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Inhaled Insulin - Afrezza
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Early reports posted on diabetes social media sites are encouraging. Most of those reporting are people with Type 1. They report being able to tolerate a higher dose than the corresponding amount of injected insulin they usually use. Most are finding they need to use correction doses after meals because of Afrezza's very short activity curve. They are also finding that they need to adjust their basal insulin after a week or so on Afrezza. For some it works extremely well. However, others are reporting that it is possible to experience hypos while using Afrezza, contrary to claims of some investors who have also been posting to diabetes social media. There aren't enough people with advanced Type 2 using it yet to determine how it will work for its target market--people with Type 2 who have put off using insulin out of a fear of needles.
Because it is inhaled, Afrezza can not be taken by people who have lung problems or by smokers. Because the long-term impact of exposing lung tissue to a growth-promoting hormone is unknown, the FDA insisted on much longer, more rigorous testing for Afrezza. I had originally thought that the testing for Afrezza had gone on longer than that for Exubera, which did eventually appear to cause some excess lung cancer, but that does not appear to be true, so a certain amount of caution would be advisable. I would personally be willing to give it a try, but I would not use it for every meal. If you do experience prolonged bouts of coughing after using it that don't go away after a week it's probably a good idea to avoid it.
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. If your doctor does prescribe it, be sure that he or she follows the instructions on the Prescribing Information and sends you for a lung function test before you start Afrezza and then follows up with one six months later. Also make sure that he gives you enough to cover snacks and occasional corrections at the dose you will need. A single box may not be enough. Most people reporting on early experiences with Afrezza are using two or even three boxes.
If that activity curve really works out that way in real life and for people with Type 2 diabetes, and the drug turns out to be safe over the longer term, Afrezza might provide a way for people who were just diagnosed with Type 2 to normalize their blood sugar because it restores their lost first phase insulin.
