Afrezza A New Extremely Fast-Acting Inhaled Insulin
Afrezza became available in pharmacies on January 26, 2015. It is being covered at a non-preferred tier by quite a few insurers and should be coming to more within the next year. Afrezza is a brand new inhaled insulin. Readers who have followed my blog know that I was very negative on the first inhaled insulin, Exubera. That was because it was extremely hard to dose and did not appear to be as good as injected insulin.
I have been following the Afrezza story for about a year, and am cautiously hopeful that, unlike Exubera, Afrezza will be a much more useful product.
That isn't just because it's inhaled rather than injected. That's a nice feature that will appeal to the many people with Type 2 who really need insulin but won't start it out of misguided fear of needles. Insulin needles are painless when prescribed correctly. So this is not a good reason to avoid insulin. But people do. We all know far too many people who fit that category. Many end up on dialysis or with amputations.
So Afrezza will be good for needlephobes. But what really excites me about Afrezza is its activity curve. It is different from all the existing injected insulins and does something that no other drug does. To understand what that is, you need to understand how our bodies normally produce insulin, in two distinct phases. You can read more about this HERE. All the current injected insulins replace second phase insulin production. They take about an hour to start working and several more to exit the body. But Afrezza appears to replace first phase insulin production which just happens to be the part of insulin production that disappears first. People diagnosed with Type 2 diabetes have usually lost all their first phase insulin production while retaining a lot of their second phase capability.
This means it might be an excellent drug for people recently diagnosed and one that is much safer than the drugs like Januvia or Victoza many are being put into at that time, whose dangers I have discussed elsewhere.
One major problem with injected insulin is that it takes a long time to exit the body. This means that you can still have insulin working a couple hours after you have finished digesting your meal. This can cause hypos and makes doctors dose fast-acting insulin very conservatively. They don't give you enough to really cover your meal because of the fear that the lingering insulin will cause lows. But because Afrezza leaves the body much more quickly, you may be able to take a larger dose that will lower your blood sugar post-meal much better, knowing it will be gone right after it lowered your blood sugar.
The above is based on the claim made by the drug company that makes Afrezza and it is supported by activity curve graph published in the prescribing information which you can see in the graph to the right:
Lispro, which is what Afrezza is being compared to here, is Humalog.
Afrezza comes in cartridges that you put into the small inhaler, inhale, and throw away. The inhaler does not need to be cleaned. Every two weeks you throw out the inhaler and use the second one that comes with the cartridges.
The doses come in cartridges sold in increments of 4 units. Because of the fast way Afrezza operates, it may be possible to use a significantly larger dose than you would use if you were injecting a slower fast-acting insulin. The prescribing information makes it sound like 4 units would be appropriate for anyone using up to 4 units of injected insulin. Whether this is true we will only know after we hear from people who report their results.
What makes me feel that I can trust the company that makes Afrezza, MannKind Corp, is that it was founded and largely funded by Al Mann, an engineering genius whose other companies developed the first modern insulin pump (which he sold to Medtronic), the artificial cochlea, and whose latest company has developed a functional artificial retina. Mann is 89 years old and has put more than 10 years into getting Afrezza to market. He understands insulin better than most, having developed the pump, so when he says that Afrezza duplicates first phase insulin, and backs that claim with a billion dollars of his own money, I listen.
Because it is inhaled, Afrezza can not be taken by people who have lung problems or by smokers. It has, however, been tested for safety over a much longer time period than most drugs. This is because Exubera, a completely different formulation, did seem to cause lung cancer. So the FDA insisted on much longer, more rigorous testing for Afrezza.
For now there is no reason for people who are comfortable using fast acting injected insulin who are getting great control with it to switch to Afrezza. But for people who have been putting off moving to meal-time insulin out of a fear of needles, and for those who don't have the necessary skill to work out insulin/carb ratios and carefully dose injected insulin to the carbs in their food, and who are having too many hypo, Afrezza may be very helpful.
And if that activity curve really works out that way in real life, Afrezza might provide a way for people who were just diagnosed with Type 2, who by restoring their lost first phase insulin might be able to totally normalize their blood sugar.
If you do try Afrezza, please let me know how it works for you. Use the email link found on the CONTACT tab at the top of this page and title your email "Afrezza report."