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Post by peppy on Jun 30, 2018 19:39:17 GMT -5
Listening to Dr. Kendall at the investors conference after the ADA. Regarding the STAT study. The units of afrezza used in the Stat with meals, were comparable to units of RAA, apart. They were dosing 4 units. That is why all the additional follow up doses were required. That explains a lot. "There is no defined inhale-able unit" dr Kendall. Dr Kendall fun facts presented at investors conference. One unit of RAA insulin = 34.7 mg of insulin, which is the amount of insulin it takes to reduce the blood glucose level of a 4.45 pound rabbit by 45 mg/dl. Another Dr. Kendall fun fact. If your blood glucose level is 30 mg/dl lower on average throughout the day, HbA1c will be lowered by 1% point. insulin dose is based on weight, with doses ranging from 0.4 to 1.0 units/kg/day of total insulin with higher amounts required during puberty. The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook notes 0.5 units/kg/day as a typical starting dose in patients with type 1 diabetes    |
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Post by agedhippie on Jun 30, 2018 20:05:16 GMT -5
Listening to Dr. Kendall at the investors conference after the ADA. Regarding the STAT study. The units of afrezza used in the Stat with meals, were comparable to units of RAA, apart. They were dosing 4 units. That is why all the additional follow up doses were required. That explains a lot. I think carb absorption rates play a part in this as well. If I am eating slow absorbed carb my insulin can clear before the carbs clear and then I am going to get a delayed spike. I would expect the short tail on Afrezza makes this a particular problem which is why the two dose approach gives so much better results. Variable carb absorption rates, which is a consequence of the food you eat at each meal, is why insulin dosing is such a joy. Notoriously Omnipod pumps used to assume that if you needed X units to cover Y grams of carbs then they could ignore that insulin. That seldom ended well... An interesting, and usually ignored, fact is that in addition to carb absorption rates you can stack carbs and often do. Consequently you will under dose and go high, it's the flip side to stacking insulin. |
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Post by chc on Jun 30, 2018 23:15:41 GMT -5
Peppy said "Listening to Dr. Kendall at the investors conference after the ADA. Regarding the STAT study.
The units of afrezza used in the Stat with meals, were comparable to units of RAA, apart.
They were dosing 4 units. That is why all the additional follow up doses were required.
That explains a lot.
"
I agree with your comments Peppy. The label needs to get changed to the doctors recommended dosing on the Afrezza website as follows.
Example Afrezza dosing.
Converting from multiple daily injections (MDI).
Initiate prandial Afrezza at 1.5 Afrezza units for every one injectable insulin unit.
Adjust mealtime doses by 4 unit increments every 3 days based on 2 hr PPG > 160 mg/dL (3 day average).
Converting Injections 1
Example
Initiating Afrezza: MDI 8 units subcutaneous injection per meal. 8 units x 1.5 = 12 units Afrezza inhalation per meal.
Adjusting Afrezza: Increase mealtime dose by 4 unit increments every 3 days until PPG controlled (additional cartridges may be required).
This conversion formula is very accurate for my wife to convert from Humalog 75/25 to Afrezza. She uses 12 units of Afrezza in place of 8 units of Humalog 75/25.
The STAT Study would have had better results and with less follow up dosage had this conversion formula been used.
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Post by sayhey24 on Jul 1, 2018 7:47:55 GMT -5
Peppy - IMO, one of the biggest mistakes Al Mann made was highlighting afrezza as insulin and then doubling down by calling the cartridges "units".
The cartridges should just be called; small, medium and large. If they come out with the 2 for the kids call it Xsmall.
For the T2s, if afrezza was just known as amino acid powder I think PCPs would feel more comfortable to prescribe once in the standard of care.
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Post by sophie on Jul 1, 2018 10:31:43 GMT -5
It would be a grave mistake to call insulin anything other than insulin and you can be sure it would never make it past the FDA. It would be an even bigger mistake to arbitrarily assign dosages to insulin. You will not find a physician that will prescribe small, medium, large doses of insulin. Even though the unit sizes are incorrect according to RAA equivalents, at least they gave a starting point and a known quantity by which to prescribe.
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Post by agedhippie on Jul 1, 2018 10:31:54 GMT -5
Peppy - IMO, one of the biggest mistakes Al Mann made was highlighting afrezza as insulin and then doubling down by calling the cartridges "units". The cartridges should just be called; small, medium and large. If they come out with the 2 for the kids call it Xsmall. For the T2s, if afrezza was just known as amino acid powder I think PCPs would feel more comfortable to prescribe once in the standard of care. At the time Al was probably more concerned at the blow back from Exubera's decision not to use units and to use mg. He probably did not want to repeat that mistake. |
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Post by peppy on Jul 1, 2018 10:50:12 GMT -5
Peppy - IMO, one of the biggest mistakes Al Mann made was highlighting afrezza as insulin and then doubling down by calling the cartridges "units". The cartridges should just be called; small, medium and large. If they come out with the 2 for the kids call it Xsmall. For the T2s, if afrezza was just known as amino acid powder I think PCPs would feel more comfortable to prescribe once in the standard of care. At the time Al was probably more concerned at the blow back from Exubera's decision not to use units and to use mg. He probably did not want to repeat that mistake. interesting exuberant was mannitol based. really sounds like a POS. |
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Post by agedhippie on Jul 1, 2018 16:54:31 GMT -5
At the time Al was probably more concerned at the blow back from Exubera's decision not to use units and to use mg. He probably did not want to repeat that mistake. interesting exuberant was mannitol based. really sounds like a POS. I avoided it because I couldn't see any benefit, a few of others tried it out of curiosity. I only knew one person who went all in on Exubera and was heartbroken when it was discontinued (I wonder if they are using Afrezza now). |
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Post by peppy on Jul 2, 2018 5:54:21 GMT -5
Please forgive the off topic of the drug group. I post it to look at data presentation and numbers. % risk reduction vs reduction in absolute risk. 36% risk reduction vs and absolute risk reduction of 1.1%   |
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Post by gareaudan on Jul 2, 2018 6:41:13 GMT -5
Please forgive the off topic of the drug group. I post it to look at data presentation and numbers. % risk reduction vs reduction in absolute risk. 36% risk reduction vs and absolute risk reduction of 1.1% yeap! This is the problem with statistics, its easy to make them say whatever you want. That's why it is so important to know what your talking about when comparing % and ask question if you dont understand... Even if it make you look like a short to some. That being said, i dont think that, in your particular exemple, it is true to say that it is exagerrating statistics. They didnt exagerrated the numbers. They are just showing the face of the coin that they want you to see. Everything they said is true, even if its a little misleading. 1% in absolute reduction can be huge if the desease is deadly. Its a question of point de vue. |
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Post by dh4mizzou on Jul 2, 2018 6:59:31 GMT -5
Statins might reduce the risk of heart attacks but they sure as heck don't play well with livers.
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Post by gareaudan on Jul 2, 2018 7:28:28 GMT -5
Statins might reduce the risk of heart attacks but they sure as heck don't play well with livers. oh im not saying that statins are good. Actually, I, personnaly, would not take it even if my cholesterol were through the roof. The benefits are just not significant enough vs the Side effects. I was just saying that we have to be careful with numbers and always have to do your own dd , specially when it come to your health. |
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Post by agedhippie on Jul 2, 2018 8:49:47 GMT -5
Please forgive the off topic of the drug group. I post it to look at data presentation and numbers. % risk reduction vs reduction in absolute risk. 36% risk reduction vs and absolute risk reduction of 1.1% Thiat is why I don't stress the whole getting to non-diabetic numbers thing. Although lowering your A1c by 1.0 halves your risk by the time you get below 6.5 (or pretty much below 7.0) if you look at the graph for complications below you see that the curve goes flat so you are halving a very small number and in real terms that means that there is no difference to the real risk. You need to look at the data and not the headline numbers.  |
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Post by mango on Jul 2, 2018 9:17:30 GMT -5
Please forgive the off topic of the drug group. I post it to look at data presentation and numbers. % risk reduction vs reduction in absolute risk. 36% risk reduction vs and absolute risk reduction of 1.1% Thiat is why I don't stress the whole getting to non-diabetic numbers thing. Although lowering your A1c by 1.0 halves your risk by the time you get below 6.5 (or pretty much below 7.0) if you look at the graph for complications below you see that the curve goes flat so you are halving a very small number and in real terms that means that there is no difference to the real risk. You need to look at the data and not the headline numbers. The fundamental problem with HbA1c is it cannot assess glucose homeostasis. HbA1c is a proxy
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Post by gareaudan on Jul 2, 2018 9:20:24 GMT -5
Please forgive the off topic of the drug group. I post it to look at data presentation and numbers. % risk reduction vs reduction in absolute risk. 36% risk reduction vs and absolute risk reduction of 1.1% Thiat is why I don't stress the whole getting to non-diabetic numbers thing. Although lowering your A1c by 1.0 halves your risk by the time you get below 6.5 (or pretty much below 7.0) if you look at the graph for complications below you see that the curve goes flat so you are halving a very small number and in real terms that means that there is no difference to the real risk. You need to look at the data and not the headline numbers. you are halving a relative number so you dont know if it is a small number or not. If at 6=2000 problems, then at 7=4000 and on that case, thats a lot. Your Graph dont show the absolut numbers si how can you say that its small? |
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