Today, more in our series on Afrezza in the Real World...
Some analysts are giving not-so-positive outlooks on Afrezza based on early financial reports that the new inhaled insulin raised just a measly $1.1 million in its first weeks on the market. But those in the Diabetes Community who are actually using this new treatment option have mostly good things to say.
We continue looking into this newest inhaled insulin product from MannKind and Sanofi by sharing some more user testimony, this time from another fellow type 1, and also a type 2 new to insulin altogether. They come from opposite ends of the D-treatment continuum, but both seem very excited about what they are seeing.
From Joanne Laufer Milo
I’ve been “dabbling” in Afrezza inhalable insulin for about a month now … and while I’m still a bit uncertain, I don’t want to stop using it!
OK, so let me start at the beginning. When I was diagnosed with T1 over 50 years ago (yes, it was actually called diabetes mellitus back then), I injected animal insulin (beef and pork) and that was the only option. Many moons later, I switched to pork only, u-500 that I imported from England (before mad cow disease and yes, I needed an import permit from the Dept of Agriculture!). After that, I used human insulin in my shots… and finally in my insulin pump. Seemed like that would be it for the rest of my life, until there was a cure or death do diabetes and I part.
Now, INHALABLE insulin? I was excited and very skeptical. But I had to try it.
First, you do need to have a pulmonary breathing test before your doctor will let you use Afrezza. This is an FDA requirement to rule out potential lung problems before you get a prescription. That made me nervous, after years with asthma… but I “passed."
My first try with Afrezza took me a while. I somehow couldn’t figure out how to put the cartridge into the inhaler.
My first breath… too big! Set off a wild coughing spell. So then I got more cautious and inhaled slowly, trying to only use half the cartridge.
The interesting thing about using Afrezza is that the dosing is not that exact. It doesn’t seem to matter if I think I’m using ½ or all of the 4 units. It just works. All without really counting carbs.
At first, I only used it when I was running high and knew that it would take my insulin a long time to bring down my blood sugars. After a month, I’m getting braver and using it much more often. This week, I’ve been using Afrezza daily, first thing in the morning (to deal with morning rises) and after lunch and dinner. I’m cutting back on my meal boluses with the pump. And if my meal is very low on carbs, I don’t bolus at all, and just use a 4-unit puff of Afrezza post-meal if I see I'm starting to rise.
With exercise, I’m still learning. With cardio, my BG’s tend to drop, so no problem there. With anaerobic exercise (weights or pilates), my bg’s tend to spike … so a little puff seems to hold down the fast rise.
And here’s what I’m noticing … and as Amy reported. My blood sugars are remaining flat! Really flat. I’m not going too low (unless I do a regular bolus AND a puff of Afrezza). I’m not running high.
I like it!
However, I’ve got two big negatives and one amusing negative:
- I’ve got a constant clearing-my-throat/cough and a somewhat warbled voice until I free my vocal cords. Manageable… but it's kind of like my new “signature” sound.
- I feel a slight tightness in my chest. It doesn’t worry me but I will discuss it with my endo next visit.
- It is “politically incorrect”! As Amy mentioned, using the inhaler looks like puffing on a joint… certainly not cool in public!
So what’s cool and what’s not cool about using Afrezza in public? Let’s take a look to the past.
When I was a teenager, my mother was terrified that if I took my shot in public (like, at the restaurant table), an undercover cop with immediately arrest me and ask questions later, after I was booked!
Then, in my young professional years, I learned to take shots anytime, under the table, right through my stockings. Again, my mom panicked … “what about using alcohol swabs??” “Oh mom, I don’t use those anymore!”
On to the pump … easy peasy! Hit the bolus under the table or in my pocket … or more boldly, out in the open!
So how do you “puff”?
- Turn your head or upper body and cover the inhaler in your hand. Be careful not to inhale so vigorously so that you end up coughing.
- Step away and do a quick pirouette as you inhale and voila, you are done! Very elegant!
- OR just take the puff and watch the reactions!
My final thoughts and confusions about using Afrezza:
I jumped on the bandwagon with Victoza (non-insulin injection), to level my blood sugar spikes. Then I added Farxiga (oral SGLT-2 inhibitor) to the mix. And now I’m using Afrezza. My dilemma is: Do I really need these other drugs if Afrezza keeps my blood sugars level?
To that question, I tried stopping Victoza, as an experiment. What I noticed was more variability (more and bigger changes), so I am now back on Victoza, at a lower dose (0.6) in the mornings (my toughest time of the day). So at the moment I’m still using Victoza and Farxiga, along with Afrezza. And there’s a new med on the horizon – Januvia or Tradjenta or Onglyza (DPP-4 Inhibitors)... more on that after my next endo appointment. Looks like I could be downing quite a cocktail mix in the near future.
One big question I still have is: How do I account for Afrezza in my total daily insulin amounts? I have NO idea. I have had to cut my basal by over 15% recently, but when it comes to calculations I don’t know if 4 units of Afrezza = 4 units of Humalog.
I also still don’t know if Afrezza causes weight gain. Would love to understand that better.
In summary: I love the benefits of Afrezza and plan to continue to use it daily.
From John A. George
This 69-year-old lives with type 2 diabetes in Florida. His father and sister are also type 2 diabetics. He can be found on twitter at @SpiroHere. Disclaimer: he does own some shares in Afrezza, but tells us this stems directly from his personal health interest in the drug.
Some A1c history -
1/2009 6.0 Doctor first called me a diabetic; of course I didn't believe it
7/2014 6.7 Started to exercise and lose weight, lost over 10 lbs and exercised regularly
2/2015 7.1 Finally accepted the fact that I was full-blown type 2 diabetic
2/27/2015 Started on 4 units of Afrezza, immediately preceding breakfast, lunch and dinner.
Because of liver problems, oral diabetes medications were not considered for my treatment. Afrezza is the only diabetes medication that I have ever taken. Because of my investment in MannKind Corporation, I was very aware of the potential benefits of early intervention with insulin in treating type 2 diabetes.
I have been using Afrezza for 51 days now. During the first week of use, I would occasionally have a slight cough, but that is no longer an issue. It took about two weeks before I noticed a significant improvement in my fasting blood glucose. I am very excited by the remarkable downward progress that my fasting blood glucose levels have shown. See my fasting BG logs:
I do not profess to know why this has happened or whether other type 2's will get the same results from using Afrezza. The only thing that I am certain about is that Afrezza has provided the medical community with another tool to fight diabetes with.
Well said, Both! Thank you for sharing your frank opinions about this surprising new treatment option.