AU,

Thank you!!! Your commentary is priceless. In my practice, I do not currently manage diabetic medication regimes. But all this discussion has been giving me flashbacks to my 1st night of overnight call as a new intern in a small regional hospital. For those of you who have not heard it before - you do not want to be hospital patient in a teaching hospital during the month of July - when all the new interns and residents start.

Anyway, at the time, I had precious little exposure to the finesse of sliding scale insulin dosages. The floor nurse would page me that Mrs. so-and-so has a blood sugar of 360 and "what do you want to do about it?" I'd whip out my pocket cheat-sheet and rattle off an order for the appropriate amount of insulin to inject. But then they'd page you back an hour later - "Her blood sugar is still ###". So being a newbie intern, you feel you have to do something, so you order more insulin, and a while later, more insulin. And so it goes. Thankfully, I never had any major crashes. But I did have to learn to sometimes do nothing (and to tell the nurses to quit checking the blood sugars so often!).

But I think now how much simpler my job might have been if Afrezza had been available. Hospital patients these days are much sicker and have many co-morbidities. The pharmacokinetics of injected insulin is anything but simple in them.

Again, thank you for your insight. I've learned a lot from you.