I’m going to rant for a minute… Sorry
First, my doctor tells me to take around 10 units more of Tresiba than my current Lantus dose. Based on my recent experience, this would have created a serious situation of lows for me!
Now, I’m having trouble getting the insurance authorization for a PFT for Afrezza, not because of my insurance but because of doctor’s offices and labs. The GWU lab told me over the phone that I needed to bring in or fax the order so that they can determine my insurance coverage. I bring in the order, and the lady says that I have to see a lung doctor (pulmonologist?) in order to have a PFT done at their lab. I tell her that I don’t have any lung problems so that would be a waste of time and money (in retrsopect, I should have been more polite but I certainly wasn’t rude). She then tells me that the people who actually handle the scheduling are not in the office (despite me calling the day before and asking their hours).
I wait for 45 minutes for them to arrive, and then she decides that it’s okay for her to call them (not sure why she wouldn’t do this earlier…) and ask. They say that I can have the test, but my endo needs to get the authorization from my insurance, and I can give the PFT lab the authorization number once my endo gets it. I call my endo and give the receptionist all the info she needs in order to call and get an authorization from my insurance. I don’t get a call back, so I call her again and she says that she couldn’t get through. She asks if I can give her the extension so she doesn’t have to wait on hold. I call my insurance, get right through to the exact same place she says she called, and they tell me there is no extension for that department. So I call her back, tell her that they’re available and she says she’ll call. She never calls me back, so I call again, and she says that the people in the office that do authorizations won’t be there until the next day, Friday. She says she’ll give them my information, but I should probably call back Friday and ask them to call.
I call throughout the day on Friday, but I can’t get through to my endo’s office at all! I called at 4 separate times on Friday and couldn’t get through. So I called this morning, and the receptionist tells me that I have to wait until Friday because the people who do authorizations won’t be in until then!!
This is a joke. What kind of office is this?? We haven’t even gotten to the part where my insurance needs to actually authorize the PFT!!!
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Sounds like a great review for Healthgrades
Sorry you’re going through this! 
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Thanks for reading my rant 
I can’t imagine how frustrating something like this would be if my health actually depended on getting a test done right away.
I’m going to have to look into getting a different doctor because this just wouldn’t be acceptable in that situation.
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@Katers87 87 - I recommend finding an internist that specializes in Diabetes. They can usually do a spirometry test right in their office. Insurance doesn’t need to authorize it. It is no different than a lab test. The only thing insurance should end up getting is a prescription for the Afrezza, and the prior authorization data showing you do not have control on the injectable insulins. Contact MannKind Cares for help on all this.
On the Tresiba, it is not unusual to start out at 10% more than a Lantus dose. I personally wouldn’t, as I would rather have high blood glucose for a week or so, while I dialed in my Tresiba. Keep in mind that a dose change in Tresiba will not actually show up in your blood glucose readings for 3 days.
When starting Trestiba, you should continue your Lantus dose and gradually reduce the dose over 3 days. My personal experience is 100% Lantus on the first day of Tresiba, reduce to 50% the second day, and stop the Lantus all together on day 3.
But I am not a doctor - YMMV.
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@Katers87 - I also meant to say that any prior authorization should state that you have absorption issues and/or lack of real-estate for injections or pump usage. Or a fear of needles.
Thanks for your input, kmichel. Maybe I’ll call MannKind Cares about this. They might know of doctors in the area that have tests in office. My doctor originally said that I needed the full PFT because I had asthma when I was a baby, but I don’t really trust her opinion right now. It would be helpful to not have to deal with the headache of this PFT situation.
My doctor recommended that I start on Tresiba at 33 units when my prior Lantus dose was 23 units, so she recommended a 40% increase in units. This would have been way too much for me. Still not sure where my final dose will land, but I started on 23 units and it was definitely a much better place to start.
My insurance told me over the phone that Afrezza doesn’t require any additional authorization, so I don’t think I need to prove that I have absorption issues in order to use it. I’m sure every insurance company is different though.
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@Katers87 - This is the first year I have had insurance that did not require a PA. You just need a doctor who will do an in-office spirometry. Only the FEV1 value is needed - the amount of air you can expel in 1 second (but you have to exhale for a full 6 seconds for the machine to register a valid test). Just remember to inhale deep into the abdomen, exhale all you can in 1 second, and just keep blowing the last dregs of your life until 6 seconds has elapsed. You will do fine.
MannKind Cares only helps with prior authorizations. Look for a doc that knows Afrezza on this site.
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@Katers87, that recommendation was surprising. I am looking forward to finding out where you balance out on your Tresiba thread!
I got really mad when I read your post! Now i am going to have to work it off by taking a long, arduous walk somewhere 
I can only imagine how you must be feeling: I am really sorry.
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Lol. Hopefully I’ll survive the test!
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