Inhaling My Way through College: A Review of Afrezza Inhaled Insulin

Elias Ashooh

Providence College '19

Elias is a junior at Providence College majoring in Public Service and is a Resident Assistant for first year students. He is the Chapter Leader of The Diabetes Link at PC and when he isn't giving insulin shots, he is playing on the Club Ultimate Frisbee team or learning about presidential history.

I was diagnosed with type 1 diabetes (T1D) the summer before my senior year of high school. Fast forward two years later, and I am still using the Novolog and Lantus pens I started out with. I am perfectly content with using insulin pens, and do not have much interest in trying a pump right now. While I had learned to deal with all of the inconveniences of giving shots before a meal, I am never opposed to looking for things to lighten the burden. One of the most annoying things about giving shots is when I would be dressed up in a sport coat, with no easy access to give a shot. I would be wearing a tucked in long sleeve button down shirt, and tucking and untucking it was a big hassle. This makes having T1D even more frustrating than it already is.

I had learned about a new type of insulin, Afrezza, an inhaled insulin that had recently received FDA approval! I immediately wanted to try it because taking a puff would be a lot easier and convenient than giving a shot (in most cases). I learned that you had to be 18 to use this new type of insulin and having just turned 18, I was excited for the opportunity. At my next endo appointment, I brought up the idea of trying it. It worked out well because the insulin was so new and unique, my endo wanted someone in the practice to try it. I was still in a pediatric endocrinologist, so the majority of patients were younger. I was one of the few who would be able to use it. The next step was to pass a simple FEV1 test to get a baseline lung function, and I was on my way to inhaling my insulin!

Because no one at the practice had used or even seen inhalable insulin before, I was pretty much left to my own devices on figuring out how to use it. My endo did tell me that there would be some trial and error at first as I learned how Afrezza insulin units would impact my blood sugar and work with my meals. I learned that Afrezza units would not necessarily translate to units of injected insulin. As with all new diabetes medications, it would be with trial and error to try to figure it out. Let the games begin!

I got my inhaler and the cartridges at the beginning of my second semester of my freshman year. The first time I tried it, I did not inhale it properly, and I blew out a cloud of insulin powder in the dining hall. I laughed along with my roommate at the time, but I wasn’t laughing after dinner when I realized my first inhalation was not effective and I was greeted with a high blood sugar. After the first mistake, it didn’t take long for me to get the hang of it. I quickly learned to love the convenience of having the inhaling insulin as an alternative to shots. I eat pretty high-carb meals, and what I found worked for me was using both injected insulin and Afrezza. I tend to give a shot before my meal and if I ended up eating more than I covered for, I could easily take a puff for it.

This was incredibly useful for me because my dining hall at school is buffet style, so before Afrezza I would end up either giving another shot for eating more (which no one wants to do) or not eating more when I was still hungry. Outside of college, it came in extremely handy as well. Whenever I am dressed up for an event, I can keep my inhaler in my pocket and take a puff of insulin with ease. Or when I was sitting in the middle seat of a plane ride, I could just take a puff instead of trying to use the little space I had to give a shot. It has also worked really well in correcting blood sugars in the low 200’s.

However, it is not all smooth sailing with Afrezza, there are some downsides. The doses of insulin are not nearly as precise as injections and takes some getting used to at first. The cartridges for the inhaler only come in units of 4, 8 and 12 unit cartridges, so you have to gauge what you eat and learn how the Afrezza units will impact your blood sugar. When inhaling, the device makes a small but noticeable whistling sound that does draw attention. And if I personally use it too much during a day, I develop a small itch in my throat. And now sometimes when I use it I am greeted by the sarcastic comment of “You Vape Bro?” Afrezza is by no means perfect, but I am very glad to have it as an alternative to giving a shot.