#83 Afrezza, the Inhaled Insulin with Ginger Vieira

Today's episode is all about Afrezza, the inhaled insulin! My Guest today is Ginger Vieira. Ginger is the Senior Content Manager at Beyond Type 1 and Beyond Type 2 and has been living with T1D since she was in middle school.  She is a WEALTH of diabetes knowledge. Be sure to check below for links to all her diabetes resources including all of the books she has written! At the moment, Afrezza is only FDA approved for people who are 18 years and older BUT, AS WE SPEAK, there is a clinical research trial being done to see if it is safe and effective in the pediatric population. After listening to this episode you are going to want them to hurry and and get that study DONE so our kids will have access to this amazing drug. I will put a link below to the trial as well. Enjoy!

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The Pediatric Afrezza Clinical Research Trial

Transcript

Katie: 0:00

Hey everybody. It's Katie and you are listening to episode 83 of the sugar mama's podcast. Today's episode is all about Afreza, which is the inhalable insulin. My guest today to talk to me about Afreza is ginger Vera. Ginger is a type one diabetic. She currently uses Afreza. She is extremely connected to the world of type one. She has written many, many books and other blog posts and resources for the diabetes community, which I will link to in the show notes. She is also the content manager at beyond type one and beyond type two, which basically means in her words that she writes a lot and creates a lot of reels for Instagram. That sounds like a fantastic job. Sign me up. I really enjoyed having ginger on. I thought she had lots of insight and wisdom to share, and I'm really excited for you guys to hear more and learn more about Afreza. Right now Afreza is only approved for use and people who are 18 or older, but currently going on as we speak is a clinical research trial to determine if Afreza is effective and safe in the pediatric population. That is very exciting news to my ears. All right. Without further ado, let's get started. Be sure to check out the show notes as always for links to other episodes that might be mentioned in the show links to where you can find ginger and all of her amazing resources and books that she's written. And not to mention links to the podcasts, buy me a coffee page and other ways that you can support this show. All right. You guys, here we go. You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseboro. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks. All right, everybody. I am here today with a great guest. Her name is ginger, but I'm going to allow her to introduce he. So ginger, just tell everybody a little bit about yourself and how you are connected to the world of type one diabetes.

Ginger: 2:36

Sure. Hi. My name is Ginger Vierira and I have lived with type one diabetes for 23 ish years. I was diagnosed when I was 13 in 1999. I actually diagnosed myself. Nobody believed me for a week. The seventh grade I was in seventh grade and our class was working on projects for the school health fair. And one of my classmates was doing his own diabetes and. I saw all the symptoms listed on his poster board while we were working on our projects in class. And I said, I think I have that. Can you die from that? And he's like, oh yeah. And you know, seventh grade. And I told my mom, she said, no only old people get that. And a few days later I just burst into tears cuz I felt so lousy and all my symptoms, you know, it's like, oh, well everybody has glasses in this family. You think you just need glasses and well of course you lost weight. You. Going through puberty and of course your legs feel heavy and you don't wanna go to school. You're a teenager, you know? And so it really ramped up quickly. But yeah, so that was, that was my diagnosis.

Katie: 3:40

Wow. That's wild. I you're, that's definitely the first I've heard of somebody diagnosing themselves as a child, at least. Um, but

Ginger: 3:48

proud of itself that they, that they very proud of themselves, that they served a purpose that year.

Katie: 3:55

yeah, had that kid just randomly chosen diabetes or did he have

Ginger: 3:58

Yeah. And you know, his, this is, again, this is seventh grade, right? So it, he didn't have type one or type two on his poster board. He just, it was just diabetes. And he later asked me out and I said, oh no, I've gotta pack for summer camp. I can't be your girlfriend. So poor guy. Yeah.

Katie: 4:16

He thought he was totally gonna get a date out of that. He's like, oh, I diagnosed her. I'm definitely gonna be able to get a date. funny.

Ginger: 4:22

So I also have a, the year later I was diagnosed with celiac because they just screened all the teenagers that was upsetting as my family's Italian and weight spaghetti, like twice a week. But I have since come to really appreciate what celiac does to keep garbage food outta your body. Not that you can't find garbage food, that's gluten free, but and I. In college developed what we're calling fibromyalgia. Lots of people are still skeptical of fibromyalgia. We can't pinpoint it, but it really. Seems to fit what I started experiencing while I was training and competing in competitive power lifting. And I just really, I think my body is prone to autoimmune disease and I triggered kind of chronic muscle spasms. And I'm now very. Sensitive to exercise. I have rebuilt my tolerance for exercise. So I, I exercise a lot. I would consider myself still an athlete, but I don't go to any extremes. I just kind of maintain physical fitness.

Katie: 5:24

Interesting. Yeah, I'm a, I'm a physical therapist by trade and you know, fibromyalgia is always such an interesting diagnosis, cuz it's so hard to talk people into like, Exercising when their body just hurts. You know what I mean? And, and, you know, I, I try to do my best to explain that like, no exercising will help. I promise it will help. It will not only help you physically, but it'll help you mentally and emotionally. And,

Ginger: 5:49

Regular exercise is part of my treatment for my fibromyalgia. It makes me feel awesome. Yes, indeed.

Katie: 5:56

Well, good. Regular exercise is just part of my mental care treatment, mental, you know, mental health treatment for myself. It's funny. Sarah asked me the, the other day, like, mommy, why do you, why do you exercise? Is it, you know, is it to like lose weight? And I'm like, honestly, honey, at this point in time in my life, it is to keep myself from going crazy.

Ginger: 6:14

Yeah, I can't, if I, for some reason don't get to go for my morning jog. I just can't think straight by like nine, 10:00 AM. Like I need to get it outta my system. So yeah. I also have mild hypothyroid that I take a, a low dose of thyroid medicine for, and, you know, it sounds like a list of things, but I know you have a lot of parents listening. I wanna tell you that I am frigging thriving and I love light. I have a ton of energy and I would say I'm thriving because I embrace what my challenges are and I figure out my limits and I figure out what helps me feel awesome. And what doesn't. And I live my life by that. And,

Katie: 6:53

Hmm. I love that. And I know parents listening love to hear.

Ginger: 6:56

Yeah. And I'm a mother. I have two children. I work full time. I walk my dog six miles a day. Life is good.

Katie: 7:03

Wow. Wow. That's awesome. Where, and, and you, you work, you work full time, correct? Tell, tell listeners a little bit about that too, because that's another way in which you're connected.

Ginger: 7:12

Roughly. Yeah. So I went to school for writing. I have a bachelor's in professional writing and I have really combined Miley passion for helping people figure out how to get through the day with type one diabetes. Safely and, you know, as joyfully as possible with writing. And so I have been writing for probably 15 years about type one diabetes. I started, I got my niche in, when I started going to the gym. I hired a personal trainer because I didn't really, I kind of acted like a typical college student for one year and my A1C jumped up and I just felt lousy. And I was like, I don't wanna feel this way. And so I got really sucked into the fitness world. And power lifting and I got really strong, very quickly. and I went to an endocrinologist shortly before my, when I, shortly after I started training in power lifting and I said to him, I would like, you know, I'm planning to compete in a few months in my first power lifting meat, but I really need some help because I, my blood sugars are not really, you know, and this is back before everybody had a CGM. I did not have a CGM. This is. Early 2000. This is maybe 2010. So CGMs were just around the corner and he laughed at me. The endocrinologist did not help me accused me of forgetting or skipping my long acting insulin dose, which I was not. I was waking up with high blood sugars because I needed help. Not because I was deliberately. Neglecting my insulin. Right. so I, I cried, I did not go back to that guy and I kind of had to figure out how to train and compete and do all of that without much help. And fortunately, my coach loved exercise physiology, so he helped me learn exercise physiology, and then mashing it in with type one diabetes. And. I set seven records at my first competition, without that stupid doctor's help. And from there kind of started trying to write exercise science in layman's terms for my fellow type ones to help them also enjoy exercising with type one. And now. 10 15 years later, I understand it even more and understand how to explain it even more. But in the midst of that have really written almost on every topic. There is for dozen different websites

Katie: 9:37

Yeah. I know when I was kind of preparing for our interview and, and you know, of course Googling you. I'm like, oh my gosh, she's, she's written quite a bit. And you know, you've actually authored a few books that I heard about one a while ago, just listening to the juice box podcast, cuz you. You coauthored it with Jenny Smith, correct. The one about pregnancy. And I remember hearing, you know, Jenny talk about how she wrote it with her friend ginger, and that's just not a name you forget. Cause I don't, I don't know that I know any other gingers, but and then I came across you you know, by other means O on the web and, and here we are connected and chatting, but so would you mind telling listeners just a little bit about the books that you've written.

Ginger: 10:16

Sure. Sure. So my very first book I wrote in college, please forgive all the typos. It was self-published with a team of college students helping me and it's called your diabetes science experiment. And that was my, really my first attempt at helping people learn how to exercise with diabetes. I am literally right now working on a. New and improved version of exercising as a beginner with type one diabetes. But I still keep selling that book despite all the typos, because people tell me how useful it's been. I also have a 30 page kind of guidebook called emotional eating with diabetes that helps people who live with diabetes for a long time. Untangle the impact it's had on their relationship with food and especially for your audience as parents. I mean, the biggest piece of advice I could give you is, do not try to force a diet and restriction upon your child with diabetes instead, help them embrace. What do I need to do around this type of food? What do I need to do around this type of food to help me thrive, to help me reach my blood sugar goals. Versus those foods are bad. Those foods are bad. You're bad for eating them. Go on a keto diet, et cetera, that can just really lead to. So much complicated emotions and behavior around food as you get older. So that book is to help people kind of untangle that and, and figure out what's going on in their head and how it's impacting their decisions and binge eating after a lot of restriction, et cetera. I also have dealing with diabetes burnout. Which also has a section for parents um, and caregivers and family and pregnancy with type one diabetes. It's still the only guide to managing pregnancy with type one diabetes out there. And all of these are on Amazon. And then we have two children's books now. My friend Mike Lawson, and I have written together, he's the artist and I'm the writer and he has type one. When I go low and ain't gonna hide my T one D and those are on Amazon.

Katie: 12:11

I think I've listened to you to an interview on a different podcast. And honestly, I might have been diabetes connection. I'm not sure you would know. Um, But I what you were talking about, that, that book when I go low and, and I listened to the interview and I, you know, loved everything you had to say. And then again, when I was kind of preparing for this interview, I'm like, oh, that she's the author of that book that I remember hearing about. So.

Ginger: 12:32

Great.

Katie: 12:33

Yeah. Okay. Well, awesome. I mean, definitely my ears perked up with the diabetes burnout situation. Cause I mean, I think it's, I don't know, as a parent who's only been dealing with this for two years, I feel like burnout is just a normal part of managing diabetes for yourself or for your kid. And I mean, hopefully as time goes on, it kind of. Comes and goes very quickly. But I feel like it, for me, at least it kind of just comes and goes in waves. You know, I'll just go through a week where I'm just completely over it and and then I'll bounce back and everything will be fine. And so I'll have to take a look at that one. And I, I, I'm gonna, I'm actually getting ready to do a little mini series with a diabetes educator. Who's also a registered dietician specifically on eating like emotional eating and just eating in general. Surround you. With type di type one diabetes in mind. So I might have to grab that and skim through it and read through it before I talk with her to, to get a little bit more questions and content, cuz that's something we haven't encountered yet in our household. But I feel like the teenage years are coming and we're just have to see. Okay, well, you are very connected to the world of type one in many different ways. But the reason I really wanted to have you on today is because I read an article recently that popped up on LinkedIn about Afreza and your use of Afreza. And I have read a lot about Afreza, but I feel like my listen. Maybe haven't just because Afreza is only approved for people who are 18 and older at this time. But I wanted to learn more about it. I think it's fascinating. And they are currently doing a study on it right now, a clinical trial on it right now. That's actually still active in recruiting participants. So at the end of this episode, if you're interested, I will link to that study in, in the show notes and people can check it out and see if. You know, recruiting in your area, but I will let you explain since you actually have firsthand experience with Afreza tell listeners what Afreza is.

Ginger: 14:32

Sure Afreza is inhaled insulin. So it's very it's this, the inhaler itself is just mechanical. There's nothing. Really complicated about it. And then you have these cartridges of powdered insulin. So they come in units of four, eight, and 12, and your first thought, and what actually kept me from trying it for a long time is how the heck could I manage type one diabetes with predetermined doses of four, eight and 12 Afreza is a totally different. It is not the same as four units of Novalog. I wouldn't even dare to say, and they do try to do this when they talk about Afreza so they can give you some context, but I wouldn't even dare to say that it converts to a specific unit of Novalog because. It just works so differently. The most significant difference of Afreza is that it is active in your system within like two and a half minutes of inhaling it because it's going through your lungs straight into your bloodstream and insulin has to get C processed and, and eventually get to your bloodstream. Right. So. It's really fast acting, which means you don't need to pre Boce for your meals. It means you can turn around blood sugars that are rising very quickly. And please remember, I am not a doctor and I am definitely not your doctor. And I'm gonna be speaking from personal experience using Afreza. I really love that. It's also out fast, so it acts fast and it's out fast. And when I say out fast, the four unit cartridge in, in the FDA approved language around this is that it's out at approximately 90. Minutes after dosing, but most people who use Afreza will tell you that they see little to no impact in their blood sugar after 60 minutes. And what's really cool about that. Especially as someone who's really active, I walk my dog three times a day and if I was taking Novalog for my meals, I would, let's say I eat my strawberries and cheese lunch at noon. I have to take NovoLog for that. And then I might be able to walk my dog an hour later, or maybe immediately, or whatever I have to account for how much NovoLog is still in my system with Afreza. I know I can eat at noon and if I wanna walk my dog at one o'clock or two o'clock, I don't have to worry about insulin on board, rapid acting insulin on board, cuz it's not on board anymore. And so the risk of going low. It's just for me, I'm always gonna bring those back to my personal experience, cuz I'm not your doctor is significantly lower. And I don't even have to think about it. And I always go on dog walks or any type of exercise with candy in my dog walking bag. Right. Or my little belt around my waist for jogging, but I never use it. I never use it anymore. And with Novalog. I never had any severe lows where I needed glucagon and I'm, you know, on the sidewalk laying down cuz of a low, but I would have to eat candy that I didn't want because I knew I had insulin on board and I know I wanna walk two and a half miles and yada yada yada. Right. So that's the coolest thing about Afreza is. It acts fast and it's out fast and the bigger the dose you take the longer, it could be still in your system. So an eight unit could still be around 90 minutes daily languages that it could be in your system for up to like two hours or something. But it really it's so minimal the biggest impact I can literally I could take, let's say my blood sugar was rising right now because I slightly underdosed for. I could look at a one 40 with an up arrow or a 180 with an up arrow, take a four or an eight, depending on what I know is digesting. Right. And turn it around. And within 15 minutes I will be headed down and not worrying about being high for the next three hours.

Katie: 18:44

Hmm. Wow.

Ginger: 18:45

correct high, really fast. So if I. Completely underestimate dessert. And I miss that I'm rising because I'm playing pegs and jokers, my boyfriend of my friends. And I look at my blood sugar. I like, oh, shoot. I'm like two 70 because I completely underdosed. And I didn't notice till just now I can bring that down within an hour I'm down. Cause I'm because it's out fast, you just land, you don't crash and then keep crashing because it out fast. So it's, it's really cool.

Katie: 19:19

So I, I have a lot of questions.

Ginger: 19:21

Okay. Yes,

Katie: 19:22

so, okay. First, what is, what's your whole insulin profile look like? Like, are you, are you taking an injection of basal insulin and using Afreza or what, what kind of combo do you got going on?

Ginger: 19:34

tried pumping. I pumped for years in my early years of type one, but I've really come to love the simplicity of multiple di daily injections. They can't fail me like an insulin pump can And so I take one dose a day of long acting Lantis, and then I do still take every day. Probably two units, a two, sorry, two doses of NovoLog, because what Afreza can't do is give me a teeny teeny amount, right in the morning, I sometimes need like a half unit for Don phenomenon. I, I am also very fond of intermittent fasting. And so the longer I fast, the more likely my liver is gonna release some glucose and I need a, a tiny, slow insulin to cover that. I also would take Novalog before bed. I save, I, enjoy carbs. In the evening. So I don't follow any strict carb diet, but I try to eat really clean whole foods during the day. And I, and give myself permission to enjoy homemade cookies or whatever it is, Hershey, kisses, whatever dessert, and because of Afrezza acts so fast. Is really great for the beginning of digesting that dessert, but then I go to sleep and I'm not gonna take a follow up dose of Afreza when I'm unconscious. So I take no vlog to help deal with the slow digestion of that meal. Same could be set for pizza, Chinese food, you know, those, those high fat, high carb foods that I personally don't eat on a regular basis, but I enjoy them as a treat here and there. So that's a combo of Afreza and NovoLog to help me tackle that slow digestion.

Katie: 21:14

Hmm. So for you personally, you, you take Afreza first when you kind of start eating the dessert or, or high fat meal like you described. And then before you would go to bed, you would take Novalog that's that's interesting.

Ginger: 21:26

It's a, and it's a very, there's a, a great learning curve to using Afreza. And. It takes a little while, but you really have to approach it. Like this is a new game of type one diabetes. And for me, it's been a really fun new game because it's just like after 23 years of doing the other game, it's like, whoa, this is so different. I love, like, I just love how, how fast it acts. I don't really ever feel the need to rage. I have overcorrected lows a couple times with Afreza where I underestimated its power. But again, because it's out so fast, the lows are not nearly as stressful as lows with Novalog where you're like, Ugh, I'm gonna be dealing with this extra insulin on board for another two hours. You know, it doesn't feel like that with Afreza because you can look at the clock and say, well, I took this dose at noon. I know it's gonna be out by one or one 30 or two. If it was a really big. It's just, it's a much more fun game in my opinion.

Katie: 22:26

Yeah. I mean, it sounds amazing. I'm I'm curious, you said you can't, you can't really compare it to dosing, like a Novalog or a Humalog or anything like that, like for a, do they call it a four unit cartridge? Like, is it actu

Ginger: 22:39

the blues are fours.

Katie: 22:41

Mm-hmm

Ginger: 22:42

The green cartridge is eights. There's also a 12, which I don't use. And I believe those are like purple. I, I haven't even seen a picture of them in so long that I can't cuz I just don't. I don't use those. And a friend of mine who loves Afreza. She has a great description of it that it's kind of like small, medium and large. So if you're eating a small meal then you know, from, and everybody's insulin needs are different, right? I'm fairly sensitive to insulin. So my insulin needs are fairly low. So for me, a four could cover a small meal or a small correction. I don't need an eight for an example to cover. To correct a high blood sugar, unless I'm like over two 50, a four can bring me down into the low hundreds. And then an eight would be a more carby meal for me. There's also because it's out fast. I tend to eat things during the day where I'm combining either fruit or vegetables with some kind of fat. So sometimes I do need a follow up dose, which means, let's say I ate strawberries and cheese at noon at one o'clock, I'll take a look at my blood sugar. You know, it depends on. How, how many miles I ran in the morning could depend on how much more follow up dose I really need. Or if I don't just that, you know, that kind of constantly fluctuating insulin sensitivity with other variables, but I might need a follow up dose of another four unit cartridge at one o'clock. If I'm trending higher that day, if I'm about to get my period, my normal dosing for that meal, isn't gonna be as effective as it. From a different time of the month. Right. So those, those little variables and I just, you just check your blood sugar and, and decide.

Katie: 24:23

yeah. Okay. So one of my questions for you, like was, does carb counting have to be as exact as it would be with like a Novalog or a Humalog. And I get the impression that it's not

Ginger: 24:34

Right. Which is a cool benefit that you don't have to, you don't have to get it exactly. Right. In order to prevent lows or highs. And if you do underestimate and I can tell within 45 minutes of like, oh, I'm gonna need more Afreza cuz it acts so fast. It's not stressful or frustrating because I can, let's say I look and I'm like, oh darn I, you know, I don't measure the blueberries. Right. So I was like, well I guess two handfuls was way more than the two handfuls I had yesterday and I need more, I can turn that rising blood sugar around so quickly that it's just, it's not a big deal.

Katie: 25:09

So does it, does it have a taste or anything? I mean, is it, is it kind of, you know, one of those things where you take it and then you're like, eh,

Ginger: 25:15

It doesn't have a taste. The only time it's made me cough in the beginning, they do, they, a mankind has it in their writing. I believe that you might cough a little bit in the beginning is you're getting used to it and also learning how to just inhale it. It doesn't have a taste. I do notice sometimes that cuz when you. you go like that that's as long as the inhale is it doesn't take, you know, lots of power. I can. I like in a swimming pool, I'm useless for holding my breath underwater. Right? Like you don't need powerful lungs. You do, you might notice sometimes a little white powder comes out once you exhale after. Taking a dose. And I do notice sometimes that the hair right in my nose, it looks a little bit white. So I always go like that after I eat, I just fight my nose quickly after I inhale. Too, it look like I don't have white powder on

Katie: 26:04

or a drug problem. Yeah.

Ginger: 26:05

I've never heard anybody else mention that, but maybe I have a moist in nostril. I have no idea. And the only other time it's made me cough is if my, my throat is already sore from something else. Like if I have a cold or I just went for a run and I'm still, you know, from my run. And then I immediately took a dose of Afreza. I might like just cough a little bit because I wasn't calm enough when I did it.

Katie: 26:28

Well, that brings up an interesting question. What if you are sick? Like what if you had a respiratory infection or there was something going on with like your lungs and that whole system? Could you still use it or have you used it? Have you experienced that

Ginger: 26:39

have not been sick. I've still not had COVID knock on wood. I really haven't been sick in like three years since the pandemic, I would say I've had like one mild cold. But I can see how, if I did have something like COVID and I was coughing a lot that I would take a break from Afreza and use Novalog because it would just, you know, it just wouldn't be as comfortable to use it. Is there aren't. If you look at the medical info on mankind's website about who can and cannot use Afreza, there's certain lung conditions that make you not such a great candidate. I don't have that memorized and I'm not even gonna try, but definitely look into that. Yeah.

Katie: 27:16

Interesting. So I'm, so I, when I was reading about Afreza, I didn't even apparently there was like a very, a much older version of inhaled insulin that was not Afreza that did not go well. And so that kind of made endocrinologists and physicians hesitant to, you know, prescribe this when it came out. Cuz they had a bad taste in their mouth from, from that. So how did you hear about it? Did you research and ask your doctor

Ginger: 27:43

So I actually was in the Exubera is the name of the other one. And I was actually in that trial for like a week, but they made me wear a CGM that was like way before CGMs were as comfortable as they are today. And I bailed on the trial cause I didn't want this thing in my arm. Exubera failed for a number of reasons. It was a completely different product. The inhaler was also like the size of your arm. It was huge and very cumbersome. And so that failed and a lot of endocrinologists still have that in their head as, oh, no, it doesn't work. Don't bother. Or, oh, it's not safe for your lungs. Don't bother. It's been FDA approved and, and researched. Like how that it is safe for your lungs. And it, I laugh when I hear the, is it safe part because it's like, well, injected insulin has a lot of dangerous to it. it's not exactly the safest thing. It's just that we've all accepted it because it's our only option, but it's not our only option anymore. People often ask me if it affects my ability to exercise. I run every day. I have seen no difference in my ability to go for a job. I seen one study where it. Afreza decreases lung function by like 2% or something. And then the study then had those people stop taking Afreza and the lung function went back to normal. So it's just because you're using your, you know, so I'm not even gonna try to go into the details of that science, but it's a, a temporary impact, not a long term impact. Nothing I personally have noticed. Another one was on the cancer risk in this group of people and the only people in the group, it was like, I'm not gonna get the exact numbers, but let's say it was like 1800 people. Three people had cancer, lung cancer and they were smokers. So that says

Katie: 29:30

right. Which came first, the chicken or the eggs type of thing,

Ginger: 29:33

Yeah. And those three smokers got cancer and all the others didn't that, that says enough. Yeah.

Katie: 29:38

Okay. Very interesting. So you are, you are MDI. Do you know, can people use Afreza if they're on an insulin pump

Ginger: 29:45

I know many people who do, yeah. I know many people who do they they'll say I, I see people who say, oh, I use it to correct highs cuz it's so fast to correct. I'm sure there are people who use it for meals as well, and then they take their basil insulin through their pump. And when it comes to closed loop pumps, I don't know enough about how you would integrate just because your pump is gonna try to correct the high and you're correcting the high with Afreza. So I don't know enough about whether you can do that or not, or people are doing that.

Katie: 30:18

Yeah. I have no idea either. We just started the Omnipod five closed loop and are really enjoying it. But yeah, I'm not sure how that would work with, I mean, from what I can tell, cause we did DIY loop for a while too. Omnipod five is a lot more conservative when it comes to giving corrections and, and whatnot. So that has kind. Forced people. I say that cautiously to kind of change their settings almost to like trick the algorithm into doing what they want it to do. So yeah, I mean, honestly, to answer your answer, that question or comment on that question, I also have no idea, but I did notice when I was reading about the study that they're currently doing. In the pediatric population for Fresno that I, I probably need to read the fine print, but I got the impression that you D you could not be on an insulin pump if you were doing this study. And I would imagine definitely not an automated system, cuz yeah, like you said, like that probably be double dipping. Right. And trying to correct or high that's already trying to be corrected.

Ginger: 31:15

Yeah,

Katie: 31:16

All right. Yeah, I mean, just note for the audio and I'm sure people can easily look it up online, but the inhaler is super small. I mean, it's smaller than like an asthma inhaler free. She has it balled up in her fist and I can't even see it. It's tiny. Is it, is it like price? Like, I mean, everybody's insurance is different and yada, yada, but like what about pricing?

Ginger: 31:35

If you go to your doctor and ask about it, they might first tell you, oh no, that's for type twos. Oh no, that's not safe. Oh no, that doesn't work. Right. You're gonna have to bring some material in explain it to them. And if you search for my articles on inhaled insulin print,'em out, there's even ones on how to talk to your doctor and bring it to them and help them learn that they might be wrong. Which I love to hear. Of course. But Where are we going? Oh, so then you have your doctor send in the prescription and it's very important. And you'll find this in the article titled putting inhaled insulin to the test directions on where your doctor should send that prescription, because if they just send it to your normal pharmacy, your is, is just gonna be a mess. Instead, you're sending it to a pharmacy that mankind works closely with mankind manufacturers of Fresno and while. Their team is helping work with your insurance company to get you approval. Mankind will actually send you Afreza for free for like three months while you're getting going, because they want you to try it and, and love it. Right.

Katie: 32:42

I love it. And fight for it. Right.

Ginger: 32:44

And help you get started while you're dealing with insurance and it's still such a new product that insurance puts up resistance. So you might, and I explained this in that article, you might have to have your doctor really explain that your current methods are not working for you. Maybe you're tired of needles. Maybe it's hurting too much to take injections. Maybe you're having too many lows. You gotta put something down on there and. If that fails. If your insurance refuses, they do have a patient assistance program. I believe it's$99 a month. And you get your Afreza prescription filled through the pharmacy that mankind works closely with.

Katie: 33:21

So have you found any issues now that you are getting a however many months supply of Afreza for yourself? Have you found any issues with your insurance company now? Not covering like another, like, like your Novalog

Ginger: 33:34

Nope. I still get my Novalog. I still get they never even questioned math or prescription and I still need the Novalog. So I would not feel safe if I didn't also have Novalog as an option, you know? So no,

Katie: 33:46

So is it, is it, I mean, you mentioned the patient assistance program, but for somebody that has insurance that qualifies. Yeah. Yeah. Mm-hmm

Ginger: 33:53

So then you can download a, I think it's a copay card from mankind that makes your copay$15 every time you fill that prescription.

Katie: 34:03

wow. Hmm. That's great.

Ginger: 34:06

So. I've heard people say, oh, it's more expensive. I'm like, I don't know. It seems a lot more affordable to me than NovoLog, but everybody's system is different, right. So

Katie: 34:15

well, yeah, I guess everybody's insurance could vary for sure. But I mean, if that's, if that's the monthly price that that's definitely not a bad price tag, so, Hmm. So what have you seen in terms of numbers, just with your own, and I don't need specifics if you don't wanna share, but just with your, you know, A1C your time and range, your standard deviation ever since you started using.

Ginger: 34:35

So I can tell you that. And I wasn't wearing a CGM ver I took a long break after pregnancy from wearing a CGM. So when I started using Afreza, I had also just started using a CGM again. So I couldn't give you really great percentages on time and range, but. I can tell you that before I started using Afreza, my A1C was 6.1 and I wasn't really trying to make it lower. I've done the intense pregnancy management with A1C in the fives. I know what it takes. I know the benefits. I just was content with my A1C at 6.1. Right. The only change I made. was that I started using Afreza and I didn't obsess more about highs. I didn't micromanage my diet more. Again, I eat dessert every day. I do not limit my carbon intake, but I'm what I would say is carb thoughtful. Right? I I'm prioritized the carbs I care about most and, and I eat mostly, very whole real food. So my A1C less than a year later was five point. And the only change I've made is Afreza.

Katie: 35:44

Yeah. I mean, that's significant. That's, that's a, I mean, 6.1 is already on the lower, on the low end for sure. But.

Ginger: 35:51

and because you have a parent audience, I wanna just put it out there that when I was a teenager, my A1C was not in the low sixties or the high fives. And I wouldn't expect that from a teenager despite any technology and, you know, so. Please don't take that to mean and that your child's A1C ought to be that I'm a grown woman and I've been dancing this dance for 23 years. Right. So that is different than managing a kid.

Katie: 36:17

I feel like I need to do a series just every week. Just have like a T one D who's now an adult, just come on and tell me stories about about how they were like awful at managing their type one when they were younger. And now they've like, you know reformed themselves

Ginger: 36:34

Right or not even awful, just a teenager whose biggest priority was not your blood sugar, your insulin doses, right? Like their. it. It's just not, it's not gonna work that way for most kids and it's okay. It's okay. I just had my annual eye exam this morning. My eyes are still dilated right now, actually, and I have zero signs of diabetes in my eyes. And I can tell you while I've never deliberately neglected my diabetes, I had A1C in the sevens high six. I've had plenty of high blood sugars throughout the last 23 years. And I am not blind or bleeding from my eyeballs. So take a deep breath and remember that your kid is a kid and encourage them to do the best. They can give them a high five, even when they're struggling, even when the blood sugar isn't perfect. If they check it, then they're trying and they get the high five for.

Katie: 37:28

Oh yeah, absolutely. I mean, we, we are, I do my very best, not to say a word, unless, unless it's like true safety concern, you know what I mean?

Ginger: 37:38

course, of

Katie: 37:38

what we have to treat your low blood sugar

Ginger: 37:40

right. It's not, I don't mean to simplify it at all, but yeah.

Katie: 37:44

Yeah. Yeah, no, I, I know. I know, but I feel like I feel, and I know it will be okay in the end. It's all gonna work itself out, but I just think I need to have somebody come on like once a week and just be like, just remind.

Ginger: 37:55

Yeah, that party in college in St. Patty's day. And you know, like it's not normally how I manage my diabetes, but holy moly, I feel grateful for how that night went. You know, like you might need stories like that.

Katie: 38:08

I do. I think I do. it'd be a good series. I don't know what I'd call it yet, but I don't know. I'll have to think of a name. all right. Let's see. Let me skim down my list of questions. So I feel like I was, you know, I had a question about cons, like if you've noticed any cons with using it, you, you mentioned a couple about it. Not being able to give you tiny doses, not being able to handle those high fat meals. Anything else that you can think of that you didn't don't

Ginger: 38:36

I mean for me. So I use a CGM that doesn't alarm. It's not continuous. I use the Libre 14 day, so I have to scan my arm to get a blood sugar. And I it's a deliberate choice. I cannot handle being alarmed at anymore. And for me, the alarms trigger me to over. React. And it just, it gives me anxiety and I used alarms during pregnancy and that's enough. I'm done with the alarms. so that's why I use this. And that means though that if I get distracted, like I was in the Cape Cod with my family a couple weeks ago and we're whale watching and I'm not thinking about my blood sugars, I'm on a boat looking for whales, right. I was also fasting and I hadn't checked my blood sugar Mylon. I'd taken that anti nausea pill. And I just thought I was probably fine and I checked my blood sugar. After hour two on this boat. And I'm up near 300, because I think, I don't know whether I, I think that anti nausea pill spikes my blood sugar because it's done it on airplanes too, but I thought it was the altitude anyway, real life of diabetes. Right. Which variable is it? Two things I don't go on a lot. Right. Is boats and airplanes.

Katie: 39:46

Mm-hmm

Ginger: 39:47

so because I don't have the alarms bring this back to Afreza the follow up dose. Can be frustrating for some people in that you do need to stop and take the time to see how that meal is digesting an hour later when Afreza is fading from your system and decide for me to follow up dose. And that could be annoying or hard to remember for some people. I mean, it's a great thing that it's out so fast, but the side, the other side of that is that you have to remember to take a follow up dose. I really like the freedom. Of how fast it works. So for me, it's a worthwhile, extra step to have to check and see where I'm at.

Katie: 40:26

Yeah. Especially somebody like you that's it sounds like you're super active. So that would be very frustrating. If you were having to plan your AC you know, your exercise and everything around. Yeah.

Ginger: 40:37

really nice because I can, even if let's say I was one 60, an hour later, if I knew I was gonna be sitting with my computer writing, then I would take another four unit cart. If I knew I was about to go walk my dog, I might hold off and see where I'm at after the dog walk. And therefore I don't end up having to eat food. I didn't wanna eat.

Katie: 40:58

Mm-hmm Well, anything else you think would be helpful for, for listeners to know? I mean, you know, parents and caregivers are the main listeners and, and I feel like most of them have young kids, but some of them have older kids that are, you know, 18 or older and going to the col college and all

Ginger: 41:13

critical thing to know when you start Afreza is because, and, and this also could be advice for, even if you're not using Afreza. I'm a really big believer in tiny tweaks in your background in insulin dose. And when you start Afreza you now don't have these multiple doses of NovoLog on board in your system all day. I mean, if you think about it, you've almost always got some NovoLog on board. Because every time you eat, it's in there for four hours, right. By the time you eat again, it's rare that it's been more than four hours, right? So that's helping covering some of your background insulin needs. So when you start Afreza, you'll likely need a small increase. In your long acting insulin. So if you take Afreza and, and there's a Facebook group where you see this, a lot of people say I started taking Afreza, but it doesn't seem like it's working and they, because they're taking it to correct a high and it's not correcting, it's not the Afreza, it's most likely that they don't have enough background insulin. So that's really something to consider.

Katie: 42:15

mm-hmm

Ginger: 42:15

And pay attention to, and I would say that also applies to even when you're not on Afreza. If blood sugars are being stubborn, if you're taking more corrections and thus you're actually having more lows, cuz you keep taking more corrections of Novalog chances are you might, your child might need a small boost to their long acting insulin dose. You're constantly taking corrections. It's not that they're not necessarily getting enough insulin with their meals. It might be that they don't even have enough background insulin and a child's insulin needs change more than anybody's right. Except for maybe pregnancy So pregnancy could be like week to week and a child's not far off from that. so especially puberty and everything. So really remember that insulin needs are not permanent and need tweaking regular.

Katie: 43:06

Yeah, no, that's a, that's a great point. Yeah. Yeah, we could always tell that Sarah's basil when she was on MDI, that it wasn't high enough or, or, or the basil rate the pump, but like, you know, we'd correct for a high and it would start to go down and we'd be like, oh, it's working. And then it would like stop and start to go back up. And you know, this is like a couple hours after she's eaten and I'm like I think that's probably her basal, you know?

Ginger: 43:27

Right. And you can get really frustrated and mad and feel like you're failing. Or you can say what's not working here. What do I know more of or less of. Right. And, and that's what you did when you adjust your basil and then you get to move on with your life until the next little diabetes moment.

Katie: 43:43

yeah. Yeah. Well, I sure do wish Sarah had some Afrezza right now cuz she is at a camp and her blood sugar is really high. So I'm like, what happened? Did you not Boles for your lunch or maybe not pre Boles? Who knows? But um,

Ginger: 43:57

Summer camp doesn't sound fun at all. So

Katie: 44:00

No, it really doesn't. Fortunately, he's there with another T one D buddy. It's not a diabetes camp, but it's just a, a, you know, camp and at least they have each other, you know, solidarity,

Ginger: 44:10

And speaking of pre bolus, I mean with Afreza, you definitely don't need to pre bolus. And in many cases, I don't even wanna take my insulin until I see my blood sugar start to rise, cuz it's so fast. So they, the only times I really. Start going low from Afreza is when I took it too early for a meal that's digesting slowly.

Katie: 44:32

Hmm.

Ginger: 44:33

So I like that freedom.

Katie: 44:35

Yeah, definitely not having to wait to eat. Absolutely. That. Fantastic. well, I'm super excited to see the results of this study. I'm, I'm kind of debating whether or not I actually wanna email the lady cuz they're they're doing they're recruiting at the university of Florida, which is not too far from where we are. But I'm like, oh, we just started the Omnipod five system. And right now we're really, really loving it. And I'm like, I know they're gonna make me come off. They're gonna make us come off of that. And. I dunno, selfishly I'm like, do I really want to, but even just to talk to her about it, you know, maybe I could have her on and be like, okay, what's what are you seeing so far?

Ginger: 45:11

There's no way Yeah.

Katie: 45:13

Okay. Maybe in two years or three years when it's over. Cause it's a long study. It's like a, it's a long study. I think it'll be a couple years before we know whether or not that gets approved for kids, but exciting stuff for sure. Well, thank you, ginger, for coming on. Thank you for your time. And I will definitely link to you know, your books and, and some of the other blogs you've written on Afreza and anything else that you would like me to link to in the show?

Ginger: 45:36

Sure ginger vera.com. I link to as much as I can there. So you don't have to go looking all over the web for it.

Katie: 45:42

Yeah. Awesome. Well, thank you so much. Have a great

Ginger: 45:44

thanks for having me.

Katie: 45:46

Thanks, bye. All right. You guys, that is it for our show today. Wasn't ginger, an awesome guest. I really love talking with her. I feel like she just has so much knowledge and wisdom to share. I might have to have her back on again, to talk about some other things like caregiver, burnout, or how to keep from going low or high while you're exercising. Make sure you check out the show notes again. I will provide you with one very convenient link to where you can find ginger in all of her diabetes resources. She has. Written them out nicely in one place with links to everything. So you can find it super, super fast. All right. My friends have a fabulous week. I hope you're weak. And your weekend with diabetes goes well, and I will chat with you soon until then stay calm and Boless on.