Short answer: Afrezza is inhaled human insulin taken at the start of each meal, for adults and children 6 and older; it carries a boxed warning on acute bronchospasm and needs a lung test first.1 NovoLog (insulin aspart) is injected 5 to 10 minutes before a meal, and can also be used in a pump.2 Afrezza's label compared it with injected insulin in general, not NovoLog by name.
| Afrezza | NovoLog | |
|---|---|---|
| How taken | Inhaled from 4, 8 or 12 unit cartridges at the beginning of each meal1 | Injected under the skin 5 to 10 minutes before a meal; pump or vein also possible2 |
| Who | Adults and children 6 and older; not for people who smoke or recently stopped1 | Adults and children with diabetes2 |
| Switching from injected mealtime insulin | Up to 3 units becomes 4 units; 4 to 5 becomes 8; 6 to 7 becomes 12; 8 or more becomes 161 | A different NovoLog dose may be needed2 |
| Tests needed | Spirometry before starting, after 6 months, then yearly1 | No lung tests2 |
| Most common besides low blood sugar | Cough: 29% vs 5% on injected insulin in type 1 trials1 | Headache 12% vs 10% on regular human insulin in a type 1 trial2 |
| Type 1 diabetes | Always with a basal insulin1 | By injection, generally with an intermediate or long-acting insulin2 |
| Missed dose | No rule in the label1 | No rule in the label2 |
| Boxed warning | WARNING: RISK OF ACUTE BRONCHOSPASM IN PATIENTS WITH CHRONIC LUNG DISEASE1 | None2 |
Afrezza is not used by people with asthma, COPD or other chronic lung disease. In a study of people with asthma, wheezing and airway narrowing followed a dose in 5 of 17. Over up to 2 years, lung function (FEV1) fell 40 mL more than on comparators; stopping is considered after a drop of 20% or more. Two lung cancers occurred in trials, both in heavy past smokers. In type 1 trials, diabetic ketoacidosis was 0.43% on Afrezza vs 0.14% on comparators.1
NovoLog's warnings are the usual insulin set: low blood sugar, low potassium, allergy, heart failure with pioglitazone-type drugs, never sharing pens, and fast high blood sugar if a pump fails.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Afrezza side effects, NovoLog side effects, the Afrezza and NovoLog dosing schedules, the NovoLog missed-dose page, the inhaled insulin and insulin aspart guides, and Afrezza vs Humalog: how does inhaled insulin compare with injected?.