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Post by sayhey24 on May 22, 2018 19:15:16 GMT -5
DBC - I stand corrected as most if not all of those interviewed have written about or used afrezza. I stand by my comment on Edelman - "got to love him" and his comment "Getting a narrow time in range for some folks is extremely hard, particularly depending on what insulin is being used. (Afrezza might help!)"
Again, I have to go back to the issue of afrezza being seen as insulin. These doctors view afrezza as "insulin". If they only knew it as afrezza "The Super Powder" they would all view it in a whole new way. Mike needs to get rid of the insulin baggage.
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Post by brotherm1 on May 22, 2018 19:38:38 GMT -5
Afrezza SP
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Post by agedhippie on May 22, 2018 19:43:38 GMT -5
Lets put CGMs in perspective for a moment - about 10% of the Type 1s in the US have a CGM and a lot of them probably aren't using it. CGMs are expensive to run, you are not getting much change out of $5,000 a year if you use it all year so most people who self-fund use it intermittently to keep costs manageable. However if you are using it you know what things look like and move on. It may well make a difference if you now try Afrezza and see the change however what is going to drive the swap to Afrezza?
There are new CGMs coming but that is going to take time and are probably not a lot cheaper. Bottom line - do not rely on CGMs to drive sales.
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Post by dreamboatcruise on May 22, 2018 20:08:02 GMT -5
Lets put CGMs in perspective for a moment - about 10% of the Type 1s in the US have a CGM and a lot of them probably aren't using it. CGMs are expensive to run, you are not getting much change out of $5,000 a year if you use it all year so most people who self-fund use it intermittently to keep costs manageable. However if you are using it you know what things look like and move on. It may well make a difference if you now try Afrezza and see the change however what is going to drive the swap to Afrezza? There are new CGMs coming but that is going to take time and are probably not a lot cheaper. Bottom line - do not rely on CGMs to drive sales. All valid points. When I was talking about CGMs coming was as much about their use in clinical trials as long term use by large segment of T2 population (which I feel isn't going to happen soon). I think post prandial excursions, TIR and more standardized reporting of hypos will become more prevalent in trials. FDA really should mandate it for new trials, IMO, even if they blind the CGMs for the patients. I think short term use, as you stated, could be very helpful for many patients. I also think CGMs should be considered standard of care in situations such as assisted living so physicians and responsible family can know what is going on.
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Post by brotherm1 on May 22, 2018 20:10:45 GMT -5
Lets put CGMs in perspective for a moment - about 10% of the Type 1s in the US have a CGM and a lot of them probably aren't using it. CGMs are expensive to run, you are not getting much change out of $5,000 a year if you use it all year so most people who self-fund use it intermittently to keep costs manageable. However if you are using it you know what things look like and move on. It may well make a difference if you now try Afrezza and see the change however what is going to drive the swap to Afrezza? There are new CGMs coming but that is going to take time and are probably not a lot cheaper. Bottom line - do not rely on CGMs to drive sales. The above coming from the gentleman who just earlier today posted that if the bionic pancreas system works, it will clean up in he T1 market. You believe this would be cheaper than $5k per year? Regarding CGM’s, I believe the Libre Freestyle is not much over $1k per year to operate.
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Post by agedhippie on May 22, 2018 20:54:04 GMT -5
Lets put CGMs in perspective for a moment - about 10% of the Type 1s in the US have a CGM and a lot of them probably aren't using it. CGMs are expensive to run, you are not getting much change out of $5,000 a year if you use it all year so most people who self-fund use it intermittently to keep costs manageable. However if you are using it you know what things look like and move on. It may well make a difference if you now try Afrezza and see the change however what is going to drive the swap to Afrezza? There are new CGMs coming but that is going to take time and are probably not a lot cheaper. Bottom line - do not rely on CGMs to drive sales. The above coming from the gentleman who just earlier today posted that if the bionic pancreas system works, it will clean up in he T1 market. You believe this would be cheaper than $5k per year? Regarding CGM’s, I believe the Libre Freestyle is not much over $1k per year to operate. I think it would cost more than $5k per year, but that would not be an issue. Right now CGMs are relatively easy to get if you are a Type 1 with insurance, however they are only 10% of the Type 1 market (pretty much 0% of the Type 2 market) because they are not compelling. If you are hypo-unaware they are a lifesaver, and CGMs improve your A1c, and significantly reduce your hypos (by about 25% I think) so there is a definite incentive, but with only 10% uptake obviously not enough of an incentive. So why would the bionic pancreas clean up and the CGM hasn't? With a CGM I actually spend more time. not less, dealing with diabetes because instead of only checking at meal times I am looking in between (am I up, am I down, where did that spike come from, all these questions I have now). With an AP it's just sitting there humming away and I can ignore it - that is compelling and this is coming from someone who avoids pumps. The Libre is subsidized at the moment as Abbott are inserting a coupon into the prescription process to keep the price to $75. When they stop the price will double based on the original price. Still cheaper than a CGM even then though if you are self-funding.
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Post by mango on May 22, 2018 22:51:07 GMT -5
The above coming from the gentleman who just earlier today posted that if the bionic pancreas system works, it will clean up in he T1 market. You believe this would be cheaper than $5k per year? Regarding CGM’s, I believe the Libre Freestyle is not much over $1k per year to operate. I think it would cost more than $5k per year, but that would not be an issue. Right now CGMs are relatively easy to get if you are a Type 1 with insurance, however they are only 10% of the Type 1 market (pretty much 0% of the Type 2 market) because they are not compelling. If you are hypo-unaware they are a lifesaver, and CGMs improve your A1c, and significantly reduce your hypos (by about 25% I think) so there is a definite incentive, but with only 10% uptake obviously not enough of an incentive. So why would the bionic pancreas clean up and the CGM hasn't? With a CGM I actually spend more time. not less, dealing with diabetes because instead of only checking at meal times I am looking in between (am I up, am I down, where did that spike come from, all these questions I have now). With an AP it's just sitting there humming away and I can ignore it - that is compelling and this is coming from someone who avoids pumps. The Libre is subsidized at the moment as Abbott are inserting a coupon into the prescription process to keep the price to $75. When they stop the price will double based on the original price. Still cheaper than a CGM even then though if you are self-funding. Man you know you don't want an AP. Let ME pay for your Afrezza so then you can eventually toss the cgm.
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Post by mnkdfann on May 23, 2018 1:07:06 GMT -5
Again, I have to go back to the issue of afrezza being seen as insulin. These doctors view afrezza as "insulin". If they only knew it as afrezza "The Super Powder" they would all view it in a whole new way. Mike needs to get rid of the insulin baggage. I feel that if a doctor thought of Afrezza as a 'super powder' rather than an insulin, he / she wouldn't really be a doctor. What you are describing sounds like it may have more appeal to chiropractors (except that most can't write prescriptions). Some of whom are already recommending 'powders' to combat diabetes: archive.sltrib.com/article.php?id=53699701&itype=CMSID"Clients start with a three-week gluten- and dairy-free diet of fruits, vegetables, nuts and beans, and drinks made with a powder that can "detoxify" their livers." (Anyone who thinks I am unfairly knocking chiropractors, please note that one of my nieces attended the foremost U.S. chiropractic college. Interpret that how you will.) I do not recall anyone mentioning it here before, but do a little googling and you'll find that treatment for diabetes is an increasing area of practice for chiropractors these days. They have theories about how diabetes arises, and how it should be treated. E.g. a connection between blood sugar and the spine.
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Post by sayhey24 on May 23, 2018 5:25:40 GMT -5
IMO, after the first month or so the CGM with the T2 on afrezza is not nearly as important as the first month. Joey and others options would be appreciated.
The big thing with the CGM is going to be the services looking to provide cloud monitoring. Even with the Libre the cloud monitoring is easy because you are going to scan the puck a lot. If you got the Glimp you will do it even more.
CGM cost is not going to be an issue. They are headed to commodity products like the razor. The money is in the cloud/Teledoc service longer term.
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Post by sayhey24 on May 23, 2018 5:32:12 GMT -5
Mnkfann - T2 diabetes management is pretty simple "stop the spike, do the super powder".
I was not aware of T2 becoming a big area in chiropractic care. Not to bust their bubble but people are not diabetic because they are not eating nuts. They are diabetic because they are not producing enough insulin for their needs.
However, maybe the VDex concept would fit better with the chiropractors. Ideally you want to provide T2s holistic care, diet, exercise and the super powder. Nothing wrong with a good walk and some nuts.
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Post by casualinvestor on May 23, 2018 9:20:35 GMT -5
Going back a bit in this thread, I thought that the inhaled aspect of Afrezza made it faster than RAA (subcutaneous makes that slow), and that has nothing to do with monomer vs dimer vs hexamer. IV insulin is still fastest in, I have not heard if IV insulin has a long tail or not. But all that is again taking the science too far down the rabbit hole. The simply said advantages of Afrezza are: - Much faster in, much faster out than anything else
- "Faster in" is fast enough to mimic first phase insulin response of the pancreas. The benefits of that could be extra reading for some docs, but it sounds sciencey enough to capture the layman's attention and would make a great soundbyte. Also, no other product does this.
- "Faster in" means you can take it a few min after you start eating, so much less risk of dosing and then not eating due to unexpected circumstance
- "Faster out" causes significantly less incidence of hypos (35% I think has been backed up by studies?), and less risk of stacking is needed
- "Faster out" means you can dose a bit higher with safety (no clue how this could be quantified), getting better A1c results
Oh, and it's inhaled vs injected. That is both an advantage and a disadvantage. Most people hate injections, but most people are careful about sucking unknown stuff into their lungs. Especially if it makes them cough. Concrete proof of inhalation safety would do wonders to turn this into a real advantage. It could be talked about as an advantage to getting corrections easily. 8u at the start of the meal and 4u later (because, dessert) is easier with inhaled
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Post by agedhippie on May 23, 2018 11:18:42 GMT -5
Going back a bit in this thread, I thought that the inhaled aspect of Afrezza made it faster than RAA (subcutaneous makes that slow), and that has nothing to do with monomer vs dimer vs hexamer. IV insulin is still fastest in, I have not heard if IV insulin has a long tail or not. But all that is again taking the science too far down the rabbit hole. The simply said advantages of Afrezza are: - Much faster in, much faster out than anything else
- "Faster in" is fast enough to mimic first phase insulin response of the pancreas. The benefits of that could be extra reading for some docs, but it sounds sciencey enough to capture the layman's attention and would make a great soundbyte. Also, no other product does this.
- "Faster in" means you can take it a few min after you start eating, so much less risk of dosing and then not eating due to unexpected circumstance
- "Faster out" causes significantly less incidence of hypos (35% I think has been backed up by studies?), and less risk of stacking is needed
- "Faster out" means you can dose a bit higher with safety (no clue how this could be quantified), getting better A1c results
Oh, and it's inhaled vs injected. That is both an advantage and a disadvantage. Most people hate injections, but most people are careful about sucking unknown stuff into their lungs. Especially if it makes them cough. Concrete proof of inhalation safety would do wonders to turn this into a real advantage. It could be talked about as an advantage to getting corrections easily. 8u at the start of the meal and 4u later (because, dessert) is easier with inhaled It's the delivery that makes Afrezza fast, it puts a lot of insulin into the bloodstream with little delay. IV is faster because it goes directly into the bloodstream. Contrary to what is often said hexamers make little difference in the end - you can see this with IV delivered Regular insulin which acts immediately and is hexamer heavy. IV insulin has a short tail and that is actually one of it's problems - you have to switch to subcutaneous insulin before you stop the IV insulin (two hours prior for Lantus, or one hour prior for RAA) or the patient goes hyperglycemic and potentially slips back into DKA. Stacking happens every day. You have a basal insulin and an RAA, you just stacked! That's a slightly snarky example, a better one would be breakfast bolus and a mid morning snack - I take the insulin needed to cover my breakfast, and then a couple of hours later with maybe 25% of my insulin left I take enough insulin to cover my snack. The second dose is stacked, but it's irrelevant because it is assigned to my breakfast carbs and so that zeros it out with the second bolus handling just the snack carbs. One way to think of it is that you stack carbs like you stack insulin so after you eat your glucose levels will be elevated until digestion is finished (this is your carb absorption rate). If you stack carbs you need to stack insulin, it's that simple.
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Post by joeypotsandpans on May 23, 2018 12:53:00 GMT -5
The above coming from the gentleman who just earlier today posted that if the bionic pancreas system works, it will clean up in he T1 market. You believe this would be cheaper than $5k per year? Regarding CGM’s, I believe the Libre Freestyle is not much over $1k per year to operate. I think it would cost more than $5k per year, but that would not be an issue. Right now CGMs are relatively easy to get if you are a Type 1 with insurance, however they are only 10% of the Type 1 market (pretty much 0% of the Type 2 market) because they are not compelling. If you are hypo-unaware they are a lifesaver, and CGMs improve your A1c, and significantly reduce your hypos (by about 25% I think) so there is a definite incentive, but with only 10% uptake obviously not enough of an incentive. So why would the bionic pancreas clean up and the CGM hasn't? With a CGM I actually spend more time. not less, dealing with diabetes because instead of only checking at meal times I am looking in between (am I up, am I down, where did that spike come from, all these questions I have now). With an AP it's just sitting there humming away and I can ignore it - that is compelling and this is coming from someone who avoids pumps. The Libre is subsidized at the moment as Abbott are inserting a coupon into the prescription process to keep the price to $75. When they stop the price will double based on the original price. Still cheaper than a CGM even then though if you are self-funding. Just an FYI, when I picked up my libre this week at CVS I was pleasantly surprised when they said "that will be $40"....I couldn't get my debit card in the pullout bin fast enough lol not sure what happened since last month but that was sweet to hear. Loving this new VGK themed font color so you will probably have to bear with it for a couple of weeks
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Post by mnholdem on May 23, 2018 14:00:11 GMT -5
Actually, joey, you would be violating the board rules with that continuous font selection. I suggest that you use it only for the words "Vegas" or "Knights".
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Post by slugworth008 on May 24, 2018 9:18:48 GMT -5
I think it would cost more than $5k per year, but that would not be an issue. Right now CGMs are relatively easy to get if you are a Type 1 with insurance, however they are only 10% of the Type 1 market (pretty much 0% of the Type 2 market) because they are not compelling. If you are hypo-unaware they are a lifesaver, and CGMs improve your A1c, and significantly reduce your hypos (by about 25% I think) so there is a definite incentive, but with only 10% uptake obviously not enough of an incentive. So why would the bionic pancreas clean up and the CGM hasn't? With a CGM I actually spend more time. not less, dealing with diabetes because instead of only checking at meal times I am looking in between (am I up, am I down, where did that spike come from, all these questions I have now). With an AP it's just sitting there humming away and I can ignore it - that is compelling and this is coming from someone who avoids pumps. The Libre is subsidized at the moment as Abbott are inserting a coupon into the prescription process to keep the price to $75. When they stop the price will double based on the original price. Still cheaper than a CGM even then though if you are self-funding. Just an FYI, when I picked up my libre this week at CVS I was pleasantly surprised when they said "that will be $40"....I couldn't get my debit card in the pullout bin fast enough lol not sure what happened since last month but that was sweet to hear. Loving this new VGK themed font color so you will probably have to bear with it for a couple of weeks Ah yes, the best team money can buy - and loose NHL regulations. LOL
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