Afrezza with Tresiba: A Perfect Match?

This video discusses my switch to the new Tresiba basal insulin for use with Afrezza. Is this ultralong-acting basal the perfect match for the ultrarapid-acting Afrezza?

After testing 18 different dose permutations of Lantus, I remained disappointed with my glucose levels between meals. Switching to Levemir improved things greatly, but introduced new problems each day.

A new basal called Toujeo contains identical ingredients to Lantus and still seems to be inconsistent in its release.  This study observed 50 people for 2 days on Toujeo. This figure shows that Toujeo’s release sometimes varied considerably between the two days and did not always lower glucose steadily throughout the day – its activity sometimes spiked or ran out.

That study was by the manufacturer of Toujeo and Lantus. Another study by its competitor showed that Lantus was over 300% more variable in its release over 24 hours than the new ultralong acting basal Tresiba.

They calculated the risk of experiencing more than double the usual maximum effect on any given day (potential hypoglycaemia) was <0.1% for Tresiba and 11% for Lantus. That’s a random hypo every 9 days on average! Plus random highs every 5.8 days on average. That’s the average for the whole group of people – some were far, far worse.

So I switched to Tresiba to see how it works with Afrezza.  It comes with many other advantages, and eliminates some routines that have ruled my life for 24 years!

The number of doses of Afrezza I use each day is reduced, including the dose I previously needed as soon as I woke up. Additionally, all of the problems introduced with Levemir are gone. It’s early days, but here’s a picture of where I’m at now.

Now that my basal is almost fully optimised, I can soon work on finding the optimal strategy for timing and dosing of Afrezza.

UPDATE: Tresiba has just received FDA approval in the US. Still waiting for Australian TGA approval.

Afrezza + Tresiba

It’s early days for Tresiba, but so far I’m very impressed.

Afrezza and Levemir

This video update covers my switch to Levemir, and its nifty pen. Scroll down for my charts comparing the two.

The high variability of Lantus prevented me from further optimising my basal dose, and the issue makes some consider it dangerous.

So I decided to switch to Levemir. My experience with Levemir mirrors that of this user in the UK, who finds “the duration of the Levemir is frustrating, as the amount taken in each of the two injections is not quite enough to get me through a twelve hour duration“. Further, I need to be cautious during its peak.

As you can see in the video, the NovoPen Echo is very cool. However my third pen has already failed once already, and I hope it’s the top display that’s wrong and not the one on the side. Novo has asked me to send in the pens to investigate.

If I can get a pen I can trust, I would like to pair the NovoPen Echo with the longer acting, flat profile Tresiba basal (not yet available in Australia).

Update: I have since changed basal insulin to Tresiba. Novo has sent two replacement pens, and I await the results of their investigation into the faults.

The goalposts have shifted a lot in a couple of weeks.

The goalposts have certainly shifted a lot in a couple of weeks.

Afrezza and Lantus doses

This video is about basal insulin and the timing of Afrezza doses.

I wish I had known that Afrezza needed a basal dose adjustment, as previous insulins were pretty forgiving. Here’s an image which sums it up:

Afrezza and Excessive Lantus Doses

My previous Lantus dose when using Apidra was 9u in the morning and 10u in the evening, and I continued with that when starting Afrezza. But my glucose always seemed high, even though I was inhaling buckets of the stuff.

I thought it was that I needed more basal, but counterintuitively that made it even worse. I wanted to keep increasing it, but my partner insisted that lowering it might help. I said that’s impossible. But somehow it worked.

Later posts will cover optimising the Lantus dose split, switching to the more stable Levemir and Tresiba, and will explain what caused those blood glucose peaks.

Update: I later switched to Levemir, and am now using Afrezza with the amazing new basal Tresiba. I will soon post more info on these changes. This link will be updated once I have collected more data.