Inhaled Insulin Guide: Afrezza Dosing, Safety, and Cost
Inhaled Insulin Guide: Afrezza Dosing, Safety, and Cost
Inhaled insulin is a way to take mealtime (rapid-acting) insulin through your lungs instead of by injection. It’s taken at the beginning of a meal (Cleveland Clinic: inhaled insulin powder).
In type 1 diabetes, inhaled insulin does not replace long-acting (basal) insulin—it’s used with it (MedlinePlus: insulin inhalation).
Key safety/eligibility point (read this first): Afrezza carries a Boxed Warning for risk of acute bronchospasm and is contraindicated in people with chronic lung disease such as asthma or COPD. Afrezza is indicated to improve glycemic control in adults with diabetes mellitus (type 1 or type 2) (DailyMed Afrezza label, updated Feb 2023).
In the U.S., when people say “inhaled insulin,” they’re usually talking about Afrezza (insulin human) inhalation powder (Mayo Clinic drug overview).
Medical disclaimer: This article is for general educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Insulin is a high-risk medication and dosing must be individualized. Do not start, stop, or change insulin (including switching to inhaled insulin) without guidance from a licensed clinician and a plan for close glucose monitoring.
What is inhaled insulin?
Inhaled insulin is rapid-acting insulin powder that you inhale through a small handheld device. It’s designed for mealtime dosing (not all-day “background” insulin).
Important limitations (easy to miss)
In addition to lung screening and monitoring, inhaled insulin has a few “scope limits” that matter in real life:
- In type 1 diabetes, it’s used with a long-acting (basal) insulin.
- It’s not intended for treating diabetic ketoacidosis (DKA).
- It’s not recommended for people who smoke or recently stopped smoking.
(These limitations are part of FDA-approved labeling; see “Limitations of Use” on the DailyMed label linked above.)
A quick history note: inhaled insulin didn’t start with Afrezza
Afrezza wasn’t the first inhaled insulin. Exubera was FDA-approved in 2006 and later withdrawn from the market—history and product challenges are reviewed in a peer-reviewed overview of inhaled insulin development (PMC review).
How does inhaled insulin work?
Injected insulin has to absorb from subcutaneous tissue into the bloodstream. Inhaled insulin is absorbed through the lungs’ large surface area, which is one reason it can act quickly.
Inhaled insulin is discussed as a fast “on” and fast “off” mealtime option. A 2025 Diabetes Care commentary summarizes Technosphere insulin (the formulation used in Afrezza) as having a faster onset and shorter duration than injected rapid-acting analogs (Diabetes Care commentary on inhaled insulin’s role in the era of AID). This time–action profile is also described in FDA-approved labeling for Afrezza (FDA label PDF).
Why that matters: a faster on/shorter off profile can make inhaled insulin appealing for post-meal spikes, but it can also mean dosing and follow-up need to be individualized and monitored closely.
Inhaled insulin vs. injected rapid-acting insulin: what’s actually different?
Both inhaled and injected mealtime insulins aim to blunt post-meal glucose spikes. The practical differences usually come down to:
- How it’s delivered (lungs vs. subcutaneous tissue)
- Time-action profile (rapid rise, shorter duration)
- Unique monitoring needs (pulmonary screening/follow-up)
| Feature | Inhaled insulin (Afrezza) | Injected rapid-acting insulin (pens/pumps) |
|---|---|---|
| How it’s taken | Inhaled powder at the start of meals | Injection or pump bolus (varies by product/regimen) |
| Common “local” issue | Cough can occur | Injection site irritation/lipohypertrophy can occur (varies by technique/product) |
| Unique major safety issue | Lung eligibility + spirometry monitoring | No routine lung testing |
| Not a 1:1 swap | Dose conversion is needed when switching from injected mealtime insulin | Dosing still individualized, but unit dosing is generally more direct within the injected insulin family |
Who might be a candidate for inhaled insulin?
Afrezza is a prescription mealtime insulin option for adults with diabetes mellitus (type 1 or type 2), per FDA-approved labeling.
In practice, the “right fit” often comes down to two questions:
- Do you need mealtime insulin coverage?
- Are your lungs a good match for an inhaled medication?
The non-negotiable safety step: lung function testing (spirometry)
Because this insulin is inhaled, lung screening and follow-up testing are part of the safety protocol.
Prescribing information describes checking pulmonary function with spirometry at baseline, again after 6 months, and then annually—even without symptoms (Afrezza Full Prescribing Information, Feb 2023 PDF).
A common spirometry measurement you’ll hear about is FEV1, short for forced expiratory volume in 1 second—basically, how much air you can forcefully blow out in the first second of an exhale.
Side effects and key risks (beyond “low blood sugar”)
Hypoglycemia
Low blood sugar is a major risk with any insulin (including inhaled insulin). Make sure you have a clinician-approved plan for preventing and treating lows.
Cough
Cough is a known side effect of inhaled insulin. In clinical trial data summarized in prescribing information, cough was reported in 27% of Afrezza-treated patients (vs. 5.2% of comparators) and was the most frequent reason for discontinuation (Afrezza Full Prescribing Information, Feb 2023 PDF).
Decline in pulmonary function
Afrezza can cause a decline in pulmonary function over time, which is why spirometry monitoring is part of prescribing (DailyMed Afrezza label, updated Feb 2023).
Diabetic ketoacidosis (DKA)
Afrezza is not intended for treating DKA (per FDA-approved labeling). If you’re at higher risk of DKA, this is a key point to discuss with your clinician.
Lung cancer: what the label says (and what it doesn’t)
The FDA label notes limited data and uncertainty about whether Afrezza has an effect on lung tumors, and it reports two cases of lung cancer observed in clinical trials (FDA label PDF).
Dosing basics: what’s different about inhaled insulin dosing?
Safety first: Afrezza dosing is not a 1:1 swap with injected rapid-acting insulin. Switching should come with a clinician-guided plan and close glucose monitoring.
A label-anchored snapshot (non-personalized)
A few dosing facts that are easy to miss:
- Afrezza comes as single-use cartridges in 4-, 8-, and 12-unit strengths.
- FDA-approved labeling includes a conversion table/approach for people switching from injected mealtime insulin.
- It’s taken at the beginning of each meal.
What research suggests about dose needs (not a conversion rule)
The INHALE-3 randomized trial compared an inhaled Technosphere insulin + insulin degludec regimen to usual care.
It enrolled 123 adults with type 1 diabetes and ran for 17 weeks.
Investigators reported that, under the study’s titration protocol, “optimized” inhaled Technosphere insulin doses were often two to three times the rapid-acting analog doses participants had used previously (INHALE-3 RCT).
This is not a do-it-yourself conversion formula.
How to use the inhaler correctly (and why technique matters)
Because delivery is through the lungs, inhaler handling and technique matter.
The safest move is to have a clinician or pharmacist walk you through first use and follow the Medication Guide/Instructions for Use that come with your prescription.
What does the research say? INHALE-3, CGM, and time-in-range
Inhaled insulin has gotten renewed attention partly because it may pair well with continuous glucose monitoring (CGM) and a “learn-your-patterns” approach.
Key takeaways reported for INHALE-3:
- HbA1c outcomes were noninferior overall—meaning the inhaled-insulin regimen performed about as well as usual care within a pre-specified “acceptable difference” margin.
- Response was mixed: some participants improved meaningfully, while others worsened.
- The most frequent side effect was a brief cough, and some participants discontinued because of it.
(Study details: INHALE-3 RCT.)
Cost and access: what to check before you switch
Cost and coverage can be one of the biggest real-world barriers—especially because Afrezza may involve extra steps like prior authorization and spirometry.
A checklist that usually prevents surprises:
- Formulary status: Is Afrezza covered by your plan? Does it require prior authorization?
- Plan restrictions: Any quantity limits, step therapy, or a specialty pharmacy requirement? (Medicare: drug plan rules)
- Pulmonary testing logistics: Do you need a separate appointment for spirometry?
- Your lowest-price route: Compare your insurance copay versus a cash price/discount.
Cost anchors (pricing varies)
- GoodRx lists prices “as low as” $433.13 for a 90-cartridge kit (4 units each), with an “average retail price” on the same page of $563.38 (retrieved Jan 2026; prices vary by location and change over time) (GoodRx Afrezza page).
- The manufacturer describes affordability options such as a savings card (“as little as $35/month” for eligible commercially insured patients) and a direct purchase program (“as little as $99/month” for eligible individuals) (Afrezza: Paying for Afrezza).
If you want a broader playbook for lowering prescription costs (including when it makes sense to use GoodRx instead of insurance), see GoodRx Guide 2025: How to Lower Prescription Costs.
How to track whether inhaled insulin is working (without guessing)
Because response can vary, it helps to define success in advance and measure it consistently.
Common metrics clinicians use:
- HbA1c (a ~2–3 month average)
- Time in range (if you use CGM)
- Frequency/severity of hypoglycemia
- Post-meal glucose patterns and correction needs
If you want a practical guide to how much A1c can change over the typical 8–12 week adjustment window, see How Much A1C Can Drop in 3 Months?.
If post-meal spikes are a big part of the problem you’re trying to solve, short walks after meals can help—but plan carefully if you use insulin. See Does Exercise Lower Blood Sugar? A Science-Backed Guide.
Optional related read: insulin sensitivity and body composition
Many factors beyond dosing—including diet, activity, and body composition—can influence insulin sensitivity over time. If you’re also working on that side of the picture, see our Insulin Resistance & Weight Loss Guide.
FAQ: inhaled insulin
Can inhaled insulin replace long-acting insulin?
Not for type 1 diabetes. Afrezza is a mealtime insulin and must be used with a basal insulin (per FDA-approved labeling).
Who should not use inhaled insulin?
Afrezza is contraindicated in people with chronic lung disease such as asthma or COPD due to risk of acute bronchospasm (see boxed warning and contraindications in the official labeling).
How fast does inhaled insulin work?
Technosphere insulin is discussed as having a fast onset and short duration compared with injected rapid-acting insulin (see the Diabetes Care commentary and FDA label linked earlier). Your exact response can vary.
What if I cough when I use it?
Cough is a known side effect. If it’s persistent, severe, or comes with wheezing/shortness of breath, contact your clinician promptly.
Do I have to get lung testing?
Yes. Baseline and follow-up lung function testing is part of prescribing and safety monitoring for Afrezza.
Is inhaled insulin approved for kids?
Afrezza is approved for adults (not pediatric use), per FDA-approved labeling.
Bottom line
Inhaled insulin (Afrezza) can be a compelling mealtime option—especially for people who want fewer injections and a fast prandial insulin profile—but it comes with non-negotiable lung screening/monitoring and dose-conversion complexity.
If you’re considering it, the safest next step is to ask your clinician for a structured switch plan that covers (1) spirometry, (2) dosing/titration, and (3) how you’ll monitor glucose closely during the transition.
