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Post by agedhippie on Sept 16, 2018 11:39:44 GMT -5
Had many pts that were not intubated and in for heart problems due to diabetes(100's yr) that could inhale. Control c iv means 1hr or less finger sticks, drives pt's crazy. I could go on and on. Pt's intubated that can't inhale or incapable have lot more to worry about than glucose levels at the time. I've worked at the VA connected to Vanderbilt in Nashville which is a teaching hospital(seen about everything). Take my word for it, no tails for diabetics capable of inhalation would be godsend. in response to below post You do realize that the tail from IV delivered insulin is the same as Afrezza? That means all the finger stick requirements would be the same. My brother's ICU uses CGMs so there are no finger sticks any way. I do not think that there is ever a point at which glucose levels are unimportant given the mountain of data on the benefits of tight glucose controls in ICUs, not least the work done at Vanderbilt on this topic. Not to mention the risk to patients from deranged glucose levels. |
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Post by georgia777 on Sept 16, 2018 12:11:21 GMT -5
Too much to write to explain, control glucose on all pt's but as high % of ICU pt's hanging by thread, glucose down list of keeping them alive on your shift. Have to work ICU to understand. On the hospital floors even worse as nurses don't have time to keep good eye on sleeping pt looking for hyo's as can be missed on 2hr-4hr checks as can happen quickly. Wish CGM's were standard of care here, but not yet. Could write a book on stuff that happens in ICU, but main focus here is low risk of HYPO's would be godsend. And IV insulin on pt ranging from 150-300 not always done as takes lot of resource time. If have 3 pt's gets tough. Good luck, finished on this subject, time for football
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Post by mnholdem on Sept 16, 2018 14:37:14 GMT -5
You seem to be a highly responsible and intelligent diabetic/ for those who don’t fall in that category discipline included / which I am willing to believe is great number of the patient population , a quick reading and breath seems like a very small price to pay for what you might consider an inconvenience more than anything. I would have loved to know the reason why the non-compliant people in the STAT study were non-compliant. Dr Kendall speculates that it is because of fear of hypos, I suspect it was a feeling that they have taken their insulin for the meal. I think not ask why was an opportunity missed because it is almost certainly reflected in the wider community. If you know what the issue is you can address it. "Compliance with TI use was based on using TI per protocol at 1- and 2-h postmeal based on PPG values. Patients were defined as compliant if ±90% of postmeal TI dosages were taken per protocol, with at least one of the postmeal inhalations taken if indicated per meal. "Four patients in the TI group were excluded from the final analysis (two dropped out the study due to non-side-effects-related reasons, and one had no CGM data and the other had incomplete CGM data (with the first 2 weeks of the study data missing)." Out of 22 patients in the TI group, 15 (68%) were compliant and 7 were noncompliant, with average compliance in the whole group of 91% ± 11%. Source: www.liebertpub.com/doi/10.1089/dia.2018.0200--- I happen to think that Dr Kendall's speculation about reasons for STAT noncompliance carries much more weight than yours. Your posts may seem educational, for some ProBoards members and nonmembers, but you never seem to post much data which supports your repeated implication that others manage their diabetes like you manage yours and have similar concerns (or lack thereof) about various treatments or their daily blood glucose levels. You may be a fine person but I have concerns about your theme (which you convey in dozens of posts) that somehow your experiences with this disease are reflective of the millions of unique human beings who deal with diabetes every day, each in his or her own way. IMO, your viewpoint should carry the same weight as each of the blogs posted by sportsrancho or harryx1, which they share with ProBoards member from men, women and children who share their experiences with Afrezza and diabetes management on the Internet. David Kendall MD has worked with thousands, if not tens of thousands, of patients with diabetes. You are one person.  |
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Post by ryster505 on Sept 16, 2018 14:50:02 GMT -5
Always a rebuttal for EVERY single intelligent post or opinion which contradicts the way aged goes about his/her methods of managing their disease. Gets annoying to say the least. How about some optimism aged? I mean you are one of the most frequent posters on this entire board. |
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Post by Omega on Sept 16, 2018 16:11:16 GMT -5
For the record; other than metformin I cannot think of another diabetes drug I would take before insulin. So Metformin is just Grand but you find the need to spend the past few days in this thread harping on how bad Afrezza is? Why are you Long MNKD? |
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Post by gamblerjag on Sept 16, 2018 21:39:44 GMT -5
For the record; other than metformin I cannot think of another diabetes drug I would take before insulin. So Metformin is just Grand but you find the need to spend the past few days in this thread harping on how bad Afrezza is? Why are you Long MNKD? I think you just answered your own question why indeed or maybe better yet why not be long! 😳 |
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Post by uvula on Sept 17, 2018 2:31:36 GMT -5
I doubt aged is short. I'm not sure why he is so patiently trying to explain his decision to not use afrezza, but he thinks afrezza is a "godsend" for T1Ds who don't have the good control that he has. He also thinks afrezza is great for T2Ds. I'm not sure if he ever stated whether he was a long shareholder either.
I've already met a few of the proboards people. The folks I would most like to meet are aged, peppy, and matt.
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Post by tingtongtung on Sept 17, 2018 2:59:21 GMT -5
Aged not being a diabetic an listening to what you have to say ! Seems like you have a more difficult regimen than just getting on board with the progress that has been made in healthcare CGM/ afrezza... what am I missing ! It's not as bad as I made it seem. I went into all the details and justifications because I thought people might be interested. The short form is that I can add an extra couple of units to my regular breakfast bolus and let the long tail deliver it when it's needed so I don't need to take extra doses later. I think that some people are very happy with a CGM + Afrezza and I am genuinely happy for them - Type 1 sucks and anything that makes people happier gets my vote (Cue: enter babaoriley with the marijuana stage left). I just don't see the gain for me in changing. To be honest the second dose is the killer for me. Aged, You look well educated - masters or a PhD? No offence - just based on your detailed writing, and analysis. In my industry, we have a huge conglomerate from Germany. They make decent products. But, when you ask the lowest person on the totem-pole (one who uses it everyday), they say one needs PhD to just to configure their products. But its like the old saying, if you IBM, you wont get fired. So, people buy them, and have a huge support contract, and end up using the old technology, which is inferior compared to some of the startups. Same with current diabetes regimen. There seems to be so many tricks/things to remember in your method. A common guy doesn't know/care (actually, shouldn't need to care). You control your food, take medicine, and be done with it. Not really experiment, make careful statistical/behavioral analysis, and come up with a pattern and hope it works fine.. If you look at any product, the biggest driver is the one in the lowest rung of the market. If you make your product easy for them to take, and easy for the doctors to prescribe to them, the product will be a success. Diabetes seems like, it requires a lot of one-on-one with the patients, and hence the current regimen, which may be not the best, but seems to work in many cases. Afrezza is different, and it needs a different/new one-on-one with patients. But this seems much easier than the older regimen, but it just needs to be spread among both doctors and patients. If Vdex/MNKD can come up with an easy to follow dosing scheme that works for 95 percentile patients, doctors can start almost blindly prescribing it (I have no idea this is how its done :-)) I could be completely wrong in my assessment as I have no background in diabetes, and not a doctor. |
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Post by uvula on Sept 17, 2018 3:13:10 GMT -5
TTT,
You just made a good argument for new T1Ds to use an "artificial pancreas".
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Post by mnholdem on Sept 17, 2018 6:05:52 GMT -5
Which is why agedhippie has argued himself into a corner. An AP / smart pump would administer a follow on dose 2 hours after an initial mealtime dose if indicated by BG levels.
That’s the protocol which was used in the STAT trial. You would take a follow on dose with a simple (click, snap, inhale), faster (onset), safer (shorter duration of insulin on board = less post-prandial glucose excursions) and much less expensive treatment for optimum BG control.
Expense aside, a smart pump would come with its own set of problems and, because it would administer SQ insulin, would not be safer.
Speaking personally (and allegorically), I would never put my life or the lives of my family at risk by getting behind the console of a $60k-$100k computer-guided vehicle. Until I see decades of safety data, I would continue to manually drive a $30k vehicle - a simple and safe vehicle with a dashboard display that gives drivers the information they want, which provides navigation advice when asked for and alerts drivers to immediate problems/dangers when needed.
This is one man’s opinion, but if you think it’s viable to get an expensive computer-guided car to every driver around the world (or even just the USA) then go for it. Find that cutting-edge automaker and invest in it.
I have applied the same logic to managing diabetes, so I choose to invest in a company whose cutting-edge technology can save thousands of lives and livelihoods that are lost every year - even though the treatment is administered manually.
Good fortune to you.
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Post by beardawg on Sept 17, 2018 10:15:30 GMT -5
Aged - so let me get this straight. You are doing all this work and "its not a big deal". However checking BG 90 minutes after eating and taking a second puff if needed is SO hard few will ever use afrezza to get better control and fewer hypos? With afrezza you don't need the tricks. The kids who will be starting on afrezza in the near future will hopefully never know or want to know about the tricks. The tandem and afrezza is something to consider. It would provide better control and a lot less sleepless nights. Then there is the question of better control. That all comes down to the amount of effort you want to put in. I already comfortably exceed the TIR the compliant Afrezza users in STAT got so what's in it for me? Fewer hypos? Well you still get them, but anyway the promised reduction would amount to maybe one or two a month (I am going to tempt fate and say it is ages since I had a serious hypo). Why would you think your TIR would drop to being the same as the participants when you use Afrezza? The average TIR is comprised of people who followed the protocol to varying degrees and those who didn't at all. You seem to want to take the time to do the many tricks, so I imagine with a better tool in your hand (Afrezza) you'd have higher time in range than the average trial participant, just like you already have a higher TIR than the trial participants that used injected insulin. You are comparing in a vacuum. Your TIR is MUCH better than injected insulin, so we can realistically expect the same jump if you were to use Afrezza, correct? Based on how you've described your current injected regimen, with Afrezza you'd have an even higher TIR than you currently have, and MUCH less effort to achieve it. |
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Post by bill on Sept 17, 2018 10:40:27 GMT -5
Then there is the question of better control. That all comes down to the amount of effort you want to put in. I already comfortably exceed the TIR the compliant Afrezza users in STAT got so what's in it for me? Fewer hypos? Well you still get them, but anyway the promised reduction would amount to maybe one or two a month (I am going to tempt fate and say it is ages since I had a serious hypo). Why would you think your TIR would drop to being the same as the participants when you use Afrezza? The average TIR is comprised of people who followed the protocol to varying degrees and those who didn't at all. You seem to want to take the time to do the many tricks, so I imagine with a better tool in your hand (Afrezza) you'd have higher time in range than the average trial participant, just like you already have a higher TIR than the trial participants that used injected insulin. You are comparing in a vacuum. Your TIR is MUCH better than injected insulin, so we can realistically expect the same jump if you were to use Afrezza, correct? Based on how you've described your current injected regimen, with Afrezza you'd have an even higher TIR than you currently have, and MUCH less effort to achieve it. There's another dynamic in play here that I don't think has been discussed. We humans are exceptionally good compensators when it comes to our own physiologies , i.e., we're very good at internalizing the abnormal as normal after a sufficiently long period of time. We only realize how bad something really was when we fix or improve it. You never realize how much better something can be until you fix or improve it. I suspect many PWDs have gotten used to feeling "normal" with the treatment regimen they are on and won't be inclined to change it unless their doctor says so--and don't realize they could feel much better and be healthier with a different treatment regimen e.g., Afrezza. However, if they tried Afrezza for a few months with a CGM, they'd realize the objective and subjective benefits as beardawg suggests. In some cases, I suspect that PWDs with good A1c numbers are reluctant to change to something "easier" because it would subjectively diminish all the hard work they've put into keeping their A1c numbers in range for all these years. There's no challenge in doing something if everyone can achieve the same great results, i.e., you're no longer special. Just a few ideas to ponder... |
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Post by uvula on Sept 17, 2018 11:05:08 GMT -5
We also don't know how old the aged one is. If he is over 60 (or maybe even 50) there is probably no long term health benefit to a better TIR. It is a different story for kids with T1D.
Aged is probably a typical long term T1D who has figured out how to maintain good control. (I don't know what percentage of long term T1Ds have good control like he does.) Doctors are not going to put as much effort into changing their patients' medication as y'all are putting into trying to get the aged one to use Afrezza. This could be part of the reason the adoption rate is so low. I would think that newly diagnosed T1Ds would be more receptive to trying Afrezza.
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Post by sportsrancho on Sept 17, 2018 11:31:27 GMT -5
I agree with both of the posts right above me. People get used to things. My girlfriend is use to a bad relationship. She doesn’t have the gumption to change it. She also wears contacts that give her dry eyes and she’s miserable most of the time, she doesn’t have the will to change that either. I have a multi focus implant. Because of that I do not have to wear reading glasses or contacts. It’s freedom ... it’s almost perfect vision. It’s 100% better! But she’s used to her glasses or contacts. Now Tom when he saw how much better my vision was after I got my implant waited a year to make sure it was all going to turn out OK and then got both of his eyes done:-) Because Tom does not except mediocre anything. That’s why his kids are on Afrezza!
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Post by ilovekauai on Sept 17, 2018 11:46:27 GMT -5
Never fear change, embrace change, because change is good and makes you a better, stronger, person in so many ways.
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