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Diabetes Bites Newsletter

Afrezza continues to show benefits.

Did you know that the insulin produced by a person’s pancreas works almost immediately?! That is a Far cry from our current “rapid” acting insulins that do next to nothing for 10 minutes or so and then slowly ramp up to a peak action around 45 minutes. (Even Fiasp only shaves that down by about 8 minutes)

So what is the difference? In someone who does not have diabetes, the moment their body gets the signal that they are eating, they have insulin working to counter the rise in blood sugar. In someone with diabetes, using rapid acting insulin blousing just before the meal, food gets a free pass to raise blood sugar completely unchecked for 10 minutes and then barely slowed for about an hour! This is the difference between a blood sugar that rises 20 points before normalizing quickly, and a blood sugar that rises 100+ points and takes 4 hours to normalize. Slow tools make for slow, and potentially clumsy, results.

Recent study highlights benefits of rapid Afrezza action, is it right for you?

But we have a faster tool, Afrezza inhaled insulin (manufacturer Mannkind). Afrezza has an absorption time of under a minute thanks to the highly vascular lining of the respiratory tract. Then it peaks in just 12 minutes! That is faster than most people pre-bolus with their rapid acting injectable insulin!! Then in about 45 minutes Afrezza is completely clear of our systems and we are back to basal only insulin.

This speed of action means that blood sugars rise significantly less in the first hour after a meal. Studies have shown significant reduction in post prandial blood sugars levels with no increase in hypoglycemia. In fact, since we have less active insulin hours following a meal we are less likely to have delayed hypoglycemia, activity related lows and insulin stacking in corrections.

What are the down sides to Afrezza use? Can we work with them?

  1. Titration: Afrezza comes in 4,6 and 8 unit cartridges. However dosing is not a 1:1 unit for unit swap form rapid acting insulin to Afrezza. It is closer to 2 units of Afrezza equaling ROUGHLY 1 unit of aspart. However this is not quite right for everyone. So one down side is that you’re going to have to do a little bit of work to figure out your carb ratios and correction factors with Afrezza vs aspart.
  2. Maneuverability: Anyone who has gone from a 1 unit dosing insulin pen to a ½ unit dosing pen can tell you that the extra maneuverability of a half a unit makes a difference in how closely we can manage our outcomes. Doing to what is effectively a 2 unit dosed insulin presents a step in the wrong direction there. However patients report and study data shows that even though patients are forced to “round” their dose to the nearest Afrezza cartridge, they are still able to get back in range more quickly and so their over all control is improved. We also still do have our aspart to use for fine tuning corrections once Afrezza has finished the bulk of the work for tighter control.
  3. Respiratory risks: Afrezza is not recommended for anyone with chronic respiratory issues. People with asthma, COPD, cystic fibrosis, people with a history of lung disease or cancer, smokers, or those who have recently quit smoking should not use Afrezza. Sorry folks, no work around here. Studies have not shown an impact on inhaled insulin use during times of short upper respiratory infection, but if one is unable to inhale deeply enough they should use injected rapid acting insulin instead of afrezza. Your doctor should perform testing to make sure that you have sufficient inspiratory volume to effectively use inhaled medication and should monitor your respiratory capacity while using Afrezza to make sure you’re not having diminished lung capacity.
  4. Other considerations: Afrezza is not recommended for use in pregnant women or children under 18. Doctors should also periodically monitor potassium levels as imbalances are an uncommon side effect of Afrezza use.

Our Takeaway?

As always it is important to work with a doctor to establish the most effective and safe medication regimen for you. But Afrezza is another tool that can be added to our diabetes kit with relative ease of use and a lot of up sides. Here at Integrated Diabetes we work with many patients to make the most of their insulin regimen and hone their tools to achieve flexibility and precision.

Back to November 2018 Newsletter