What’s going on with all those “flat line graphs” showing up on the continuous glucose monitors of many Afrezza users out there? It’s truly remarkable as a diabetic to post graphs like that–something nearly impossible on traditional insulins. In the past month, I have been “flat-lining” while sleeping and used to wake up with no “dawn effect” or a rise of blood sugars in the morning. However, as my insulin resistance began reversing I started seeing a downward slope on my CGM for the entire night. It was puzzling because I never had a severe low but I did end up reducing my evening dose of Lantus 2 times until I started flat lining again. To be able to “flat line” is to demonstrate ultimate control of diabetes–like taming an out of control roaring lion into a passive, tame house cat. For most of us on afrezza this is the new trick we love to show off to other diabetics, and below I will provide some feedback so when you wake up, you too will be able to do it! And how about flat lining during and post meal situations–yes, I’ll cover that too!
Keep in mind that even healthy people will have a spike of blood sugars so a spike is perfectly normal but a spike over such high numbers such as 200 is not. While it’s fun for us to watch ourselves “flat-lining” a meal it is not necessary and certainly does not happen every time. You too will be able to do it but it will be nearly impossible if you “under dosed” or had a very large carb meal which could send your glucose levels higher for 1 or 2 hours after a meal. This is where experience with a new treatment come into play. And this is where Afrezza has no competition. When I experience this, I take a follow-up dose of Afrezza immediately. Many people have told me it’s frightening to do because of their bad experiences with traditional insuIin in the past and the length of time it took when they used injectables (including me-I understand the fear, but Afrezza because of it’s pharmakinetics is perfectly suited for this task). And at the same time, I do see opponents of Afrezza writing about the fact that we “pop” Afrezza all day long (after all does it get any easier, faster or less painless–no!). My question to you is what do you think we do with needles? Do you think as diabetics we only take 3 needle shots a day? If a type 1 diabetic takes 1 cartridge with each major meal and then a follow-up dose which by the way is not at every meal but that would still be only 6 inhales per day. I can tell you most type 1 diabetics takes at least 5 to 6 injections in a 24 hour day to have “tight control” (don’t get too far out of normal blood sugar ranges) either with a needle or a pump. So my point is do not expect to “flat line” meals when you first try Afrezza, but as you keep “nipping it” in the bud (rising sugar levels over 150 or so), you will gain mastery over glucose spikes, and guess what? The flat lines will appear sometimes. Moreover, keep in mind that we are not perfect and you can have a huge glucose spike from stress, sickness or worry so just because it may not happen for you every single time doesn’t mean Afrezza isn’t working for you. If that is the case then no insulin works because that’s what we constantly do on rapid-acting analogues/injectables all the time.
What is really great about Afrezza is that you can correct those “uptrends that get away from you” and get back in line so quickly. To give you an example, last week I ate some peaches at midnight and then fell asleep. I Woke up at 2:20am at 250. This was the first time I hit 250 on Afrezza when I didn’t actually take Afrezza. To correct this, I took 2 cartridges and had my sugar back to 90 in 40 minutes. At 3:15 am I went back to sleep with absolutely no worries. Now, when I was on my old treatment in this situation I would only have 2 options. First, do not take insulin and leave my sugars “high” all night harming my body or second, take insulin and stay up until 6am. I have already had several near death experiences in this situation so no I do not take any chances. With Afrezza those long “tail ends” are non-existent and it takes me a much shorter time to get back into range even if I make a mistake. The thing I want to express is that with Afrezza you can relax, and do corrective doses day or night, and this will become the “new normal” for you–ie. tight control, with gentle hills and “flat lines” as you figure out your drop rate and duration for your dosing. Afrezza is a miracle drug, and we are all still amazed to be able to “flat line” in a good way!
In my next blog article, I’ll dig deeper about Afrezza, some observations, and talk about March Madness–and it’s not about basketball! Stay tuned friends…
As a Type 1 aren’t you supposed to take basal insulin before you go to bed? Has AFREEZA taken the place of basal too? When you ate the peaches the basal should have handled that right?
Basal insulin is our background insulin that cannot handle meals. Afrezza does not replace basal insulin as it acts as a bolus. I did take my basal insulin but a basal is released over a 24 hour period. I attached an article that might help explain this.
http://www.diabetes.co.uk/insulin/basal-bolus.html
Basal Bolus – Basal Bolus Injection Regimen
A basal-bolus injection regimen involves taking a number of injections through the day.
A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person’s body delivers insulin.
A basal-bolus regimen may be applicable to people with type 1 and type 2 diabetes.
What is a basal-bolus insulin regimen?
A basal-bolus routine involves taking a longer acting form of insulin to keep blood glucose levels stable through periods of fasting and separate injections of shorter acting insulin to prevent rises in blood glucose levels resulting from meals.
What is basal insulin?
The role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting.
When fasting, the body steadily releases glucose into the blood to our cells supplied with energy.
Basal insulin is therefore needed to keep blood glucose levels under control, and to allow the cells to take in glucose for energy. Basal insulin is usually taken once or twice a day depending on the insulin.
Basal insulin need to act over a relatively long period of time and therefore basal insulin will either be long acting insulin or intermediate insulin.
What is bolus insulin?
A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used.
Bolus insulin is often taken before meals but some people may be advised to take their insulin during or just after a meal if hypoglycemia needs to be prevented.
Your doctor will be able to advise you if you have any questions as to when your bolus insulin should be taken.
Excellent post. Thanks for sharing your Afrezza experience. Not only are you helping the diabetic community out there but dedicating your time on projecting your experience to all Afrezza supporters. I am not a diabetic but thanks to you and others on twitter I am becoming aware and sharing your experiences with friends and family with diabetes. Keep up the good work. Let the madness begin.
What if your on the pump?
Eric is on a pump for basal. Eric takes Afrezza to cover his meals instead of additional bolus insulin from his pump to cover his meals. He still uses his pump for his basal.