Blogheader1 Mealtime Insulin
Type 2

Why do I need insulin at mealtime?

By: Suzanne Appel, MannKind Corporation

When you're living with type 2 diabetes, your body does not make enough insulin or it does not use it properly. Since insulin is the hormone that regulates the movement of sugar out of your blood and into your cells, not having enough insulin may cause your blood sugar level (also called blood glucose) to rise too high (hyperglycemia).1

Diabetes therapy is designed to manage blood sugar levels throughout the day and night, in order to prevent health complications. Over time, too much sugar in your blood can damage your large blood vessels. This could cause problems with the heart, brain and legs (macrovascular complications) and damage to the small blood vessels, causing problems in the eyes, kidneys, feet and nerves (microvascular complications).2

Long-acting, or basal, insulin stays in your body throughout the day and can help control your blood sugar when you are not eating. However, long-acting insulin may not manage the increase in blood sugar when you eat food. To control those mealtime blood sugar spikes your healthcare provider may prescribe a fast-acting mealtime insulin to better match the insulin to what your body needs. The chart below shows an example of the spikes in blood sugar levels that can happen with meals.3

Blood Sugar Control with Diabetes


Type 2 diabetes is a progressive disease. This means it may become more challenging to control as time goes on. If your healthcare provider prescribes insulin, it does not mean you or your body have failed. If you find your current therapy is not working for you, talk with your healthcare provider. It may be time to make changes to your therapy. If you notice typical symptoms of hyperglycemia such as tiredness, irritability, blurry vision, more frequent urination and thirst, call your healthcare provider.2 Through a combination of proper nutrition, exercise, medication and not smoking, the risk of most diabetes-related complications can be reduced.4

The information provided on this blog is for general educational, communication and information purposes only and is not intended to replace medical advice, treatments or diagnosis by your own healthcare provider.

Articles are written by MannKind Corporation staff and contributors from the diabetes community


[1] Kawahito S, Kitahata H, Oshita S. Problems associated with glucose toxicity: Role of hyperglycemia-induced oxidative stress. World Journal of Gastroenterology. 2009;15(33):4137-4142. doi:10.3748/wjg.15.4137. 

[2] Fowler M. Microvascular and Macrovascular Complications of Diabetes. Clinical Diabetes. 2008 Apr, 26 (2) 77-82; DOI: 10.2337/diaclin.26.2.77 

[3] Columbia University. Pharmacologic Treatment of Type 2 Diabetes. Columbia University Website. Accessed 4.11.18

[4] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53.

Important Safety Information for Afrezza (insulin human) Inhalation Powder

Afrezza can cause serious side effects, including: Sudden lung problems (bronchospasms). Do not use Afrezza if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting Afrezza, your healthcare provider will give you a breathing test to check how your lungs are working.


What is the most important information I should know about Afrezza?

Afrezza can cause serious side effects, including:

Sudden lung problems (bronchospasms). Do not use Afrezza if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting Afrezza, your healthcare provider will give you a breathing test to check how your lungs are working.

  • Afrezza is a man-made insulin that is breathed-in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus. 
  • Afrezza is not for use in place of long-acting insulin. Afrezza must be used with long-acting insulin in people who have type 1 diabetes mellitus. 
  • Afrezza is not for use to treat diabetic ketoacidosis. 
  • It is not known if Afrezza is safe and effective for use in people who smoke. Afrezza is not for use in people who smoke or have recently stopped smoking (less than 6 months). 
  • It is not known if Afrezza is safe and effective in children under 18 years of age.

Do not use Afrezza if you:

  • Have chronic lung problems such as asthma or COPD.
  • Are allergic to regular human insulin or any of the ingredients in Afrezza. See the end of this Medication Guide for a complete list of ingredients in Afrezza. 

Before using Afrezza, tell your healthcare provider about all your medical conditions, including if you:

  • Have lung problems such as asthma or COPD
  • Have or have had lung cancer
  • Are using any inhaled medications
  • Smoke or have recently stopped smoking
  • Have kidney or liver problems
  • Are pregnant, planning to become pregnant, or are breastfeeding. Afrezza may harm your unborn or breastfeeding baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements.

Before you start using Afrezza, talk to your healthcare provider about low blood sugar and how to manage it.

  • Read the detailed Instructions for Use that comes with your Afrezza.
  • Take Afrezza exactly as your healthcare provider tells you to. Your healthcare provider should tell you how much Afrezza to use and when to use it.
  • Know the strength of Afrezza you use. Do not change the amount of Afrezza you use unless your healthcare provider tells you to.
  • Take Afrezza at the beginning of your meal.
  • Check your blood sugar levels. Ask your healthcare provider what your blood sugar should be and when you should check your blood sugar levels.
  • Keep Afrezza and all medicines out of the reach of children.
  • Change in level of physical activity or exercise, weight gain or loss, increased stress, illness, change in diet, or because of other medicines you take. 

While using Afrezza do not:

  • Drive or operate heavy machinery, until you know how Afrezza affects you.
  • Drink alcohol or use over-the-counter medicines that contain alcohol.
  • Smoke.

Afrezza may cause serious side effects that can lead to death, including:

See “What is the most important information I should know about Afrezza?” at the top of this page.

  • Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:
    • Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.
  • Decreased lung function. Your healthcare provider should check how your lungs are working before you start using Afrezza, 6 months after you start using it and yearly after that.
  • Lung cancer. In studies of Afrezza in people with diabetes, lung cancer occurred in a few more people who were taking Afrezza than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to Afrezza. If you have lung cancer, you and your healthcare provider should decide if you should use Afrezza.
  • Diabetic ketoacidosis. Talk to your healthcare provider if you have an illness. Your Afrezza dose or how often you check your blood sugar may need to be changed.
  • Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:
    • A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.
  • Low potassium in your blood (hypokalemia).
  • Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with Afrezza may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with Afrezza. Your healthcare provider should monitor you closely while you are taking TZDs with Afrezza. Tell your healthcare provider if you have any new or worse symptoms of heart failure including:
    • Shortness of breath, swelling of your ankles or feet, sudden weight gain.

Treatment with TZDs and Afrezza may need to be changed or stopped by your healthcare provider if you have new or worse heart failure.

Get emergency medical help if you have:

• Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.

The most common side effects of Afrezza include:

  • Low blood sugar (hypoglycemia), cough, sore throat

These are not all the possible side effects of Afrezza. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 (1-800-332-1088).

Active ingredient: human insulin

Inactive ingredients: fumaryl diketopiperazine, polysorbate 80

General information about the safe and effective use of Afrezza.

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Afrezza for a condition for which it was not prescribed. Do not give Afrezza to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about Afrezza. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about Afrezza that is written for health professionals. For more information, go to or call MannKind Corp. 1-877-323-8505.