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Post by ezrasfund on Mar 1, 2015 23:46:26 GMT -5
From the article linked by Afrezzauser www.endocrineweb.com/conditions/type-1-diabetes/what-insulin"The cells in your body need sugar for energy. However, sugar cannot go into most of your cells directly. After you eat food and your blood sugar level rises, cells in your pancreas (known as beta cells) are signaled to release insulin into your bloodstream. Insulin then attaches to and signals cells to absorb sugar from the bloodstream. Insulin is often described as a “key,” which unlocks the cell to allow sugar to enter the cell and be used for energy." Insulin does not metabolize glucose, instead it enables the cells to metabolize glucose; so the limiting factor is the capacity of the cells, not the amount of insulin. But the capacity of the cells is a rate of absorption, not an absolute amount. So RAA's that are present in the blood for a longer time mean more glucose metabolism. Excess levels of insulin in the blood do have an important function however, as they signal the liver to stop producing glucose. Here's an analogy: Imagine a restaurant that can serve 100 meals per hour. If 40 people show up for lunch hour, they serve 40 people. If 80 or 100 people show up they all get served. But if 120 people or even 400 people show up, only 100 are fed. If those who can't get served during lunch hour go away (Afrezza) the restaurant only serves 100. But if those excess people beyond the first 100 hang around all afternoon to get a table (Novolog) now the restaurant has served as many as 400 people in 4 hours. So much business may have depleted the storeroom (glucose) and they may have to call their supplier for extra food (that diabetic snack). And the restaurant's bank account is getting fat. But there is still another aspect to this, which is hepatic glucose production. Although Afrezza leaves the blood there is still a level of basal insulin and a need for glucose. As blood glucose approaches a lower limit (about 50?) the liver begins to release glucose. With Afrezza out of the system and the hepatic gluco-genesis having been stopped, the liver can now produce the needed glucose. But in contrast with Humalog still in the system and helping to metabolize more glucose, and with the liver having never completely stopped supplying glucose, the liver cannot release enough glucose to prevent hypoglycemia. I do not think we need a "smart insulin." What we have here is a smart system that works with Afrezza.
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Post by afrezzauser on Mar 2, 2015 10:27:56 GMT -5
My son has seen the same thing many times. You can read his letter to the FDA on my website. Once you go all the way to the point of no return it really affects you mentally. That is probably as close to death as I can come and completely recover.You know you are slipping away with just a matter seconds or a minute to save yourself. I wish nobody would ever experience that.
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Post by alethea on Mar 2, 2015 11:17:32 GMT -5
My son has seen the same thing many times. You can read his letter to the FDA on my website. Once you go all the way to the point of no return it really affects you mentally. That is probably as close to death as I can come and completely recover.You know you are slipping away with just a matter seconds or a minute to save yourself. I wish nobody would ever experience that. Dear Afrezzauser, I am a T2 with a pretty good A1c of 5.9 last time. I am quite insulin resistant. I have Morning Syndrome, aka Dawn Effect of high morning blood glucose readings even after having gone to bed with normal BG (about 100 or so). Last week I took 16 uts of Humalog when I had a BG of 172 at 9:00 am. I purposely did not eat anything afterwards. After two hours my BG was down to 114. I then ate 1 ounce of almonds, about 5 grams of carbs. After another 1 and a half hours my BG was down to 79. I just post this to illustrate how insulin resistant many T2's are. In 11 years I have never come close to having a dangerous hypo. I have been working on my doctor for more than a year trying to convince her to let me try Afrezza as soon as approval. Her response was concern that she could be in trouble for doing so since my A1c was so"good". THIS IS WHAT DIABETICS ARE UP AGAINST. Yes, I am trying with all my might to change doctors but my deal is complicated by having been forced to change insurance companies. I feel I KNOW that using Afrezza would allow me to live again more like a non-diabetic. A few days ago I broke down and had Chinese for lunch, Szechuan Pork with a big portion of rice. Had a BG of 244 about an hour and a half later. Humalog acts way too slowly to prevent this type of episode for me. It's incredibly frustrating that I cannot easily begin using Afrezza today. My life probably quite literally depends on it. I intend to do whatever it takes to get a doctor to get me on Afrezza. But I will have to solve my health insurance company restrictions. I want to express a BIG, HEARTFELT THANK YOU to you Afrezzauser for all the good you are doing. Thank God for you! Thank God for Al Mann.
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Post by gomnkd on Mar 2, 2015 11:51:16 GMT -5
alethea your solution is simple. change your doc. By changing your doc, you are doing yourself and the doc a favor.
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Post by alethea on Mar 2, 2015 12:16:07 GMT -5
alethea your solution is simple. change your doc. By changing your doc, you are doing yourself and the doc a favor. Yes, I WILL do so by whatever means necessary. BUT, my hands are tied behind my back by restrictions placed on me for choosing health insurance insurance companies. I am severely limited in my options of choosing health insurance companies due to the Affordable Care Act (Obamacare). Not a dig on Obamacare, I am very grateful for it! But the reason for my post was really to show just how different the needs of T2's are versus T1's. An equivalent poster to Afrezzauser who is a T2 would be a great, powerful development in the movement to educate the community about this new and wonderful treatment for diabetics, T2's as well as T1's.
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Post by pktrump on Mar 2, 2015 13:18:25 GMT -5
Great thread. Much appreciate Afrezza user. Also, can't agree more with having an equivalent T2 Afrezzauser.
Restablishing the phase I insulin response with AFZ and controlling post prandial glucose excursions with confidence decreases stress on the pancreas 'and' the brain. A new life indeed.
LT I would suspect the stress on the arterial system, nervous system, etc.. is attenuated or might I say eliminated in those that start AFZ early.
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Post by cybergym66 on Mar 2, 2015 13:35:18 GMT -5
alethea your solution is simple. change your doc. By changing your doc, you are doing yourself and the doc a favor. Yes, I WILL do so by whatever means necessary. BUT, my hands are tied behind my back by restrictions placed on me for choosing health insurance insurance companies. I am severely limited in my options of choosing health insurance companies due to the Affordable Care Act (Obamacare). Not a dig on Obamacare, I am very grateful for it! But the reason for my post was really to show just how different the needs of T2's are versus T1's. An equivalent poster to Afrezzauser who is a T2 would be a great, powerful development in the movement to educate the community about this new and wonderful treatment for diabetics, T2's as well as T1's.I'm sure you've seen this, but in case you haven't... www.activatethecard.com/7055/I haven't heard of anyone successfully using this yet...
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Post by tripoley on Mar 2, 2015 13:42:35 GMT -5
My son has seen the same thing many times. You can read his letter to the FDA on my website. Once you go all the way to the point of no return it really affects you mentally. That is probably as close to death as I can come and completely recover.You know you are slipping away with just a matter seconds or a minute to save yourself. I wish nobody would ever experience that. Dear Afrezzauser, I am a T2 with a pretty good A1c of 5.9 last time. I am quite insulin resistant. I have Morning Syndrome, aka Dawn Effect of high morning blood glucose readings even after having gone to bed with normal BG (about 100 or so). Last week I took 16 uts of Humalog when I had a BG of 172 at 9:00 am. I purposely did not eat anything afterwards. After two hours my BG was down to 114. I then ate 1 ounce of almonds, about 5 grams of carbs. After another 1 and a half hours my BG was down to 79. I just post this to illustrate how insulin resistant many T2's are. In 11 years I have never come close to having a dangerous hypo. I have been working on my doctor for more than a year trying to convince her to let me try Afrezza as soon as approval. Her response was concern that she could be in trouble for doing so since my A1c was so"good". THIS IS WHAT DIABETICS ARE UP AGAINST. Yes, I am trying with all my might to change doctors but my deal is complicated by having been forced to change insurance companies. I feel I KNOW that using Afrezza would allow me to live again more like a non-diabetic. A few days ago I broke down and had Chinese for lunch, Szechuan Pork with a big portion of rice. Had a BG of 244 about an hour and a half later. Humalog acts way too slowly to prevent this type of episode for me. It's incredibly frustrating that I cannot easily begin using Afrezza today. My life probably quite literally depends on it. I intend to do whatever it takes to get a doctor to get me on Afrezza. But I will have to solve my health insurance company restrictions. I want to express a BIG, HEARTFELT THANK YOU to you Afrezzauser for all the good you are doing. Thank God for you! Thank God for Al Mann. Check out this thread about insulin resistance: mnkd.proboards.com/thread/1791/why-afrezza-reduce-produce-resultsHyperinsulinemia might be a culprit in insulin resistance. The shorter tail on Afrezza might help to reduce this. Works on the glucose spike from eating and nothing more. The area under the curve (left image) in the PD profile shows how long insulin (lispro) floats around compared to Afrezza: Attachment Deleted
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Post by alethea on Mar 2, 2015 13:50:19 GMT -5
Yes, I WILL do so by whatever means necessary. BUT, my hands are tied behind my back by restrictions placed on me for choosing health insurance insurance companies. I am severely limited in my options of choosing health insurance companies due to the Affordable Care Act (Obamacare). Not a dig on Obamacare, I am very grateful for it! But the reason for my post was really to show just how different the needs of T2's are versus T1's. An equivalent poster to Afrezzauser who is a T2 would be a great, powerful development in the movement to educate the community about this new and wonderful treatment for diabetics, T2's as well as T1's. I'm sure you've seen this, but in case you haven't... www.activatethecard.com/7055/I haven't heard of anyone successfully using this yet... Yes, I am aware it and thanks very much! I still have to change insurance companies and find an amenable doctor when I do so. Thanks again!
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Post by alethea on Mar 2, 2015 13:55:50 GMT -5
Dear Afrezzauser, I am a T2 with a pretty good A1c of 5.9 last time. I am quite insulin resistant. I have Morning Syndrome, aka Dawn Effect of high morning blood glucose readings even after having gone to bed with normal BG (about 100 or so).............. I feel I KNOW that using Afrezza would allow me to live again more like a non-diabetic. A few days ago I broke down and had Chinese for lunch, Szechuan Pork with a big portion of rice. Had a BG of 244 about an hour and a half later. Humalog acts way too slowly to prevent this type of episode for me. It's incredibly frustrating that I cannot easily begin using Afrezza today. My life probably quite literally depends on it. I intend to do whatever it takes to get a doctor to get me on Afrezza. But I will have to solve my health insurance company restrictions............. Check out this thread about insulin resistance: mnkd.proboards.com/thread/1791/why-afrezza-reduce-produce-results
Hyperinsulinemia might be a culprit in insulin resistance. The shorter tail on Afrezza might help to reduce this. Works on the glucose spike from eating and nothing more. The area under the curve (left image) in the PD profile shows how long insulin (lispro) floats around compared to Afrezza:
Thank you! I will do so.
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Post by shmaser on Mar 2, 2015 14:44:55 GMT -5
explained by mike on tudiabetes:
Folks, Afrezza has loose dosing and low hypo risk because of the near-direct administration into the blood, which results in fast clearing time.
Everyone's confused because of the linear dosing model we've all been using with subQ administration, which naturally leads to an "understanding" that there is some sort of consumption of insulin involved in metabolizing sugar. I.e., sugar must be "paired up" with insulin, and it takes "X" units to "handle" "Y" carbs.
Well, that's not how it works, physiologically. Insulin is a hormone signal, not a participant in metabolizing sugar. It has an indirect relationship to sugar quantity. The relationship between insulin and carb metabolism is a function of QUANTITY and TIME. By stretching the presence of elevated insulin in the blood over many hours with subQ administration, the action approximates a linear relationship. However, when all of it dumps into the blood in a short time, that linear relationship no longer holds.
To fully understand this, you have to understand how insulin works, glucose channels, insulin receptors, glucose transport, etc. Not to the depth that some PhD would, but just the general broad strokes to see why.
Insulin is a "key" that opens a "door" (channel) on the cell surface that allows glucose to pass in to the cell. This is only the case for certain tissues that are insulin sensitive. And, contrary to what most people "understand", insulin plays no role in actual metabolizing sugar -- it only acts to store sugar.
So, if you raise insulin levels in the blood enough, those receptors can all get saturated, so that there are no more "doors" to open. Adding even more insulin will result in no change -- the rate of glucose clearance stays the same.
In this scenario, how much glucose is cleared becomes independent of insulin level, and becomes dependent, instead, on how long the channels are open. Longer, more glucose is cleared. So, in this scenario, glucose clearance rate will follow insulin clearance rate, not blood insulin concentration (which is what we control with dosing).
SubQ insulin administration, because of the absorption profile, biases the who process toward insulin quantity -- the actual insulin levels are relatively low compared to what a healthy pancreas would produce in phase 1. It continues to trickle in over time from diffusion. It's not enough to saturation receptors, so the amount of channels open is proportional to the insulin level, which is proportional to the bolus delivered.
In contrast, Afrezza is -- by comparison -- dumped entirely into the blood in a short time. It's there for a short time. Time metabolically active becomes much more of a factor than with subQ, for reasons explained above. As for hypos, it just doesn't hang around in the blood long enough to drive you down there.
I'm sure, however, that one could force a hypo with Afrezza pretty easily. Take 8U. Then, take 8U again in 45 minutes, so that the high levels are not allowed to clear. I'll bet a pretty hard hypo would result
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Post by mechstan on Mar 2, 2015 15:16:14 GMT -5
I get all that, but let's assume a diabetic knows that 4u drops their BG by 50 pts. What's the big deal with taking it on an empty stomach and dropping 50 pts in 30 minutes vs 2-3 hours? My assumption here is that 4u of Afrezza drops BG the same as 4u of humalog. I know that everyone is different, so maybe it's equal to 5u of humalog, but for this situation just assume we know what equal doses are. Is there anything special about not eating when taking insulin? If Afrezzauser was at 70, didn't eat, and took 4u of Afrezza he'd still drop to 20 and have a nice hypo, right? Is the point that the hypo from going down to 20 only would be a few minutes before it starts to trend back up? I don't entirely understand in the example AU posted why his BG would start trending back up after it hit 50. With Afrezza, glucose absorption rate is non-linear... within 1.5 hours it drops your blood glucose level dramatically by 50 pts, then the residual insulin clears out of your system in another hour without causing any noticeable drop in your blood glucose level because the amount of residual insulin is minute. So if your glucose level is at 100 before you take Afrezza and you take 4U of Afrezza, the maximum glucose drop is 50 pts if you eat nothing. Which drops to glucose level to 50 which is not considered dangerous to have you knocked out. With injected insulin, glucose absorption is linear (proportional to the amount in which monomeric insulin is released from the breakdown of the hexomeric insulin). Let's say you inject yourself. One and a half hour later, you blood glocose start dropping it keeps dropping your blood sugar dramatically for the next 3 hours. Let's say you don't eat anything, and that your blood glucose level drops 30 pts in the first hours, 25 pts in the second hour, and 15 pts in the third hour. So your glucose level drop by about 70 pts which puts your glucose level at around 30 which is consider dangerously low. Now do you understand the advantage of Afrezza? Even if you loosely dose, it's still pretty hard to cause hypo unless you really intend to cause a hypo. Which is take one 4U dose, then an hour later take another 4U dose and don't eat anything. You'll like get a hypo for sure. But that's your own doing though. The main advantages of Afrezza are very low risk of hypo (less hypo) and precise dosing is not required. Of course the Afrezza label doesn't say that because the people working for the FDA were stuck with the Rapid Acting Analog (RAA) philosophy that as long as your A1C number is under a certain number, then you are good which is NOT TRUE. Your A1C number can be good but you can still be hurting your body because you don't stay in range most of the time. Afrezza keeps you in range. Being in range is how you can defeat diabetes, not by keeping your A1C number under a certain number. People working at the FDA are not very smart. Either that or they are corrupt or both.
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Post by Chris-C on Mar 4, 2015 11:57:05 GMT -5
Apparently, if a drug is too effective and easy to use, it can be intimidating. Afrezzauser tweeted this last evening (with apologies if already posted on another thread): "Is this defamation against me?Mannkind?Sanofi?This is how low some people will go to stop #Afrezza $mnkd $sny myabetes.blogspot.com. See the blog at the link below. There had a been a photo of Sam with a defamatory heading. I'm not sure what motivates this type of attack, but it is very sad. The world contains an interesting array of personalities — some of whom I'd prefer not invite to dinner. myabetes.blogspot.com/2015/03/mannkinds-inhaled-insulin-afrezza.htmlGLTAL Chris C
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Post by savzak on Mar 4, 2015 12:08:09 GMT -5
Apparently, if a drug is too effective and easy to use, it can be intimidating. Afrezzauser tweeted this last evening (with apologies if already posted on another thread): "Is this defamation against me?Mannkind?Sanofi?This is how low some people will go to stop #Afrezza $mnkd $sny myabetes.blogspot.com. See the blog at the link below. There had a been a photo of Sam with a defamatory heading. I'm not sure what motivates this type of attack, but it is very sad. The world contains an interesting array of personalities — some of whom I'd prefer not to invite to dinner. myabetes.blogspot.com/2015/03/mannkinds-inhaled-insulin-afrezza.htmlGLTAL Chris C I was just reading some of the tripe on this blog. Unlike Sam, this person has no obvious reason to be proselytizing, particularly in such an aggressive fashion. Whereas Sam has a very informed history and now months of experience with Afrezza, this person is uninformed. Worse, this person is spreading FUD, including the old "lung cancer" chestnut. I suppose it's possible that a wing nut would spend hours to write this crap without any self interested motive, but I doubt that is the case here.
I think there will be more and more of this as Afrezza rolls out. Too much to lose on the other side. They won't go down easily.
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Post by jfl on Mar 4, 2015 14:07:39 GMT -5
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