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

Key takeaways

Metformin (Glucophage) and Afrezza (inhaled insulin) are both medications used to manage diabetes, but they work in different ways. Metformin is taken orally and is primarily used for Type 2 diabetes. It helps lower the amount of sugar your body makes or absorbs and improves your body's use of insulin. Afrezza, on the other hand, is a fast-acting insulin inhaled through the mouth and is used for both Type 1 and Type 2 diabetes. It helps your body absorb and store sugar from your bloodstream after meals. Metformin rarely causes weight gain or low blood sugar, but it can cause stomach issues like diarrhea and nausea. Afrezza is a good option for those who dislike injections, but it can cause low blood sugar, cough, and throat irritation, and isn’t suitable for people with breathing problems like asthma or COPD. Additionally, Afrezza is not recommended for smokers or those who have recently quit smoking.

Metformin

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Afrezza

(insulin)

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Summary for Metformin

Prescription only

Immediate-release metformin is an oral diabetes medication. It's approved for people 10 years of age and older with Type 2 diabetes. The medication belongs to the drug class called biguanides. It works best to lower blood sugar levels with a diabetes-friendly diet and exercise plan. Immediate-release metformin comes as a tablet and an oral solution. You take this medication by mouth usually two to three times a day. It's recommended to take each dosage with food to help lessen side effects like diarrhea and nausea.

Indications for Metformin

Type 2 diabetes in people ages 10 years and older

Pros and Cons for Metformin

Pros

One of the first-choice options for Type 2 diabetes
Works well at lowering blood sugar levels (can lower your A1C by up to 1.5% in a few months)
Unlikely to cause weight gain
Available as a liquid for people who have trouble swallowing tablets

Cons

Typically need to take a couple times per day
Can cause stomach upset, including diarrhea, nausea, gas, and stomach cramping
Not a good choice for people with severe kidney problems
Not recommended for people with liver problems

Common Side Effects for Metformin

Diarrhea (53%)
Nausea or vomiting (26%)
Gas (12%)
Weakness (9%)

Warnings for Metformin

Lactic acidosis
Low vitamin B12 levels
Low blood sugar (hypoglycemia) when taken with certain other diabetes medications

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