For a while I’ve wanted to try Afrezza. Well, let’s be honest. Since I heard about it. It sounded rather different from anything we’ve seen on the Type 1 treatment front (well, if you discount Exubera) and looked like it would do some interesting things. The talk from the many US users always expressed how good it was and the blog of Matt from Melbourne, at Afrezza Down Under made for some very interesting reading.
After conversing with him and his partner on the goings on regarding Afrezza in the US and whether it was treated fairly, plus some discussions around glucagon suppression, they sent me a few capsules of Afrezza to try out. This was very generous of them as it isn’t cheap.
Sadly, I managed to get Bronchitis just as it all arrived, so rather than test it there and then, I thought it wise to leave it on the back burner whilst I built the monitoring tools, and wait until I was fully fit to try it out.
Now firstly, let me be clear. This was undertaken with no medical oversight. I have read the clinical trials and submissions to the FDA for US clearance and satisfied myself that the risk from Afrezza is no higher than that from taking a Ventolin inhaler.
In discussion with healthcare professionals in the UK, the over-riding feedback I received was that they would never inhale insulin in any form as the addition of any growth factor to the lungs was an unknown quantity, and in the past, they had only recommended Exubera where they felt risk to the lungs was outweighed by quality of life to the user.
Therein lies the conundrum with Afrezza. Does inhaling a growth factor into the lungs run the risk of much greater issues? Lung cancer, specifically? The trials showed that the incidence of lung cancer in the trials was reasonably low. All of the data presented to the FDA is available in this previous blog post and there is a host more data relating to Lung safety trials listed here.
Suffice to say that I made up my mind that I was happy to try this out with a few cartridges and see how it went.
Trial One: The Fast Carb Trial
With that background considered, I elected Easter Sunday as my testing day and for full disclosure purposes, due to food onboard and a high glucose level of 10.5mmol/l I’d taken a correction bolus of 3.5u at 16.55. This was my test subject:
Why this bright pink Chocolate Pig from M&S? Well he was Easter chocolate and his carb content seemed perfectly matched to my I:C ratio given that the Afrezza I have is rated at 8u per capsule. So off I went and inhaled from the little device at 17.35:
This was immediately before eating. I then stuffed my face with the rather fabulous pink pig (raspberry flavoured) pig for the next 10 or so minutes.
And then I watched. Now as I mentioned, there was a correction dose of Novorapid onboard, but I wasn’t quite prepared for what happened next. Normally, this pink pig would have shot my glucose levels up like a firework. Even with three units of Novorapid onboard. But this is not what happened. From this point, my levels never went up. They did the exact opposite.
As you can see from the picture below, they just went down, half an hour after eating.
And they continued to go down fast,
In fact, they were going down so fast that an hour after eating (when nominally, from previous experience, the chocolate should have stopped being absorbed) they were here:
And I had taken 40g of carbs to ward off the drop.
Now it was my own fault. I didn’t need the earlier correction dose, but the rather more important point is the complete lack of any rise as a result of eating the pink pig. Nothing. Even with 3.5u of Novorapid on board and 94g of carbs being eaten I’d expect to see something. It just didn’t happen. Quite an astonishing result and also an indicator for the next time. Take it after eating!
Even after the munching on additional carbs, my bg level recovered to the 5s and stayed there. A truly remarkable result that demonstrated to me just how effective this delivery mechanism is. The initial drop was so profound that it was a little scary and I was very pleased of the realtime monitoring I had in place to understand what was going on. This would have been unpleasant without it.
- A slight cough that took about 15 minutes to abate
- A slightly tight feeling in my lungs that took about 5 minutes to clear
- A massive head rush!
Trial Two: The Chicken Katsu Curry Trial
It also clearly demonstrates (even off just two uses) that Afrezza is perfectly designed for Sugar Surfing. You use it at precisely the points registered when you surf and the instant action just makes this work. Matt wrote a reasonably detailed view on this in the Afrezza Down Under blog and I can’t say I disagree with anything he’s written there. It really does provide flexibility in a way that other Insulins don’t simply by virtue of the speed of action and clearance.
From my limited testing, I get the feeling that for many, the benefits of this one may well outweigh those risks.