Last week I attended a diabetes education meeting where I was introduced to Afrezza by an endocrinologist using it with many of his patients. If you don’t know, Afrezza is the new inhaled insulin from Sanofi. It’s not quite yet ready for primetime with consumers, but it’s making the rounds with health care providers. At my meeting there were three Sanofi reps, two doctors, one nurse and me.
Afrezza’s benefits are largely that it takes away the fear of needles for type 2s. But I like the idea that it works faster than today’s rapid-acting insulins so one doesn’t have the typical after-meal blood sugar spikes. Faster in, faster out.
I arrived at the meeting with great curiosity – I’ve been reading about people really liking Afrezza, including type 1s like Amy Tenderich above, who wrote a fantastically informed post about trying it herself on her blog here – and I came with two concerns.
At the meeting one of my concerns went away, yet I don’t know how they do this. As a type 1 who eats a very low carb diet I use very little mealtime insulin. 1 unit is typically my coverage for a meal any time of day other than early morning when I’m experiencing the Dawn Phenomena. Thus, I couldn’t figure out how Afrezza – where the lowest dose is 4 units – and I could ever be compatible. I still can’t make sense of the answer, but I learned that you don’t calculate it as in a 1:1 conversion. If you use anything less than 4 units of rapid-acting insulin, you take one blister pack (a 4 unit dose) of Afrezza. Math is obviously done differently in the pharma world.
However, my other concern lingers. For some reason I heard at the meeting that Afrezza has been in clinical trials for two years* (Many have corrected me, see below. The rep just sent me the package insert which may explain the two year period. I’ve put it under ‘Comments’). While Afrezza shows no particular strong influence of harming the lungs, currently it’s not recommended if you’re a smoker or do have any lung issues. Many people experience a cough, some lose it, some don’t. To start Afrezza, you need to first have a lung function test.
As for that pharma math, I’m about to give Toujeo, the new basal insulin, a test drive. A CDE friend gave me a sample. Toujeo is a concentration of insulin three times greater than Lantus and Levemir, so you can’t do a 1:1 comparison here either. Thus the warning, don’t attempt to extract it out of its pen with a syringe.
All in all, I’ll wait a few more years to watch whether Afrezza does impact lung function. In addition, I wouldn’t want to change two variables – Touneo and Afrezza – at once when it comes to my diabetes management. It would be too hard to know which is causing what.
But it is an odd thought that after a decade of using Lantus and Humalog, that have become like old friends, in a few years I may throw them over for two completely different BFFs.
* Readers let me know what I heard at the meeting was incorrect regards Afrezza’s length of time spent in trials. See comments.