Whatever happens, many are enjoying the Afrezza experience in the meantime, and we're happy to continue sharing their various stories here as part of our #RealWorldAfrezza series.
Today, we hear from renowned endocrinologist and type 1 himself Dr. Jeremy Pettus in San Diego, CA, who's just recently decided to start using Afrezza again after a failed first try. Jeremy also works with the beloved Taking Control of Your Diabetes (TCOYD) conference series, and runs the We Are One Diabetes group for PWDs who work professionally in diabetes.
A Guest Post on Afrezza by Jeremy Pettus
I wanteJeremy Pettusd to write today about Afrezza. My tune on this med has changed slightly after Dr. Steve Edelman and I put on a very interesting focus group on a during the first weekend of December to discuss the medication. The purpose of the group was to learn how successful Afrezza users use Afrezza successfully (say that 10 times fast!) with the intent of designing a clinical trial around this info.
Some of the comments we heard during the focus group:
A big takeaway from this focus group meeting: There are people out there using this medication very well to achieve crazy-low A1Cs, like in the 5s, along with low rates of hypoglycemia. I mean these people got pissed when their BG was above 130! So how are they doing it?
Well, let me back up a second first and explain my first experience with Afrezza. Basically when I first took it, I took 4 units and then ate a sandwich. An hour or so later, my BG was over 250mg/dL, so I thought it didn’t work and never took it again.
Turns out my experience is somewhat common. The reason for this is that one unit of Afrezza is NOT equal to one unit of subcutaneous insulin. In fact, inhaling 4 units of Afrezza is closer to injecting 2.5 or 3 units. So basically, I dramatically under-dosed myself.
Now that I know that, I have been trying Afrezza for the last couple days, taking the right dose at the start of a meal or even 10 minutes into it and being slightly more aggressive. The really nice thing about the drug is that it works really, really fast but then totally hits the brakes.
Yesterday, I had a high of ~250 BG, took 8 units of Afrezza and my BG came screaming down with two down arrows on the CGM. I started to get nervous, but by like an hour into it, my BG totally flattened out without going low. So it truly is rapid-on and rapid-off. Yes, it takes some getting used to the new dosing regimen, inhaling something that can make you cough initially, and whipping out something that resembles a crack pipe in public always makes for some interesting reactions. But overall, it does fit an unmet need and has its place in our world.
You should have heard some of these comments from people in the focus group talking about their control.
One guy was “complaining” that the high alarm on the Dexcom should let you go lower than 120mg/dL... wow! Can you imagine setting your HIGH alarm at 120?! He was saying this because he really was achieving perfect control, mostly by controlling that annoying post-meal spike. If you can control that, you'll never again have to deal with the all-too-common scenario of correcting for a high post-meal BG which makes you go low, then raiding the fridge, eat everything in sight and yelling at your significant other “don’t tell me what to eat!”... And then going high again, having to rage bolus 20 units of insulin, and then going low again and repeating. I call it being on the rollercoaster, but instead of being fun like an actual rollercoaster, it just sucks.
Afrezza seems to take care of this rollercoaster effect (see also glucoastering) very well.
www.healthline.com/diabetesmine/afrezza-focus-group-feedback#1
