@mountainman, from what I can see and read of afrezza, you don't remove the need to carb count. It remains exactly as it did before, and equally "intensively".
Sam seems to be a type 2 rather than a type 1 diabetic.
Afrezza is not a smart insulin. By ingestion via the lungs into the blood directly it acts more quickly than subcutaneous injections (understandably).
In the meantime, Novo are currently market trialing a very fast acting insulin aspart that I assume is designed to compete with this.
In addition, the clinical trials were not without side effects. Across all the type 1 and 2 participants, 27% developed a cough (for many bad enough to cease use) and in the clinical trials lasting up to two years, 6% of users suffered a decline in forced exhaled volume of more than 15% whilst on average there was a decline in lung performance.
Yes it works, but at what cost? The numbers reporting side-effects was high compared with injectable insulin. In addition, Hypos were not eliminated and were encountered by 67% of type 2 patients.
Alfred Mann was frustrated that the FDA set up the clinical trials so that patients were limited as to when they could use Afrezza , not taking it at the best time related to the meal. So far, there is no report of ANY COUGH in anyone taking it in the USA. Hypos are all but eliminated since they are not in the clinical trials now and can take Afrezza exactly WHEN THEY WANT. A CGM is a great tool and a high can be headed off at the pass in 30 minutes with Afrezza. No need to inject and wait to see where you land, always waiting with Orange Juice on hand.
Yes it is an interesting step on the insulin application road, but it is not a miracle solution.