We know, we know, analysts have been split on whether new inhaled insulin Afrezza will be a success. All we can tell you is that all the users we've heard from so far have been quite enthused; our Afrezza in the Real World series continues today, with yet another type 1 raving about this new, non-invasive form of insulin.
A Guest Post by Howard Stevenson
Hi, my name is Howard and I am a type 1 diabetic (now found on twitter as @Afrezzaguy). I was born and raised in Philadelphia, PA, then moved to Arizona in 1990 to attend the University of Arizona. I never left Arizona and have been in public safety for almost 19 years. Over my lifetime I have always prided myself on being in great shape, mostly eating healthy foods and making an effort to workout three or four times a week.
Then in October of 2013, I went to a bio screening my employer was sponsoring to have some general health tests conducted, including a blood sugar test. I had not eaten for many hours and was advised by the nurse that my blood sugar was a 275.
I went to an endocrinologist who diagnosed me with LADA, a form of adult type 1 diabetes. She advised me I would be insulin-dependent the rest of my life and instructed me on how to inject myself with Novolog and Lantus.
After some months of horrible control and terrible A1Cs, I was moved to an insulin pump with Novolog only. I truly only had limited success with the Novolog when I did not eat many carbs, or bolus myself 30 minutes before the meal. I was experiencing a few hypos a week some were fairly severe, including a couple down in the mid-thirties (!) I was not feeling great most of the time due to all the ups and downs and always worrying when the next crash would come. Diabetics know the huge swings in blood sugar levels really take a toll on you and are very draining.
A friend at work had told me about this new insulin you inhale called Afrezza which was waiting for FDA approval at the time, and should be available within the next six months. I told my doctor about it and let her know I wanted samples as soon as they became available. I finally got my samples and started using Afrezza the first week in April of 2015. I take one dose of Lantus at night and bolus with Afrezza only for meals/snacks.
Since starting on it, my control is awesome. I am spending 92% of time in my target range (70-165) with zero hypos! For the first 40 days, my average blood sugar has dropped to 122, which is in the range of a 5.87 A1C (before Afrezza my A1C was a 7.7).
What I found with Afrezza is that it is very forgiving and does not throw you into a rapid descent. It is fast-acting and does not linger in your body too long, usually gone in 60-70 minutes. I also went back on the insulin pump to see if there was any difference in using Afrezza with fast-acting basal insulin compared to slow-acting basal insulin. The only issue I found was that I had to adjust my basal settings: a little off here, a little more there due to Afrezza’s awesome control. So, Afrezza is working great in conjunction with my insulin pump. Those folks who like the pump can use Afrezza for bolus and the pump for basal and really dial in some tight control. Personally I will be spending most of my time off the pump only because I do not like being attached to it.
It took me a couple of days to stop comparing and treating Afrezza like injectable insulin — which IT IS NOT. Once I changed my mindset on that, my control got even better.
I really do not carb count anymore; I just carb estimate and identify if the food is fast or slow absorbing. With the fast-absorbing stuff, I dose before I start eating and depending on the size of the meal I might do a follow up dose at the end. For slow-absorbing carbs and bigger meals
I dose after just starting to eat and again around 60 minutes later. I am using 4-unit cartridges per dose. Before I snack I use a 4-unit dose if it would require anything in the range of 2 units or more. For anything under that I do not dose. I have found corrections are rarely needed with the control I am experiencing now, but when they are, Afrezza does a nice job of getting in quick and leveling you out without lingering.
Side effects for me? None. I have not experienced any breathing issues, dry throat, coughing or weight gain. Actually I have lost 4 pounds because I no longer have to eat to correct the hypos I was having. I run on a regular basis, miles at a time and have not experienced breathing problems. I have exercised and done strenuous yard work a few times since using Afrezza and have not had any issues with lows at all.
I did notice that if I inhale too strongly while dosing I do cough a couple of times. But when I pulled back and inhaled easier there is no coughing. Not much effort is needed to administer the powder, in fact so little I have to check the cartridge, not believing it is empty. The applicator is very easy and fast to use---drop a cartridge in and with one small puff you have just dosed yourself with insulin. The inhaler is also small, which makes it easy to carry and discrete to use.
Over the last 40 days I have truly tested, explored and pushed Afrezza to its limits to try to find some issues with it and there are very few. I still have those meals once in a while that make you just scratch your head and wonder what the heck is going on? Is it my calculations, insulin, ate too much? Nope, it is just the unpredictability of diabetes. In my fight of this disease Afrezza is the clear-cut choice hands down. The goal here is get everyone suffering from diabetes as healthy as possible, and I believe Afrezza will help do just that. Afrezza is truly a wonderful drug to put in your arsenal against diabetes.
Afrezza does such a nice job smoothing out the peaks and valleys; a spike of blood sugar for me is now anything over 170 instead of 270, and I have not experienced any lows yet. I am fully confident my A1C tests will be lowered to unheard-of levels in T1 diabetes, which means a longer, healthier, better-quality life.
In conclusion, Afrezza has been life-changing for me and I believe it is going to make diabetics across the board much healthier. Even after 40 days, I still cannot believe my numbers and the control I have now over this terrible disease. The constant spiking and crashes are a thing of the past (not to say there won’t be some here and there—no one is perfect). But I am finally on offense instead of always playing catch up.
(FYI -- I purchased a thousand shares after using Afrezza for a week or so after seeing how well it works. So I have a very small stake in MNKD, which is secondary to how amazing this drug really is and how many people are going to benefit from it.)
Well thank you for sharing, Howard. Your financial stake notwithstanding, this is an interesting perspective from yet another T1 pumper using Afrezza.