This blog tracks updates to the Blood Sugar 101 Web site.

Wednesday, January 28, 2015

Afrezza, Super fast-acting inhaled insulin now on Sale. Afrezza page added to Blood Sugar 101

Page added:

 Text added:

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."

Monday, January 12, 2015

Updated 5% Club Page with Reports from 2014

Page changed: The 5% Club They Normalized Their Diabetic Blood Sugar and So Can You!

Updated some outdated links. 


Note: After the newsgroup succumbed to robot-spam, I received many more such reports from readers of the site and my books who emailed me, but because most of them repeated the experiences described by newsgroup participants, I stopped updating this page. Now, in response to request from site visitors for more recent stories, I have started off this section with extracts from reports I received from visitors to this site and readers of my books during 2014, This should reassure you that people who follow the strategies I recommend continue to report these very exciting results.

Reports from Members of the 5% Club

  2007 Dx'd at 358 bg fasting and a 10.3 HbA1c.  I got into the 5% club within the first 18 months keeping only metformin. I have had only one in 6's since (6.2), and my last test a week ago was my lowest at 5.5.  I do shoot [insulin] now (4 yrs) to give my remaining betas a rest plus basal because I could not get the fasting down on my own. I"m usually 5.7-  5.9 hba1c.
  --Bill 1/7/2015

October 2011 I was sent by ambulance to ER.  EMT could not read my BG. All their meter showed was "HI". Not uncommon for DKA you might be thinking, but the meter they used topped at 900.  Needless to say they started IV insulin immediately.  When I got to the ER they took a reading; "HI" again.  Talk about panic.  Their meter topped at 1500!  It was so high they couldn't even measure an A1c. 

So fast forward to now.  How am I doing?  Well I don't take any medications, I eat very low carb, and rarely see a meter reading over 110- typically under 100 at any time. 

A1c has been in the 4.8-5.2 range for over two years now.  Which I will take as a 5.0 and chalk the 0.2 variance to lab error.  Not too shabby!
--David 12/20/2014

I sent you an email a couple years ago to thank you for helping me turn around my Type II and get it under control.
I am 53 years old and yesterday I had a doctor’s appointment and A1C was 5.9.

--W. 12/19/2014

I started to apply your principles and my results are going very fast, with no medication. ... The principles work....2014
October 23 — lab FBG 217, a1c 9.4

November 10 — FBG 125, lab a1c 8.5

November 20 - FBG 105, home a1c 7.8

Today, November 21 — FBG 95
--Inez 11/21/2014

I was diagnosed Type 2 ,3 and a half months ago at 49 with a A1C of 12 % and a fasting sugar of 18.8. I was told by the Doctors to take metformin 'if my kidneys were not damaged already' and that I would be on insulin in a few years.They told me it was extremely difficult to lower your A1C even with drugs.My feet  were becoming numb and my eyes were bad as well as all the other symptoms,I had them all and I had been in denial.

After the shock of the diagnosis and what the Doctors said I thought I was finished,a short painful life probably with my feet amputated all because I had got fat.I was nearly having panic attacks but I started reading everything I could , diabetes books and sites on the internet including yours and I started feeling more positive.

I refused the metformin (maybe it was unwise with those numbers) and started a low carb diet with non starchy vegetables,I took supplements like co-enzyme 10 and alpha lipoic acid,I did alot of exercise both aerobics and weights,and tested my blood sugar regularly. I was very strict and motivated and I lost about 33 lbs in that time but the most amazing thing was my blood was tested the other day and my A1C was 5.8%.I knew it had dropped on my meter but was amazed that my A1C dropped so much so quickly. I had to ask the Doctor for the result,there was no acknowledgement from him and they want to retest me,probably can't believe you can do that so quickly with no medication,
--Yvonne 8/28/2014

I have now completed my first year since diagnosis. My A1c at diagnosis was 7.7. Three months later it was 5.2 and has remained at 5.2 ever since.
Your advice and my solid health care coverage (two full plans from two employers), which means I can test, baby, test have been the keys to my success.

I have lost 112 lbs, without really trying and am gently slowing down.

--Fred 7/28/2014

I am a 70 year old woman who got the diagnosis of diabetes early in May this year.  My doctor wanted me to try to handle it with diet and exercise.  I went to the dietician to receive nutritional instruction.  She but me I a diet of 75 grams of carbohydrates for each meal 3 times a day along with some routine literature, and told me not to test more than twice a day.  Needless to say I did not really reduce my blood glucose dramatically even though I cut down my carb intake below her recommendations.  I was becoming somewhat depressed.

I found your site and it became crystal clear what I needed to do.  I bought a scale.  I reduced my carb intake to low amounts, tested rigorously, and have worked up to 40 minute work outs every day.  I am testing under 120 an hour after every meal and now some mornings I am under 100 even though my count goes up during the night. 
--Christine 5/25/2014

About 3 months ago I went to my doctor thinking that I must be doing
great!  I eliminated most meat from my diet, and stuck to a fish,
vegetable, fruit, and grain diet.  My A1c was higher than before at
7.4.  My doctor told me to avoid all sugars and come back in 3 months
for another A1c test.  I came across your site which gave more details
on how to eat right and get my blood sugar under control.  I eat mostly
grass fed or organic meats, vegetables, and raw seeds and nuts.  My A1c
result is now 5.7 on today's visit to my doctor.  It would have been
lower, had I not had the 2 jelly filled doughnuts three weeks ago...
--Tom 5/22/2014

I emailed you about 1-1/2 years ago, all excited about losing a bunch of weight and getting my blood sugar under control. You congratulated me, and put me in my place a bit by telling me that if I made it 3 years, that would really be considered a success.

Well, as of January 22, it has been 3 years.  I have kept off the 120plus pounds lost, my A1C is 5.1, and I'm still working out every day. I have even been able to stop taking Metformin with no adverse results. Thank you again for your encouragement and research. It has been invaluable.

--Craig 2/11/2014

I'm a rocket scientist (seriously... ) who REALLY had problems with what my diabetes-diet-councilor was telling me.... Heck, I learned about the krebs cycle in high-school.... Heck, I taught high-school biology just after the Army & none of my STUDENTS would buy that banana-juice I was being fed...You provided understandable & useful information... my A1c is down from 9.7 to 5.7 on just metformin, glipizide, and a diet worked out with your TEST,TEST,TEST method

--Scott 1/08/2014

Note: Because of space constraints, I have omitted the many reports I have received between 2014 and 2007 when I stopped updating this web page as there were already more reports than most people wanted to read.