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Post by lennymnkd on Aug 16, 2018 10:37:06 GMT -5
Part of the veins of gold / hmmm
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Post by stevil on Aug 16, 2018 23:32:41 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza...
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Post by agedhippie on Aug 17, 2018 8:57:54 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza... Do they mention any brands of insulin (Humalog, Novolog, Apidra,...) in the podcast? |
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Post by peppy on Aug 17, 2018 9:04:34 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza... is that you? |
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Post by mnholdem on Aug 17, 2018 11:53:17 GMT -5
Wow, what a memory!  |
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Post by agedhippie on Aug 17, 2018 13:31:43 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza... They are talking about the results from the UKDPS trial which a decade after the trial ended still had the people who had been in the tight control (target A1c 7.0) group getting markedly better results that the control arm. In other words even having decent control for a while (ok - the UKPDS trial was 20 years long) has benefits that carry forwards. 64% of Type 1 diabetics use an insulin pump. Notice that they talk about the generic names of insulins (lispro, and aspart) rather than brand (Humalog, and Novolog). If they had mentioned Afrezza they would have talked about inhaled insulin rather than Afrezza. They talk about the closed loop pumps as the future. Aim for A1c less than 7.0. That's a potted summary. The talk is episode 67 ( AFP: AMERICAN FAMILY PHYSICIAN PODCAST Episode 67) and lasts from the 1:50 mark to 7:00 UKDPS for those who want to see more about that study (it's one of the foundational studies) is here - UKPDS Study. |
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Post by peppy on Aug 17, 2018 14:00:11 GMT -5
Episode 67 of AFP podcast addressed intensive insulin therapy for type 1's and the benefits of tight glucose control. No mention of Afrezza... stevil, I Have a question. when you were in medical school, did you get a course/lecture on how medical (pharmacy) insurance works? |
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Post by brotherm1 on Aug 17, 2018 14:05:38 GMT -5
crash course: follow the $$$$$ 😟
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Post by babaoriley on Aug 17, 2018 19:03:15 GMT -5
For decades, studies have conclusively demonstrated that early intensive insulin therapy administered to newly-diagnosed Type 2 diabetes patients can result in remission of the disease. One meta-analysis report, conducted more than a decade ago and involving over 3,000 patients, demonstrated results of nearly 50% of patients who underwent early intensive insulin therapy achieving drug-free remission for up to two years. Clinical data has also demonstrated that early intensive insulin therapy has resulted in a significant reduction of insulin resistance, a common precursor of Type 2 diabetes.
In a clinical study by Model Clinical Research LLC, Baltimore MD, in collaboration with MannKind Corporation, investigators are seeking to demonstrate that the addition of mealtime Afrezza (aka Technosphere Insulin) can significantly lower HbA1c within 3 months in uncontrolled type 2 diabetes patients initially having HbA1c of 7.5 or higher, despite at least 6 months of prior therapy with diabetes medications.
The trial protocol instructs patients to follow a weekly Treat-to-Target BG Testing Regimen and make Afrezza dose changes according to an Afrezza Titration Algorithm.
In spite of growing clinical evidence that early initiation of insulin therapy has repeatedly demonstrated significant results, including complete remission of the disease, the American Diabetes Association still has insulin therapy as the last step in its Diabetes Standards of Care.
In early stages of Type 2 diabetes, insulin resistance and other factors often causes the pancreas to become over-stressed and unable to keep up with the body's demand for insulin. In layman's terms, the beta cells in the pancreas begin to wear out. Critics of the ADA and the AACE are becoming increasingly vocal in their dissent against the recommendation within the ADA's Standard of Care which advocates early treatment of diabetes with oral medications, such as Metformin, stating that Metformin does nothing to assist the pancreas or improve its ability to produce sufficient levels of insulin. Early intensive insulin therapy, on the other hand, can provide a respite to the over-stressed pancreas by providing much-needed insulin and enabling the pancreas to recuperated and generate new insulin-producing beta cells at a rate that will meet the body's demand while, at the same time, lowering insulin resistance.
Recently, the American Diabetes Association announced changes that would enable the organization to more rapidly response to scientific discoveries for the treatment of diabetes, stating in a press release that, "Beginning with the 2018 ADA Standards of Medical Care in Diabetes, the Standards document will be a “living” document where notable updates are incorporated into the Standards, as determined appropriate by the Professional Practice Committee, noting that their decades-long practice of annually reviewing medical advances would be replaced with more frequent updates, what they described as a "living" Standards of Care, in response to important events such as "new treatments with the potential to impact patient care" and publication of new findings "that support a change to a recommendation and/or evidence level of a recommendation".
Many critics of the ADA are advocating that there is now more than sufficient clinical evidence to meet the ADA's criteria to update its Standard of Care to move short-term intensive insulin therapy to the first step in treating early diabetes. It's hard to argue with results and the incredible potential of this therapy, its puzzling why the ADA has taken so long to advocate early short-term insulin therapy as a first step in combatting this disease. I know of no other treatment that has the potential of remission of diabetes for 50% of treated patients.
Delaying this therapy may result in continuous deterioration of the pancreas to the point where it is no longer repairable and sentences the patient to a difficult life of continuously fighting diabetes. It's a fight that can be won with a 1st Round knockout. It's time for the American Diabetes Association and the American Association of Clinical Endocrinologists to recognize this important treatment and to put it in its proper place in the 2019 ADA Standards of Medical Care in Diabetes.
The clinical trial, entitled "Initiating Mealtime Ultra-Rapid Acting Insulin (Afrezza) in Uncontrolled Type 2 Diabetes Patients" is scheduled to be completed in September 2018.
Trial Link: clinicaltrials.gov/ct2/show/NCT03324776?term=mannkind&recrs=abdfg&rank=3
One of the best written posts ever, anywhere! Professionally done! Have one question, why didn't you run it by a lawyer first  , oh, no, that's not it, that's just reflex. Actually, my law partner, who has an A1c of about 6.2 liked this post but is asking, as am I, about the following: "Clinical data has also demonstrated that early intensive insulin therapy has resulted in a significant reduction of insulin resistance, a common precursor of Type 2 diabetes." We understand why the addition of insulin would "give the pancreas a break," but why and how does it reduce insulin resistance, which as I understand refers to the fact that the cells which are receptors of the insulin don't want to let much of the insulin in, and thus it takes more insulin to overwhelm the resistance and "force" a sufficient amount into the receptor cells.
Thanks, I figure there are many here, certainly including you, who can explain that, or attempt to debunk it (Aged One?).
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Post by peppy on Aug 17, 2018 19:12:24 GMT -5
For decades, studies have conclusively demonstrated that early intensive insulin therapy administered to newly-diagnosed Type 2 diabetes patients can result in remission of the disease. One meta-analysis report, conducted more than a decade ago and involving over 3,000 patients, demonstrated results of nearly 50% of patients who underwent early intensive insulin therapy achieving drug-free remission for up to two years. Clinical data has also demonstrated that early intensive insulin therapy has resulted in a significant reduction of insulin resistance, a common precursor of Type 2 diabetes.
In a clinical study by Model Clinical Research LLC, Baltimore MD, in collaboration with MannKind Corporation, investigators are seeking to demonstrate that the addition of mealtime Afrezza (aka Technosphere Insulin) can significantly lower HbA1c within 3 months in uncontrolled type 2 diabetes patients initially having HbA1c of 7.5 or higher, despite at least 6 months of prior therapy with diabetes medications.
The trial protocol instructs patients to follow a weekly Treat-to-Target BG Testing Regimen and make Afrezza dose changes according to an Afrezza Titration Algorithm.
In spite of growing clinical evidence that early initiation of insulin therapy has repeatedly demonstrated significant results, including complete remission of the disease, the American Diabetes Association still has insulin therapy as the last step in its Diabetes Standards of Care.
In early stages of Type 2 diabetes, insulin resistance and other factors often causes the pancreas to become over-stressed and unable to keep up with the body's demand for insulin. In layman's terms, the beta cells in the pancreas begin to wear out. Critics of the ADA and the AACE are becoming increasingly vocal in their dissent against the recommendation within the ADA's Standard of Care which advocates early treatment of diabetes with oral medications, such as Metformin, stating that Metformin does nothing to assist the pancreas or improve its ability to produce sufficient levels of insulin. Early intensive insulin therapy, on the other hand, can provide a respite to the over-stressed pancreas by providing much-needed insulin and enabling the pancreas to recuperated and generate new insulin-producing beta cells at a rate that will meet the body's demand while, at the same time, lowering insulin resistance.
Recently, the American Diabetes Association announced changes that would enable the organization to more rapidly response to scientific discoveries for the treatment of diabetes, stating in a press release that, "Beginning with the 2018 ADA Standards of Medical Care in Diabetes, the Standards document will be a “living” document where notable updates are incorporated into the Standards, as determined appropriate by the Professional Practice Committee, noting that their decades-long practice of annually reviewing medical advances would be replaced with more frequent updates, what they described as a "living" Standards of Care, in response to important events such as "new treatments with the potential to impact patient care" and publication of new findings "that support a change to a recommendation and/or evidence level of a recommendation".
Many critics of the ADA are advocating that there is now more than sufficient clinical evidence to meet the ADA's criteria to update its Standard of Care to move short-term intensive insulin therapy to the first step in treating early diabetes. It's hard to argue with results and the incredible potential of this therapy, its puzzling why the ADA has taken so long to advocate early short-term insulin therapy as a first step in combatting this disease. I know of no other treatment that has the potential of remission of diabetes for 50% of treated patients.
Delaying this therapy may result in continuous deterioration of the pancreas to the point where it is no longer repairable and sentences the patient to a difficult life of continuously fighting diabetes. It's a fight that can be won with a 1st Round knockout. It's time for the American Diabetes Association and the American Association of Clinical Endocrinologists to recognize this important treatment and to put it in its proper place in the 2019 ADA Standards of Medical Care in Diabetes.
The clinical trial, entitled "Initiating Mealtime Ultra-Rapid Acting Insulin (Afrezza) in Uncontrolled Type 2 Diabetes Patients" is scheduled to be completed in September 2018.
Trial Link: clinicaltrials.gov/ct2/show/NCT03324776?term=mannkind&recrs=abdfg&rank=3
One of the best written posts ever, anywhere! Professionally done! Have one question, why didn't you run it by a lawyer first , oh, no, that's not it, that's just reflex. Actually, my law partner, who has an A1c of about 6.2 liked this post but is asking, as am I, about the following: "Clinical data has also demonstrated that early intensive insulin therapy has resulted in a significant reduction of insulin resistance, a common precursor of Type 2 diabetes." We understand why the addition of insulin would "give the pancreas a break, " but why and how does it reduce insulin resistance, which as I understand refers to the fact that the cells which are receptors of the insulin don't want to let much of the insulin in, and thus it takes more insulin to overwhelm the resistance and "force" a sufficient amount into the receptor cells.
Thanks, I figure there are many here, certainly including you, who can explain that, or attempt to debunk it (Aged One?).
It has to be the phase one insulin reaction, the liver? Afrezza stops the liver stop making glucose out of glycogen.  insulin resistance: Adipose tissue consists of adipocytes and the so-called stromal-vascular fraction that encompasses blood vessels and stroma with macrophages. Adipose tissue has the unique capacity to store large amounts of energy in the form of triglycerides (TG). For a long time, it has been presumed that this was the only function of adipose tissue. However, adipose tissue (i.e., adipocytes and the stromal vascular fraction) acts as an endocrine organ by secreting various hormones and cytokines (also referred to as adipokines) with effects on glucose and lipid metabolism and energy homeostasis [9]. It now appears that in those obese subjects that develop insulin resistance, adipose tissue dysfunction plays a role. Adipose tissue dysfunction is characterized among others by large adipocytes and secretion of adipokines with a proinflammatory profile ultimately leading to (among others) ectopic fat deposition [10]. Ectopic fat is defined as storage of TG in tissues other than adipose tissue, that normally contain only small amounts of fat, such as the liver, skeletal muscle, heart, and pancreas. Ectopic fat can interfere with cellular functions and hence organ function and is associated with insulin resistance.
 Makes sense doesn't it. |
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Post by brotherm1 on Aug 17, 2018 21:16:10 GMT -5
Good one Pep. “Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin Sujani Poonuru, MD, Sumedha R. Pathak, MD, [...], and Ram D. Pathak, MD Additional article information ABSTRACT The conventional methods of treatment of severe hypertriglyceridemia are dietary restriction and lipid lowering medications, mainly fibric acid derivatives. In the medical literature, use of insulin infusion to treat hypertriglyceridemia has not been highlighted sufficiently. We report a 53-year-old male who presented with a four-day history of epigastric pain. The patient’s clinical history was significant for hypertriglyceridemia, type-2 diabetes mellitus with medication noncompliance, obesity, status post-gastric bypass surgery, and alcohol abuse with prior admissions for detoxification. Physical examination revealed mild epigastric tenderness. Laboratory studies revealed severely elevated serum triglyceride (TG) level (8116 mg/dL). Computed tomography (CT) scan of the abdomen exhibited no evidence of pancreatitis. Regular insulin infusion was started at 3 U/h and gradually increased to 7–10 U/h. Dextrose infusion was titrated to avoid hypoglycemia and maintain blood glucose levels below 150 mg/dL. Gemfibrozil and niacin were also started. After 24 hours, his TG levels were decreased to 2501 mg/dL. Insulin infusion was continued for about 48 hours. A low carbohydrate diet excluding simple carbohydrates was given. The patient’s serum TG levels normalized over a period of one month. Thus insulin infusion can be considered a safe modality of treatment for rapid reduction of serum TG in addition to fibrates and niacin....” www.ncbi.nlm.nih.gov/pmc/articles/PMC3064759/ |
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Post by brotherm1 on Aug 17, 2018 21:27:46 GMT -5
Afrezza, being insulin, lowers TG’s. And opposed to other insulins, it bypasses the liver and precludes it from making glucose which can also turn into cellular fat which creates insulin resistance. Am I correct Peppy?
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Post by mnkdfann on Aug 17, 2018 21:32:37 GMT -5
Afrezza, being insulin, lowers TG’s. And opposed to other insulins, it bypasses the liver and precludes it from making glucose which can also turn into cellular fat which creates insulin resistance. Am I correct Peppy? FWIW, the FDA warning says "If you have kidney or liver problems, Afrezza is not for you", so I would be surprised if it bypasses the liver entirely. If it does, why is that line there? Okay, I just googled and looked at the VDEX white paper; it seems to suggest that Afrezza actually signals the liver earlier than other insulins. |
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Post by sayhey24 on Aug 17, 2018 21:42:54 GMT -5
Joslin's theory to answer the question "But why and how does it reduce insulin resistance, which as I understand refers to the fact that the cells which are receptors of the insulin don't want to let much of the insulin in?" is the resistance is viral based. The extra insulin allows for the displacement of what they call viral insulin-like peptides (VILPs) which are causing the resistance. Over time the displaced virus can't replicate and are destroyed resulting in reduced resistance. Joslin says they have identified four distinct viruses, so far. www.joslin.org/news/virus-can-produce-insulin-like-hormones-active-on-human-cells.html |
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Post by brotherm1 on Aug 17, 2018 21:49:09 GMT -5
Afrezza, being insulin, lowers TG’s. And opposed to other insulins, it bypasses the liver and precludes it from making glucose which can also turn into cellular fat which creates insulin resistance. Am I correct Peppy? FWIW, the FDA warning says "If you have kidney or liver problems, Afrezza is not for you", so I would be surprised if it bypasses the liver entirely. If it does, why is that line there? Okay, I just googled and looked at the VDEX white paper; it seems to suggest that Afrezza actually signals the liver earlier than other insulins. it’s 32 pages on my little phone. What page is it you are referring to? |
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, oh, no, that's not it, that's just reflex. Actually, my law partner, who has an A1c of about 6.2 liked this post but is asking, as am I, about the following: "Clinical data has also demonstrated that early intensive insulin therapy has resulted in a significant reduction of insulin resistance, a common precursor of Type 2 diabetes." We understand why the addition of insulin would "give the pancreas a break," but why and how does it reduce insulin resistance, which as I understand refers to the fact that the cells which are receptors of the insulin don't want to let much of the insulin in, and thus it takes more insulin to overwhelm the resistance and "force" a sufficient amount into the receptor cells.
