afrezza device
tidepool loop device

Summary

Inhalable regular human insulin. Cartridges come in three doses: 4, 8, and 12-unit doses.

Tidepool Loop is the first fully interoperable automated insulin dosing app that originated as a patient-led initiative.

Background: A diabetes non-profit called Tidepool decided in 2018 to officially support Loop and shepherd it through the FDA process. Tidepool Loop was cleared by the FDA in January 2023 with plans to launch with Dexcom and other alternate controller-enabled (ACE) pump partners (RileyLink will no longer be necessary).

2023 Updates from Tidepool:

  • Medtronic and Tidepool have decided to discontinue the development of a Medtronic insulin pump system compatible with Tidepool Loop.
  • As Omnipod 5 is now commercially available, Insulet is devoting all available resources to their Omnipod products, including the global launch and further development of Omnipod 5.
  • Future ACE Pumps that will be commercially compatible with Tidepool Loop will need to be FDA-cleared for use with third-party interoperable automated glycemic (iAGC) controllers.

Components

Afrezza : Inhaler

Afrezza : Inhaler

Small refillable inhaler contains a compartment for powdered insulin containing cartridges.

Afrezza : Cartridge

Afrezza : Cartridge

Cartridges come in three doses: 4, 8, and 12-unit doses. All color coded.

Tidepool Loop  : Controller

Tidepool Loop : Controller

Smartphone or smartwatch receives CGM readings and automatically adjusts insulin delivery via insulin pump.

Device Details

Overview

Nothing on the body when not in use. Visible when dosing. 

Tidepool Loop is the first fully interoperable automated insulin dosing app that originated as a patient-led initiative.

Affordability and Access

$$$$
Widely covered. Price range; 0-$99/month, depending on insurance coverage. $35/month for medicare and commercial insurance plans. 

$$$$
Pump and CGM supply information is not yet available. iPhone is not covered and must be set up independently.

Data Monitoring Options

No Options

Yes
Compatible with Tidepool - a web-based diabetes data management system. 

Data View Options

No Options

Yes
Data can be viewed on an iPhone. 

Duration and Storage

10 Days
Open cartridges last up to 10 days. Sealed cartridges may be stored in a refrigerator at 36°F - 46°F until the expiration date.

Pump and CGM information not yet available. 

Vision / Auditory / Dexterity

NO text to speech
NO 
vibration alerts
LITTLE
 dexterity needed

NO text to speech
YES 
vibration alerts
A LOT 
of dexterity needed

Patient Considerations

Active Lifestyle

Body free of devices. Does not remain attached to the body.

Automatic responses. Can set custom blood sugar targets and insulin and carb sensitivities based on type of activity. App automatically responds to blood sugar changes during activity.

Avoiding Highs and Lows

Very short-acting. Absorbs quickly through the lungs to correct high blood sugar but requires attention to prevent lows. 

Automatically adjusts insulin delivery. Increases or decreases insulin delivery to meet glucose targets. Insulin delivery settings can be aggressive or conservative.

Comfort

Many components. Have to carry multiple cartridges that can be bulky. 

Low-profile mobile app. Dosing and other adjustments can be done directly on the mobile app. 

Easy Insulin Dosing

Less precise but easy dosing. Dosing may be less precise due to the inhaled method of dosing, but color-coded cartridges make dosing easier. Dosing can also be done based on small, medium, or large meals and can be administered 1-2 hours post meals. 

Customizable. Can bolus from phone or smartwatch and all settings are expected to be customizable. More information on modifications to insulin delivery will be available soon. 

Easy to Use

Simple design. Whistle-like device for inhaling insulin.

Easy dosing. Software makes most dosing decisions easy to do on the fly.

Fewer Fingersticks

Frequent finger-sticks are required. 

Factory-calibrated sensor. Fingersticks needed for backup only.

Privacy

Hideable. Small, discreet, and portable device that's not as noticeable as injections. 

Discreet. Ability to give insulin via watch or phone. Ability to check sugar on phone or watch. Alerts available.