Wil Dubois

Got diabetes? Need advice? Of course you do! And you came to the right place: Ask D'Mine, our weekly Q&A hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Today, Wil goes deep into questions about one of the newest diabetes meds on the market, and how we can (or can avoid) responding to insensitive and ill-informed comments about diabetes. Read on to learn what Wil's sniffed out here...

{Have diabetes questions of your own? Email us at AskDMine@diabetesmine.com}



Lana, type 1 from California, asks: What do you think of MannKind’s inhaled insulin Afrezza? Aside from what’s already out there (like possible cancer risk, etc.), do you have any thoughts on the subject of inhaled insulin, as a whole? And, most importantly, will you take MannKind’s Afrezza or recommend it to your patients? Why or why not?

Wil@Ask D’Mine answers: First and foremost, I need to be clear that I have no experience with Afrezza. I’ve never tried the drug. I’ve never held the inhaler. None of the Sanofi reps have come to see me yet (which, naturally, has my nose a bit bent out of shape). And in fact, I really haven’t been paying attention to MannKind’s struggles to get it approved over the last few years and how it's played out since becoming available early this year. So I really don’t know that much about it.

But, of course, none of that keeps me from having an opinion.

And my opinion is that inhaled insulin is a stupid idea, and I thought so back when Pfizer was peddling Exubera, the first FDA-approved inhaled insulin. Don’t get me wrong; I like having every possible arrow in my quiver, and it’s refreshing to have a totally new type of therapy available, instead of yet another me-too drug. (There’re only so many GLP-1s and SGLT-2s that the world needs, and yet that’s all we seem to be getting nowadays.)

The main reason I think inhaled insulin is stupid is not so much the drug itself, but the expectations being set for it in the “market.” There are a lot of investors salivating, thinking there’s this HUGE market of scared-of-needles type 2s, which isn’t necessarily the case.

Also, first and foremost, Afrezza is an inhaled rapid-acting insulin. Before anyone would need it, they would most likely need to start by taking a basal insulin. So by the time most type 2s need a rapid product, they are already over the whole needle thing. Secondly, it turns out type 2s aren’t really as afraid of needles as you might expect. Byetta and its descendants proved that. Turns out that most people with T2 diabetes were afraid of insulin itself, rather than the needles, due to a host of long-standing urban, suburban and rural myths; the needle was just an easy excuse to say “no.” And thirdly, we don’t really use fast-acting insulin for type 2s much in the first place, and even less so nowadays, as the GLP-1s workAfrezza Inhaler better for most.

Still, would I try it? Oh, hell yeah. I would and I hope to. I’m always keen to try a new drug.

OK, that didn’t come out sounding quite the way I intended. I hope you know what I mean. I’d love to test-drive it, but I doubt I’d use it for front-line therapy for myself. The pump is easier. The one place I see that inhaled could be useful for me, as a T1, is to cover a rapid-spike type meal that my Snap pump, with it’s slow-poke subcutaneous “rapid-acting” insulin can’t handle. An inhaled product will get into the blood stream more quickly and therefore get to work more quickly. Of course we could argue that if you can’t handle a food with your current insulin, maybe you shouldn’t be eating it in the first place. But that’s a subject for another day. Anyway, if it worked for me, I could totally see myself carrying an Afrezza inhaler in my GoBag for culinary emergencies.

You know: Break glass in case of hot fudge sundae.

As to my patients, that’s a solid maybe. But not yet. I’m adventurous with my own body, but more conservative with the ones entrusted to my care. In general, I like a drug to be on street for at least a year before I recommend it to patients. Lots of things show up in the “after market” that don’t show up in clinical trials. Of course, sometimes those things don’t show up for decades, but if a new drug is going to make 1-out-of-10 people’s butts turn blue—or whatever—we’ll know in a year. When it comes to new drugs my rule is: Would I want my mom taking this?

Now, speaking of breathing (which you have to do to “take” inhaled insulin) and hot fudge sundaes, this next letter will take your breath away:


Jean, type 1 from Florida, writes: I have a question for you regarding an incident I had shortly after being diagnosed with type 1 diabetes in my mid 50’s. I was still trying to come to grips with the diagnosis, trying to feel comfortable with the insulin injections, and the lifestyle changes, when I went out to eat at a restaurant with my sister. I had been told not to take my insulin until my food was on the table and I discretely did so. However, this offended my sister, who told me I should have retreated to the bathroom to take the shot. Then at the end of the meal, I passed on what used to be my favorite dessert, a hot fudge sundae. However, the icing on the cake so to speak (no pun intended) was that as my sister sat in front of me eating her hot fudge sundae, she said, “You're really lucky that you have diabetes. You don’t have to worry about gaining weight.” I was stunned at her comment and insensitivity. What made it even worse is that she is a nurse!!! How do you respond to people who tell you that you are lucky to have diabetes?

Wil@Ask D’Mine answers: Ho Lee Chit. Where to even start? I’m sure in hindsight you’ve already thought of a hundred things you should have said to her. Like: "Oh, yes, I’m very lucky, indeed. You should join me." Or: "Yes, this diabetes was the best thing that ever happened to me, now I don’t have to worry about being fat like you." Or even the totally honest: "I can’t believe that you, as my sister and a healthcare worker, could have just said such an insensitive thing!"

But how you respond to people who tell you that you are lucky to have diabetes depends on who said it.

While families are often the worst when it comes to crimes of insensitivity, at least we can respond to them more directly than we can to morons who aren't hanging from the branches of our family tree. When it comes to kinfolk, you should be honest with them the way you were honest with me. You should look your sister straight in the eye and say to her: "You really hurt my feelings. You were not supportive when I tried to follow my doctor’s advice on when to take my insulin, you chose to eat something I love in front of me when I felt I could not do so, and you made light of the most traumatic thing that’s ever happened to me. What were you thinking?"

That’s what you probably should have done, and what’s more, I think you should still do it. It’s probably water under the bridge to her, but it’s still a fresh, bleeding wound to you. I can feel it in your words.

Now, if someone unrelated to you were to be so boldly rude, I suggest setting the record straight by simply saying: "Well, I’m not so sure I agree. Diabetes is very hard work, and if I don’t do everything I need to do just right, horrible things can happen to me. It’s great that I don’t have to worry about my weight (never mind that this is not true) but I don’t think I would have chosen this disease myself, and I would only be too happy to give it to you if I could."

But ask yourself this: Could your sister be right? Can those of us who have it be said to be lucky to have diabetes? A great many people will disagree with me, but I feel that in some ways we are lucky to have diabetes.

How could I say such a thing?

Because diabetes demands attention and the penalty for not paying attention is steep. To survive, we must be strong, determined, focused, and powerful. Our bodies may have betrayed us, but we overcome our weaknesses with intelligence, will power, and strength of character. All of which grows day by day. Diabetes also gives us a second family tree, one with deep roots and strong branches to lean on when our own weather gets stormy.

 Doesn’t that make us pretty lucky?


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.