Mealtime control is possible with individualized dosing1
TYPICAL DOSING AT MEALTIME
In clinical trials, most patients received 12-24 Afrezza® insulin units per meal at the end of the study2,3
Clinical trials have shown it may take ~1.5x the amount of Afrezza to achieve a comparable glucose-lowering effect to injected insulin2,4
Like all insulin therapy, monitor therapeutic effect of Afrezza and adjust dosing as needed to achieve optimal glycemic control1
INSULIN DOSE CONVERSION TABLE AND ANTICIPATED DOSE AFTER TITRATION1,4
*Calculation based on the 1.5-times conversion rate from injectable insulin units.
Reaching an effective dose is critical to maximizing the clinical benefits of Afrezza
Starting mealtime dose for insulin-naïve individuals:
- Start on 4 units of Afrezza at each meal1
Starting mealtime dose for individuals using SC prandial insulin:
- Determine the appropriate Afrezza dose for each meal by converting from the injected dose using the table above1
- For example, if the patient is currently using 6 units of SC prandial insulin then consider starting with 8 Afrezza units with each meal
Starting mealtime dose for individuals using SC pre-mixed insulin:
- Estimate the mealtime-injected dose by dividing half of the total daily injected pre-mixed insulin dose equally among the 3 meals of the day1
- Convert each estimated mealtime-injected dose to an appropriate Afrezza dose using the table above1
- Administer half of the total daily injected pre-mixed dose as an injected basal insulin dose1
Mealtime dose adjustment:
- Adjust the dosage of Afrezza based on the individual’s metabolic needs, blood glucose monitoring results, and glycemic control goal1
- Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function, or during acute illness1
- Carefully monitor blood glucose control in patients requiring high doses of Afrezza. If, in these patients, blood glucose control is not achieved with increased Afrezza doses, consider use of SC mealtime insulin1
CONSIDER correction doses of Afrezza at 1 and/or 2 hours post-meal IF NEEDED4
†2-hour correction used only if blood glucose is ≥201 mg/dL and has not decreased by ≥50 mg/dL between 1 and 2 hours.
Data from the STAT study patients with T1D with A1C levels 6.5% to 10%. Individuals were randomized to treatment with titrated Afrezza (n=22) or titrated SC RAI aspart (n=34) and included in the final analysis. All were required to wear a real-time CGM throughout the trial. Patients in the Afrezza group were advised to take supplemental inhalations at 1 and 2 hours after meals if indicated based on PPG values. Two-hour correction dose was used only if blood glucose was ≥201 mg/dL and did not decrease by ≥50 mg/dL between 1 and 2 hours.4
Afrezza mealtime control is possible with individualized dosing1
TITRATION BOXES OFFER FLEXIBILITY FOR GETTING PATIENTS STARTED ON AFREZZA
Afrezza is an ultra rapid-acting inhaled insulin used at the beginning of a meal with an oral inhaler and 1 or more single-use cartridges. Afrezza comes in 4-, 8-, and 12-unit color-coded cartridges. Patients can mix and match cartridges for their prescribed dose. For example, two 12-unit cartridges provide a dose of 24 units of Afrezza.
Prescribe additional boxes as needed to control glucose levels. Afrezza should be dosed based on the patient’s metabolic needs.
DOSING WITH AFREZZA
This video helps patients understand how inhaled Afrezza doses are different than injected insulin. It also introduces the Dosing Worksheet and how to dose with Afrezza cartridges.
References: 1. Afrezza (insulin human) Inhalation Powder Prescribing Information. MannKind Corporation. 2. Bode BW, McGill JB, Lorber DL, Gross JL, Chang PC, Bregman DB. Inhaled Technosphere insulin compared with injected prandial insulin in type 1 diabetes: a randomized 24-week trial. Diabetes Care. 2015;38(12):2266-2273. 3. Rosenstock J, Franco D, Korpachev V, et al. Inhaled Technosphere insulin versus inhaled Technosphere placebo in insulin-naïve subjects with type 2 diabetes inadequately controlled on oral antidiabetes agent. Diabetes Care. 2015;38(12):2274-2281. 4. Akturk HK, Snell-Bergeon JK, Rewers A, et al. Improved postprandial glucose with inhaled Technosphere insulin compared with insulin aspart in patients with type 1 diabetes on multiple daily injections: the STAT study. Diabetes Technol Ther. 2018;20(10):639-647.