Invokana vs. Afrezza for Diabetes Type 2: Important Differences and Potential Risks.

Key takeaways

Invokana (canagliflozin) and Afrezza (insulin human) are both medications used to manage diabetes, but they work in different ways. Invokana is a sodium-glucose cotransporter 2 (SGLT2) inhibitor taken orally once a day to help lower blood sugar in adults with Type 2 diabetes. It also reduces the risk of heart and kidney problems in these individuals. Afrezza, on the other hand, is an ultra rapid-acting insulin inhaled at the start of meals, used for both Type 1 and Type 2 diabetes. Invokana and Afrezza are only available as brand-name medications. Invokana can cause side effects like urinary tract infections and yeast infections, while Afrezza may lead to low blood sugar and cough, and is not suitable for people with lung issues like asthma. Both medications can be used with other diabetes medications, but blood sugar monitoring is recommended because of the increased risk of low blood sugar.

Invokana

(canagliflozin)

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Afrezza

(insulin)

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Summary for Invokana

Prescription only

Invokana (canagliflozin) is a medication that's used together with a healthy diet and exercise to lower blood sugar levels in adults with Type 2 diabetes. It can also lessen the chance of worsening heart and kidney problems in some people with Type 2 diabetes. This medication is taken by mouth once a day.

Indications for Invokana

Type 2 diabetes
Lowering the risk of major heart events (e.g., heart attack, stroke) in adults with Type 2 diabetes and heart disease
Lowering the risk of hospitalization for heart failure, death due to heart problems, and worsening of kidney problems in certain adults with Type 2 diabetes and diabetic kidney disease

Pros and Cons for Invokana

Pros

Only taken once a day
Can use alone or together with other diabetes medications
Dose can be adjusted based on how well the medication is working for you

Cons

Only available as brand only
Might raise the risk of genital infections or bone fracture
Not recommended in second and third trimesters of pregnancy
Unknown if safe or works well in people on dialysis

Common Side Effects for Invokana

Vaginal yeast infection in females (11-12%)
Urinary tract infections (UTIs; 4-6%)
More urination (5%)

Warnings for Invokana

Leg and foot amputations
Ketoacidosis
Low fluids in the body (leading to low blood pressure or dehydration)
Genital and urinary tract infections
Low blood sugar (hypoglycemia) when used with certain other diabetes medications
Severe allergic reactions
Bone fractures

Summary for Afrezza

Prescription only

Afrezza is an ultra rapid-acting inhaled insulin for adults with diabetes. It helps manage blood sugar levels from meals. You breathe in the medication through the mouth using the Afrezza inhaler usually at the start of meals. Common side effects are low blood sugar and cough. There's also a risk of bronchospasm (sudden narrowing of the airways), which can make it hard to breathe. So Afrezza (insulin) isn't for people with breathing problems like asthma or chronic obstructive pulmonary disease (COPD).

Indications for Afrezza

Type 1 diabetes (T1D) in adults
Type 2 diabetes (T2D) in adults

Pros and Cons for Afrezza

Pros

A good choice for people who don't want to use injectable insulin
Can help people with either Type 1 or Type 2 diabetes manage blood sugar
Starts to work in about 12 minutes and lasts between 1.5 and 3 hours, depending on your dose

Cons

Might need to use more than one cartridge of insulin for your dose (if you need more than 12 units of insulin)
Not for people who smoke or for people with breathing problems (e.g., asthma, COPD)
Not approved for children

Common Side Effects for Afrezza

Low blood sugar (up to 67%)
Cough (up to 29%)
Throat pain or irritation (up to 6%)
Headache (up to 5%)

Warnings for Afrezza

Breathing problems
Low blood sugar levels (hypoglycemia)
Changes in blood sugar levels with changes to your insulin routine
Diabetic ketoacidosis
Low potassium levels
Swelling from fluid buildup and risk of heart failure when taken with certain diabetes medications