Using Inhaled Insulin with Type 1 + Type 2 Diabetes
Editor’s Note: Educational content related to inhaled insulin is made possible with support from MannKind, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 1. This article includes Ginger Vieira’s personal experience using Afrezza, and what has worked for her may not work for everyone. Please consult your health care team before making any changes to your diabetes care regimen.
In the timeline of managing diabetes with insulin, inhaled insulin is still a relatively new option. FDA-approved in 2014, Afrezza (insulin human) inhalation powder, manufactured by MannKind, is the only inhaled insulin on the market.
Steadily gaining popularity amongst people with type 1, latent autoimmune diabetes in adults (LADA) and type 2 diabetes, Afrezza works differently than today’s other rapid or ultra-rapid injectable insulins.
Here is a brief overview of Afrezza inhaled insulin:
- Afrezza (insulin human) Inhalation Powder is a man-made insulin that is breathed in through your lungs and is used to control high blood sugar in adults with diabetes.
- Afrezza must be used with long-acting insulin in people who have type 1 diabetes.
- As with most medications, there are some people that should not use Afrezza, including anyone with long-term, chronic lung problems such as asthma or chronic obstructive pulmonary disease (COPD).
- Afrezza is not recommended for people who smoke or have recently stopped smoking.
- Afrezza is not for use to treat diabetic ketoacidosis.
- It is not known if Afrezza is safe and effective in children under 18 years of age.
Here are a few reasons why people with type 1 and type 2 diabetes might love using Afrezza inhaled insulin.
Afrezza starts working in about 12 minutes.
Afrezza is fast. It enters the bloodstream about one minute after inhalation and starts working in about 12 minutes. In the day-to-day management of my blood sugar, the fast action of this insulin can influence several aspects of life with diabetes.
For example, I do not pre-bolus when I’m dosing Afrezza for a meal. Instead, I take my insulin dose at the very beginning of my meals because the fast action of Afrezza is like the insulin response of a person without diabetes, so it better matches the digestion of a meal.
With the fast-in-fast-out profile of Afrezza, I’ve found that I’m also able to correct most high blood sugars within 60 minutes of using it, and it makes it possible for me to correct quickly and land within my target range.
This brings me to another big reason why inhaled insulin is gaining popularity.
A dose of Afrezza is out of my bloodstream within one and a half to three hours.
Afrezza not only acts fast, but it’s also out fast. A 4-unit dose of Afrezza is out of my system within 90 minutes. I especially appreciate this when I’m planning physical activities like walking my dog or chasing my kids around the playground.
I’ve found that I can often prevent low blood sugars thanks to how quickly Afrezza is out of my system. If I do go low with Afrezza in my system, I’ve personally experienced that I need very few carbohydrates to treat the low. It’s important to remember, though, that with any insulin, there is always a risk of experiencing dangerously low blood sugars.
Afrezza allows for mealtime flexibility.
Afrezza comes in three doses: 4 units, 8 units and 12 units. These dosages are not the same as injected insulin doses. While your health care provider will prescribe Afrezza dosing based on your needs, the way I have been able to use it is that the 4, 8 and 12-unit cartridges are for what I consider small, medium and large meals, respectively. (In clinical trials, most patients received 12 to 24 Afrezza® insulin units per meal.)
The specific 4, 8 and 12-unit cartridges may sound simplified compared to traditional injectable therapy, but Afrezza has a variety of titration and combination boxes that allows for flexible dosing. Personally, I’ve found I have more flexibility in the timing of my meals. I’ve found that because it’s out of my system so fast, depending on the macronutrient content of a meal, I may need a “correction” dose an hour or so later.
By working with my health care team when I first began using Afrezza, I gradually learned when I might need a 4-unit cartridge versus an 8-unit cartridge for a meal.
These experiences are my own, and you will want to work with your care team to figure out what your doses should be.
Afrezza is different.
Afrezza is a different experience when it comes to taking insulin, because of how quickly it’s in and out—and because it’s inhaled. While it can take some time to master, I gave myself plenty of time to learn how to use it as part of my diabetes management.
For me, the experience of using inhaled insulin has afforded flexibility and spontaneity when it comes to mealtime glucose management. I love knowing that I’m able to get insulin active in my bloodstream quickly and knowing it’s out of my system quickly, too.
Important Safety Information
What is the most important information I should know about AFREZZA?
AFREZZA can cause serious side effects, including:
- Sudden lung problems (bronchospasms). Do not use AFREZZA if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting AFREZZA, your health care provider will give you a breathing test to check how your lungs are working.
What is AFREZZA?
- AFREZZA is a man-made insulin that is breathed- in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus.
- AFREZZA is not for use in place of long-acting insulin. AFREZZA must be used with long-acting insulin in people who have type 1 diabetes mellitus.
- AFREZZA is not for use to treat diabetic ketoacidosis.
- It is not known if AFREZZA is safe and effective for use in people who smoke. AFREZZA is not for use in people who smoke or have recently stopped smoking (less than six months).
- It is not known if AFREZZA is safe and effective in children under 18 years of age.
What should I tell my health care provider before using AFREZZA?
Before using AFREZZA, tell your health care provider about all your medical conditions, including if you:
- Have lung problems such as asthma or COPD
- Have or have had lung cancer
- Are using any inhaled medications
- Smoke or have recently stopped smoking
- Have kidney or liver problems
- Are pregnant, planning to become pregnant, or are breastfeeding. AFREZZA may harm your unborn or breastfeeding baby.
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, or herbal supplements.
Before you start using AFREZZA, talk to your health care provider about low blood sugar and how to manage it.
What should I avoid while using AFREZZA?
While using AFREZZA do not:
- Drive or operate heavy machinery, until you know how AFREZZA affects you
- Drink alcohol or use over-the-counter medicines that contain alcohol
Do not use AFREZZA if you:
- Have chronic lung problems such as asthma or COPD
- Are allergic to regular human insulin or any of the ingredients in AFREZZA.
What are the possible side effects of AFREZZA?
AFREZZA may cause serious side effects that can lead to death, including:
See “What is the most important information I should know about AFREZZA?”
Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:
- Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.
Decreased lung function. Your health care provider should check how your lungs are working before you start using AFREZZA, six months after you start using it, and yearly after that.
Lung cancer. In studies of AFREZZA in people with diabetes, lung cancer occurred in a few more people who were taking AFREZZA than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to AFREZZA. If you have lung cancer, you and your health care provider should decide if you should use AFREZZA.
Diabetic ketoacidosis. Talk to your health care provider if you have an illness. Your AFREZZA dose or how often you check your blood sugar may need to be changed.
Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:
- A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.
Low potassium in your blood (hypokalemia).
Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with AFREZZA may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with AFREZZA. Your health care provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your health care provider if you have any new or worse symptoms of heart failure including:
- Shortness of breath, swelling of your ankles or feet, sudden weight gain.
Get emergency medical help if you have:
- Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.
The most common side effects of AFREZZA include:
- Low blood sugar (hypoglycemia), cough, sore throat
These are not all the possible side effects of AFREZZA. Call your doctor for medical advice about side effects.