Short answer: The Afrezza label gives one inhalation per cartridge at the beginning of each meal. People new to insulin start at 4 units per meal. People switching from injected mealtime insulin use the label's conversion table: up to 3 units becomes 4 units of Afrezza, and 8 or more becomes 16. Spirometry comes first. In type 1 diabetes it is always used with basal insulin. The label has no missed-dose rule.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Afrezza is approved for: Afrezza is an inhaled mealtime insulin approved to improve blood sugar control in adults and children 6 years and older with diabetes (section 1). It is not recommended for diabetic ketoacidosis, and not recommended in people who smoke or have recently stopped smoking.
Source
AFREZZA (insulin human) inhalation powder, for oral inhalation use, prescribing information, Medication Guide and Instructions for Use. MannKind Corporation. DailyMed, version published June 26, 2026. DailyMed setid 29f4637b-e204-425b-b89c-7238008d8c10
Afrezza is inhaled by mouth through the Afrezza Inhaler at the beginning of each meal, with a single inhalation per cartridge; doses larger than one cartridge use more than one. The inhaler is kept level once a cartridge is in; turning it upside down, pointing the mouthpiece down, shaking or dropping it can lose the dose (section 2.2).
Cartridges come in 4 units (blue), 8 units (green) and 12 units (yellow). Patients and caregivers are trained first; after training, people aged 10 and older may self-administer if the healthcare provider decides it is appropriate. An inhaler is used for up to 15 days, then replaced (sections 2.2 and 3).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Current subcutaneous mealtime insulin dosage | Starting dosage of AFREZZA |
|---|---|
| Up to 3 units | 4 units |
| 4 to 5 units | 8 units |
| 6 to 7 units | 12 units |
| 8 or more units | 16 units |
People new to insulin start at 4 units at each meal. Doses above one cartridge use combinations of 4, 8 and 12 unit cartridges.
| When | What the label says |
|---|---|
| Before starting | Medical history, physical exam and spirometry (FEV1) in all patients |
| After the first 6 months | Spirometry, even without symptoms |
| Every year after that | Spirometry, even without symptoms |
| FEV1 down 20% or more from baseline | Consider stopping Afrezza |
| Wheezing, bronchospasm, breathing trouble or lasting cough | Consider checking more often; stop if symptoms persist |
| Item | Refrigerated, not in use | Room temperature, in use |
|---|---|---|
| Sealed foil package | Until the expiration date (within 10 days if not refrigerated) | Not given |
| Sealed blister cards and strips | Within 1 month | Within 10 days |
| Opened strips | Not given | Within 3 days |
From premixed insulin, the mealtime part of the dose is estimated from that insulin's label and then converted with Table 1. Basal insulin, if needed, is dosed per its own label.
The mealtime dose is adjusted by metabolic needs, glucose monitoring and glucose goals, with more frequent checks while titrating. If glucose control is not reached with higher doses, stopping Afrezza is considered.
In type 1 diabetes, Afrezza is always used with basal insulin.
Cartridges sit at room temperature for 10 minutes before use. A card or strip is not put back in the refrigerator after room-temperature storage.
The Afrezza label gives no missed-dose rule. Neither the prescribing information nor the Medication Guide says what to do if a dose is missed; both say Afrezza is taken at the beginning of each meal.
When switching from another insulin, a different dose may be needed, with more glucose monitoring. Each injected mealtime dose (or pump bolus) is converted using Table 1.
Any change of insulin strength, maker, site, type or method is made under close medical supervision with more frequent glucose checks.
In Dose Track you set up Afrezza as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.