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Post by Deleted on Feb 28, 2019 10:06:57 GMT -5
It doesn't take Afrezza to obsolete current pumps, the automated insulin delivery systems coming out do that. This is what Dr Bode talks about the most, not Afrezza. That said I have difficulty seeing automated systems spreading to T2 simply on cost grounds. What do automated insulin delivery systems use for insulin and does it have to be absorbed through subcutaneous tissue? Use same insulin. Infusion sets / process same as current pumps. Some of the automated pumps have features such as low BG suspend. AI if you will.
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Post by slugworth008 on Feb 28, 2019 10:34:35 GMT -5
That is such an obvious fit - Who knows maybe it will actually happen.
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Post by prcgorman2 on Feb 28, 2019 12:05:37 GMT -5
What do automated insulin delivery systems use for insulin and does it have to be absorbed through subcutaneous tissue? Use same insulin. Infusion sets / process same as current pumps. Some of the automated pumps have features such as low BG suspend. AI if you will. Doesn't that imply the same challenges with estimating dose for a meal and time to onset of peak effective action? I do not understand how an automated pump is competitive to Afrezza. As for low BG suspend, I think that's a great feature for a pump, but seems unnecessary if a PWD uses Afrezza instead.
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Post by rockstarrick on Feb 28, 2019 14:03:40 GMT -5
Use same insulin. Infusion sets / process same as current pumps. Some of the automated pumps have features such as low BG suspend. AI if you will. Doesn't that imply the same challenges with estimating dose for a meal and time to onset of peak effective action? I do not understand how an automated pump is competitive to Afrezza. As for low BG suspend, I think that's a great feature for a pump, but seems unnecessary if a PWD uses Afrezza instead. What is an “automated pump” ?? Is this a different name for the APS ?
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Post by agedhippie on Feb 28, 2019 17:00:06 GMT -5
The automated insulin delivery class is bigger than APS, the APS is the ultimate form of automated delivery.
The automated system is a pump / CGM pair and does not require you to be accurate with doses, it just requires you to be in the ballpark like Afrezza. The pump will zero in automatically from there. The Medtronics 670G (the 670G is a combined pump and CGM) averages 72% TIR in trials and there are improvements that can be made to that. The next generation will just require you to say you are eating and not to input any dosing information at all, they will work it all out for themselves. This is why Dr Bode, afrezzauser's endo, thinks they are the most important step since the discovery of insulin.
While this could easily also be used for T2 I think it would be cost prohibitive as it stands so I don't see it having much impact in the T2 market for some time. That said Medtronics have pay by result contracts with Aetna and UHC where they provide the 670G and the insurers pay for the outcome, that might get extended to some T2 if Medtronics can make the finances stack up for the insurers.
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Post by sayhey24 on Feb 28, 2019 17:49:17 GMT -5
Aged - what happened to the rotary phone, then the push button phone and even the flip phone? Al Mann publicly said at the John Hopkins presentation years ago that afrezza would obsolete current pumps. Its taken a while but now more and more the greater community is seeing the value we have discussed here for many years. TNDM won't be alone.
With Tresiba or split Lantus dosing and afrezza the pump market will shrink. It was a good move by Joey's Tandem guy to jump ship to MNKD. It doesn't take Afrezza to obsolete current pumps, the automated insulin delivery systems coming out do that. This is what Dr Bode talks about the most, not Afrezza. That said I have difficulty seeing automated systems spreading to T2 simply on cost grounds. Aged - I am not really sure what you are talking about. Who developed the insulin pump? I think it was the same guy who invented the CGM and the first AP. Who was that, yes Al Mann. What did Al say the problem was with pumps/AP? Yes, the RAA used in the pumps was TOO DAMN SLOW. The pumps are not the problem and better alogirthms are not going to fix them. Its the insulin inside.
Why did Al develop afrezza? Yes, to solve the problem of the insulins being too damn slow. In doing so Al Mann obsoleted all pumps. Call them APs, automated systems or whatever they all have the same problem - the insulin inside. If it was just dosing algorithms Al would have developed those in his sleep. The bottom line is afrezza obsoletes the pumps. At the time Tresiba was not yet approve and Al said for T1s all they need is a patch pump. With Tresiba most T1s just need the Tresiba and afrezza.
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time.
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Post by lennymnkd on Feb 28, 2019 18:04:03 GMT -5
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time. Read more: mnkd.proboards.com/thread/11024/endo-visit-yesterday#ixzz5grzHGJVK Always want to make that comment ! But felt I didn’t have the credibility on this board to make it . Glad you did sayhey...
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Post by mango on Feb 28, 2019 18:08:10 GMT -5
It doesn't take Afrezza to obsolete current pumps, the automated insulin delivery systems coming out do that. This is what Dr Bode talks about the most, not Afrezza. That said I have difficulty seeing automated systems spreading to T2 simply on cost grounds. Aged - I am not really sure what you are talking about. Who developed the insulin pump? I think it was the same guy who invented the CGM and the first AP. Who was that, yes Al Mann. What did Al say the problem was with pumps/AP? Yes, the RAA used in the pumps was TOO DAMN SLOW. The pumps are not the problem and better alogirthms are not going to fix them. Its the insulin inside.
Why did Al develop afrezza? Yes, to solve the problem of the insulins being too damn slow. In doing so Al Mann obsoleted all pumps. Call them APs, automated systems or whatever they all have the same problem - the insulin inside. If it was just dosing algorithms Al would have developed those in his sleep. The bottom line is afrezza obsoletes the pumps. At the time Tresiba was not yet approve and Al said for T1s all they need is a patch pump. With Tresiba most T1s just need the Tresiba and afrezza.
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time.
This Al Mann you speak of must have been one brilliant fella!
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Post by sayhey24 on Feb 28, 2019 20:20:18 GMT -5
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time. Read more: mnkd.proboards.com/thread/11024/endo-visit-yesterday#ixzz5grzHGJVK Always want to make that comment ! But felt I didn’t have the credibility on this board to make it . Glad you did sayhey... Lenny - its happening and everyone and their brother is in the game. "They" tell me the iWatch Tim Cook is walking around with works. Google is doing something. Fitbit is doing something plus investing in other companies doing something.
Here are a few of the less known developments <iframe style="position: absolute; width: 18.600000000000023px; height: 4.840000000000003px; z-index: -9999; border-style: none;left: 15px; top: -5px;" id="MoatPxIOPT0_22850082" scrolling="no" width="18.600000000000023" height="4.840000000000003"></iframe> <iframe style="position: absolute; width: 18.6px; height: 4.84px; z-index: -9999; border-style: none; left: 875px; top: -5px;" id="MoatPxIOPT0_3356365" scrolling="no" width="18.600000000000023" height="4.840000000000003"></iframe> <iframe style="position: absolute; width: 18.6px; height: 4.84px; z-index: -9999; border-style: none; left: 15px; top: 181px;" id="MoatPxIOPT0_4026177" scrolling="no" width="18.600000000000023" height="4.840000000000003"></iframe> <iframe style="position: absolute; width: 18.6px; height: 4.84px; z-index: -9999; border-style: none; left: 875px; top: 181px;" id="MoatPxIOPT0_73975613" scrolling="no" width="18.600000000000023" height="4.840000000000003"></iframe>
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Post by agedhippie on Feb 28, 2019 20:40:06 GMT -5
It doesn't take Afrezza to obsolete current pumps, the automated insulin delivery systems coming out do that. This is what Dr Bode talks about the most, not Afrezza. That said I have difficulty seeing automated systems spreading to T2 simply on cost grounds. Aged - I am not really sure what you are talking about. Who developed the insulin pump? I think it was the same guy who invented the CGM and the first AP. Who was that, yes Al Mann. What did Al say the problem was with pumps/AP? Yes, the RAA used in the pumps was TOO DAMN SLOW. The pumps are not the problem and better alogirthms are not going to fix them. Its the insulin inside.
Why did Al develop afrezza? Yes, to solve the problem of the insulins being too damn slow. In doing so Al Mann obsoleted all pumps. Call them APs, automated systems or whatever they all have the same problem - the insulin inside. If it was just dosing algorithms Al would have developed those in his sleep. The bottom line is afrezza obsoletes the pumps. At the time Tresiba was not yet approve and Al said for T1s all they need is a patch pump. With Tresiba most T1s just need the Tresiba and afrezza.
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time.
What can we do with pumps in use today? A Medtronics 670G averages 72% TIR, Afrezza with ideal (not average) dosing achieves 62% in the STAT trial. The pump is already getting better results despite using inferior insulin. Modern pumps use software to compensate for the speed of RAA by continually adjusting the dose in the same way that a fly-by-wire computer adjust and aircraft's control surfaces and engines. People get hung up on the idea of the behavior of a single dose which matters for MDI, but far less in modern pumps. Once you get away from the idea of a single dose the insulin speed becomes less important. And this is before the dual hormone pumps with glucagon arrive. Al knew what he was talking about at the time he was talking about it, but times move on.
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Post by sayhey24 on Feb 28, 2019 20:54:38 GMT -5
Aged - during non fasting hours 8am-8pm afrezza users where 100% in range. Afrezza is a prandial and not a basal. Don't look for afrezza to affect fasting BG at 2am. That is not afrezza's job.
To achieve fasting "time in range" the PWD would need to do what Dr. Kendall suggested and increase the basal.
If you want to use a patch pump to do that, great. If you want just Tresiba or split dose lantus, thats fine too. Its really a personal choice. However the need for highly sophisticated AP systems is no longer needed.
We have known for years the best results gotten with APs was when they used afrezza for meals. The Yale study will show the same.
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Post by uvula on Feb 28, 2019 21:23:08 GMT -5
My simplistic view of control systems: When you eat you get a quick spike in sugar. SQ insulin is slow no matter how to get it in to the body. You can't chase something quick with something slow.
Picture a fly and a slow computer controlled flyswatter. There is a limit to how much fancy software and AI can help the performance of a slow flyswatter. What you need is a faster flyswatter.
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Post by peppy on Feb 28, 2019 21:31:22 GMT -5
Aged - I am not really sure what you are talking about. Who developed the insulin pump? I think it was the same guy who invented the CGM and the first AP. Who was that, yes Al Mann. What did Al say the problem was with pumps/AP? Yes, the RAA used in the pumps was TOO DAMN SLOW. The pumps are not the problem and better alogirthms are not going to fix them. Its the insulin inside.
Why did Al develop afrezza? Yes, to solve the problem of the insulins being too damn slow. In doing so Al Mann obsoleted all pumps. Call them APs, automated systems or whatever they all have the same problem - the insulin inside. If it was just dosing algorithms Al would have developed those in his sleep. The bottom line is afrezza obsoletes the pumps. At the time Tresiba was not yet approve and Al said for T1s all they need is a patch pump. With Tresiba most T1s just need the Tresiba and afrezza.
In three to five years everyone will have a CGM on their wrist not just PWDs. They will be in the IWatch and Fitbit and other devices. Dr. Bode can talk about whatever he wants but when prediabetics and early T2s see their BG post meal going to 200+ they will realize they have a problem and should do something. That something is not attaching some device to their body. What they will do is take the afrezza at meal time.
What can we do with pumps in use today? A Medtronics 670G averages 72% TIR, Afrezza with ideal (not average) dosing achieves 62% in the STAT trial. The pump is already getting better results despite using inferior insulin. Modern pumps use software to compensate for the speed of RAA by continually adjusting the dose in the same way that a fly-by-wire computer adjust and aircraft's control surfaces and engines. People get hung up on the idea of the behavior of a single dose which matters for MDI, but far less in modern pumps. Once you get away from the idea of a single dose the insulin speed becomes less important. And this is before the dual hormone pumps with glucagon arrive. Al knew what he was talking about at the time he was talking about it, but times move on. agedhippie /All, Talk to me old buddy old pal. I went to the Tandem site trying to figure out what they are selling. I had to dig and dig. Finally I found the pump. Small. www.tandemdiabetes.com/products/infusion-setsSo where is this pump? On the body? covered by what? Because, the reason I ask, is what they are selling seems to be a algorithm program and bluetooth technology. and what is shown on the main pages are, Here is my question. what am I looking at? Am I looking at a continuous glucose monitor sensor and a graph to the Monitor/phone/bluetooth? OR, am I looking at a continuous glucose monitor sensor and a pump in one? What are they selling where? as in where on the body, how many mechanisms? am I asking correctly? I haven't ever looked at pump technology, word is it started with the auto syringe. I am that old.
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Post by Deleted on Mar 1, 2019 9:10:16 GMT -5
Use same insulin. Infusion sets / process same as current pumps. Some of the automated pumps have features such as low BG suspend. AI if you will. Doesn't that imply the same challenges with estimating dose for a meal and time to onset of peak effective action? I do not understand how an automated pump is competitive to Afrezza. As for low BG suspend, I think that's a great feature for a pump, but seems unnecessary if a PWD uses Afrezza instead. I have not read up on the closed loop systems but apparently they use CGM data and run algos to determine IOB, glucose trends and other inputs to come up with dosing. For many, Afrezza will be much easier. Realistically a informed and disciplined Type 1 who also has a bit of luck on their side could have very good control with a closed loop system but the majority of Type 1s would not fall under this characterization. In the world of Rx (and healthcare in general) patient compliance is a challenge and many times, asking the patient to do the most simple of things is an exercise in futility and Liane can likely speak to this extensively. Ask a pharmacist how many of the diabetic patients that come in for insulin know which one they need - you would be shocked how many have not a clue. Easy to dose, very forgiving and less patient judgement required make Afrezza a winner for the PWD and in their very complicated lives, making compliance easier with better outcomes is a winning formula.
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Post by agedhippie on Mar 1, 2019 10:29:58 GMT -5
... Here is my question. what am I looking at? Am I looking at a continuous glucose monitor sensor and a graph to the Monitor/phone/bluetooth? OR, am I looking at a continuous glucose monitor sensor and a pump in one? What are they selling where? as in where on the body, how many mechanisms? am I asking correctly? I haven't ever looked at pump technology, word is it started with the auto syringe. I am that old. You are looking the CGM unit and the pump all combined into one unit. In the case of the Tandem the insulin lives in that unit and is pushed down a tube to the catheter under the skin. The pump decides what to send based on what it sees from the CGM, and on what you tell it you are doing. A pump is a miniaturized auto syringe, nothing more, nothing less. Tell it how you want the drug delivered and it does it. The newer pumps have the smarts to dynamically change the delivery based on what it sees. You have that exactly right.
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