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Afreeza versus Humalog/Novolog/NovoRapid

Note: Afreeza is the brand name of an inhaled insulin that has just been approved by the FDA.

Afreeza is an inhaled insulin. Its action is reputably faster than that of current rapid acting insulins (Humalog, Novolog, NovoRapid) which must be absorbed into the bloodstream from subcutaneous tissue (muscle and fat) as well as disassociate from hexamer form (a collection of 6 insulin molecules that is ideal for long term storage) to monomer form (the form of insulin that actually does the work). Afreeza, being delivered to the lungs, has very easy access to the bloodstream, and is already delivered in monomer form.

Faster insulins should result in better HbA1C results, always assuming that the doses are correct.

If doses are incorrect, then faster acting insulins should result in more severe Hypos.

Charts 1 - Faster return to normal BG with Afreeza

The chart below demonstrates how faster acting insulins result in a faster return to normal blood sugar levels, and less time out of range, leading to less long-term complications.

Measure Humalog  (above at 12am) Afreeza  (above at 12pm)
Carbs 75g (normal GI carbs) eaten at 12am 75g (normal GI carbs) eaten at 12pm
Dose 5 units Humalog given 5 units Afreeza given
Target/starting BGL 5mmol / 90mg
Peak 12.5mmol / 225mg 10.8mmol / 194mg (lower peak - great)
Return to target 5 hours 3 hours (faster return - great)
Maximum rise 7.5mmol / 135mg 5.8mmol / 104mg (less change in BGL - great)

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Charts 2 - Low GI foods a bigger problem for Afreeza?

The chart below demonstrates that low GI food (e.g. pizza, lasagne, paleo diets) could be a bigger problem for Afreeza than current rapid insulins. If the starting BGL was 5mmol/90mg, then while Humalog would induce a Hypo, the same dose of Afreeza would induce a more severe Hypo. The chart below shows a higher starting point.

Measure Humalog (above at 12am) Afreeza (above at 12pm)
Carbs 45g (Low GI carbs) eaten at 12am 45g (Low GI carbs) eaten at 12pm
Dose 3 units Humalog given 3 units Afreeza given
Target/starting BGL 10mmol / 180mg
Lowest 7.5mmol / 135mg 6.3mmol / 113mg (lower sooner, which is great)
Return to start 4 hours (remember this is LOW GI) 3.5 hours (remember this is LOW GI)
Maximum drop 2.5mmol / 45mg 3.7mmol / 66mg

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Available scenarios:

How does Low GI food affect my blood sugar?
Calculating Correction Ratio
Calculating Carbohydrate Ratio
Should I inject before my meal?
Afreeza versus Humalog/Novolog/NovoRapid
Lucy thought she was Low
Undiagnosed versus diagnosed Type 2 diabetic
Diabetes and Blindness

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