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Afrezza- inhaled insulin

Wow!? When I was first diagnosed I would have never dreamed that something like this could exist. But here it is, and it’s just one of the many incredible advancements that have been made in diabetes over the last few years. As I always say, having diabetes sucks, but now is a really good time to have it.

So… how does Afrezza work? Does it work at all? And what is the context in which it should be used?

Afrezza is a rapid-acting insulin that comes in powder form and is inhaled using a small disposable inhaler (sort of like an albuterol inhaler). It is meant to be used as a replacement for rapid-acting insulin injections (with meals or for correction boluses). It does not replace basal insulin! The onset of action is ~12 minutes (injections 10-20 minutes), the peak is 35-45 minutes (injection 1.5-2hrs), and it is out of the user’s system within 1.5-3hrs (injection 4-5hrs). Because it is inhaled, it cannot be used in people with a chronic respiratory illness such as asthma or COPD due to risk of bronchospasm. It is also not recommended for smokers or people who have recently quit smoking (within the last 6 months).

Afrezza comes in 3 dosages; 4-unit, 8-unit, and 12-unit. For a requirement of more than 12 units multiple inhalations are required. Also, 1 unit of rapid acting insulin is equivalent to ~1.5 units of Afrezza. Because of this, more Afrezza units are typically needed than that required of Humalog etc.

For example; if the user would normally take 4 injected units or less for a meal, then they would use the 4-unit inhalation dose; 5-8 injected units would require the 8-unit inhalation dose, and 9-12 injected units would require the 12-unit dose. For more than 12 units, the doses would be combined. For 13-16 injected units, the user would inhale two 8-unit doses or one 12-unit dose and one 4-unit dose.

Some people use Afrezza to completely replace rapid acting insulin. I personally use it as a “rescue” to quickly reduce my hyperglycemia. I also use it when I want to eat foods high on the glycemic index (because its onset time is so quick). It's also beneficial for many of my type 2 patients who refuse to start prandial injections.

Afrezza is a great tool to have in your diabetes tool kit and I encourage you all to ask your clinician about it!

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