1 Year Later: Why I Still Love Inhaled Insulin for Type 1 Diabetes
Editor’s Note: Educational content related to inhaled insulin is made possible with support from MannKind, an active partner of Beyond Type 1 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.
I started using inhaled insulin about a year ago. This ultra-rapid-acting insulin—Afrezza, manufactured by MannKind—can be used for mealtime and correction doses of insulin. For me, it’s offered a refreshing new approach to managing my blood sugar.
I was diagnosed with type 1 diabetes at age 13 during the seventh-grade health fair, nearly 23 years ago. Throughout those past 23 years, I’ve used a few different brands of insulin pumps and continuous glucose monitors (CGM), taken thousands of injections of different types of insulin and pricked my finger more times than I can count.
The two things I treasure most in my diabetes management toolkit today?
What is inhaled insulin?
- Afrezza (insulin human) Inhalation Powder is a man-made insulin that is breathed in through your lungs and is used to manage 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 just a few reasons why I love using inhaled insulin for type 1 diabetes—and why I’d recommend it to anyone living with any type of diabetes.
The most obvious: Fewer injections
Afrezza can’t replace all of my insulin needs. I still take my long-acting Lantus dose every night via injection, and I still use rapid-acting Novolog for slow-digesting meals or very tiny corrections.
But I truly love the reduction in my daily injections that comes with using Afrezza. People have talked for years about the desire to take insulin without injections—and Afrezza is the only FDA-approved form of mealtime insulin that offers just that.
It’s also convenient to take in public, at the playground, on an airplane, at a busy restaurant bar, on a treadmill at the gym, or when I’m head-to-toe in snow pants and a thick winter jacket about to take my dog for a walk.
With Afrezza, I don’t have to pull down clothing and reach for an injection spot. Instead, I can prepare my Afrezza inhaler and inhale.
I have flexibility around exercise.
One of the biggest things that makes Afrezza unique is how quickly it starts working—and how soon it’s out of my system. Afrezza starts working in about 12 minutes and is out of your system within one and a half to three hours, depending on your dose (the 4-unit and 12-unit cartridges, respectively), and I’ve found this to be pretty accurate.
When it comes to exercising, this is a huge perk for me. I am a high-energy gal—on a daily basis, I walk my dog at least 4 to 6 miles a day, run or jump rope for at least 30 minutes, lift weights and chase my kids around on scooters or in the swimming pool.
I refuse to let type 1 diabetes (T1D) interfere with my love of exercise, fitness, keeping my kids active and taking long dog walks.
With Afrezza, I know I can eat lunch at 12 p.m., take an inhalation of 4 units of insulin, and walk my dog for 40 minutes at 1:30 p.m. because the majority of my lunchtime insulin dose is already out of my system. Before Afrezza was part of my diabetes toolkit, I would sometimes find myself eating fast-acting carbs to reduce my chances of going too low during that dog walk. With Afrezza, I’ve found that I’ve experienced fewer low blood sugars.
I have more flexibility around meals.
If you’re taking fast or rapid-acting insulin via pen/syringe/pump, the “pre-bolus” is the standard recommendation for meals that are moderate in carbohydrates, dietary fat and protein. A pre-bolus is when you take your mealtime insulin approximately15 minutes prior to eating in an effort to match the timing of insulin action with the digestion of your meal.
Afrezza is so fast—I notice it starts lowering my blood sugar in about 12 minutes of inhalation—that a pre-bolus isn’t necessary. Instead, I know I can take my Afrezza dose when I start eating.
The diabetes community has begged for this flexibility—and this is it.
My other favorite mealtime quality of Afrezza is that because it is out of my system in 1.5 to 3 hours depending on the dose (for the 4- and 12-unit cartridges, respectively), I can take more if I’ve underestimated my carb count, because of how quickly it’s in and out of my system. While some people may wonder how to dose precisely with 4-unit, 8-unit, and 12-unit cartridges—Afrezza has a variety of titration and combination boxes that allows for flexible dosing, which is something many Afrezza users appreciate.
With Afrezza, I’ve felt comfortable trying new foods because I can watch the impact of a meal on my CGM and take more insulin one to two hours after meals if I underestimated the carb count and insulin dose. I feel in control because I know within ~12 minutes, Afrezza is going to start addressing that rising post-meal blood sugar.
I feel confident in correcting high blood sugars.
There are few things more challenging in diabetes management than waiting and waiting for a high blood sugar to come back down into your goal range. I feel concerned about the potential long-term consequences. Because of how Afrezza works getting into and out of my system, I personally feel confident that it helps me lower my sugars fast while decreasing my potential for going too low. I’ve found that Afrezza helps keep me within my target range.
Of course, with all insulin products, including Afrezza, there is the risk of hypoglycemia. The most common side effect of Afrezza is cough, but I found that it helps to drink a little sip of water after I inhale my dose.
I love Afrezza
When I’d first heard about Afrezza, I was skeptical and dismissive. How could insulin that’s in and out of my bloodstream that fast really work for type 1 diabetes?
Afrezza has truly been a convenient option for me in controlling my blood sugar because it acts fast and it’s out fast.
Yes, there’s definitely a learning curve that comes with using inhaled insulin. I worked closely with my healthcare team for the first few weeks to get a clear grasp on how my body reacts to Afrezza. For the first few months, I truly put myself in the mindset that this was a learning phase. I’d had 20+ years to learn how to use injected insulin—so I should give myself time to learn how to use inhaled insulin, too. As with any medication, talk to your healthcare provider about using Afrezza, and know that your results could be different than mine.
Today, my only diabetes regret is that I didn’t try using Afrezza sooner.
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 healthcare 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 6 months).
- It is not known if AFREZZA is safe and effective in children under 18 years of age.
What should I tell my healthcare provider before using AFREZZA?
Before using AFREZZA, tell your healthcare 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 healthcare 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 healthcare 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 healthcare provider should check how your lungs are working before you start using AFREZZA, 6 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 healthcare provider should decide if you should use AFREZZA.
Diabetic ketoacidosis. Talk to your healthcare 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 healthcare provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your healthcare 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.