Dr. Jaiwant Rangi explains Afrezza, the only ultra-fast-acting insulin, which enters the bloodstream in one minute and peaks in 12 minutes. It works for unpredictable meals and glucose spikes but requires lung function testing and is contraindicated in asthma, COPD, smoking, and vaping.
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Hi, I'm Dr. Renge, I'm endocrinologist and a diabetes specialist in Sacramento, California. Today I wanted to talk to you about inhaled insulin. We get a lot of patients who've never heard of inhaled insulin or I get patients who come asking if they can have inhaled insulin because that is something they've been interested in and they're not able to get it from their doctors. So I wanted to just discuss few things today in regards to who are the right patients for inhaled insulin and who are not the right patients for inhaled insulin. Once we understand that, then we'll have a follow up another educational video where I'm going to talk about the how to monitor the lung function studies, how to prescribe and how to take your medication and how to do storage and travel with inhaled insulin. So let's talk about who are the right patients and who can benefit from inhaled insulin. Anybody who needs mealtime insulin or short acting insulin will benefit from inhaled insulin. Inhaled insulin is the only ultra fast acting insulin that is in your system within a minute and it's peaking and trying to reduce your blood sugar by 12 minutes. So that is something that makes it very attractive for my patients because when they're snacking and life is not predictable and when they have meals that they didn't expect, they did not understand the carb counting and they can see the trend going up on their continuous glucose monitor. That is very helpful for these patients to take the inhaled insulin right away to decrease it from going further. Yes, it is something where they need to be educated about how much they need with certain kind of meals. But also it helps you when you have snacks, snacking in between meals because of the benefit of quick in and quick out. So having said that, who are the right patients? Patients who with type 2 diabetes, they don't need to be on a basal insulin. This could be the first insulin that we introduce if needed. Now in my practice I do a lot of continuous glucose monitoring. So based on the continuous glucose monitoring, if I see there's some spikes that need to be taken care of or rise in blood sugars that are happening, then we consider mealtime insulin Afrezza instead of injectables. And usually it's at the background setting of a GLP1 agonist and metformin or maybe a basal insulin in the back. Now in regards to type 1 patients, they always need to be on multiple daily injections or a basal insulin in the back and Afrezza or the mealtime insulin in between for their meals and snacking. I would give it to anybody who has injection phobia or somebody who has skin reactions or it's very common for diabetic patients to miss their mealtime insulin. I am not diabetic and I do not take insulin. But if I were to take three shots a day, I am pretty sure I'll be missing one or two in a day. And when you talk to patients, we do find out they often miss at least one or two injections a day out of the three that they prescribe for each meal. So compliance gets better. Patients are more comfortable taking inhaled insulin compared to injectable insulin. I would give it to somebody who has, like I mentioned, injection phobia or tendency to forget taking insulin. Obviously, we're going to do the lung function studies first before we give anything that is inhalable. This is very similar to a medication that we give for asthma where you inhale the medication. However, who would I not give it to? I would not give it to somebody who has underlying asthma or they have underlying lung disease, or they're smokers or they have COPD or any kind of lung problem in younger patients or youth. I make sure they're not vaping or smoking weed because those are the conditions where we don't have enough data to see the safety. And obviously it can hurt them as well. So they are better off with injections than the inhaled insulin. So having said that, I hope that gives you a good idea. How would you choose patients who could benefit? And if you are a diabetic who you think will benefit, then please go ask your doctors. There is a little learning curve here because I think that is the hindrance. So that is the barrier to adaptation because it's not typical like any other insulin, to prescribe this medication. However, I'm sure in your area you will have somebody from Afrezza or Mankind Company that can help and educate your staff or educate the patients. That is one thing that really helped my practice. Before I had the educational training by the company, my prescriptions for Afrezza were not as much and I was always worried about writing something that needs to be educated to patients and taking longer time because we are always in the fight or flight situation in the clinic and we have more patients to see. But now with that educational piece going away, it's made me take care of the medical part of it and I just identify my patients and go ahead and prescribe the medication and get the help from the company to educate these patients. Obviously, I'm going to take full responsibility for prescriptions and monitoring their lung function studies. I hope that helps you choose your patients who you could write Afrezza for or the inhaled insulin. And I'm happy to answer any questions. And if you want to refer, we have virtual practice for diabete ladies care and we could be reached at 530-677-0700 or you could reach us at rangemd. Com. Thank you so much.
