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MannKind Has More Positive Inhaled Insulin Data
A person uses Afrezza inhaled insulin powder. [Image courtesy of MannKind]MannKind announced top-level 30-week results from its Phase 4 INHALE-3 study comparing inhaled insulin to traditional delivery methods.
The Danbury, Connecticut-based company designed Afrezza, a rapid-acting inhaled human insulin, to improve glycemic control in adults with type 1 diabetes mellitus. The INHALE-3 study looks at Afrezza against usual care.
Mannkind defines usual care as multiple daily injections (MDI), an automated insulin delivery system, (AID) or a pump without automation. The study utilized a higher initial conversion dose from mealtime injectable insulin to inhaled insulin.
Results showed that additional participants with type 1 diabetes achieved target A1c levels during the extension Phase. The computer analysis included all people on inhaled insulin, evaluated in two separate groups. One utilized Afrezza (plus basal insulin) over 30 weeks. The other switched to Affreza at week 17 from usual care.
MannKind reported continued improvement in the Afrezza (plus degludec)-treated group. Subjects in that group achieved A1c less than 7% at 30 weeks, marking a 100% increase from baseline. Switching from usual care Afrezza at week 17 allowed more subjects to achieve that level of A1c at week 30 compared to the number at week 17.
"The data from the extension phase of this study showed that more people living with T1D are able to reach target A1c levels when they remain on Afrezza (plus basal insulin) or switch to Afrezza from usual care – whether they are using multiple daily injections or pumps," said Michael Castagna, CEO for MannKind. "We believe this data demonstrates to healthcare practitioners that Afrezza is an effective tool for their patients who want to improve their glycemic control."
How To Lower Your Blood Sugar
Blood sugar is your body's main source of energy, but chronically elevated levels are the cause of diabetes, which can cause serious health problems. Knowing how to lower your blood sugar is not only important for people with diabetes, but also for anyone who wants to maintain good health. Fortunately, there are many different things you can do to lower your blood sugar, such as getting some exercise, eating the right foods, and taking medication, if necessary.
Blood sugar is your body's main source of energy. Knowing how to lower your blood sugar is important not only if you have diabetes, but for anyone who wants to maintain good health. There are many ways to lower your blood sugar, such as getting some exercise, eating the right foods, and taking any needed medication. (Photo Credit: Westend61/Getty Images)
There are different categories of carbohydrates, or carbs. One group, known as simple carbohydrates, break down into glucose quickly. That can cause your blood sugar to soar after you eat or drink something that contains a lot of simple carbs, such as sweets, fruit juice, or soda.
The other group of carbs, called complex carbohydrates, include starches and fiber. Complex carbs tend to break down into glucose slowly, or not at all, in the case of fiber. That means your blood sugar is less likely to spike after you consume complex carbs. Complex carbs also contain more vitamins and minerals than simple carbs. Some starches may cause your blood sugar to rise rapidly after a meal, so picking the right foods can help keep yours in check. Some good choices for complex carbs include:
Fiber is a complex carbohydrate that your body doesn't absorb or break down into glucose, so it doesn't cause your blood sugar to skyrocket after a meal. It has many other benefits, such as improving digestion and making you feel full, so you eat less food. Fiber seems to protect your heart and prevent colon cancer, too.
There are two types of fiber, called soluble (which dissolves in water) and insoluble (which doesn't). Soluble fiber is a champ when it comes to controlling blood sugar, so choose these foods:
The glycemic index (GI) is a tool that can help you choose foods that don't cause your blood sugar to spike. The GI assigns a number value based on how rapidly it causes blood sugar to rise, compared to pure glucose, which has a GI of 100. Foods that are low on the GI scale (a GI of 55 or less) raise blood sugar modestly. Those higher on the scale (55 or higher) raise it more dramatically.
Choosing mostly low-GI foods can help you keep your blood sugar down by helping you make better choices when you're hungry.
Low-GI foods to lower blood sugar:
Generally staying active throughout the day is a great way to keep your blood sugar under control. When you get up and go, your body produces energy by burning sugar that you have stored away in your muscles and liver. When those reserves start to run low, your body rebuilds them by taking sugar out of your blood. The more you exercise, the lower your blood sugar goes.
Of course, if you have diabetes, it's essential to check your blood sugar before, during, and after a session of exercise to make sure it's in the safe zone. You should stop exercising if you feel symptoms of low blood sugar, such as feeling jittery, dizzy, or weak.
Most adults should try to get at least 150 minutes of moderate-intensity physical activity (such as brisk walking, water aerobics, or gardening) each week. If you prefer a more vigorous workout, such as running or swimming, getting at least 75 minutes of activity per week is a good goal. But you can add short bursts of physical activity into your day with some simple strategies:
Your blood sugar naturally rises for 30 to 90 minutes after you eat a meal. One proven way to keep that spike to a minimum is to drop your napkin, lace up your walking shoes, and take a stroll. In fact, a recent study, published in the journal Nutrition, Metabolism and Cardiovascular Diseases, found that as little as 3 minutes of walking after a meal helped prevent a rise in blood sugar (although in that trial people walked up and down stairs). Also, the study showed that 10 minutes was even better, since the bodies of the people in the study became more sensitive to insulin, the hormone that stores blood sugar in cells. The message is simple: Don't collapse on the sofa with a book or the remote control after a meal. Instead, taking a few laps around the block can help keep your blood sugar under control.
When you don't drink enough water or other fluids, you can become dehydrated. That causes the water level in your blood to drop, which makes your blood sugar more concentrated. This shift in your blood's ratio of sugar to water will cause your blood glucose numbers to increase.
Studies have shown that dehydration makes it harder for people with diabetes to manage their blood sugar. If you have diabetes, keep in mind that feeling very thirsty can be a sign that your blood sugar levels are too high and have probably been that way for a long time.
There's no magic number for how many glasses of water you should drink every day, but some experts say that at least four to six cups of plain water is a good daily goal for most people who are considered healthy. Drink more on hot days or when you exercise (before, during, and after if it's a long workout). One sign that you're not drinking enough fluids: Your pee will likely turn darker.
If you're overweight or obese, losing some weight can have some important health benefits, such as lowering your risk of heart disease and other medical conditions. But losing even a small amount of weight can also help you manage your blood sugar.
Weight loss has an important effect on insulin, the hormone that allows your cells to use blood sugar for energy. Shedding some pounds helps your body use insulin more effectively, which makes your blood sugar levels go down. If you have type 2 diabetes and use medication to control your blood sugar, losing weight could allow you to lower your dose or maybe even stop taking one of your medicines.
Losing just 5% of your body weight can help you keep your blood sugar under control. Ask your doctor to help you choose a weight target and create a diet plan that you can stick with.
If you're struggling with sleep, studies show that getting more rest can help you get better control of your blood sugar, whether or not you have diabetes. Simple strategies like avoiding electronics before bedtime and putting blackout shades on your windows to keep your bedroom dark can help you get better rest. But if they don't work, talk to your doctor, who can find out if you have a sleep disorder and recommend a solution.
If you use diabetes medication of any kind, the treatment your doctor recommends is designed to keep your blood sugar in a healthy range – not too high, not too low. Achieving that goal calls for you to take your medicine consistently and at the right time of day. Studies show that missing even a single dose of insulin can significantly decrease the amount of time your blood sugar is in the healthy range. If you're missing doses of medications that you need to keep your blood sugar under control, talk to your doctor. They can recommend ways to keep up with your treatment or possibly switch you to a medication that you'll find easier to take.
If you have diabetes, monitoring your blood sugar levels is of the utmost importance. Using a tool to track your "numbers" creates a track record of your blood sugar levels. Your doctor can use that data to find out if your treatment plan is working or needs to be adjusted to keep your blood sugar in the healthy range. If you have type 1 diabetes, you need to monitor your blood sugar frequently throughout the day, such as when you eat, exercise, or go to bed.
Your doctor will recommend when and how often you should monitor your blood sugar. The common way to check it is by using a lance to prick your finger, placing a drop of blood on a test strip, and putting that in a meter, which produces a blood sugar reading. But a growing number of people with diabetes use continuous glucose monitors (CGMs), which are devices worn on the body that check blood sugar levels every few minutes. Your doctor can view data from your CGM to learn more about your diabetes, such as how much time your blood sugar is in the healthy range. There are also many apps that let you to track trends in your blood sugar levels and share data with your doctor.
The makers of many dietary supplements and other natural products promote them for lowering blood sugar. Here are some and what we know about them:
Alpha-lipoic acid. This antioxidant is in every cell in your body and helps turn glucose into energy. But a 2019 review of 10 studies found no proof that it lowers blood sugar.
Apple cider vinegar. A few studies have found that drinking this popular cure-all after a meal may prevent blood sugar spikes. Scientists think it may work by preventing your body from completely absorbing carbs, which keeps them from getting turned into blood sugar. Avoid it if you have kidney disease.
Probiotics. These supplements contain "good" bacteria and are being studied as a treatment for many medical conditions. There is intriguing evidence that they may lower blood sugar, but results of clinical trials have been inconsistent. More research is needed.
Berberine. This substance found in various plants has been touted as having various health benefits, such as promoting weight loss. One review of 46 studies found evidence that it might lower blood sugar, but the authors pointed out that berberine's effects varied in studies, some of which were low-quality.
Cinnamon. This popular spice is one of the most-studied herbal supplements for the purpose of lowering blood sugar. The authors of a 2024 analysis of 24 clinical trials found that cinnamon appears to lower fasting glucose and said that the spice may have a role as an add-on treatment for people taking medication for diabetes. Scientists think it may work by making cells more sensitive to insulin.
Fenugreek seeds. In a recent analysis, the seeds of this clove-like herb were second only to apple cider vinegar for their ability to lower blood sugar in a comparison of several natural products. Scientists aren't sure how it works, but it may be that fenugreek slows down digestion, preventing carbs in a meal from hitting the bloodstream quickly. Some scientists say that eating some fenugreek in a salad is thought to be safe, but that taking large doses in supplements may be unsafe, especially if you're pregnant.
Magnesium. Studies show that people who have high levels of this mineral in their blood have a reduced risk of diabetes. A 2019 trial published in the journal Nutrients found that people taking magnesium supplements lowered their blood sugar, which appeared to be because their cells became more sensitive to insulin.
Ginseng. This popular Chinese herb may help control blood sugar, according to a review of 16 clinical trials published in the journal PLOS One. Scientists aren't sure how ginseng might lower blood sugar, but it may do so by helping the body make more insulin and making cells more sensitive to the hormone.
It's important to know a few things about dietary supplements and other natural products. These products aren't as well-studied as over-the-counter and prescription drugs. Nor are they closely regulated by the FDA, which means that their safety and effectiveness are not monitored. Most importantly, they should never be used instead of medications your doctor prescribes. If you want to try a supplement to lower your blood sugar, tell your doctor beforehand.
Monitoring your blood sugar has many benefits, which include detecting blood sugar levels that are too high, known as hyperglycemia. If you feel OK but your numbers are high, some steps that may help bring them down include:
If you use insulin to control diabetes, talk to your doctor about how to lower your blood sugar if you develop hyperglycemia. They may advise you to use a supplement of short-acting insulin, which quickly reduces blood sugar.
Hyperglycemia that goes untreated can threaten your life and is a medical emergency. Get medical help right away if you have diabetes and have any of these symptoms:
Doctors will likely treat you with insulin, intravenous fluids, and electrolytes.
Blood sugar is your body's main source of energy, but chronically high levels can lead to many serious health problems. If you have diabetes, following the treatment plan your doctor has designed for you is critical. But anyone can benefit from making diet changes, getting more exercise, and adopting other lifestyle strategies that naturally lower blood sugar.
What foods lower blood sugar right away? There are no foods that lower blood sugar immediately. However, eating a balanced diet is part of an overall plan that can keep your blood sugar from spiking. One effective strategy at meal time is to combine foods that are high in carbohydrates with others that are healthy sources of protein and fiber, which can help keep the carbs from raising your blood sugar quickly.
How can I lower blood sugar after steroid injections? If you use steroid injections to treat a medical condition, one possible side effect is a spike in blood sugar that can last for up to several days. Studies show that if you have diabetes and it's well-managed, your blood sugar level will return to normal after a steroid shot sooner than if you're currently struggling to keep the condition under control. Talk to your doctor about ways to bring down your numbers after a steroid shot.
How can I lower blood sugar right away without insulin? Drinking plenty of water and getting some exercise may help lower your blood sugar. But if you have high blood sugar and symptoms such as nausea, unquenchable thirst, and fruity-smelling breath, seek medical help right away. You may have a serious case of hyperglycemia, which can be life-threatening.
What should I eat if my sugar is high? Ask your doctor or a registered dietitian to recommend a diet that can help lower your blood sugar. But in general, eating a variety of healthy foods can help keep blood sugar under control. Be sure to fill your diet with plenty of whole grains and high-fiber food (such as whole-wheat bread and brown rice), leafy greens and non-starchy vegetables (like peppers and tomatoes), fruit (especially berries), and nuts.
Does drinking water lower blood sugar? Drinking plenty of water can help maintain the proper balance of fluids in your blood, which is essential for maintaining healthy blood sugar. Try to drink water throughout the day and avoid feeling thirsty.
Cases Of Adverse Mental Health Outcomes Developing With Continuous Glucose Monitoring
Using a continuous glucose monitor (CGM) can cause harm to mental and physical health and may not be advisable for some people not living with diabetes (PNLD), according to study results presented at the American Psychiatric Nurses Association 38th annual conference, held in Louisville, Kentucky from October 9-12, 2024.
No evidence-based guidelines are available to inform CGM use among PNLD. However, PNLD are increasingly utilizing CGM for weight loss efforts. More than 10 million individuals use CGM worldwide, and that figure is likely to increase since the United States Food and Drug Administration (FDA) approved over-the-counter CGM.
To evaluate the potential adverse effects of CGM use on mental and physical health, Amanda Lyn Sheehan, MSN, NP-BC, NP-C, BSN, RN, BS, from Johns Hopkins School of Nursing reviewed 3 cases of CGM associated with patient harm.
Case 1 was a 64-year-old woman with type 1 diabetes (T1D), obsessive compulsive disorder (OCD), anxiety, and anorexia. The patient had an obsession with maintaining sensor glucose levels at 70 mg/dL or less to prevent diabetic complications. This behavior manifested as severe anorexia and resulted in a BMI of 16 kg/m2. The patient's teenage child was ultimately taken into custody by the Department of Children and Families and the patient was hospitalized with anorexia and later on developed dementia. Frequent hypoglycemic episodes likely contributed to the onset of dementia.
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While CGM can be life changing for people with diabetes, there is a lack of independent data or guidelines supporting safe/beneficial use in people not living with diabetes.
Case 2 was a 44-year-old man with latent autoimmune diabetes in adults and OCD. After initiating CGM, the patient experienced obsessional thinking about the discrepancy between sensor and blood glucose levels and questioned the monitor's accuracy. The patient would compulsively check their CGM and blood glucose levels and call their doctor for help. The patient experienced new-onset panic attacks and ultimately died by suicide using a firearm.
Case 3 was a 20-year-old man with a new diagnosis of T1D, autism spectrum disorder, and anxiety. The patient had a very selective eating pattern at baseline, consuming high glycemic index foods. After their diabetes diagnosis and receiving education about a healthy diet, the patient incorporated more vegetables and protein. However, the patient also began engaging in compulsive exercise, walking 40,000 steps per day to keep their glucose levels tightly controlled such that they did not use rapid-acting insulin. The patient experienced weight loss to a BMI of 17 kg/m2.
Overall, CGM use has potential psychological and eating-specific risks. Some individuals may begin engaging in obsessive thinking or develop anxiety, panic attacks, or feelings of being overwhelmed. Individuals may avoid certain foods, restrict their food or beverage consumption, or develop an eating disorder.
Ms Sheehan made several recommendations to avoid potential adverse effects of CGM use. She endorsed performing a preassessment and providing psychoeducation or combining CGM initiation with therapy, mindfulness, a support group, and/or exposure response prevention.
The study author concluded that there is a lack of independent data or guidelines to support CGM use among PNLD. More research into use of CGM among PNLD is needed.
Visit Clinical Advisor's meeting section for more coverage of APNA 2024.
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