Does Afrezza work?

I totally tried Afrezza. Here is my official review of this high cost, inhalable insulin:

About a year ago, I decided I wanted to try Afrezza, the new (at the time) inhalable insulin.

My Endocrine PA wasn’t comfortable prescribing Afrezza (it had never been prescribed by anyone in her clinic before), and she wanted me to meet with one of the M.D. Endocrinologists in the office before getting the prescription.

Naturally, getting an appointment with the Endo M.D. took 8 months.

During that 8 months, I did some research and prepared my presentation to the Endo.

I’ll spare you the details, but here are the resultant highlights of the proposal I submitted to the Endocrinologist:

1. I would start by trying the 4-unit inhalable insulin cartridges (Afrezza comes in 4, 8, and 12 unit cartridges)
2. I would wait until my blood sugar was high (>250) before trying Afrezza, just because I’d  heard that 4 units of Afrezza does not affect the diabetic human body as predictably as 4 units of human or analog injectable insulin, so to play it safe, it’s best to start off with a high blood sugar before inhaling 4 units of Afrezza.
3. I would not use Afrezza regularly or even daily. I would use it for incidental cases only (unexplained highs, occasional planned carbohydrate binging, etc.) - this is because I learned that some people experience what amounts to a “tolerance” to Afrezza. In other words, the more often you use it, the less effective Afrezza becomes.

My Endocrinologist is pretty practical, and I think the fact that I'd done so much research helped me establish credibility with her, so she agreed to let me try the Afrezza.

But first, I had to wait for the insurance company to deny coverage.

Then, I had to wait for the insurance company to deny the appeal and prior authorization for coverage.

After receiving the expected insurance denials, I found and printed a coupon from the Afrezza webpage. Then I went into the pharmacy, coupon in hand, and shelled out $150 cash for my box of Afrezza cartridges, which is a pretty great discount, considering I would have paid more than $300 without the coupon.

That afternoon, I ate a carby snack and chose not to take any insulin, so that I could purposefully cause my blood sugar to go above 250 so that I could try my Afrezza.

After thoroughly following the instructions on the Afrezza package insert, I took my first “puff.” Then I waited. You can watch what happened in the video below, or your can read the short version below (just scroll past the video).

Here’s the short version:

• I purposefully caused my blood sugar to go high, so that I could safely experiment with this insulin.
• With a blood sugar of 275, I took a puff of Afrezza
• 5 minutes after the puff, my blood sugar was 268
• 10 minutes after the puff, my blood sugar was 269
• 15 minutes after the puff, my blood sugar was 246
• 30 minutes after the puff, my blood sugar was 222
• 60 minutes after the puff, my blood sugar was 196

Since the initial experiment, I’ve tried Afrezza numerous times and had a bunch of interesting experiences. Here’s what I’ve found:

1. The higher my blood sugar is, the less effective Afrezza is. For example, Afrezza doesn’t do much to my blood sugar if I’m super high (>350). It works best when I’m in the 200-300 range.
2. If I use Afrezza too frequently, it seems to become less effective over time.
3. When Afrezza works for me, it works VERY quickly to lower a high blood sugar (80 mg/dL in 60 minutes!).
4. 4 “units” of Afrezza equals about 1½ units of Humalog (for me). So it’s definitely not as potent as injectable short acting analogs.
5. I do not plan to use Afrezza regularly, as part of my daily routine.
6. I will use Afrezza as my “rescue inhaler” for high blood sugars.
7. Mannkind should not market Afrezza as an inhaler that can be used regularly.
8. Mannkind should market Afrezza as a rescue inhaler for high blood sugar. A rescue inhaler that all occasionally hyperglycemic diabetics should have.
   

Do you have experience with Afrezza? Leave a note in the comments!