I admit it, had I not been invited to a two-day meeting to learn about inhaled insulin, Afrezza, I would still have the same general misconceptions most people do about the product. Primarily, that it may damage your lungs. Secondarily, that as a type 1 I can’t use it because the smallest insulin dose is marked ‘4 units.’ But I have been educated, and I have converted my own views now learning what a fantastic add-on to my blood sugar management Afrezza can be. I know many type 1s use the product and have said the same before me.
Mannkind manufactures Afrezza and invited about a dozen online diabetes advocates to meet with their senior leadership team at their office complex in Danbury, Connecticut. Readying themselves to get the word out about Afrezza in a much bigger way, they wanted to familiarize us with the product and learn from us how they should use social media.
Four dynamic fellow diabetes advocates. From left to right Kelly Kunik, Christel Oerum, Meri Schuhmacher and me.
After a lovely meet and greet dinner Monday night, the formal meeting began Tuesday. After introductions we had a factory tour, seen above. Both the inhalable insulin compound and inhaler are manufactured right at their facility. We also got and a detailed explanation how Afrezza’s crystal insulin compound is created and gets broken down and into the lungs and bloodstream. We actually tested whether we were breathing it in properly and we all quickly agreed on the necessity of making sure people get instruction on how to breathe it in or you could miss your dose.
But what I learned in the afternoon from CEO Mike Castagna and CMO David Kendall was well worth the trip. I’ve listed the major points below. Principally, that Afrezza begins working as soon as you inhale. It travels to the lungs and within seconds crosses over to the bloodstream. All this occurs in less than a minute. The mere speed of Afrezza is stunning when you are used to rapid-acting insulin. And that means spending much less time having high blood sugar.
Mannkind has a wealth of positive data from clinical and comparative trials with injectable insulin because they’ve actually been in the diabetes space for years. In the last year or two they partnered with Sanofi which didn’t work out, yet unfazed, leadership are passionate about their product and bringing it to the public.
As a small company devoted currently to one product they are the “David” amongst the “Goliath” pharmaceutical companies ike Novo Nordisk, Lilly and Sanofi. But expect to be hearing about them over the coming months. In the meanwhile –
What I learned:
- Afrezza begins working in 12 minutes, peaks in 35 and is mostly out of the body in 90. Compare that to any rapid acting insulin (Humalog, Novolog, Apridra). Because injectable insulins need to go through layers of skin and fat and get transported to where they can get absorbed, they take 20 plus minutes before they start working, two hours to peak and leave the body in 4 to 7 hours. I know my biggest annoyance with insulin therapy is how long rapid acting insulin takes to start working. Part of this problem is the liver continuously puts a small amount of glucose into the bloodstream. When your blood sugar is high, the liver continues to do this until your insulin starts working. With Afrezza, beginning to work almost immediately, the liver shuts off its glucose output into the blood and you now have two mechanisms helping your blood sugar come down.
- Clinical trials show no evidence of lung damage, people show lower A1C, spend more time in range and Afrezza reduces severe hypos by more than 30%.
- The Afrezza cartridges of inhaled insulin come in 4, 8 and 12 packs yet they don’t translate into injectable insulin in the same unit amount. For instance the 4 unit pack actually works like 2-2.5 units of rapid acting insulin.
- Currently Afrezza users are 50% type 1s and 50% type 2s. In fact, some type 1s who use a pump use Afrezza for their meal-time insulin because of its quick action.
- Afrezza can cause weight loss for some. Reading point 1 again on the list, often you have to take so much insulin to come down from a high you end up going low and then have to eat to treat the low. With Afrezza, avoiding the spike, you avoid the extra calorie intake.
Mannkind is working hard to help people go through the process of getting Afrezza approved by their insurance company. I know for myself, anytime I approach my insurance company for a newish diabetes product I have to go through prior authorization from my endo and sometimes three attempts before I get approval. Word on the street has it that health insurance companies have been advised to reject many drug requests on the first ask and it is those who persevere who often get that rejection overturned.
Because I am an insulin-sensitive type 1 who follows a low carb diet I am disappointed I cannot use the product for most meals. The dose would be just a bit too much. I have, though, almost not believed my eyes when I have taken it when I am over 180 and watched my blood sugar slide back down to where it should be in just half an hour. Gorgeous.
So I plan to use Afrezza, provided I can get it from my insurance company (I tried a 6 pack sample my doctor gave me) to correct highs and when eating the occasional pizza or pasta.
All in all, it was an enlightening two days and as always a delight to spend time with my fellow diabetes friends and acquaintances I don’t see often enough. Thank you to Mannkind’s Mike, Chad, Joe, David, Matt, Azul and Naomi for bringing us in to hear the patient voice and to be part of the strategy roll out.
Disclosure – My expenses to attend the meeting were covered and an honorarium was paid. However I was not asked to write about Afrezza.