Milo Afrezza with Bon Bon

Here I am with my Afrezza inhaler and my Lhasa Apso, Bon Bon

I’ve been using Afrezza intermittently for the past 2 years … and am continually amazed at how well and how fast it works! 

What is Afrezza?  Developed by Al Mann (who also developed the insulin pump and the cochlear hearing implat, among many other great advances – see a tribute to him in my blog archives), Afrezza is the only inhalable insulin available on the market today. 

Afrezza is dried human insulin produced in a lab from recombinant DNA. The powder is placed into carrier particles (called Technosphere particles) that are so small that once inhaled they can reach your deep lungs, which have the surface area of about half the size of a tennis court.

Just take a moment and visualize one side of a tennis court … that’s the amount of surface that is reached when you inhale Afrezza into your lungs. 

It comes in 4-unit, 8-unit and 12-unit cartridges, which equate, roughly, to 2.5U, 5U and 7.5U of liquid fast-acting insulin. 

 

 

Afrezza 2But there are very distinct advantages:

  • Enhanced absorption: this is due to the very large, accessible surface area within the alveoli of the lungs
  • Rapid onset of action: Since the lung tissue consists of a large alveoli-capillary network, protein molecules such as insulin cross a thin barrier formed by the alveolar wall and the capillary wall, allowing for rapid delivery into the bloodstream.  Indeed it starts working within 10 minutes of inhaling and is mostly out of your system within 2 hours (as opposed to injectable insulin with an onset of 1/2 hour and duration up to 4 hours)
  • Absence of digestive enzymes that can inactivate insulin

 

afrezza chart

 

On the downside:

  • About 1/4 of patients using Afrezza have reported a cough
  • Some decline in pulmonary function

My take on using Afrezza:

  • I think Afrezza should be in our toolkit as a rescue medication for very high blood sugars to start the lowering of BG immediately and for very heavy carb meals to stop the extreme and fast rise of BGs.

I’ve used Afrezza as a rescue med for a few years … and it is amazing.  If I’m experiencing one of those stubborn high blood sugars that don’t seem to move for hours, one “hit” with a 4 unit cartridge starts to bring my levels down within 10 minutes … and then levels off so that I don’t crash. 

  • Several of us in the d community use it in combination with short acting insulin.  But it makes you think very differently about dosing.  Basically, you don’t “count carbs”.  You assess the “size” of the meal: is this a small, medium or large meal?
    • For a small meal, I don’t necessarily use Afrezza. 
    • For a medium meal, I could use just 4 units of Afrezza.
    • And for a large meal, I can use a 4 unit cartridge of Afrezza along with a lesser bolus of pump insulin.  If I start to rise very rapidly, after an hour, I can add another 4 unit of Afrezza.  Of course, everyone is different and you’d have to figure out what works best for you and your meals. 

Read more:

And a great video by Dr. Steve Edelman