As a Type 1 Diabetic college student, I am always on the lookout for ways to make my hectic schedule more manageable in terms of my health. Having an active and unpredictable lifestyle can make mealtime insulin administration difficult, especially when considering the timing of when to take a dose in relation to your meal. Thankfully, the ultra rapid-acting Afrezza has presented itself as a viable option for on-the-go college students like myself. I had the honor to sit down with Dr. Eric Pinashin, the Manager of Medical Education at MannKind – who is also living with Type 1 diabetes – to talk about Afrezza and its potential benefits to the life of a young adult.
Musaddiq, Question: What is the purpose of Afrezza, how does it work, and what is the average profile of somebody currently using the drug?
Dr. Pinashin, Answer: Afrezza is the only ultra rapid-acting inhaled insulin for patients over the age of 18 with type 1 or type 2 diabetes1. It is to be used alongside a long-acting insulin for people who have type 1 diabetes. We like to describe Afrezza as a “needle free” product, as it is administered purely by breathing it in through your lungs. Afrezza comes in a 4-, 8-, and 12-unit cartridge that is inserted into an inhaler and gets into your system quickly. That means that patients do not have to wait 15 minutes before eating after using Afrezza, as they might with other insulin delivery methods, they are able to take it before the first bite of food. Afrezza isn’t a replacement for long-acting insulin, so it must be used alongside it in people who have type 1 diabetes.
M, Q: What was the inspiration behind creating an inhalable insulin?
Dr. P, A: Our founder Al Mann, who had developed numerous revolutionary medical products including the insulin pump as well as cochlear hearing implants, understood that current insulin delivery systems on the market were not working fast enough to combat post mealtime blood sugar spikes. He invested in an insulin delivery system that could deliver insulin to the bloodstream in a manner that mimicked a healthy person’s insulin response, while simultaneously making it less cumbersome for patients. The drug was also of course created to be an injection-free alternative.
M, Q: What are the differences between Afrezza and injectable insulin?
Dr. P, A: Other than Afrezza being needle free, Afrezza is also ultra rapid-acting. Insulin is typically characterized as either rapid acting or long acting, but the effect of Afrezza peaks at 35-45 minutes after taking it, and is out of the system anywhere between 90 minutes to 3 hours, depending on the dose (4- and 12-unit cartridges respectively). This contrasts with normal rapid-acting insulin injections that peak at about 90-120 minutes and are completely out of the body within ~275-300 minutes (or 4.5-5 hours)2,3. The clinical significance of differences in pharmacodynamic parameters has not been established.
M, Q: Is Afrezza being marketed towards type 1 or type 2 diabetics as of now?
Dr. P, A: Afrezza is approved for both type 1 and type 2 diabetes, and currently there is about a 50/50 split between type 1 and type 2 patients with diabetes using Afrezza. Afrezza is great for type 1s as it is the only insulin that works at the speed of human physiological insulin4. Also for this reason, I personally feel that it is also a great option for type 2 diabetes because it allows them to control blood sugar without injections.
M, Q: Can Afrezza act as a full-replacement mealtime insulin for a patient with type 1 diabetes like me?
Dr. P, A: Oh certainly! I’ve been using Afrezza for 3.5 years as a full replacement insulin, so I take Tresiba for my long-acting insulin and Afrezza for my mealtime doses. Patients can start small, maybe one meal or one correction every day and build up into a full replacement schedule.
M, Q: What has been the largest difficulty in terms of getting patients to switch to Afrezza for their primary mealtime insulin needs?
Dr. P, A: As a Type 1 myself, I know that we have been promised many things from the diabetes healthcare industry that hasn’t necessarily happened yet, including a full cure for the disease, an integrated pump, and several other things that just haven’t worked. So getting patients to trust that this product works as advertised has been a barrier so far. Additionally, patients getting used to a new form of insulin delivery has demonstrated itself to be a barrier.
M, Q: Why might a young adult using a more traditional form of insulin delivery switch to Afrezza? What makes it particularly suitable for young adults?
Dr. P, A: Young adults are always on the go, and their lifestyles come with a lot less structure than older folks, especially college students. This hectic way of life does not always provide patients with enough time to plan out their meals and take their insulin 15 minutes ahead of time. Since Afrezza can be administered directly before eating, it allows for a lot more spontaneity which can be important for a college student.
M, Q: What are the side effects of Afrezza, and who is it not suitable for?
Dr. P, A: Apart from hypoglycemia, which is the most common side effect of any insulin, the next most common side effect would be cough. Since Afrezza is a dry powder inhalable, it can take some getting used to for patients. In our clinical studies, coughing was mild and typically declined with continued use after 1-4 weeks. In fact, a cough led to discontinuation in only 1.1% of Afrezza-treated and 3.4% of placebo-treated subjects5. Taking Afrezza at room temperature and drinking a small sip of water before and after taking Afrezza may help in alleviating coughing associated with the inhalation. Afrezza is approved only for patients over the age of 18, but we are currently in the process with the FDA of studying Afrezza in children between the ages of 4 and 17. Afrezza is also not recommended for patients with any chronic lung disease such as asthma or COPD, and is not recommended for people who smoke or have recently stopped smoking.
Thanks to my interview with Dr. Pinashin, I was able to learn more about the various benefits of Afrezza, and how it can be suitable for people like me. This conversation has left me extremely excited and hopeful for the future, as more novel and innovative diabetes treatment options continue to develop.
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.
- Afrezza® (insulin human) Inhalation Powder Prescribing Information. MannKind Corporation.
- Fiasp (insulin aspart injection) Prescribing Information. Novo Nordisk.
- Lyumjev (insulin lispro-aabc injection) Prescribing Information. Eli Lilly and Company.
- Heinemann L, Baughman R, Boss A, Hompesch M. Pharmacokinetic and pharmacodynamic properties of a novel inhaled insulin. J Diabetes Sci Technol. 2017;11(1):148-156.
Rosenstock J, Franco D, Korpachev V, et al. Inhaled Technosphere insulin versus inhaled Technosphere placebo in insulin-naïve subjects with type 2 diabetes inadequately controlled on oral antidiabetes agent. Diabetes Care. 2015;38(12):2274-2281.
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