I have been reading all of FUD posts and links on Afrezza. I had no idea how uninformed I was and am going to start using it. I have talked with my doctor and I qualify as far as no lung issues. I’ve never smoked. I am insulin sensitive so I thought it wouldn’t work for me but I understand now thanks to you all @Sam about how it works. Also thank you for the links for direct pay. I have a feeling Medicare won’t pay for it. Does anyone have experience with that? The YouTube video of making a 2u cartridge was great. Purchasing a 12u and dividing it looks like a good option! So. How should I start? Ha big question. Like should I get script for 4u until I learn my individual response? Any advice for initial use is appreciated!
5 Likes
How exciting you’re eligible to try Afrezza! I hope it winds up being another good tool in your tool belt for diabetes.
Well, they sell a 4-8-12 unit mixed pack. And a 4 and 8 unit pack. So those might help. EH finds the 12 to almost always be too much for him, but YDMV. Your doctor should be able to write an RX for the 4 & 8 unit box. While looking for a photo of the box I stumbled across this, which might be helpful:
https://www.afrezza.com/hcp/prescribing-afrezza
Darn. The snappy photo didn’t turn up. Never do understand what will do what on this app. 
I’ve added screenshots.
2 Likes
Also I misread your initial post a tad.
I don’t know about splitting them up. It seems like a fussy project for a limited savings possibly? But I shouldn’t knock it! Maybe it’s easy? There’s a $15 copay option for insurance holders as well as a few other programs. Check out this article:
1 Like
I get a combination box of 4 unit and 8 unit cartridges. (90 cartridges of each). I’ve found that has worked best for me. I would start with that or boxes of the 4 unit cartridges at first.
If you do decide to split up a 12 unit cartridge, each 3 cartridge pack is supposed to be used within a few days (3 I think?). That might be a bit too much for when you’re just starting out, so I’d recommend waiting until you know how much you’ll use. While I’ve thought a 2 unit cartridge would be nice at times, I’ve never split a cartridge. I’m not sure it’s worth the effort.
Just saw your post @TravelingOn -that’s the exact combo pack I was referencing. It’s a good starting point!
2 Likes
I first tried Afrezza by getting free samples from my doctor. Got quite a few, since no one else interested, and he wasn’t really supportive of it. So you might check with your doctor. They might be able to get some samples by contacting mannkind.
I just got first shipment from the mail order offer, the 4+8 combo pak. Will probably end up splitting some of the 8s. Agree, don’t really use/need 2s, but could split if needed.
2 Likes
Thank you! The links you have sent are beyond helpful! I am lucky to have a doctor who is open, trusting and willing to work with anything I come up with and usually learns along with me!
As far as the splitting YouTube video I definitely would not attempt that until I am much more experienced and decide that it would help as chances are as you say it may not be worth it.
We are a creative bunch aren’t we T1’s!!
I have learned so much from all of you. After 50 years starting with urine tests and 1 shot/day of pig insulin - we soon learn that it is NOT a one tool disease it is a compete combined toolbox! I am very excited!
So as far as the nitty gritty of starting to dose with it, where is a good starting point? I can see it’s usefulness for both meal bolus and post meal highs from the links posted. Since it is so different from injectable as far as the concept of units, how do you know where to start?
5 Likes
My doctor is working on sample as we speak.
I know it is a totally new mindset and like @Sam mentioned once I wish they used a different term of measurement rather than units. Knowing that, I very rarely would ever give 4u of say humalog. I’m focusing on changing that mindset.
1 Like
I’m happy for you too 
Afrezza is awesome. It takes a little getting used to, so try to be patient at first. I was a bit frustrated the first few days before I started to get the hang of it.
I would recommend treating each 4 unit increment of Afrezza as 2 units of Humalog/Novolog that kicks in faster. Be sure to dose either with your meal or right after you eat. I’d start with after you eat at first. I’d also recommend starting with well-known foods and then branching out after you feel more comfortable.
Afrezza is less likely to make you drop low, but if you dose way too much, you will still drop low. I’m mentioning this because I did have a couple of lows when I first started that I didn’t expect after reading other’s posts. Since Afrezza works so quickly, the drop can be steep and a little scary. Overall, I’m much, much less likely to drop low using Afrezza than Humalog/Novolog, but it takes some time to learn how to dose.
I love Afrezza. It’s just very different than other fast-acting insulins, so there’s a bit of a learning curve. Once you figure it out (which I’m sure you will ), I have no doubt you’ll love it too.
You could start with a meal or at a time when you need a correction of 2 units. I think either way would be fine. If you start with a correction, try not to freak out when you drop to 70/80 fairly quickly. As long as you begin to flatten out around 70/80, then you probably won’t drop low. Afrezza kicks in quickly and can drop off quickly once you’re in normal range (or above that if you didn’t take enough). Landing highs with Afrezza is much less risky than with Humalog/Novolog.
6 Likes
Thanks for the warning. As long as I’m prepared I can handle the freak out! It is scary for sure just being new. I will start slow like you advised.
GREAT information! Can’t thank you enough!!
4 Likes
I wouldn’t get caught up right away about worrying about the dose sizes… those concerns are very overrated imo…
If you normally take less than 8u of insulin get whatever combination or 4 and 8s seems appropriate…
You’ll learn as you go how it best works for you, keep an open mind
3 Likes
Seems like lots of good tips here for you! I was thinking about older threads which might be helpful too:
I’m glad you’re going to give it a try! Keep us posted!
1 Like
Thank you for taking the time to send those! I will read through them. Now I’m waiting for my samples and researching financial links I saw about help with self pay since I doubt Medicare will pay.
2 Likes
Been on Afrezza for about a month now. It’s extremely effective in the morning, and very effective with a high carb meal. I used to wait about 25-30min with Fiasp, with Afrezza its like 5min and i better eat. Its also nice that with the short tail im not getting low when i hit the gym, there’s no trickling lower later. On the downside though i notice that when i take it at lunch time it doesn’t seem as reliable in effectiveness, i eat the same thing and one day i would take 12u and next i would be doing another hit with 4u or 8u to keep it flat. I measure my carbs with a gram scale. I’ve found i like taking a shot of fiasp better for lunch. It also seems to have a odd attribute of softening the drop once it crosses maybe 80. With Novolog/Fiasp it will just keep tanking hard, but with Afrezza is seems more likely to not cross past 70 which is a unusual attribute. Other thoughts i have are i don’t like the excessive packaging with blister packs, multi inhalers, huge boxes in fridge, the packaging isn’t elegant, and it’s expensive stuff. Maybe the company could have also did better maybe by marketing the product as a supplementary to shots, like specifically for taking down high blood sugars.
5 Likes
Wow that’s amazing. What a helpful review! I’m learning so much. Thanks to everyone! As I learn and apply it to my BG experience/digestion etc I can see it becoming a combination of Fiasp and Afrezza. It will be an experimental process like everything with this disease and I will keep you all posted. I’m so anxious to start it and I know that’s going to be the first hurdle - finding the best way to afford it. My Dr is working on getting my samples this coming week! I have been experimenting with Fiasp in my X2 this week. They say it is not advised and I’ve heard others say they had occlusions etc but I’ve had none and so far after a week I’m liking it. But there’s another thing that’s expensive and not covered! Thank you all again!
1 Like
@Jattzl Ditto to the great insights folks have shared with you so far. I am very glad I added it to my D arsenal.
It seems like in the beginning, Afrezza had just a bit more impact for me than I see right now (higher Correction Factor and I/C ratio). The few serious lows I had in the first month were when I stacked several Afrezza doses or combined it with units of Humalog with an aggressive correction or bolus.
I also split 4u cartridges to 2u ones in the beginning - after saving a hand full of used cartridges first. After a few months, splitting wasn’t necessary for me (I didn’t need 2u doses and my insurance covers enough).
Now, I use Humalog (pump) with Afrezza as needed (higher carb meals, to bring down a stubborn high, and/or to blunt a quick climbing BG. 80% of the time a 4u cartridge is enough, the rest of the time an 8 will work.
5 Likes
This is exactly what I’m needing and hoping for! Thank you!
1 Like
Does anyone have experience with Medicare coverage or the process of getting it approved through them?
1 Like
Fiasp is not FDA approved for the pump. Which is different then Tandem advising against it. It is my understanding that Novo Nordisk has submitted to the FDA for approval for Fiasp in pumps although I do not know if the approval would be for only one pump (guess which one) or for any pump.
We use Fiasp in the X2 and have zero issues with occlusions.
3 Likes
Excellent point @SFBob!
And really, @Jattzl consider reaching out to Mannkind. They are a really good company as far as helping customers get approved. I’ve never seen anybody go to bat for us as hard as they did. I don’t know about Medicare approval, but they will I believe.
1 Like
I’m contacting them first thing Monday. Someone else recommended getting a mannkind rep so I think that will help. That’s how I got my X2 originally by having a rep do most of the work for me!!
1 Like