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Post by abcabcacba1 on Mar 12, 2015 9:05:17 GMT -5
IMO, Sanofi Afrezza will decide to have a massive price competition to those inferior meal time drug maker. It will keep insurance company happy. After market monopolization, Mannkind can have a massive production, lower the cost to benefit diabetic patience worldwide.
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Post by bradleysbest on Mar 12, 2015 9:19:24 GMT -5
Silence is deadly! SNY will start their "full court press" soon.
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Post by silentbob on Mar 12, 2015 9:45:27 GMT -5
Hi dmb, thanks for sharing your results!
We are all hungry for information and real-life experiences here, so you taking the time to inform us is much appreciated!
It is unfortunate (and somewhat infuriating) that you can't get your hands on the 8U cartridges.
There should be a box with only 8U cartridges in them for T2's. You need more then one box a month anyway, so your RX could be a mix of 8U boxes with a 4U box (or a 60/30 mix box). I hope SNY/Mannkind fix this soon.
I read that you occasionally have had trouble with the tail end of your meal. You may have tried this already, but these things might improve efficacy:
1. Taking you first dose of Afrezza 15 minutes after first bite. This will help lining up the glucose spike with the insulin spike.
2. Splitting your dose into two. Only for big/carb heavy/ and/or slow digesting meals. The first dose could be taken 15 minutes after first bite, the second one 30 to 45 minutes later. -> Careful though, as a T2 your minimum effective dose might be 8U or even higher. So I wouldn't split up 12U into 8U and 4U for example.
3. You might have delayed stomach emptying. This affects mostly meals that include a good deal of protein as well. If this is the case then Afrezza might be finished before most of your meal is digested. Splitting your dose might help, but you can also try to add Betain HCL (with pepsin) which speeds digestion.
I don't know if this is helpful so I will stop there, but please ask if you would like to know more...
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Post by gamblerjag on Mar 12, 2015 10:59:41 GMT -5
It's great seeing people on the AFrezza page "being shocked at their new numbers".. says volumes..
Holy crap! Today is the first day that #Afrezza has TRULY impressed the hell outta me. 75 carb lunch, 5 4U carts. 130 at 1hr, 107 1.5hr
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Post by jay1ajay1a on Mar 12, 2015 12:12:56 GMT -5
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Post by Deleted on Mar 12, 2015 12:18:38 GMT -5
Per MNKD, it will be in the 2nd quarter. Valuewalk, I've found, loves to regurgitate others "news", but often gets it wrong.
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Post by dmb247 on Mar 12, 2015 23:00:23 GMT -5
Hi dmb, thanks for sharing your results! We are all hungry for information and real-life experiences here, so you taking the time to inform us is much appreciated! It is unfortunate (and somewhat infuriating) that you can't get your hands on the 8U cartridges. There should be a box with only 8U cartridges in them for T2's. You need more then one box a month anyway, so your RX could be a mix of 8U boxes with a 4U box (or a 60/30 mix box). I hope SNY/Mannkind fix this soon. I read that you occasionally have had trouble with the tail end of your meal. You may have tried this already, but these things might improve efficacy: 1. Taking you first dose of Afrezza 15 minutes after first bite. This will help lining up the glucose spike with the insulin spike. 2. Splitting your dose into two. Only for big/carb heavy/ and/or slow digesting meals. The first dose could be taken 15 minutes after first bite, the second one 30 to 45 minutes later. -> Careful though, as a T2 your minimum effective dose might be 8U or even higher. So I wouldn't split up 12U into 8U and 4U for example. 3. You might have delayed stomach emptying. This affects mostly meals that include a good deal of protein as well. If this is the case then Afrezza might be finished before most of your meal is digested. Splitting your dose might help, but you can also try to add Betain HCL (with pepsin) which speeds digestion. I don't know if this is helpful so I will stop there, but please ask if you would like to know more... Everything you've said, I've contemplated, and will being doing once I get the 8U carts, hopefully tomorrow. Dr called in 8Ux60/4Ux30 today, two boxes. But this Betain HCL? What on earth is that? Do you really think this may help?
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Post by silentbob on Mar 13, 2015 8:21:31 GMT -5
Everything you've said, I've contemplated, and will being doing once I get the 8U carts, hopefully tomorrow. Dr called in 8Ux60/4Ux30 today, two boxes. But this Betain HCL? What on earth is that? Do you really think this may help? Only if your gastric emptying is slower then average, and only if it is due to certain causes. That would mostly meals with a significant protein component more then low-protein meals. It is quite common but it is difficult to test for. The good news is that HCL is cheap, safe, OTC, and has been used by tens of thousands for many years. It is a supplement, not medicine. The simplest way to know if it helps you is trying it out. www.amazon.com/Now-Foods-Betaine-HCl-Capsules/dp/B000M4CD2C/Start with 1 pill/meal and work your way up, only take with food.
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Post by kball on Mar 13, 2015 8:29:49 GMT -5
Just wanted to add how nice it is to hear that even with trouble , skepticism, and poor results initially that DMB now has it dialed in and looks forward to even better results.
Something i've been thinking about as an asthmatic who has to be very careful about what i eat and or breathe (fragrances can set off wheezing), a real bonus of Afrezza use HAS TO BE how much less loved ones will now worry about their diabetic significant others at mealtime and after.
Also as one who has been sucking an inhaler forever, a slow normal inhalation has worked better than a quick suck of the meds. The fast suck always has unwanted consequences.
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Post by silentbob on Mar 14, 2015 5:18:46 GMT -5
DMB,
I must say I am a little worried about you raising your lantus dose so rapidly. With fluctuations in activity and cab intake this could be a hypo risk.
Have you ever considered an SGLT-2 inhibitor? This is a class of drugs that removes glucose from the blood through the urine. It sidesteps the whole resistance issue, and would give your liver and pancreas a break from having to process so much glucose. It should also work together with Afrezza to reduce insulin resistance by exposing cells to less glucose & insulin.
Further, it is self regulating in that less glucose is discarded the lower your blood sugar goes. Who knows, it may help with your 3-hr spike as well.
Using an SGLT-2 inhibitor should allow you to reduce your Lantus dose and may reduce your overall hypo risk as well.
The main reason I like that class of drugs is that the biggest problem we have in diabetes is excess glucose intake, and SGLT-2 inhibitors remove some of that excess glucose.
Examples of this drug are Invokana and Farxiga. There are potential side effects but in your case it certainly seems worth the risk.
Maybe something to consider?
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Post by xoxoxoxo on Mar 14, 2015 7:41:57 GMT -5
I think the point with going straight to insulin therapy is that you eliminate the need for taking stuff like Invokana. If the risk of hypo is extremely low with a Lantus/Afrezza combo, why would anyone want to take a pill that can do the following:
General
The most commonly reported adverse reactions were hypoglycemia when used in combination with insulin or an insulin secretagogue, vulvovaginal candidiasis, urinary tract infection, and increased urinary frequency.[Ref]
Genitourinary
Very common (10% or more): Female genital mycotic infections including vulvovaginal mycotic infection, vulvovaginitis, vaginal infection, vulvitis, and genital infection fungal (up to 11.4%), recurrent male genital mycotic infections (22%) Common (1% to 10%): Urinary tract infection, increased urination, male genital mycotic infections including balanitis, balanoposthitis, balanitis candida, and fungal genital infection Uncommon (0.1% to 1%): Phimosis[Ref]
Cardiovascular
Common (1% to 10%): Adverse reactions related to reduced intravascular volume (postural hypotension, orthostatic hypotension, hypotension, dehydration, and syncope)[Ref]
Metabolic
Very common (10% or more): Hypoglycemia when combined with insulin or an insulin secretagogue (up to 49%), hyperkalemia (up to 27%) Common (1% to 10%): Increased serum magnesium, increased serum phosphate, increased low-density lipoprotein (LDL-C)[Ref]
Gastrointestinal
Common (1% to 10%): Constipation, thirst, nausea, abdominal pain, pancreatitis[Ref]
Musculoskeletal
In a pooled analysis of 8 clinical trials with a mean duration drug exposure of 68 weeks, the rate of bone fracture was 18.7 and 17.6 per 1000 patient years of exposure to the 100 or 300 mg dose, respectively compared with 14.2 in those receiving comparator drug or placebo. Upper extremity fractures were more common in the canagliflozin (the active ingredient contained in Invokana) exposed group.[Ref]
Uncommon (0.1% to 1%): Bone fracture, upper extremity fracture[Ref]
Hypersensitivity
Common (1% to 10%): Hypersensitivity reactions including rash, pruritus, urticaria, and angioedema Frequency not reported: Serious hypersensitivity reaction[Ref]
Renal
In a pooled analysis among patients with moderate renal impairment, the incidence of renal related adverse reactions such as increased serum creatinine, decreased eGFR, renal impairment, or acute renal failure, was 8.9% and 9.3% in patients receiving canagliflozin (the active ingredient contained in Invokana) 100 mg or 300 mg, compared with 3.7% in those receiving comparator drug or placebo.[Ref]
Frequency not reported: Increases in serum creatinine, decreases in eGFR, renal impairment, acute renal failure[Ref]
Dermatologic
Uncommon (0.1% to 1%): Photosensitivity reactions, rash, urticaria[Ref]
Other
Common (1% to 10%): Fatigue, asthenia[Ref]
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Post by silentbob on Mar 14, 2015 15:50:47 GMT -5
I think the point with going straight to insulin therapy is that you eliminate the need for taking stuff like Invokana. If the risk of hypo is extremely low with a Lantus/Afrezza combo, why would anyone want to take a pill that can do the following: I'm not suggesting dropping anything. I am suggesting an Afrezza/Lantus/SGLT2i combo. Or at least if dmb tolerates it. The SGLT2i class of drugs has a lower hypo rate then Lantus. If you read dmb's comments on twitter you will see that he is increasing Lantus dosing at an alarming rate and it is not having the desired effect. Severe insulin resistance is a serious condition and could have much more serious consequences then Adding extra insulin at these doses just forces cells to take up more glucose, while they are already signalling that they have an excess. SGLT-2 inhibitors go to the root of the problem - removing glucose from the system entirely. And yes the SGLT2i label is scary. But so is that of Afrezza. The main risks are UTI's but they are usually mild for males. There are other risks as well, but the risks of not removing excess glucose from the system seem drastically higher to me. I am only suggesting this for him to consider it and talk it over with his doctor, as an alternative to sky-high basal insulin. I don't know why that should be a bad thing.
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Post by dmb247 on Mar 16, 2015 0:37:33 GMT -5
silentbob, I will look into it, thanks.
I've been increasing the Lantus so quickly because the result hasn't been as desired. The most I've one in a day is 8unit increase, and I am extra careful when I change anything. I'm checking my BG 12-16x a day sometimes.
I'm up to 70U a day now, 35 2times, and I have found that seems to be the magic number. It keeps me steady once my post prandial BGs are sorted out. I haven't increased it in 3 days now, and it seems to be working pretty well.
I am having issues with wheezing after taking 2 8U cartridges though unfortunately. Haven't had any asthma issue in nearly 15 years. I hope it sorts itself out like the cough did originally, but if not, Afrezza might have to be my #2 with Humalog being my primary insulin. in which case, I can see a pump in my future.
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Post by babaoriley on Mar 16, 2015 2:14:35 GMT -5
Good luck with it and to you, dmb, and thanks for keeping us up to date!
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Post by jpg on Mar 16, 2015 2:24:01 GMT -5
dmb,
If you are asthmatic (as you obviously seem to say you are) and reacting to the medication (which you again are from what you say) you should maybe simply forgo Afrezza and obviously talk to your doctor. It's probably simply not for you as you are part of the 20-25% of patients who shouldn't be on it.
Good luck and thank you for the info.
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