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Post by harryx1 on Jun 10, 2019 12:01:57 GMT -5
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Post by celo on Jun 10, 2019 12:21:37 GMT -5
Great idea by the geniuses at the ADA. Too bad diabetics are going to have a hard time staying in range because the ADA recommendations for medications are archaic.
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Post by peppy on Jun 10, 2019 12:42:33 GMT -5
New Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring Presented Today at the ADA’s Scientific Sessions "recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes, and 63-140 mg/dL " Is this the reason for the price jump this morning? these can not be met with out afrezza. unless you are eating to the beat of your blood glucose reading. going to go low, butter eat some crackers and drink some juice. The new doctor approval letter. Dr health insurance agency. as the physician for ____ a type one diabetic patient since age 12, I find that in order to meet the ADA time in range recommendations of 70-180 mg/dL [3.9-10.0 mmol/L] my patient will require Approval for Afrezza (human insulin). Afrezza is the only insulin that works to keep my patient in range. I look forward to a reply of approval. Dr. I read the studies.
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Post by goyocafe on Jun 10, 2019 12:43:51 GMT -5
New Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring Presented Today at the ADA’s Scientific Sessions "recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes, and 63-140 mg/dL " Is this the reason for the price jump this morning? these can not be met with out afrezza. unless you are eating to the beat of your blood glucose reading. going to go low, butter eat some crackers and drink some juice. AgedHippie will be along in a little while to tell you otherwise. Stay tuned...
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Post by agedhippie on Jun 10, 2019 16:36:52 GMT -5
New Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring Presented Today at the ADA’s Scientific Sessions "recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes, and 63-140 mg/dL " Is this the reason for the price jump this morning? these can not be met with out afrezza. unless you are eating to the beat of your blood glucose reading. going to go low, butter eat some crackers and drink some juice. AgedHippie will be along in a little while to tell you otherwise. Stay tuned... You called? According to STAT they cannot be met on Afrezza either without the second dose protocol. (Image from Seeking Alpha where they thoughtfully drew the lines on the graph) The missing bit in the article is what percentage of time in range is good enough. I keep on looking at the Diabetes Care page hoping the rest of the article turns up.
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Post by sayhey24 on Jun 10, 2019 17:58:41 GMT -5
Aged - this graph is highly misleading. Both compliant and non-compliant afrezza patients where 100% in range during the time action period of afrezza. Can you post that graph please.
To reach 100% TIR during sleeping hours the T1 would need to do what Dr. Kendalls recommendations were which is increase basal. Its very doable with as Dr. Kendall said no increase in hypos.
Trying to tie afrezza to BG levels at 2am is not only misleading but missing a major afrezza benefit which is fast in/out. If your RAA is affecting BG at 2am you got a problem and that is the historic problem.
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Post by agedhippie on Jun 10, 2019 20:01:47 GMT -5
Aged - this graph is highly misleading. Both compliant and non-compliant afrezza patients where 100% in range during the time action period of afrezza. Can you post that graph please. To reach 100% TIR during sleeping hours the T1 would need to do what Dr. Kendalls recommendations were which is increase basal. Its very doable with as Dr. Kendall said no increase in hypos. Trying to tie afrezza to BG levels at 2am is not only misleading but missing a major afrezza benefit which is fast in/out. If your RAA is affecting BG at 2am you got a problem and that is the historic problem. Why are BG levels at 2am misleading? My bed time correction of RAA will still be active at 2am and helping control my level. That fast in/fast out is a problem there because Afrezza tailed off over an hour earlier and has not been providing cover - I would say that is highly relevant because a longer tail is an attribute of RAA. Endos need to know what will happen when they move a patient to Afrezza which is why TIR continuous and not just for optimal intervals (ignoring any time after 1pm would help with non-compliant results for example.) As to higher basals - that sounds great until you don't eat as expected and the basal gives you a hypo. That is why your basal needs to be set at a neutral point so it suppresses your basal glucose and only your basal glucose. When did Dr Kendall say that you could do this because it's wrong which is why I would like to see if I am missing something?
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Post by peppy on Jun 10, 2019 20:28:29 GMT -5
Aged - this graph is highly misleading. Both compliant and non-compliant afrezza patients where 100% in range during the time action period of afrezza. Can you post that graph please. To reach 100% TIR during sleeping hours the T1 would need to do what Dr. Kendalls recommendations were which is increase basal. Its very doable with as Dr. Kendall said no increase in hypos. Trying to tie afrezza to BG levels at 2am is not only misleading but missing a major afrezza benefit which is fast in/out. If your RAA is affecting BG at 2am you got a problem and that is the historic problem. Why are BG levels at 2am misleading? My bed time correction of RAA will still be active at 2am and helping control my level. That fast in/fast out is a problem there because Afrezza tailed off over an hour earlier and has not been providing cover - I would say that is highly relevant because a longer tail is an attribute of RAA. Endos need to know what will happen when they move a patient to Afrezza which is why TIR continuous and not just for optimal intervals (ignoring any time after 1pm would help with non-compliant results for example.) As to higher basals - that sounds great until you don't eat as expected and the basal gives you a hypo. That is why your basal needs to be set at a neutral point so it suppresses your basal glucose and only your basal glucose. When did Dr Kendall say that you could do this because it's wrong which is why I would like to see if I am missing something? Here is the point aged. Kind of like, the old "can you hear me" now commercial. How long did it take you to learn you and your insulin dosage so well? hmmmm. Same difference. People have to learn how to dose their insulin. With CGM's it has just gotten easier. One more thing... "My bed time correction of RAA will still be active at 2am and helping control my level." do you drink orange juice at 3 am when you wake up to take a pee?
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Post by letitride on Jun 11, 2019 3:29:25 GMT -5
This is huge in that it is the first step to admitting the SOC is broken and why. And I do believe I know a fix for it.
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Post by agedhippie on Jun 11, 2019 8:53:58 GMT -5
Why are BG levels at 2am misleading? My bed time correction of RAA will still be active at 2am and helping control my level. That fast in/fast out is a problem there because Afrezza tailed off over an hour earlier and has not been providing cover - I would say that is highly relevant because a longer tail is an attribute of RAA. Endos need to know what will happen when they move a patient to Afrezza which is why TIR continuous and not just for optimal intervals (ignoring any time after 1pm would help with non-compliant results for example.) As to higher basals - that sounds great until you don't eat as expected and the basal gives you a hypo. That is why your basal needs to be set at a neutral point so it suppresses your basal glucose and only your basal glucose. When did Dr Kendall say that you could do this because it's wrong which is why I would like to see if I am missing something? Here is the point aged. Kind of like, the old "can you hear me" now commercial. How long did it take you to learn you and your insulin dosage so well? hmmmm. Same difference. People have to learn how to dose their insulin. With CGM's it has just gotten easier. One more thing... "My bed time correction of RAA will still be active at 2am and helping control my level." do you drink orange juice at 3 am when you wake up to take a pee? I think you learn how insulin works, but there is a big jump when you change insulin technology and you more or less have to learn again. Likewise MDI to pump for me. It is like all things with age though - you have more experience so you are aware of a wider range of options. I like CGMs (not the Libre so much - another story), but I love xDrip because of it's tracking and prediction mode does so much of my work for me. No, because (a) Happily my prostate seems relatively well behaved for my age so the 3am pee is not necessary , and (b) orange juice would put me far to high. Generally my levels start to rise around 4am from around 90 at 3am to 125 by the morning (110 if I am on Tresiba). If I do need to correct at night my level is usually around 75 and I take a dextrose tablet (4g of carbs) which will get me to about 90. Between about 1am and 4am the body reduces it's basal glucose output so you need less insulin
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Post by agedhippie on Jun 11, 2019 18:50:00 GMT -5
They don't make it easy to find this stuff. The ADA/ATTD consensus target TIR is 70% in range, less that 25% above 180, less than 5% below 70. There are different targets for the elderly or pregnant.
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Post by peppy on Jul 4, 2019 8:10:55 GMT -5
They don't make it easy to find this stuff. The ADA/ATTD consensus target TIR is 70% in range, less that 25% above 180, less than 5% below 70. There are different targets for the elderly or pregnant. While the panel maintains that CGM-based glycemic targets must be personalized to meet the needs of each individual with diabetes, the group reached a general consensus on glycemic recommendations based on data from large pre-CGM clinical trials, CGM randomized controlled trials and expert opinion. In their recommendations, the International Consensus on TIR targets, the panel outlines recommended cut points that individuals with type 1 diabetes, type 2 diabetes and women with diabetes during pregnancy should strive to achieve. The group recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes, and 63-140 mg/dL [3.5-7.8 mmol/L] during pregnancy, along with a set of targets for the time per day [% of CGM readings or minutes/hrs]). The recommendations also outline setting conservative CGM targets for people with diabetes who are older and/or considered high-risk, with a strong focus on reducing the percentage of time spent <70 mg/dL (<3.9 mmol/L) and preventing excessive hyperglycemia. The consensus group also emphasized that one important way to translate these new CGM targets into clinical practice is to implement a standard CGM report like the ambulatory glucose profile (AGP Report).
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Post by goyocafe on Jul 4, 2019 8:22:12 GMT -5
The consensus group also emphasized that one important way to translate these new CGM targets into clinical practice is to implement a standard CGM report like the ambulatory glucose profile (AGP Report). Read more: mnkd.proboards.com/thread/11294/new-recommendations-time-range-targets?page=1#ixzz5siMhHqW6Perhaps they can include the treatment protocol in effect at the time the standard CGM report is created. Correlating the treatment protocol and the values generated with each report would go a long way to identifying best in class treatment options.
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Post by peppy on Jul 4, 2019 8:32:33 GMT -5
I'd like to see a CGM on the GLP-1s. glucose-dependent insulinotropic peptide (GIP), GLP-1 I would like to see how the medication is really working on blood glucose levels. agedhippie and all, have you seen CGM on GLP-1? Throw up a link if you can please. 12.1 Mechanism of Action TRULICITY contains dulaglutide, which is a human GLP-1 receptor agonist with 90% amino acid sequence homology to endogenous human GLP-1 (7-37). Dulaglutide activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. Dulaglutide increases intracellular cyclic AMP (cAMP) in beta cells leading to glucose-dependent insulin release. Dulaglutide also decreases glucagon secretion and slows gastric emptying.Approved exenatide (Byetta, Bydureon), approved in 2005/2012. liraglutide (Victoza, Saxenda), approved 2010. lixisenatide (Lyxumia), approved in 2016. albiglutide (Tanzeum), approved in 2014 by GSK. dulaglutide (Trulicity), approved in 2014—manufactured by Eli Lilly. semaglutide (Ozempic), approved in 2017.
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Post by agedhippie on Jul 4, 2019 9:30:40 GMT -5
I'd like to see a CGM on the GLP-1s. glucose-dependent insulinotropic peptide (GIP), GLP-1 I would like to see how the medication is really working on blood glucose levels. agedhippie and all, have you seen CGM on GLP-1? Throw up a link if you can please. I don't think I have ever seen a CGM on GLP-1. It would have to be from a trial (they are very unlikely to give you a CGM if you are on GLP-1) and the graphs don't get published, only point in time data if that.There is one paper (it's a good paper) that looks at various drug combinations and even includes averaged CGM graphs and TIR here (you could dramatically improve the results by increasing their basal by a unit or two): - Basal Glucose Can Be Controlled, but the Prandial Problem Persists—It’s the Next Target!
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