Afrezza Update

So, in a previous post, I mentioned that I would be giving a bit of an Afrezza update based on how it fits into my "Carb Counting Lite" diet, per se. I figured now would be a good time to give an update, too since I've been using it for about 4 months and a lot of the internet chatter seems to have died down about it.

So we'll start with addressing the pros & cons from my old post to see if/how those have changed. Follow along with the grey text, to see my older comments, and the bolded font to see my new opinions.

CONS:

• Suuuuuper awkward in public. I've gotten used to quietly beep beep booping away in the corner with everyone else oblivious to what's happening. Of course I'm pretty nonchalant about doing finger sticks, but people are generally cool with that because it's familiar. We've all seen the obesity documentaries. We know what diabetes is. But shoving powders into a plastic whistle and doing your best Snoop Dogg impression? Attention grabbing, to say the least. This one is still very true. It's also happened multiple times that people just start asking me a bunch of questions and I just have to kind of nod along and gesture while inhaling deeply with the whistle hanging out of my mouth. Actually though, one time someone just thought I had asthma so that was kind of a relief. 
• Dosing is confusing, to say the least. It's just in and out so fast...it's hard to know how much is actually going "in." And it doesn't seem to hang around very long, so it can lead to some roller-coastering around mealtime. Some people have recommended doing a pump bolus and an Afrezza bolus...I'm still investigating. Pump/Afrezza combo is definitely the way to go. I will sometimes use Afrezza instead of a pre-bolus if I don't feel comfortable dosing an hour before a meal, or if I simply don't have the heads up on eating. I use it to stave off an initial post-prandial spike, but I always (okay mostly) make sure to do an adjusted pump bolus at the same time so that it will hit essentially right as the Afrezza is finishing up.
• Still have to wear a pump--for basals, for food bolusing (because I'm still figuring out the dosing, I mainly use the Afrezz' for corrections). So that means I'm a whistle-blowing, ever-beeping cyborg now. Still wear my pump. 
• It doesn't keep for very long (although I haven't tested this) but once you open a foil pouch (which contains roughly 10 blister packs of 3 cartridges each), it's only good for 10 days. And it takes up more space in your refrigerator, too. This is not an issue...I definitely take more than 10 days to use a pack and I haven't noticed significant problems. 
• It's hard to keep track of--I rely on Diasend to help me manage things, but since I'm taking less pump boluses and there's no way to automatically upload my Afrezza use (and no app that lets me upload all my data plus add in manual timestamped notes in once place), it's messing with my organization. And since I'm also Type A, in addition to Type 1, I don't love that. Ugh still annoyed by this. The right diabetes app is harder to find than good real estate!!

PROS:

• It works. It works. It works, it works, it works. I CANNOT say that one enough. It just does. Wicked post-prandial spikes after breakfast? Accidental snacking binge at the staff meeting? random CGM delay that shows you at 113 --> one minute and 181 double arrows up 5 minutes later? SHAWTY DON'T PLAY. One 4U puff and things are smoothing out. No rage-bolusing. No vigorous, frustrated walks or bike rides that BF is forced to endure. No 5 hour snooze alarm on my Dexcom going off to remind me that I've been out of range for way too long. We're talking results within the half hour. STILL VERY TRUE!!!! Nothing works faster, even on high fat/high carb meals. 
• It works, just the right amount. As in, this weird flattening out effect where I never seem to drop below 65 with it, as long as there's little to no other insulin in my system. And then I usually drift gently back up into the 80s or 90s. It's confusing, sure, and I sometimes treat for hypos that never happen...but still...Soooooo, this is less true now. I am generally pretty insulin-sensitive, and I think 4U is really just too much for me. If I haven't eaten in the past 2-3 hours, and/or I don't have plans to eat immediately, it's a little too strong for me to take unless I'm above 250 and still rising. 

BOTTOM LINE: Afrezza is great at what it does, but it's no substitute for subcutaneous. It's perfect for those formerly really frustrating situations, like a blood sugar of 200 when you're about to go out to dinner with friends, or an unexpected meal opportunity, or wanting to eat right after exercise/waking up and not being able to pre-bolus. It can help if you accidentally eat the fridge AND the kitchen sink after a low blood sugar, too. It's also really helpful with foods that are guaranteed to give you a spike, like fruit or non-chocolate candy. I also like to take it if I know I'm going to be hiking soon--I'll eat breakfast, cover it with Afrezza only, then leave on the hike about an hour later, as it's wearing off. Since it clears out so quickly, I don't have to worry about IOB while hiking. 

However, it's still a little too tricky and unpredictable to really be a basis for good control, in my opinion. It is definitely a tool to get there, but it is so strong (at least initially) that if you have any other IOB, or exercise going on, the risk of going low is too high in my opinion. It's also not enough to cover a full meal on its own--even with two doses spaced apart, I usually end up yo-yo-ing a lot, and have to spend a lot of time glued to the old Dexcom. 

I still highly recommend Afrezza, however. While it's true that a low-carb diet and rigorous bolus-ing with a pump and super-accurate basals and a consistent schedule can control your blood sugar better, that's just not a 100% reality of life. Afrezza allows you to have a bit more freedom and breathing room (HA.HA. See what I did there? Because it's inhalable?) while still living your actual life. I recently went on a 2 1/2 week road trip and it was invaluable to keeping things relatively under control. Of course I still ran higher than I preferred, but have you ever tried asking for a carb count on a meal in rural Wyoming? Or a salad? 

BOTTOM BOTTOM LINE: Guess what, big surprise, Afrezza is still not your pancreas. But it can help you feel a lot less of the stress and guilt of being pancreas-challenged.