Afrezza: Another Tool in My Diabetes Toolbox
One of the biggest lessons I have learned from living with Type 1 diabetes for decades is that there is rarely one perfect solution for every situation.
Sometimes, the insulin pump works beautifully. Sometimes, exercise makes glucose management remarkably easy. Sometimes, the right food choices make the glucose curve almost boring—which, when you have diabetes, can be a wonderful thing!
And sometimes, you need another tool.
Recently, I added Afrezza, an inhaled rapid-acting insulin, to my personal diabetes toolbox. I started conservatively with the smallest cartridge, labeled as 4 units, and so far, I have found it particularly interesting for situations where I want insulin to begin working very quickly without having a long insulin “tail” afterward.
I don't see Afrezza as replacing my insulin pump. Quite the opposite. My Tandem Mobi remains the center of my insulin therapy.
For me, Afrezza is another option.
And that distinction is important.
Why Afrezza Interested Me
Afrezza is fundamentally different from the rapid-acting insulin I normally receive through my pump. Instead of being delivered into the subcutaneous tissue, it is inhaled into the lungs, where insulin can be absorbed rapidly into the bloodstream.
That rapid action is what attracted me.
In my own diabetes management, there are occasional situations where speed is especially valuable.
One example is an infusion-site failure.
Anyone using an insulin pump probably knows the frustration. Everything is going well, and suddenly glucose starts climbing rapidly. You give a correction, but nothing seems to happen. Eventually, you realize that the problem isn't the insulin dose—the infusion site simply isn't delivering insulin properly.
Another situation for me is the pronounced glucose rise I can experience after waking up, often described as the feet-on-the-floor phenomenon. My glucose can begin climbing surprisingly quickly even before I eat breakfast.
These are situations where I have been experimenting with Afrezza, under the guidance of my medical team.
What I Like About It So Far
The first thing I noticed is exactly what made Afrezza interesting to me in the first place:
It is fast.
The insulin begins acting quickly, but equally important for me, its glucose-lowering effect does not linger in the same way I experience with subcutaneous rapid-acting insulin.
That creates an interesting additional option.
Diabetes management is often about anticipating what glucose will do several hours into the future. Whenever we correct a high glucose level, we also have to think about the insulin that is already active in our bodies.
Too much overlapping insulin can turn a high into a low.
Having an insulin option with a different action profile potentially gives us another way of approaching certain situations.
But—and this is extremely important—Afrezza is still insulin.
Fast insulin can also cause hypoglycemia. The fact that it works differently does not make it something to experiment with casually.
Afrezza and My Tandem Mobi: An Important Safety Consideration
This deserves its own section because I don't want anyone reading about my personal experience and simply copying what I do.
I use a Tandem Mobi insulin pump, and Tandem's official safety information specifically warns against using inhaled insulin while using the Mobi system. The reason is important: insulin taken outside the pump is not known to the pump's algorithm. The system therefore cannot properly account for that insulin when making its own insulin-delivery decisions.
In my personal management, when I use Afrezza, I am extremely conscious of insulin-on-board and pump automation. I have been using manual pump operation around Afrezza and paying particular attention to having little or no pump-delivered insulin on board.
But that is my personal approach—not a recommendation for someone else.
If you use an automated insulin-delivery system such as Tandem Mobi and are interested in Afrezza, this is something I strongly recommend discussing specifically with your endocrinologist or diabetes team. Ask them how—or whether—they want you to combine the two therapies.
Don't simply copy my settings or strategy.
Afrezza Isn't for Everyone
There is another important consideration: Afrezza is delivered through the lungs.
The FDA prescribing information includes a boxed warning regarding acute bronchospasm in people with chronic lung disease. Afrezza is contraindicated for people with chronic lung diseases such as asthma or COPD, and pulmonary-function testing is required before starting therapy. Follow-up lung-function testing is also recommended.
There are additional precautions and contraindications that need to be considered.
This is another reason Afrezza should be viewed as a prescription therapy to discuss with your physician, not simply another diabetes gadget to try.
Technology Is One of My Four Pillars
Afrezza also fits into a much bigger philosophy I have developed around managing my diabetes.
I think of my approach as resting on four pillars:
Modern diabetes technology. Low- to mid-carbohydrate nutrition. Mindfulness and meditation. Low-intensity steady-state exercise (LISS).
None of these pillars works completely independently of the others.
Technology gives me information and increasingly sophisticated ways to deliver insulin. Nutrition helps me reduce the size and unpredictability of glucose excursions. LISS exercise improves my glucose management while supporting cardiovascular health and fitness. And mindfulness and meditation help me manage something that is too often ignored in discussions about diabetes: the enormous mental burden of managing a chronic condition every hour of every day.
Afrezza belongs primarily in that first pillar: modern diabetes technology and treatment options.
And what excites me isn't necessarily Afrezza itself.
What excites me is choice.
Diabetes Management Is Becoming a Toolbox
I remember a time when managing Type 1 diabetes meant far fewer choices than we have today.
Now we have continuous glucose monitors. Sophisticated insulin pumps. Automated insulin-delivery algorithms. Faster insulins. Smart pens. Different infusion sets. Smaller pumps. Better apps. And, yes, inhaled insulin.
Not every technology will work for every person.
I have tried diabetes technologies that looked fantastic on paper but simply didn't fit the way I live or eat. Others have transformed my diabetes management.
That's okay.
The goal shouldn't be to use every new technology.
The goal is to build the combination of tools that makes diabetes easier to manage while helping us achieve the health and quality of life we want.
For me, Afrezza is beginning to find a place in that toolbox.
I am starting cautiously with the smallest cartridge and using it only in specific situations. I am watching my CGM carefully. I am learning how my body responds. And I am continuing to refine the approach together with my medical team.
That is how I believe we should approach diabetes technology in general:
Stay curious. Stay educated. Experiment carefully with your healthcare team. Keep what works. Change what doesn't.
Because every useful tool we add to our toolbox has the potential to make living with diabetes just a little bit easier.
And after living with Type 1 diabetes for so many years, I still find that incredibly exciting.
Important: This article describes my personal experience with Type 1 diabetes and Afrezza and is intended for educational purposes only. It is not medical advice. Insulin dosing and changes to insulin-delivery methods can cause severe hypoglycemia or hyperglycemia. Afrezza also has specific contraindications and pulmonary monitoring requirements. If you are considering Afrezza—or combining it with an insulin pump or automated insulin-delivery system—please discuss it with your endocrinologist or diabetes care team before making any changes.
