Speeding up insulin absorption on MDI

[novorapidboi26]

its been a long day.......was just curious as to how an inhaled insulin could even compete against injectable alternatives...

 

[steve_p6]

Simple answer is that if you take exactly the right correction dose then you will be down to target in about 4 hours.

If you take a larger correction then you will come down quicker but will then need carbs to correct for the excess IOB when you hit target. Obvious caveat is this carries much higher risk of causing a hypo.

 

[lizdeluz]

Hi @lizdeluz - I have exactly the same issue as you in the mornings, if I wake high then it takes me till lunchtime to get my BG down to single figures again, apart from taking correction doses I tend to test every 2 hours till I get it down again. If I am able to then I try and either do some exercise or gardening as both these will help improve my BG levels at a faster rate, however if i'm at work (sat at a desk) then there's nothing else I can else except correct.

Good point about gardening! It never fails to lower my BG, and it never raises my BG like swimming can - but I've just lost my garden by moving house, and now have a small courtyard which is practically empty at the moment! So no digging, - unless I decide to dig up the paving! - or lifting - unless I decide to get some massive pots ....

 

[lizdeluz]

Simple answer is that if you take exactly the right correction dose then you will be down to target in about 4 hours.

If you take a larger correction then you will come down quicker but will then need carbs to correct for the excess IOB when you hit target. Obvious caveat is this carries much higher risk of causing a hypo.

Really informative - thanks for explaining.
It has taken me 6 hours to get down to target, well nearly on target: 6.4 mmol. But that includes 0.8u IOB.

 

[Eldorado]

Is there a way to speed up insulin absorption on MDI. If I wake on a HI of, say, 15.0, (not recommended I know), it seems a slow process to get down to normal levels.
This morning:
06:45- 15.0 mmol/L - no breakfast, 5u NovoRapid, 20u Lantus.
07:28- 13.9 mmol//L - no food, 5.1 units of Insulin On Board, no NovoRapid injected
08:56- 11.4 mmol/L - cup of tea, splash of milk, 3.1 units of Insulin on Board, no NovoRapid injected

So, two hours later, only a cup of tea, and the journey down to an ok blood sugar level is really slow.
Exercise maybe, but exercising on high blood sugar can push blood sugar up, not down? This quite often happens when I swim, though I will get a LO later in the day.
Obviously, getting a high blood sugar in the first place is something I must avoid, but any advice on how to speed up the return to normal blood sugar levels?

Might be worth trying the new fast acting insulin, Fiasp. I'm going to ask about it at my next consultant's appointment. Other than that I find a brisk one hour walk helps but that might not be practical if you're working.

 

[CathP]

IM injections are very effective at bringing down elevated blood sugars quickly. Probably best done with CGM to monitor the drop though.

 

[tim2000s]

its been a long day.......was just curious as to how an inhaled insulin could even compete against injectable alternatives...

It's way more effective. The insulin is absorbed directly into the pulmonary circulatory system through the lungs and we think affects the liver far more than injectable insulin can. It doesn't require absorption in the same way. I tried it and was hugely impressed with its effectiveness.

It's not licensed in Europe though.

 

[TheBigNewt]

It's way more effective. The insulin is absorbed directly into the pulmonary circulatory system through the lungs and we think affects the liver far more than injectable insulin can. It doesn't require absorption in the same way. I tried it and was hugely impressed with its effectiveness.

It's not licensed in Europe though.

I wonder why it's not. I read several threads about people who have pretty nasty skin reactions to subQ injections no matter what type of insulin they use. I'd thing inhaled would solve that problem right away. Maybe they just put up with one Lantus shot a day instead of that plus 3-4 boluses.

 

[mentat]

its been a long day.......was just curious as to how an inhaled insulin could even compete against injectable alternatives...

Afrezza is based on a chemical particle called "Technosphere" (have a look at this paper) which passes easily through the lining of the lungs into the bloodstream, where the Technosphere particle breaks apart releasing the insulin that is held within it.

This is why Afrezza is more effective than previous attempts at inhaled insulin.

When insulin is injected into fat, most of it sits there for hours, slowly diffusing into the bloodstream. Since muscle has better blood flow, insulin injected into muscle enters the bloodstream faster. But Afrezza is faster still.

While on Afrezza you still need some sort of basal insulin (or a pump).

I order Afrezza through InternationalPharmacy.com, which is legal where I live (Australia) but I'm not sure about other places. It costs a fortune but has been life-changing. Personally I use it for corrections and for rapidly-digesting meals (works well on soft drinks, McDonald's, and breakfast cereal).

 

[tim2000s]

I wonder why it's not. I read several threads about people who have pretty nasty skin reactions to subQ injections no matter what type of insulin they use. I'd thing inhaled would solve that problem right away. Maybe they just put up with one Lantus shot a day instead of that plus 3-4 boluses.

When Mannkind agreed with Sanofi to market Afrezza, part of the deal was that Sanofi would get the European licensing sorted out. As with many other things, they didn't. Mannkind have since said that they would seek this.