Inhaled Insulin: Meet a Type 1 Who Uses Afrezza And Keeps Her A1C Below 6.0


Editor’s Note: This content was originally published at OnTrack Diabetes, acquired by EndocrineWeb, and is republished with permission.

This article is about Judi Hoskins personal experience using Afrezza, and what has worked for her may not work for everyone. Please consult your healthcare team before making any changes to your diabetes care regimen. Beyond Type 1 has an active partnership with MannKind, makers of Afrezza. This article was not published as part of that partnership, and the company had no input in its creation. 

Afrezza inhaled insulin isn’t widely used, but that may have less to do with the actual product and its delivery system than other factors, including health insurance coverage. Here is the story of a person with type 1 diabetes who uses it with excellent results.

Judi Hoskins has type 1 diabetes (T1D) and uses Afrezza inhaled insulin to supplement her pump when she has high-carb meals.

Judi Hoskins has lived with T1D since the age of 5. She was diagnosed in 1958, at a time when the only treatment option available was a mixture of cow and pig insulin. Back then, testing your blood sugar at home wasn’t an option for most people with diabetes either. Today, thanks to consistent hard work, along with the aid of an insulin pump, Judi, 63, has been able to maintain an A1C below 6.0 for the past 15 years.

About a year and a half ago, Judi added Afrezza’s inhaled insulin technology to her treatment method with excellent results. (Read Ginger’s experience of using Afrezza here.)

Ginger Vieira: I can’t help but wonder what using cow and pig insulins was like compared to today’s insulin options. Can you describe what it was like to use these insulins?

Judi: It was all that you knew, so I don’t ever remember thinking it was terrible. It was certainly preferable to death. Before I started using early insulin, I’d gone a long, long time—nearly a year—before being properly diagnosed. The doctors kept telling us that I needed vitamins, and my mother kept saying, “No! This isn’t about a lack of vitamins!” So, getting some kind of treatment was better than nothing at all. 

When did you begin using Afrezza, and how have you fit into your diabetes management routine?

Judi: I started using it in June of 2015. Basically, I use my pump as my basal insulin, and I use Afrezza for really high-carb meals, like something with more than 50 grams of carbs. A 4-unit cartridge of Afrezza is equivalent to about two or three units of Novolog insulin, and that’s the smallest amount it comes in. So, if I needed five units for the dose, I’d fill in the other two units with the insulin in my pump. But if I only need two units of insulin for a meal, I’d need to use the insulin in my pump instead of my Afrezza.

Because I’m a 63-year-old woman, I don’t eat large amounts of food, so most of my meals don’t require using Afrezza. Certain foods, like an apple, have too few carbs for me to use Afrezza. Dinner is where my carb count is most often near 50 grams, so that’s when I use it the most.

My son uses Afrezza, too!

What are the most significant benefits of using Afrezza compared with taking a dose of rapid-acting insulin from your pump?

Judi: With Afrezza, the insulin is delivered very quickly into your system and leaves rapidly, too—usually after only 90 minutes. With rapid-acting insulin from a pump (or a syringe, or pen), it takes longer to start working, and it’s in your body much longer, four hours or more.

I eat many meals out at restaurants because I’m older, and I don’t cook as much anymore. At a restaurant, I enjoy the convenience of taking my dose of Afrezza when I place my order because it’s fully working in my system by the time I start eating 15 or 20 minutes later. I also like that I don’t have to pre-bolus with Afrezza, because it works so quickly. With insulin in my pump, it takes nearly 30 minutes to start working.

Another pro is that you might benefit from using one type of insulin over another, depending on what you’re eating. For example, if I’m going to have a meal that is high in both carbs and fat, like a burger on a white bun, I’d use Afrezza two hours after eating it, instead of at the time of the meal. Because it works so quickly, it prevents my blood sugar from going much higher than 140mg/dL on my continuous glucose monitor (CGM). Afrezza is great for situations like that! It’s so much faster than traditional insulin.

The design of the inhaler itself has come a long way since the debut of Exubera in 2006 when it was practically the length of a forearm. Do you feel self-conscious about using your inhaler in public?

Judi: It does not bother me at all to use it at the table in a restaurant. No one has ever asked me about it, but I’d tell them to mind their own business if they did.

Some concerns have been raised about the long-term impact of using inhaled insulin since it hasn’t been around long enough for researchers to make definitive conclusions. How has Afrezza affected your lungs?

Judi: Sometimes it makes me cough a little bit, but I have found that drinking some water afterward stops the coughing. Since I started using Afrezza, I’ve had two lung functioning tests; my second test was actually stronger than the first one.

Since you’re already on an insulin pump, was it challenging to get insurance coverage for another form of insulin delivery?

Judi: I didn’t have a hard time getting insurance coverage because of insulin pumping, but I did have to be pre-approved for it. My doctor is great at writing letters for pre-approval. Once I received pre-approval, my insurance moved it to the highest tier of my insurance plan. 

Thank you for sharing your experience, Judi!

WRITTEN BY Ginger Vieira, POSTED 01/04/22, UPDATED 12/10/22

Ginger Vieira is an author and writer living with type 1 diabetes, celiac disease, fibromyalgia and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1 as digital content manager, Ginger wrote for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.