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

Inhaled insulin is nothing like its injectable cousins. It’s the odd duck in the family. The dosages are various. The speed is different. The duration is different. 

Managing your diabetes with inhaled insulin is a different game. individuals who use Afrezza — the only inhaled insulin on the market today — are often pretty emphatic about it. You won’t find lukewarm reviews. It’s more like “I really like a lot it!” or “Nope, I tried it. Not for me.”

I’ve been utilizing Afrezza for the past numerous years and I’m in the first group: I love it.

Research presented at the American Diabetes Association’s 84th annual Scientific Sessions confirmed what I’ve seen throughout the diabetes online community: The people who love it quickly become huge fans of the product and its impact on their diabetes.

But there’s another group: They don’t like it one bit. Here’s a closer look at these contrasting experiences with inhaled insulin.

Inhaled Insulin Helps Some, Hurts Others

The topline results from the Inhale-3 study initially seem unimpressive. Researchers split 123 adults with type 1 diabetes into two groups — half were given Afrezza inhaled insulin to replace their usual rapid insulin, and the other half continued with their usual category of diabetes management. After several months, an analysis found no significant difference in A1C. It looked like inhaled insulin was no better or worse than traditional injectable insulin.

“But this really doesn’t tell the story,” explained lead investigator Irl Hirsch, MD, an endocrinologist from University of Washington Medicine. A closer look at the results showed that a substantial percentage of participants loved using Afrezza and enjoyed impressive glycemic improvements. But a roughly equal number saw their glycemic control get worse.

• 30 percent of patients using inhaled insulin achieved an A1c under 7.0 percent compared with only 17 percent on injections or pumps.
• 24 percent of patients using inhaled insulin achieved a time-in-range above 70 percent with no increased risk of hypoglycemia, compared with 13 percent on injections or pumps.

Many participants expressed that Afrezza made exercise simpler (because there is less insulin on board during the extended hours after eating) and was easier to use while traveling. When the trial concluded, more than 50 percent of subjects who had been assigned Afrezza wanted to continue using it.

But not everyone benefited from the switch to inhaled insulin.

“We had responders who got better and nonresponders who got worse,” added Hirsch. A large minority of participants, 26 percent, saw their A1C increase by over 0.5 percent.

Hirsch suggested that the people who saw their blood sugar control decline largely struggled with remembering to take follow-up doses for their meals, especially tardy at night.

A Whole New Way of Dosing Insulin

Dosing Afrezza is both simpler and a bit more complicated than injectable insulin, and each meal may need more than just one or two boluses. Hirsch suggested that the people that thrived on Afrezza were those who were more highly motivated to dose frequently. 

• Afrezza is faster but clears your system faster, too: The speed of Afrezza means you don’t have to prebolus before meals. But it also clears your system extremely quickly: It stops working within 60 to 120 minutes, depending on the size of the dose. 
• Using Afrezza is less about precision and more about attentiveness: Afrezza’s speed of action means you will likely need one or more additional doses an hour or two after eating, especially meals with extra fat or protein. This can be hard to stay on top of. It also means that your first bolus doesn’t need to be quite as precise; perfect carb counting is less important than tracking and responding to blood sugar changes after a meal.

Keeping your blood sugar in range after eating with Afrezza generally requires several insulin doses. For this reason, Hirsch said they also found a big A1C difference between people who were willing to use Afrezza in the evening and those who were not. It can feel daunting to take a dose of inhaled insulin in the minutes or hour before bed.

By contrast, injectable insulin takes longer to work and remains effective longer. It is easier to manage a single meal with a single dose of insulin (as long as you don’t plan on adding physical activity to the mix).

“With subcutaneous injections, you give a dose for a meal and you can’t really give another dose for three or four hours,” explained Roy Beck, MD, PhD, an endocrinologist at the Jaeb Center for Health Research. “With inhaled insulin, you can redose after an hour or so without worrying about hypoglycemia.”

People who use insulin pumps already have the ability to easily administer complex bolus patterns around mealtime. But remarkably, even 43 percent of learn about participants who previously used an insulin pump wanted to switch to Afrezza permanently after the study.

There are pros and cons to each method of using rapid-acting insulin, leaving any person with diabetes to determine: What type of insulin management workload is best for you?

The funny thing about inhaled insulin is that many people (and their doctors) are reluctant to try it simply because it is so different. The insurance process requires prior authorization and a few very specific details to get approval, and units of Afrezza don’t correspond to units of other insulins.

It’s so different, you simply have to let go of everything you think about dosing insulin and approach it with a clean slate.

While the study didn’t demonstrate that inhaled insulin is ideal for everyone, it did recommend that patients willing to embrace the learning curve can find even more blood sugar management success.

Diabetes Daily

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