as fast as Afrezza. For bringing down stubborn highs Afrezza also works without lingering effects of humalog and possible stacking from having to guess when it will finally budge. When it does finally work hours later I usually drop fast and have extended lows. I have had no negative lung issues from Afrezza.
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I use Afrezza for almost all of my bolus now. Absorption is a big problem for me and this is really interesting to me. I have not paid attention because I have been focused on learning Afrezza but that effect on my basal absorption makes sense. Iām going to keep a better eye on it. Thanks!
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DITTO. 100% in agreement and experience with 670G AM and MM. Relieved and grateful I was able to get out of it survived.
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Interesting to me, too. I also never considered it or paid much attention, but Iām curious now.
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I feel like under absorption at insertion sites is very significant and yet rarely discussed. Insulin is a growth factor for cells - when you grow cells in a dish in a lab it is something you have to add to get cells to divide and multiply. The more you add, the more cells multiply. Essentially itās the reason they talk about why it is so critical to make sure children have enough insulin. Itās the reason us bad diabetics 
who havenāt always changed our insertion sites when we were supposed to get that little ābumpā at the site. Certainty part of that is irritation/slight infection but itās also a Lipoma (fat cell tumor). A Lipoma will ALWAYS grow there, even if it is so small we canāt see or feel it. I am not saying it is a dangerous tumor - it goes away, but we know tumors, malignant or begnin, suck resources and prevent other tissues from getting resources.
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You just popped up with this comment, which I should read more thoroughly before responding to it, and it is all very fresh on my mindā¦ My blood sugar has been ridiculous since yesterday evening. Changed out the set, did IV, blood sugar plummeted, and then blood sugar climbed back to ridiculous height again where it stayed over night. Pulled out my set and found a bent cannula. More IVs, an IM or two, and then a run. I barely dropped below a 300 in 6 miles. I did almost 2 units of insulin during that run. And I KNOW what my blood sugar should be doing in that scenarioā¦
LONGEST way to make a point ever, but what Iām trying to say is that my sugar was high yesterday evening, I changed the set, went high again (then realized i didnāt get the insulin), changed again this morning and didnāt come down, even after a run, until after doing an IM. Three sets all in the same locationā¦ because I wasnāt messing around about being a bad diabetic. Maybe??
Frickin diabetes, boy. It can really raise my blood pressure. And sugar. 
You also donāt have to respond. Iām just venting a little today. 
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I had a similar inexplicable run of high BGs despite changing everything ā one step at a time, of course ā until I feared that perhaps my recurrent intra-abdominal E.coli infection might be emerging, low grade (no fever shows in this now very familiar conditionā¦). So to avoid an unnecessary course of antibiotics, I decided to recharge everything & then change the pump battery. WOW! It was replacing the pump battery (with the highest quality AA rechargeable) that (appeared) to solve it!
P.S. Iām aware of behavior of different battery electro-chemistry designs, and have known of the warnings to not use rechargeables in a variety of (generallyā¦) LV low-voltage electric motor devices ā especially in my 670G insulin pump, if memory serves me accurately.
But my love of an Earth as our species has been so lucky to exist in has me using rechargeables whenever I possibly can. P.S. Iāve found the āeneloopā AA models are top performers by every measure, but even they have diminishing delivery as they approach depletion, and an insulin pump motor runs at varying durations, and even rates, in basal/bolus modes plus in loading. So: my fault for running high, in this case! Yay! Not a re-infection!!
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Sorry Iām late on replying here, but I completely agree with the above. Iām just adding extra here, and we can totally have someone split the forum, but Iām not adding anything to disagree with Nicky - just some extra info to contextualize for others who have not used AM or anyone interested in the idea of using it for just overnights. Iām also happy to write more on it and my experience.
Because for some this may seem vague for someone who hasnāt used AM, Iāll try to put numbers to my experience with automode. I would say 4/7 nights within a given week, overnight AM would run me between 140-160; 2/7 of the nights it would run me at 120-140; and one night a week Iād go higher than 160 - usually stuck between 180-220, and while in this higher range, Iād sleep through and AM would continue to do itās thing but failing to give me large enough microboluses to bring me down. Very rarely did I ever have nights that I would go low while in AM.
For the situation that Nicky describes above - 5/7 mornings a week Iād wake up at whatever AM left me at and my morning boluses would go fine. 2/7 mornings a week, I would get a pre-breakfast spike or post-breakfast spike (to a lasting high (for me above 180, cannot be brought down an hour to three hours even with aggressive bolusing)) that I believe was due to too small amounts of microboluses/basals early morning before Iād woken up.
these are my estimates of a typical week of AM overnight only and MM during the day FOR ME. Automode varies person to person but I figured supplying some numbers would help contextualize. For some people, these numbers sound great and satisfy their individual goal for stability overnights. Which is great and they should totally try it out! And Iām sure some have had more success with tighter ranges than me, that they were super happy with. However, this is not true for everyone and is largely dependent on how AM works for each individual (dependent on insulin and microbolus needs) as well as the individualās goals; for me, AM failed to satisfy in both categories overtime, and I problem solved overnights to be less of hassle using MM, no suspends - a solution Iām much more comfortable with. Again, entirely dependent on the individual
Sorry I didnāt even know I had anything to say really LOL
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Wow. This is new to me. I do an IM sometimes. Usually deltoid or thigh. But never heard of IV. How do you do this? Thanks
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Hi @Jane17!
I know whether you decide to try this is not my business, but since I have been contributing to the IV portion of this thread heavily, I will say I would be completely uncomfortable just leaving you some tips. It has great potential but also comes with riskā¦ and more than a handful of rules. It would be completely irresponsible of me to provide the kind of information that might send you off to try it without lots and lots of discussion prior to doing so. In my case, my friend in here provided lots of information, lots of examples, demonstrations, rules, etcā¦ before I was even willing to try. And rightfully. think thatās because he wanted me to respect the process (and maybe fear it?) before doing it. So I do IV now, but I still respect the process, follow all the rules, and use it sparingly.
I get preachy. Sorry. I really only mean to do the right thing here. I do have good reason for wanting to engage in conversation about it and have enjoyed whatās taken place here, but I also donāt want to encourage the practice easily and openly. Donāt know how others in here feel, butā¦I apologized and preached more. 
You say you use IM on occasion?? Any thoughts on that?? I hear others talking about it being spotty and would have to agree. Hoping to come across someone with the secretā¦
Which would okay, too. 
That was really interesting, @LarissaW. Now you are talking about Auto just overnight though, right?? I do remember doing that for a spell, and although it wasnāt every night, by any stretch of the imagination, it was more like 3-4 (easily?) mornings a week. In general, I found 2 overnight patterns, one that was insulin-heavy early on and light just before waking (which would lead to high BGs in the morning) and one that was light insulin between 12-3 with a big push in insulin between about 3 and waking. On those particular mornings, I had to watch out for a crash, but I really think I had those 1-2 times a week at most. The first pattern was the predominant one in my case, and I wasnāt fond of it.
Agreed. In this case, we saw the same thing. Auto was great for overnight lows. Just wasnāt feeling it for the rest of the day.
Right. I was in that category until I wasnāt. There definitely are people who would be happy getting those kinds of numbers without dealing with the lows.
We landed in the same place.
Since youāre throwing around numbers, I think Iāll go back and check out an old videoā¦ unless itās only in my mind. I think I did one comparing morningsā¦ hmmm. Maybe itās only in my mind. 
Yup, those trends above talking about auto overnight only then switching to manual mode during the day. I did that for about a month, but didnāt look too into patterns of how much insulin auto was giving me at what time like you have above. I would say I very very rarely (maybe once or twice in that month?) had a morning crash, and I couldnāt say confidently that it was AM in particular responsible for the crash (considering all the other variables with diabetes). I could go back and try to find that data to look into AM overnight insulin patterns, but that might take me a month or two of sitting around to get to 
@Jane17 I will certainly share what I do and how I do it: 1) as a I said I have used Regular, Humalog, and Novolog. I would NEVER use a ācloudyā based insulin; 2) I always use a bottle that I know is new or relatively clean; 3) I always wipe the top of the bottle and the skin/vein with an alcohol swab and use a NEW UNUSED syringe; 4) I choose a vein that is easy to see. Usually one on my arm or the spot in the crease of elbow where the lab draws blood; 5) I draw up LESS insulin in the syringe than I know need. I give a SQ bolus for the rest. I also typically donāt do this when I am going to sleep or back to sleep in an hour if the IV injection; 6) I lay the brand NEW UNUSED needle as close to parallel to the vein/skin as I can. Insert the needle into the vein and draw back the plunger to make sure it fills with blood. If it doesnāt, I move the needle a hair back or forward (usually back) so I am in the vein and getting blood. 7) I inject the insulin (and blood) in the vein.
I know there are people who bandage it when they are done. I donāt. Much like I donāt bandage after a lab blood draw that isnāt bleeding, a blood donation, or a vaccination (if they do it, I rip the bandaid off immediately) .
I also donāt obsess about air in the syringe when drawing up the insulin. I do what I can to keep/get the air out of the syringe, just like I do when drawing up a SQ injection. I know some people worry about this, but they have decided that air in the VEIN isnāt as dangerous as they used to believe it to be. ARTERIES yes, get the air out, VEINS no, not so important. If you can see it, itās bluish, and you are using a 1/2" or less needle itās a vein. Arteries in the legs and arms are much deeper. If you have had IVās in a hospital in the past 5 years or so, you will notice that they no longer go through all the work and waste of getting air out of IVās either.
I know that some people worry about infection. I will reiterate what I have previously said I like to remind myself of: IV drug users do this in an alley or a dirty crack house with a used syringe and dirty spoon and you rarely hear of them getting blood infections. A veterinary will swab a dirty animal in a dirty barn with a bit of alcohol and do an IV injection and you rarely hear of that livestock getting a blood infection.
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Thank you for this information. Good to know although I hope I never have to use. I had just never heard of. Your explanation was very detailed and thorough.
I hope I didnāt come across arrogant or uptight when I said Iād prefer not to provide that kind of information in a thread, but I believe doing so has the potential for harm. I thought your write up was great and am not trying to get into it with you, but although you covered the main concerns, you failed to mention anything about the size or rate of action of the bolus. This is a critical piece of information, and itās why I wanted to avoid just posting a āhow toā here.
I logged an IV shot the other day because I was interested in seeing if it were really out in an hour. I would be happy to provide the data in here if anyone sees the value of it, but I will summarize by saying I went from a 220 to a 175 in 10 minutes (G6 showed a stable 216). 20 minutes following my shot, I was at a 135 (G6 showed a 178 angled arrow down). 30 minutes out I was at a 105, and at an hour I was at a 61 and stable. It was out in an hour, but that was a 2 unit shot (which is not a sizable one for me)ā¦ and it dropped me 160 points in an hour, 45 points in the first 10 minutes. Thatās insane. It does have a place in my diabetes tool box, but it is an inappropriate course of action more often than it is an appropriate one, and people should know that.
In regard to the other items, I really do agree for the most part. My friend explained bubbles and how big they need to be to cause trouble (one would have to be of significant size). Infectionā¦ Iām not totally on board with only because I tend to pick them up easily and prefer to take necessary measures to prevent one in the first place. I agree about the drug addicts and all of thatā¦ and still follow every precaution.
Anyway, I meant it that I have really enjoyed the discussion here, I just want to be responsible in what I leave. Not sure if you agreeā¦
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An old veterinarian told a story about when he was in veterinary school. The teaching vet hooked up a needle to a bicycle pump, inserted it into a horseās vein, and had one of the students pump continuously for 5 minutes while the demo/lecture continued. The horse just stood there, completely unperturbed, eating some hay. If Iām remembering the story right, the teacher explained that the blood in the vein is sent through the lungs, which easily clears large amounts of gasses out of the bloodstream. The danger of an air bubble is in an artery. That blood travels to the heart, and a sufficiently large bubble of air in the heart just compresses and expands without actually being pushed through, so the heart no longer is pumping blood.
I support Nicky on this. Itās an ethically strong stance.
My endo bluntly told me donāt do IV. The significant risk of infection is straightforward to mitigate with proper hygienic technique. But IV insulin is both potent and fast. If you take more than you needed, thereās a very real chance that you will pass out and die before you notice in time to rescue yourself. Now ask yourself, have you ever taken more insulin than you needed?
I understand that if someone takes a sufficiently undersized dose and monitors closely they can make IV work, but this is really dangerous compared with everything that we are used to. Are you willing to die just to bring down your BG somewhat faster? If not, then how about trying Afrezza rather than going the IV route. Afrezza is really fast and has a much more benign risk profile than IV insulin. If Afrezza is unavailable, then IM insulin has a much better safety profile than IV insulin. Sure IM isnāt as fast, but really, itās fast enough to keep you healthy. You donāt need IV.
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This summed up my thoughts on all of the various ways being discussed for a faster acting insulin. I have no experience with IM or IV and have no desire to try it. IMO When I hear the comparisons of risk and results vs afrezza, logically I donāt see any reason behind not choosing afrezza or even considering the others unless it is the cost or availability factors.
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@Nickyghaleb I didnāt find anything disparaging about your comments (and FYI I am by no means the easily offended type!). We simply have different opinions on what info has the potential for harm.
I felt like we had covered rates of action early in the thread. I purposely avoided the topic of āhow muchā because it varies so much on individual and situation. Itās definitely a learned skill. To illustrate how much it varies, and in an effort not to make anyone feel bad about how much they may need, I will at least say that for a 220 BS I could, and would, take well over 4 times what you took without a second thought, and thereās no way it would lower my BS to 60.
I am sure we have different sliding scales, different body masses, possibly different insulin brands, I could have insulin resistance after all these years, likely different metabolic rates, etc.
@bkh did the old veterinarian tell you the classic veterinary pharmacology story - - they did an experiment and found that you can give a horse twice as much acid as an elephant because equine metabolism is so high? It really illustrates that a mammal is not always mammal, and even a species is not always a species. To keep with the veterinary theme - some dog breeds canāt take Heartguard (Ivermectin), most breeds can.
I hope forums like this remind us all what works for one of us, may not work for another. Most importantly I hope these forums serve as a tool help us learn about the options available instead of just having to hear from a physician āthis is what you do,ā and then feeling like we have failed when success doesnāt come with 1 specific method.
@bkh I am curious to know if when your endo bluntly said ādonāt take insulin IVā if you asked why? Anytime ANYONE says do or donāt do X, if the rationale isnāt obvious to me, I ask for rationale. I understand some people accept "because the doctor said so, " but that is not me. I always remind myself that physicians used to advise pregnant and nursing women to drink alcohol.
@bkh and @Jattzl, I didnāt mean to imply Iād like not to use it. Iād just like not to feel like Iāve potentially sent someone down a dangerous road. Iām a huge proponent of itā¦ when I talk to almost no one about it except for my buddy who showed me the ropes. Itās why I was so interested in this thread. I have heard very little mention of it everāonly here and twice in The Honest Exchange, where one mention was comparing the risk of Afrezza to the risk of IV. Of course it all comes with risk. Insulin comes with risk. But the more we understand it, the sturdier we are, and the fewer the mistakes. I feel about IV the exact same way. There is a way to use it safely, but it requires knowledge, patience, commitment and discipline. I could not have done this a couple of years ago because of a complete lack of everything on that list. At this stage though, theyāre a part of my everyday maintenanceā¦ as is IV. Dosing is carefully considered, carefully calculated, and carefully performed. And what it has done for my willingness to handle a climbing blood sugar is beyond words. There is no number I see anymore that makes me want to say eff it, which means I always have the mental and physical energy to tackle it. For me, thatās a really big deal. Afrezza might be able to do the same. I plan on asking my doc for a sample on Tuesday. Iād love to compare the two. Iād also love to see some good long term studies on the impact on the lungs. I believe MannKind (its maker?) did present some findings that were positive in that regard, but I didnāt particularly like their wording in that it sounds only like it is comparatively less of a risk more than it is independently not a risk at all:
āOther data presented at this meeting showed that the pulmonary function of patients with diabetes is more impacted by factors such as high body mass index, elevated HbA1c levels and the time since onset of diabetes than by the effect of inhaled insulin. Kendall added āwe believe that these and other recently published data significantly advance our understanding of the treatment opportunity that Afrezza therapy can offer.āā
Since I have little faith in these companies to begin with, it doesnāt take much to get me questioning stuff, and it feels less than straightforward?? Been wrong before, so Iām not ruling that out either.
@Dc53705, I loved your response. So we really are pretty much on the same pageāmaybe entirely.
Iām not sure we do. I would never want to talk bolus sizes for someone else. And you were right that we had talked about it earlier in the thread. It all makes sense, and I couldnāt agree more about our individual needs. I would never try an 8 unit IVā¦ not sure what would happen, but Iāve got a few ideas. I think the priority in discussing IV should be safety first (with emphasis on rate of action and technique) and then debunking myths. And itās been done in here.
This forum is all of that. I came here as a very dependent patient. Good listener. Easier to let the doctor decide than to think for myself. In the year Iāve been here, Iāve evolved into a real pain in the ass patient who wants what I want, expects an explanation if I canāt have it, and who is an independent thinker with some skills to boot. I honestly learned it all here. With the diabetes whisperers. 
Just wanted to say I appreciate your starting and contributing to the thread. I think itās a good threadā¦
But Iāve been wrong before and havenāt ruled that out.
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By nursing textbooks, onset of medications including insulin, would be fastest through IV, then IM, slowest through SQ. I have not tried this.
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