Podcast Summary: Taking Control Of Your Diabetes® – The Podcast!

Episode: “Inhaled Insulin (Afrezza): Dosing, Timing & The Power of Inhaled Insulin”

Release Date: November 24, 2025
Hosts: Dr. Steve Edelman (A) & Dr. Jeremy Pettus (B)

Overview

In this episode, Drs. Steve Edelman and Jeremy Pettus—both endocrinologists living with type 1 diabetes—deliver an in-depth, experience-rich discussion on inhaled insulin, namely Afrezza. Using personal anecdotes, patient scenarios, and practical tips, they explore how Afrezza works, its correct dosing and timing, and how it can transform diabetes self-management. The conversation is energetic, candid, and aimed at empowering listeners with actionable information.

Key Discussion Points & Insights

1. What is Afrezza and Why is it Different?

[00:23–03:46]

• Afrezza is an inhaled insulin developed as a rapid-acting alternative to traditional subcutaneous (injectable) insulins.

• Its standout feature is speed: it starts acting in 15–20 minutes and is out of the system within ~90 minutes.

• Compared to subcutaneous rapid-acting insulins (which take longer to start and last for hours), Afrezza is much closer to the body’s natural insulin response.

• The hosts stress that the key advantage is not just avoiding injections, but having “a much sharper tool” for controlling post-meal and stubborn high blood sugars.

  “The benefit really is how fast it is. Rapid onset and it gets out of your system very, very quickly.” – Dr. Jeremy Pettus [01:13]

2. Dosing: Unlearning the Old Rule

[03:46–07:02]

• Early dosing guidance was wrong: the initial 1:1 conversion from standard mealtime insulin led to under-dosing.

• The real-world effective dose is more like 2–3x subcutaneous insulin (e.g., if you normally use 5 units injected, you’d need around 10–15 units of Afrezza, in matched cartridge increments).

• Cartridges come in 4, 8, and 12 unit increments; people adapt by estimating “small, medium, large” meal sizes versus calculating exact carb counts.

• Both doctors candidly share early mistakes with under-dosing, encouraging listeners to learn from their journey.

  “It wasn’t that it didn’t work, it’s just that I didn’t take the right dose... if you’re off by a factor of two... That’s taken a long time to kind of figure out.” – Dr. Jeremy Pettus [04:44]

3. Timing Strategies

[07:02–09:41]

• Unlike traditional insulins, Afrezza generally can be taken right at meal start.

• If blood sugar is high (>180 mg/dL), a short pre-bolus (10 minutes prior) may help. If you’re lower, you can even dose right after starting your meal.

• Because it clears quickly, you can safely give a follow-up/correction dose 60–90 minutes after the first, if needed.

  “The vast majority of the time, you can take it right when you eat... It’s kind of up to the fight in terms of how fast carbs are absorbed. That’s how fast Afrezza’s working.” – Dr. Jeremy Pettus [08:22]

4. Correction Dosing & Flexibility

[09:41–11:52]

• Afrezza enables frequent “taps” for corrections—a major contrast with the wait-and-see required for traditional insulins (which can cause stacking and lows).

• The “big picture” approach (using 4, 8, 12-unit increments) simplifies decision making and makes diabetes management less obsessive.

  “You kind of put it in those buckets... kind of simplifies diabetes a little bit.” – Dr. Jeremy Pettus [11:27]

5. Reducing Hypoglycemia – Especially Delayed Lows

[12:33–13:53]

• Studies show less delayed hypoglycemia with Afrezza compared to standard insulins.

• Particularly useful before exercise: since it exits quickly, there’s little lingering insulin on board to cause lows during activity.

• The hosts share personal and patient scenarios where Afrezza’s “rapid on, rapid off” profile prevents those persistent or unanticipated lows.

  “I don’t think I’ve gotten low on Afrezza maybe once in using it for many, many years. So it’s really safe that way.” – Dr. Steve Edelman [06:50]

6. Real-Life Example: The Trix Cereal Incident

[14:20–15:19]

• Dr. Edelman recounts eating a bowl of sugary Trix cereal and restoring his high blood sugar within minutes using 16 units of Afrezza—a vivid, practical demonstration.

  “I was 247 with two arrows straight up and I took 16 units [Afrezza]... Now I am 2:42 with trend arrow diagonal down.” – Dr. Steve Edelman [14:55]

7. Practical Tips for Use & Side Effects

[15:27–19:25]

• Let Afrezza cartridges warm to room temperature (~30 mins out of fridge) to avoid clumping/coughing.
• Carry cartridges in a Ziploc, avoid heat, and use within 1–2 weeks (even though official guidance is shorter).
• Main side effect: initial mild cough, which usually resolves in weeks. A gentle inhale (not a “big suck”) minimizes this.
• Rotate inhalers every 2 weeks, tap out powder residue periodically.
• “There’s a lot of flexibility... everyone’s going to find the way that suits them.” – Dr. Steve Edelman [17:57]

8. Use with Pumps, Hybrid Closed Loops, and As Needed

[19:31–21:50]

• Afrezza integrates well with hybrid closed loop systems; just don’t enter meal carbs and treat with Afrezza instead.
• It can be used “as needed” for corrections, for certain meals, or as a primary meal insulin.
• No wrong way: “It can be an addition, it can be a substitution...” – Dr. Jeremy Pettus [20:40]

9. Pediatric Use & Starting Dose Adjustments

[21:50–22:41]

• Afrezza is not yet approved for kids, but FDA approval may be near.
• The “minimum” 4-unit dose is less concerning when accounting for conversion (it’s equivalent to 1–2 units injected for many people).

10. Who Should Not Use Afrezza

[23:27–24:20]

• Not recommended for current smokers or those with reactive asthma/COPD.
• Spirometry (FEV1 test) required at baseline, 6 months, and annually, but this is a simple, quick test, not a full PFT.
• “Afrezza does not cause lung problems... However, if you have underlying asthma or an underlying condition, it can exacerbate it.” – Dr. Jeremy Pettus [24:13]

11. Addressing Resistance from Providers & Insurance

[24:20–28:14]

• Many clinicians are unfamiliar with Afrezza, leading to resistance and dismissive responses.

• Both doctors urge patients to advocate for themselves, seek out dedicated Afrezza pharmacies, and leverage available company support (including trainer staff who do hands-on teaching).

• Coverage/prior authorizations are improving—“It’s worth the fight.”

  “It might be a little more of an uphill lift, certainly, than just continuing on Humalog or Novolog or whatever, but generally it’s worth a fight.” – Dr. Jeremy Pettus [25:33]

12. Empowerment & Final Thoughts

[28:14–29:34]

• Afrezza is a valuable, underutilized tool that offers control, convenience, and freedom—especially for addressing stubborn highs and enabling dietary flexibility.

• The hosts encourage listeners to explore resources on their website and always tailor diabetes care to what works for the individual.

  “Such a sharp tool.” – Dr. Steve Edelman [29:04]

Notable Quotes & Memorable Moments (w/ Timestamps)

• On Afrezza’s Advantage:
  “Afrezza actually peaks in about 15, 20 minutes... It does work fast enough that you can actually take it a lot of times right when you eat.” – Dr. Jeremy Pettus [01:21]

• On Under-dosing at Launch:
  “I took four units of Afrezza... blood sugar was like 250. And I said, man, this stuff doesn’t work... It wasn’t that it didn’t work, it’s just that I didn’t take the right dose.” – Dr. Jeremy Pettus [04:33]

• On Correction Dosing:
  “You can actually give a Correction Dose within 60 to 90 minutes of your first inhalation because it gets out of your system quickly.” – Dr. Steve Edelman [09:07]

• On Hypoglycemia Risk:
  “They’ve consistently shown... people actually have less hypoglycemia, specifically what we call delayed hypoglycemia, like after like two to four hours after eating.” – Dr. Jeremy Pettus [12:38]

• On Dose Buckets:
  “Is this kind of small, medium, large? Is this a 4? Is this an 8? Is this a 12? ...it kind of simplifies diabetes a little bit.” – Dr. Jeremy Pettus [11:27]

Important Segment Timestamps

| Topic | Timestamp | |----------------------------------------|------------------| | What is Afrezza? Action Profile | 00:23–03:46 | | Dosing Debate & Early Mistakes | 03:46–07:02 | | Timing Best Practices | 07:02–09:41 | | Correction Dosing & Flexibility | 09:41–11:52 | | Dose Increments & Big Picture Simplifying | 10:52–11:52 | | Reducing Hypoglycemia & Exercise Use | 12:33–13:53 | | Real-Life Example: Trix Cereal | 14:20–15:19 | | Practical Usage Tips | 15:27–19:25 | | Use with Pumps/Closed Loops | 19:31–21:50 | | Pediatric Approval, Dose Floor | 21:50–22:41 | | Who Should Not Use Afrezza | 23:27–24:20 | | Provider Resistance & Insurance Tips | 24:20–28:14 | | Final Thoughts & Empowerment | 28:14–29:34 |

Conclusion

This episode masterfully blends personal experience, scientific insight, and relatable humor to demystify Afrezza for both patients and physicians. By tackling dosing, timing, safety, system integration, and the reality of navigating medical resistance, the doctors make a compelling case for considering (or re-considering) inhaled insulin as a practical, effective wingman in diabetes management.

Not only do listeners walk away understanding how to use Afrezza—they are better equipped to advocate for their own care, experiment safely, and reclaim a sense of control in the day-to-day rollercoaster of living with diabetes.