Afrezza & Tresiba Update

This post reflects on the positive impacts on my day-to-day life since switching to Afrezza and Tresiba, along with some new challenges. A simple mistake led to three weeks of terrible glucose results, and the cause took a while to track down.

The day after I have my best ever 24hr glucose result (see charts at bottom), my glucose levels began going out of control. Unexpected highs between meals led me to try increasing my basal dose. Then major lows began, so I started changing the time of dosing basal. My total daily dose of Afrezza dramatically increased. I even switched back to injectable bolus for two days to see if that would help.

When my basal cartridge ran out, I discovered what the problem was. I had accidentally refilled the pen with a Levemir cartridge. Both cartridges are green, and are in blank foil blister packs. The pen can also completely cover the label, depending on how the cartridge is rotated. I certainly won’t be making that mistake again.

Both cartridges have green rings and are in blank foil packs.

Both cartridges have green rings and are in blank foil packs.

When I restarted Tresiba, I dosed twice in the first 24 hours to try and speed up the transition. After the third dose, levels were returning to normal.

As troubleshooting this issue has consumed about three weeks, in the video I reflect on the positive impact that switching to Afrezza and Tresiba have had on my life so far. In addition, there are some new challenges that these treatments present.


All of the impracticalities of dosing insulin before a meal are gone. When I’ve eaten enough and I feel full, I now don’t have to force myself to finish the meal. If I want to share food I’m eating with someone else, I can offer it to them without having to explain that I have already had the insulin for everything that’s on my plate.

Cooking is a pleasure now I don’t need to weigh ingredients, or weigh dishes while serving. I no longer have to copy numbers from nutrition panels and look up web sites in order to perform a series of complex mathematical equations before every meal.

I am no longer constantly worrying about encountering another company like HelloFresh again, who provide diabetics with potentially lethal falsified carbohydrate data.

Previously, visiting friends for dinner required them listing all the ingredients and quantities for the meal before it was served. I avoided going to restaurants wherever possible to avoid the impossible task of dosing for unknown meals of unknown sizes being served at an unknown time. It’s an amazing feeling being relaxed for the first time in these settings.

However there are new challenges. Afrezza acts for a shorter length of time than injected insulins. Some fatty meals like pizza require split doses of injectable insulin. After about a year of trial and error I settled on injecting two doses five hours apart. Without a CGM, I don’t have alerts for when my glucose is going out of range so identifying the optimum timings using Afrezza will take some time. I hope to systematically develop some simple guidelines for dosing to help out others that are not using CGMs.


For the first time in my life, I can sleep in on weekends without glucose levels suffering. Many years ago I dosed Lantus once daily in the evening which allowed me to sleep in, however it was unable to last 24 hours so levels were rising in the evenings.

With Lantus and Levemir twice daily I had to return home at the same time every evening for my second dose, ruling out spontaneous social events. It’s liberating to be able to chose when I want to go home, rather than have my basal always counting down the minutes.

So far, I have not observed any detectable difference if I dose one morning and then wait until the next night. As summer approaches here, I am sure I will have more opportunities to test out the limits of Tresiba’s flexible dose spacing.

The only downside so far is managing the different basal requirements I have on the weekend. I imagine this was a problem before, but is highly visible now I’m using the FreeStyle Libre.

During the week, I eat three times a day and am less active that I am on weekends where I tend to eat twice daily. My solution so far is to eat or drink something sugary while doing extended physical activity like working in the garden.

23 Sep - Best Results. Note the Interquartile Range.

23 Sep – Best Ever 24hr Period. Note the tight interquartile range.

FreeStyle Libre Data

23 Sep – FreeStyle Libre Data

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.