Moving from Tslim/Dexcom to Dexcom G6, Toujeo and Afrezza

Finally got my samples! Yesterday I forgot to pre bolus for my med carb low fat dinner and shot up to 234 fast. So I use my first 4. Immediate dropped fast to 81! Both excited and scared but it worked miraculously! Here’s my question. After about 1:45 it climbed again. I’m assuming it was slow digestion :woman_shrugging:t3:I gave a reg bolus because I was worried that BG wasn’t as high and I wasn’t eating. I was afraid it would drop too low if I took a second Afrezza dose. Also if the script is written for one/meal don’t you run out using repeated doses?

What do you think? Also it made me wonder. I’m searching through old posts from ‘17 some people use both a injection and Afrezza. How do you figure out the ratio for lowering the injection. Hope that made sense.

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A lot of this is just trial and error. A drop from 234 to 81 is a pretty big drop. Were you active or walking around during that time? Afrezza is more sensitive to that than humalog IMO. I think I may have been a little more sensitive to Afrezza when I first started.

I’m comfortable following most meals up with another dose 2 hours later if it’s needed, and I base that Afrezza dose amount off of the arrow angle on my Dexcom. High fat/protein meals like pizza tend to benefit from some humalog instead of an Afrezza follow-up dose. I usually dose with humalog as I sit down to eat (no prebolus) and attempt to cover the carbs I estimate won’t have digested by the end of 2-3 hours (paired with an Afrezza dose for the carbs I estimate I’ll digest in the first 2 hours). It’s a guessing game! The difference is that if you mess up the estimate, you have a super fast-acting insulin on your side now.

My Afrezza prescription is written for the max dose/meal. If you end up using more than you expected, your doctor can revise the prescription so you have enough (hopefully covered by insurance!).

Edit: With a high fat meal like pizza, I usually dose the Afrezza after I eat.

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Thank you that was very helpful! No I wasn’t active at all :flushed:. I’m insulin sensitive but I have already DIY some 2u doses :shushing_face:

I am on Medicare. The company is working with my dr and they have some programs that sound hopeful.

I’ll keep at it today!

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Smart!! Let us know how that works out. I’ve thought about doing that, but I guess I’m lazy :smile:

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Just saw your reply @Katers87!

Does anyone else have feedback on the DIY 2u doses? It’s hard to tell if the amounts are equal but it’s so forgiving I guess it’s okay. It was very easy.

Also I’m curious why the Afrezza posts in search are so old. I’m surprised it hasn’t caught on. Is it the cost?

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I think the cost is probably the largest part. Some people are leery of Afrezza because we don’t have long-term history of people using it. While there’s no reason it should cause any problems long-term, we don’t have the history to back that up yet.

There are quite a few people that use it on this forum though. I think @TravelingOn’s partner, @MM2, @CatLady, and @Sam are using it. I’m trying to remember who else.

Here’s my thread from when I started: Afrezza & upcoming endo appt

It’s a year old though.

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It isn’t available to anyone under 18, we have tried to get our practice to prescribe it without luck. I think the cost is also an issue. Also, reading through the threads on this as people have started out with it, it would seem that reasonably quickly people get the hang of it and stop asking for advice, so I take that as a good thing.

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Yes that all makes sense. I’m surprised but not surprised how resistant some people are to it. Especially providers. They seem to like to go with the easier way of what they know.

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Probably also because long-term safety is unknown. Its safety short-term is well-established (outside of people with pulmonary rule-outs), but it’s simply impossible at this point to know what the effects might be decades down the line of regular use. It’s why personally, I’d be hesitant to use it as a primary short-term insulin just yet, vs as an adjunctive one (although I can certainly understand people making other choices after weighing pros/cons for themselves). Pediatric providers are going to be way more cautious on that front, given that their patients have a lot longer to live still, so possible unknown long-term side effects are more concerning. I don’t think it’s about going the easier route, but the safer one.

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I primarily use Afrezza for corrections and glycemic meals (such as Thai food). I don’t use it often enough, though, to have a good sense of timing or how many carbs a dose covers. I did self-pay for my 4-unit doses and got samples for the 8s from my doctor’s office.

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The host in the podcast, Craig Stubing, does he talk about it in other podcast sessions? Do you follow him on social media?

I’ve never really gotten into the facebook, instagram, or twitter scene. It’d be interesting to see if Afrezza is being talked about there.

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Yes he does! And there are three different podcast under the BetaCell umbrella. I really like their outlook and information. He is not as active on social media as
Laura Pavlakovich who I think you related to.

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This is what I’m starting with and have a feeling it may be how I end up using it. I would rarely use an 8u so I am splitting them to help me financially.

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Rather than safer route, I would guess its more known vs unknown. Afrezza has not been shown to be unsafe.

The dosing difference is the other obstacle. With my pump, I rarely bolus more than 3-4 units for meals. But for higher carb meals, will bolus 1-2 units pump, in addition to 4 unit Afrezza. I have 8 unit Afrezza that I usually split, but on occasion use full 8 when have fast rising BG, with higher carbs “food on board”. Without CGMS, I would not be as aggressive with Afrezza.

It is not covered by my insurance, also obstacle for more usage. But signed up for lower cost program offered this year, but will likely stop once that program ends.

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I’m not sure I’m comfortable with characterizing Afrezza as a less safe route either.

Prior to starting Afrezza, my average bg level was 130. Using Afrezza and Tresiba, I had a 90 day average around 118 (prior to starting Metformin). You can see this in my past posts. My time spent in the low range has remained overall consistent, but my A1c dropped .3% which is significant since it was already low when I started. In addition, my standard deviation dropped from around 35-40 (depending on the week) to 30-35.

Given that we have no reason to believe Afrezza should cause problems, I feel that I’m much safer taking Afrezza.

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Yes, I should rephrase, it’s the more conservative route re: safety concerns.

And while I agree there’s no specific reason to think it causes problems, there’s also no reason to assume inhaling insulin is safe for the long-term either, so it is a risk trade-off. And if it’s a useful way to obtain significantly better control, I’d agree that I’d think it’s most likely a worthwhile risk for that person.

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I think Afrezza’s action profile allows for better control with less effort as well. We all make lots of adjustments in our lives to stay in range so that we can feel good and reduce our risk of developing complications.

We have no reason to believe that Afrezza will cause long-term problems, but we know that it can help significantly balance the time spent managing diabetes and living the rest of our lives. Maybe not for everyone, but I know it did for me.

While there’s a risk/reward for most things diabetes, the long-term risk is not measurable for this one. So I suppose for me, there are lots of other risks out there that are known and tangible. Afrezza helps me minimize those and allows me to focus my mind on other things.

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I agree 100%. After 50 years of multiple tools , it is all a risk and trial and error. The safety issue of Afreeza has not concerned me.

Thank you. Very helpful!

Dexcom is pivotal for me in regards to all aspects of my management.

Well said. That’s my goal.

Update- So far it is going very well and improving as I am learning! I am very happy with the results I am getting. In the middle of the process of approvals, auths, appeals,cash pay program help. I am holding back my excitement with how well it is working for me because of this unknown.

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Again, I think that makes perfect sense! It’s probably the same way I’d think about it for the most part. My main point was that my experience, pediatric providers often tend to weigh unknown longterm risk much more heavily than most of us would (whether that’s a helpful decision or not).

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To clarify this. This was in reference to providers and insurance coverage etc. There are a wide array of endos out there and each is more open to doing things out of their own box than others. There are some who will only prescribe Medtronic pumps and you need to fight for a Tandem etc. I’m sure safety especially for peds, the unknown and the easier way all play into it differently. I tend to lean towards the unknown. It would take time on their part to learn about using Afrezza and it is very reliant on each individuals trial and error for dosing. This makes many providers uncomfortable.

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