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Post by peppy on Jul 5, 2018 9:57:19 GMT -5
Thanks for the responses. Did some more reading on the net about the suite of side effects and it sounds like most everything is tied to adverse changes in blood vessels big and small at some level. On a side note, for the past couple of weeks, I've been working for a Type I diabetic who had been assisting me with some light physical labor. He's in his 70's and it was obvious his blood sugars were off now and then. At one point he was down to 80 and chugged a big glass of juice. He is on a pump and bolus's with injections. I had to ask if he had heard of Afrezza and he had. He thought it was only approved for Type II, so I told him it was approved for both. Gave him a very short run down on the speed of action and some of the general outcomes of the STAT study. His response was that he saw the longer tail of the injection as a benefit to deal with residual sugars. His injection is based on carb counting. He had an appointment with his endo the following day in Wenatchee WA...we both live in Ellensburg WA. It turns out the am and pm had been reversed on his pump so his blood sugars had been off for the last several months and was feeling better. He didn't mention anything more about Afrezza and I didn't push it because he seemed satisfied with where he was at. While he appeared impressed with the improvements that came with the use of Afrezza, it didn't seem to be enough to make a change...for now. Maybe sometime down the road, but the feeling I got was that his control was good enough with his current treatment methods to continue whats he's doing. reading the bits and pieces from diabetics, older diabetics, especially the ones with pumps are not going to change any time soon. Paraphrasing, it has taken them years to get as dialed in as they are. They have pumps and continuing glucose monitors with cost managed with insurance and they are not changing. |
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Post by wsulylecoug on Jul 5, 2018 10:01:52 GMT -5
That was exactly what I took away from our exchange as well.
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Post by agedhippie on Jul 5, 2018 10:23:18 GMT -5
According to Dr. Kendall, in a healthy body, BG peaks in about 45 minutes to an hour after a meal and leaves in about 2 hours. Afrezza mimics a healthy pancreas and also peaks in 45 minutes and departs in 2 hours. RAAs however peak in about 2 hours after a meal and leave in about 5 or 6 hours. Either Dr. Kendall is grossly misleading and wrong or this is very significant regarding meal time spikes and the relationship to the body. Diabetics know the significance of these meal time spikes. I'm going with Dr. Kendall and sayhey as their view appears to be based on current technology and science. Could we get this right please. RAA peaks in just under an hour (Afrezza peaks at 14 minutes, non-diabetics peak at 30 minutes). Here is a pretty graph from Integrated Diabetes with it marked out, it is identical to the graphs Mannkind publishes.  While RAA takes 4 to 5 hours to leave the body by the time you hit 2 hours half of it is already gone, and as you can see from the graph the tail is a low level of insulin. Even Afrezza has a tail out to 5 hours if you look at Mannkind's data, it's just that the level is so low you can ignore it. The tail on Afrezza is also dose dependent so as the dose increases the tail grows. I would love to see where Dr Kendall says the insulin peaks at 2 hours with RAA because that is flatly wrong and I cannot believe he would say it. |
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Post by peppy on Jul 5, 2018 11:15:25 GMT -5
That was exactly what I took away from our exchange as well. There are type ones diagnosed every day. I have been surprised how many are diagnosed @ 18 years of age. I have seen an omnipod on an infant, 10 months? on facebook. I was taught rule of thumb 10 to 13 years of age. Then there are the LADA. diagnosed generally older than 18? These are our target audience. And people that get hospitalized for hypos. |
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Post by mango on Jul 5, 2018 11:19:47 GMT -5
According to Dr. Kendall, in a healthy body, BG peaks in about 45 minutes to an hour after a meal and leaves in about 2 hours. Afrezza mimics a healthy pancreas and also peaks in 45 minutes and departs in 2 hours. RAAs however peak in about 2 hours after a meal and leave in about 5 or 6 hours. Either Dr. Kendall is grossly misleading and wrong or this is very significant regarding meal time spikes and the relationship to the body. Diabetics know the significance of these meal time spikes. I'm going with Dr. Kendall and sayhey as their view appears to be based on current technology and science. Could we get this right please. RAA peaks in just under an hour (Afrezza peaks at 14 minutes, non-diabetics peak at 30 minutes). Here is a pretty graph from Integrated Diabetes with it marked out, it is identical to the graphs Mannkind publishes. While RAA takes 4 to 5 hours to leave the body by the time you hit 2 hours half of it is already gone, and as you can see from the graph the tail is a low level of insulin. Even Afrezza has a tail out to 5 hours if you look at Mannkind's data, it's just that the level is so low you can ignore it. The tail on Afrezza is also dose dependent so as the dose increases the tail grows. I would love to see where Dr Kendall says the insulin peaks at 2 hours with RAA because that is flatly wrong and I cannot believe he would say it. Peak plasma insulin concentration is reached <15 minutes with Afrezza, as illustrated in the graph provided by aged. |
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Post by peppy on Jul 5, 2018 11:53:59 GMT -5
Could we get this right please. RAA peaks in just under an hour (Afrezza peaks at 14 minutes, non-diabetics peak at 30 minutes). Here is a pretty graph from Integrated Diabetes with it marked out, it is identical to the graphs Mannkind publishes. While RAA takes 4 to 5 hours to leave the body by the time you hit 2 hours half of it is already gone, and as you can see from the graph the tail is a low level of insulin. Even Afrezza has a tail out to 5 hours if you look at Mannkind's data, it's just that the level is so low you can ignore it. The tail on Afrezza is also dose dependent so as the dose increases the tail grows. I would love to see where Dr Kendall says the insulin peaks at 2 hours with RAA because that is flatly wrong and I cannot believe he would say it. Plasma insulin concentration peaks < 15 minutes with Afrezza, as illustrated in the graph provided by aged.   Standards of Care 2018 supplement care.diabetesjournals.org/content/41/Supplement_1/S73Rapid-acting inhaled insulin used before meals in patients with type 1 diabetes was shown to be noninferior when compared with aspart insulin for A1C lowering, with less hypoglycemia observed with inhaled insulin therapy (21). However, the mean reduction in A1C was greater with aspart (–0.21% vs. –0.40%, satisfying the noninferiority margin of 0.4%), and more patients in the insulin aspart group achieved A1C goals of ≤7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol). Because inhaled insulin cartridges are only available in 4-, 8-, and 12-unit doses, limited dosing increments to fine-tune prandial insulin doses in type 1 diabetes are a potential limitation. Postprandial glucose excursions may be better controlled by adjusting the timing of prandial (bolus) insulin dose administration. The optimal time to administer prandial insulin varies, based on the type of insulin used (regular, rapid-acting analog, inhaled, etc.), measured blood glucose level, timing of meals, and carbohydrate consumption. |
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Post by mango on Jul 5, 2018 12:02:28 GMT -5
Plasma insulin concentration peaks < 15 minutes with Afrezza, as illustrated in the graph provided by aged. Standards of Care 2018 supplement care.diabetesjournals.org/content/41/Supplement_1/S73Rapid-acting inhaled insulin used before meals in patients with type 1 diabetes was shown to be noninferior when compared with aspart insulin for A1C lowering, with less hypoglycemia observed with inhaled insulin therapy (21). However, the mean reduction in A1C was greater with aspart (–0.21% vs. –0.40%, satisfying the noninferiority margin of 0.4%), and more patients in the insulin aspart group achieved A1C goals of ≤7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol). Because inhaled insulin cartridges are only available in 4-, 8-, and 12-unit doses, limited dosing increments to fine-tune prandial insulin doses in type 1 diabetes are a potential limitation. Postprandial glucose excursions may be better controlled by adjusting the timing of prandial (bolus) insulin dose administration. The optimal time to administer prandial insulin varies, based on the type of insulin used (regular, rapid-acting analog, inhaled, etc.), measured blood glucose level, timing of meals, and carbohydrate consumption. Future proves past. Afrezza still demonstrates superiority and is everything Al Mann said it was, and more. When will the Standards of Care change? |
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Post by tinkusr8215 on Jul 5, 2018 12:34:51 GMT -5
When will the Standards of Care change? When a trial with a significant number of patient profiles in 10,000's is done over many years with all combination therapies to prove one approach is better than other. Come back in 2035.
By then i see a lot more advancements
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Post by mango on Jul 5, 2018 12:41:08 GMT -5
When will the Standards of Care change? When a trial with a significant number of patient profiles in 10,000's is done over many years with all combination therapies to prove one approach is better than other. Come back in 2035.
By then i see a lot more advancements
That's a ridiculous way to use a brain. Good thing Dr. Kendall and his team of global diabetes experts don't see it that way. God speed. |
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Post by tinkusr8215 on Jul 5, 2018 13:32:34 GMT -5
When a trial with a significant number of patient profiles in 10,000's is done over many years with all combination therapies to prove one approach is better than other. Come back in 2035.
By then i see a lot more advancements
That's a ridiculous way to use a brain. Good thing Dr. Kendall and his team of global diabetes experts don't see it that way. God speed. yep ridiculous way to use the brain. But some body needs to cough up the $. If you have the $ , go ahead and pay for the supply of afrezza to all those who are in need. You cant demand other's to pay for other's insulin when they have their own agenda.
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Post by bill on Jul 5, 2018 13:53:00 GMT -5
That's a ridiculous way to use a brain. Good thing Dr. Kendall and his team of global diabetes experts don't see it that way. God speed. yep ridiculous way to use the brain. But some body needs to cough up the $. If you have the $ , go ahead and pay for the supply of afrezza to all those who are in need. You cant demand other's to pay for other's insulin when they have their own agenda.
I find these arguments somewhat silly. Here are the facts I focus on. - The Afrezza delivery mechanism is more effective than the injected RAAs.
- Afrezza does a better job of mimicking a healthy pancreas than the injected RAAs.
- Most PWDs that use Afrezza, particularly those with a CGM get better A1c and TIR results than those using RAA's.
The only question in my mind is: Are the benefits thereby achieved worth the extra hassle and/or expense of getting access to Afrezza? Eventually, endos, BPMs, and the ADA Standards of Care will catch up with the obvious... Isn't everything else just noise  ? |
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Post by goyocafe on Jul 5, 2018 13:58:28 GMT -5
yep ridiculous way to use the brain. But some body needs to cough up the $. If you have the $ , go ahead and pay for the supply of afrezza to all those who are in need. You cant demand other's to pay for other's insulin when they have their own agenda.
I find these arguments somewhat silly. Here are the facts I focus on. - The Afrezza delivery mechanism is more effective than the injected RAAs.
- Afrezza does a better job of mimicking a healthy pancreas than the injected RAAs.
- Most PWDs that use Afrezza, particularly those with a CGM get better A1c and TIR results than those using RAA's.
The only question in my mind is: Are the benefits thereby achieved worth the extra hassle and/or expense of getting access to Afrezza? Eventually, endos, BPMs, and the ADA Standards of Care will catch up with the obvious... Isn't everything else just noise ? Well, if there’s a hole in your boat and you need endos, PBMs, and/or the ADA to happen so you don’t sink, it’s a little more than just noise, it’s a game of survival. |
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Post by bill on Jul 5, 2018 14:06:40 GMT -5
I find these arguments somewhat silly. Here are the facts I focus on. - The Afrezza delivery mechanism is more effective than the injected RAAs.
- Afrezza does a better job of mimicking a healthy pancreas than the injected RAAs.
- Most PWDs that use Afrezza, particularly those with a CGM get better A1c and TIR results than those using RAA's.
The only question in my mind is: Are the benefits thereby achieved worth the extra hassle and/or expense of getting access to Afrezza? Eventually, endos, BPMs, and the ADA Standards of Care will catch up with the obvious... Isn't everything else just noise ? Well, if there’s a hole in your boat and you need endos, PBMs, and/or the ADA to happen so you don’t sink, it’s a little more than just noise, it’s a game of survival. - Your observation is not about Afrezza but about the fiscal health of Mannkind. You are correct that the amount of time and money needed for Afrezza and Mannkind to be self-sustaining is an issue. While I'm not sure when that happens, I am sure that their fiscal health has improved significantly over the last year and trending towards more rather than less healthy. The wild cards are how many more times will Mannkind needs to raise cash through shareholder dilution, how that dilution will affect share price between now and profitability, and how long shareholders will have to wait to become profitable. I believe very few people believe Mannkind will go bankrupt in the process, but it doesn't guarantee that shareholders will see substantial profits any time soon either. |
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Post by rockstarrick on Jul 5, 2018 16:35:17 GMT -5
Where do these guys come from  We need a membership fee to pay for cleaning up all the bs. |
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Post by akemp3000 on Jul 5, 2018 16:48:55 GMT -5
Interesting that some message board posts, yet no industry thought leaders, are challenging what Dr. Kendall has presented publicly as fact. How about this one..."45 new diabetes drugs have been approved in the past ten years but have not resulted in significant A1c improvements for diabetics". Maybe it's time to stop getting lost in the weeds discussing technicalities about RAAs since they haven't been effective anyway. Now Afrezza on the other hand...
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