The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes

Mike Joyce has an incredible type 1 diabetes story. four years ago, he weighed 275 pounds and was chained to a desk in a soul-crushing corporate job. That’s when he changed his diet, started exercising, and generally took life by the horns. Now he’s hiked both the Appalachian and the Continental Divide Trails, and is planning even more adventures (his Instagram page is a great follow).

One of the keys to his remarkable adjust was Afrezza, the unique ultra-rapid inhaled insulin. Mike believes that Afrezza has been essential to his lifestyle, both during adventures and between them, and wants more individuals to be aware of about it.

This article is going to sound like an ad for Afrezza – I promise you that Mike is not a paid spokesman or influencer. He’s just a guy that is really devoted to a medicine that he thinks has significantly improved both his diabetes management and his mental wellbeing.

“I believe I first fell in really like a lot with Afrezza because my CGM showed how long it took my injected fast-acting insulin to work. On my CGM, Humalog or NovoLog wouldn’t stop lowering my blood sugar until 45-55 minutes after the injection.”

“And when I saw how rapidly Afrezza would begin affecting my blood sugar, I couldn’t believe it. Within 3 dots of the Dexcom reading – 15 minutes – I’ll see the line turn down.”

It works so fast, in fact, that it has completely changed the way he doses insulin for meals.

“I don’t pre-bolus because Afrezza works too fast for that. My body will not digest the food fast enough. Afrezza is so fast that I actually bolus after I’m done eating.”

“I eat, and I watch my CGM. As soon as I see the line start to bend down on my CGM – it might be soon, it might be hours – I’ll commonly use an 8-unit dose. And then I keep an eye on the CGM. If my blood sugar hasn’t gone back down within 30 minutes, I can just take more.”

“It works so fast that I don’t really have to worry about stacking. With NovoLog, if I took more, 3 hours later I might be at 35 mg/dL and eating the whole refrigerator.”

If you crave more detail on why Afrezza works so quickly, Mike strongly recommends listening to this Diabetes Connection interview of Mannkind CEO Mike Castagna.

Mike mostly sticks to a low-carb diet, which makes bolusing fairly simple, but his strategy still works for heavy carb splurges like pizza and sushi:

“For higher-carb meals, I’ll use up to a whole cartridge (24 units) when I see the CGM start to trend up. It sounds like a lot – 24 units? – but in my experience Afrezza units are maybe half as powerful as injected insulin. So that 24 units is really the equivalent of 12-15 units of NovoLog, which is what I was taking for big meals before.”

He also doesn’t bother worrying much about tardy spikes, whether from a big protein meal or “pizza impact. ” He just takes it easy and responds with more insulin when his Dexcom shows another upward trend:

“For any meal, I don’t have to predict, I just react. If it spikes again hours later, I just take another small dose. I stopped having to plan ahead. That was the game changer for me.”

“I’m gonna eat, and then I’ll take some insulin, and then I’ll take some more if I require it.”

The only time this doesn’t work well is overnight – to attend to a late spike after a late meal, he’ll have to wake up in the middle of the night. But that’s not so different from what most people with type 1 diabetes deal with.

More importantly, the radical change of mindset – “I can be reactive instead of proactive” – has also considerably alleviated the stress caused by the constant mindfulness that diabetes usually demands.

“I don’t believe we talk enough about the psychological outcomes of diabetes. It takes up so much mental space. But with Afrezza, I have so much more time to live now.”

“With injections, you have to be proactive. You have to think ahead and make a guess. But with Afrezza, I can just react in real-time. That’s what I love about it.”

“I no longer worry about those other factors – whether or not I have rapid insulin on board, what I did a few hours ago. I’m no longer thinking about diabetes every minute of the day. If there’s an problem – oh, I’m trending up? – let me take some insulin and I go back to my life. It used to be more like, oh, let me take some insulin and see if it comes down in an hour.”

“Carb counting is a thing of the past for me. It’s so fast in and out I don’t have to have perfect calculations to stay in range.”

Mike’s remedy strategy would be impossible to pull off without a CGM.

“I think everyone with diabetes should have a CGM. Period. I don’t think I’d be capable to do anything I do if I didn’t have a CGM. I don’t know how I survived without one! I’ve only been utilizing it for three or four years, and I can no longer imagine life without it.”

The other big blood sugar factor in Mike’s life is exercise. Whether he’s walking 20 miles per day in the mountains or just jogging after work, he loves that Afrezza’s effect is so short-lived.

“I used to have hypos during exercise all the time. But Afrezza is out of my system so quickly. As long as it’s been two or three hours since my last dose, I know that I won’t go low.”

“Even if I were to go back on a pump, I would always want to have Afrezza on hand. When pump failures happen, you can go from 100 mg/dL to 400 mg/dL with ketones in an hour. It’s dangerous. Nothing will get your blood sugar down as quickly as Afrezza. If I could inhale some Afrezza first and then change my pump infusion second, my blood sugar would be back in range by the time the pump is on my body.”

“Given how common pump failures are, I wish doctors insurers would let people have an Afrezza prescription as a second short-acting insulin. We should have access to more than one fast-acting insulin, because they work so differently.”

Some readers may have difficulty gaining access to Afrezza. Doctors are less familiar with it, and not all insurers automatically cover it. If that’s your case, Mike recommends simply not taking “No” for an answer:

“You can get anything covered by insurance, you just have to sit on the phone for five hours! It’s annoying, but if you’re willing to advocate for yourself and your physician is willing to resubmit the request multiple times, they’re eventually going to give it to you.

There has been some worry that frequently inhaling Afrezza could cause side effects, or worse. The drug is not recommended for patients with lung problems (or smokers), and patients usually need to submit to some pulmonary testing before they can get their prescription. Mike – who must have extremely healthy lungs, gulping down that mountain air for months at a time – hasn’t had any issues himself.

“The inhaler has never bothered me at all. The spray gets deep in the lungs very quickly and very easily. If I don’t have it angled the right way, I can feel it hit the back of my throat, and I’ll breathe some of it out. And even though I’m not sure exactly how much insulin I got, it’s out of my system so quickly that it’s not a big deal to take more if I need it.”

For the record, Afrezza is inhaled through the mouth, not the nose. It’s an easy mistake to make.

“No, I don’t snort my insulin!”

Afrezza, frankly, is not super popular. I spend a lot of time in the diabetes online community, and I see relatively little buzz for this unique insulin. Maybe it’s the lack of access, or maybe it’s suspicion about the novel delivery mechanism or potential side effects. But one segment of the diabetes population is pretty enthusiastic about it: those with needle phobia.

“I just spoke to a mother of a small boy that has both type 1 diabetes and sensory issues, so he can’t really do a pump, and he hates injections. The doctor wrote him an off-label Afrezza prescription, and it’s been life-changing for them. He is doing a lot better.”

“Once they get it approved for children, I think that’s when you’ll see more people start using it. Parents are adamant about finding the newest and the greatest techniques and medicines for their kids, whereas adults tend to find something that works and stick with it.”

Mike is planning his next adventure – possibly the Pacific Crest Trail. He hopes that his story can help inspire others.

“I know a lot of people probably look at me and think they could never do what I do. Four years ago I was 275 lbs, working a corporate desk job, struggling to make a living. I’m an extreme athlete now, but it was a gradual progression to get where I am. It’s been a development, all from a starting point that lots of other people are at today. I want other people to see that that’s possible, that they’re not stuck where they are.”

Diabetes Daily

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes