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Post by peppy on Jun 7, 2019 10:38:18 GMT -5
In reply to aged post: The body pushes out insulin as needed and it is immediately active - there is no absorption phase since it is dumped directly into the bloodstream. It means the onset is driven by the glucose levels rather than the dose. You can see that the pancreas is ahead of Afrezza initially and then Afrezza gets ahead. This is because at that point the body does not need that quantity of insulin, but if you are taking a dose of insulin you cannot make that exact match. Your point about getting ahead of the game is a good one because although the insulin isn't required the timing gap is sufficiently small for the body to be able to handle the excess insulin (it will just dump a bit of glucose to offset it), and when it is needed for the first phase the insulin is there. This is how Afrezza matches the first phase and as is clear the RAA is rising far too slowly. What happens next is the second phase which is the hump following the spike of the first phase. This is where the bulk of the carbs turn up. The RAA is in sync with the pancreas there, and Afrezza falls out of sync at that point which is why you need the second dose. I suppose the ideal combination would be Afrezza to cover the first phase, and RAA to cover the second phase. The gold standard is the pancreas and that green dotted curve because that is an exact match to the body's requirements. That is what you want to mirror. ================================================================================================ afrezza users say they feel better than when they user RAA. no weight gain. It is the first phase. the below written by MattB while using Afrezza to manage his type one.
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Post by shawnonafrezza on Jun 7, 2019 12:10:14 GMT -5
afrezza users say they feel better than when they user RAA. no weight gain. These two statements are hard to be too direct with, unfortunately. Insulin is insulin, it's a hormone that encourages growth; that's why T1D is a wasting disease. Weight gain can be caused because of constant over eating correcting lows which isn't a direct thing to do with Afrezza vs RAA but how the user experience in using them differs. Same to the comment about how they feel. Many users go from >8 A1C to sub 6. If that was done on RAA they'd also feel better. Now you could say Afrezza maybe made it easier for them to do so but it's not as direct as Afrezza doesn't make you feel bad like RAA. I can say that heavy doses of RAA > 6U IOB (which is a decent amount for me) can make me feel a little jittery but not always. Is that because it's RAA or because an oncoming crash or just because it's a lot for me compared to normal? Can't really say. Just my $0.02.
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Post by longliner on Jun 7, 2019 12:15:40 GMT -5
Have you a link to this Aged, other than Afrezza? Of course Here you go: Early Insulin Treatment in Type 2 Diabetes. There is a ton of papers on the early use of insulin in Type 2 out there. I think mnholdem even published a list somewhere here. Thanks for the link! The article references a slightly higher risk of hypoglycemia and weight gain associated with this treatment. I didn't see Mannkind referenced in the conflict of interest section. I assume it used products inferior to Afrezza represented by BP in the article. Isn't it awesome that the Levin patients on Afrezza suffered neither hypoglycemia or weight gain!
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Post by peppy on Jun 7, 2019 12:16:11 GMT -5
afrezza users say they feel better than when they user RAA. no weight gain. These two statements are hard to be too direct with, unfortunately. Insulin is insulin, it's a hormone that encourages growth; that's why T1D is a wasting disease. Weight gain can be caused because of constant over eating correcting lows which isn't a direct thing to do with Afrezza vs RAA but how the user experience in using them differs. Same to the comment about how they feel. Many users go from >8 A1C to sub 6. If that was done on RAA they'd also feel better. Now you could say Afrezza maybe made it easier for them to do so but it's not as direct as Afrezza doesn't make you feel bad like RAA. I can say that heavy doses of RAA > 6U IOB (which is a decent amount for me) can make me feel a little jittery but not always. Is that because it's RAA or because an oncoming crash or just because it's a lot for me compared to normal? Can't really say. Just my $0.02. the study was a type two study. Type one weight totally different. shawnonafrezza I wasn't kidding when I said I am a foodie. my sassy words. No one will tell them. The assumption they will not change. There is no money in telling them. Afrezza and NO fat diet would probably cure. NO OIL. No Meat. No diary. Whole Foods plant based. Rice and Beans. Oatmeal. Salads. Fruits. potatoes. squash.
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Post by agedhippie on Jun 7, 2019 12:43:12 GMT -5
Thanks for the link! The article references a slightly higher risk of hypoglycemia and weight gain associated with this treatment. I didn't see Mannkind referenced in the conflict of interest section. I assume it was products inferior to Afrezza represented by BP in the article. Isn't it awesome that the Levin patients on Afrezza suffered neither hypoglycemia or weight gain! The article was from 2009 and is a survey paper so it pre-dates Afrezza. What is shows is RAA. I am not sure where you get the idea that the Afrezza users did not suffer from hypos from (weight wasn't measured at all) as the table clearly has hypos increase from 1.2% to 2.4% of time in hypo.
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Post by shawnonafrezza on Jun 7, 2019 12:43:55 GMT -5
These two statements are hard to be too direct with, unfortunately. Insulin is insulin, it's a hormone that encourages growth; that's why T1D is a wasting disease. Weight gain can be caused because of constant over eating correcting lows which isn't a direct thing to do with Afrezza vs RAA but how the user experience in using them differs. Same to the comment about how they feel. Many users go from >8 A1C to sub 6. If that was done on RAA they'd also feel better. Now you could say Afrezza maybe made it easier for them to do so but it's not as direct as Afrezza doesn't make you feel bad like RAA. I can say that heavy doses of RAA > 6U IOB (which is a decent amount for me) can make me feel a little jittery but not always. Is that because it's RAA or because an oncoming crash or just because it's a lot for me compared to normal? Can't really say. Just my $0.02. Afrezza and NO fat diet would probably cure. NO OIL. No Meat. No diary. Whole Foods plant based. Rice and Beans. Oatmeal. Salads. Fruits. potatoes. squash. Maybe. I know some coaches that preach that diet. Then virta health has published results (which to my knowledge doesn't exist for the low fat coaches) on a keto approach which is 70% fat. Who is right? Maybe both. Just like with RAA vs Afrezza there is a lot of nuance to diet. Dr. Barnard is the dude who talks about the whole "key" think and I know he has at least 3 studies on it in various journals and not one of them does he get A1C to normal. Personally I've tried it. IR went down, I use barely any insulin but I'm also T1 and had pretty bad GI issues during it. I also do question the long term absence of fat from the diet as it is a precursor to a lot of hormone production. Maybe 20-30% of calories is good but how that works in the model above I do not know. I do know if you eat something that is just fat + carbs like a doughnut the short term effects on insulin absorption are horrible.
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Post by peppy on Jun 7, 2019 12:55:28 GMT -5
Afrezza and NO fat diet would probably cure. NO OIL. No Meat. No diary. Whole Foods plant based. Rice and Beans. Oatmeal. Salads. Fruits. potatoes. squash. Maybe. I know some coaches that preach that diet. Then virta health has published results (which to my knowledge doesn't exist for the low fat coaches) on a keto approach which is 70% fat. Who is right? Maybe both. Just like with RAA vs Afrezza there is a lot of nuance to diet. Dr. Barnard is the dude who talks about the whole "key" think and I know he has at least 3 studies on it in various journals and not one of them does he get A1C to normal. Personally I've tried it. IR went down, I use barely any insulin but I'm also T1 and had pretty bad GI issues during it. I also do question the long term absence of fat from the diet as it is a precursor to a lot of hormone production. Maybe 20-30% of calories is good but how that works in the model above I do not know. I do know if you eat something that is just fat + carbs like a doughnut the short term effects on insulin absorption are horrible. you are type one. your cells need calories. glucose calories. the food you use to get there your choice. Fat has more than twice as many calories per gram as carbohydrates and proteins. A gram of fat has about 9 calories, while a gram of carbohydrate or protein has about 4 calories.
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Post by shawnonafrezza on Jun 7, 2019 13:25:23 GMT -5
Maybe. I know some coaches that preach that diet. Then virta health has published results (which to my knowledge doesn't exist for the low fat coaches) on a keto approach which is 70% fat. Who is right? Maybe both. Just like with RAA vs Afrezza there is a lot of nuance to diet. Dr. Barnard is the dude who talks about the whole "key" think and I know he has at least 3 studies on it in various journals and not one of them does he get A1C to normal. Personally I've tried it. IR went down, I use barely any insulin but I'm also T1 and had pretty bad GI issues during it. I also do question the long term absence of fat from the diet as it is a precursor to a lot of hormone production. Maybe 20-30% of calories is good but how that works in the model above I do not know. I do know if you eat something that is just fat + carbs like a doughnut the short term effects on insulin absorption are horrible. you are type one. your cells need calories. glucose calories. the food you use to get there your choice. Fat has more than twice as many calories per gram as carbohydrates and proteins. A gram of fat has about 9 calories, while a gram of carbohydrate or protein has about 4 calories. True. But if glucose was needed then you'd be dead after not eating for 3 days or anyone who has ever done a marathon. The human body will happily made all needed glucose from amino acids hence why fasting doesn't kill you. Calories are only half of the equation as well because what matters in terms of overeating is satiety which comes both from a stretch reflex (which is why low cal things like veggies are great) and hormone signaling. I maintain quite a lean physique even though I eat over 180 (1600 calories) of fat a day. Not lacking energy or I'd find deadlifting 3x my body weight impossible. Food isn't black and white.
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Post by peppy on Jun 7, 2019 13:49:08 GMT -5
you are type one. your cells need calories. glucose calories. the food you use to get there your choice. Fat has more than twice as many calories per gram as carbohydrates and proteins. A gram of fat has about 9 calories, while a gram of carbohydrate or protein has about 4 calories. True. But if glucose was needed then you'd be dead after not eating for 3 days or anyone who has ever done a marathon. The human body will happily made all needed glucose from amino acids hence why fasting doesn't kill you. Calories are only half of the equation as well because what matters in terms of overeating is satiety which comes both from a stretch reflex (which is why low cal things like veggies are great) and hormone signaling. I maintain quite a lean physique even though I eat over 180 (1600 calories) of fat a day. Not lacking energy or I'd find deadlifting 3x my body weight impossible. Food isn't black and white. Quote: satiety which comes both from a stretch reflex you are so CORRECT. Rice and Beans. oatmeal. foods that soak up the water. high fiber. I ran across an interesting observation. we eat approximately the same weight of food every day.
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Post by shawnonafrezza on Jun 7, 2019 14:12:47 GMT -5
I don't want to derail this thread (maybe there is an off topic forum) but I'll just say I used oatmeal to bulk. 120g dry weight or 500 cals worth and it'd go down like butter. You're so focused on the stretch reflex you're ignoring that there are multiple components to hunger. If the goal is fiber, those 500 cals of oats have 13g fiber or the same as 250 cals from avocado which is a high fat food I eat. If you want to calorie match you could eat 500 cals of almonds but then also not feel full at all. Food isn't black and white.
"I ran across an interesting observation. we eat approximately the same weight of food every day."
That is interesting. I wonder if that's why people struggle with just calorie restriction but eat the same foods, just less.
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Post by sayhey24 on Jun 8, 2019 6:43:07 GMT -5
Aged - forget about the RAAs. While you think they maybe almost as safe they are after the last Step in the SOC basal insulin and thats not changing. They require shots and are considered too dangerous for most T2s. Calculations, carb counting, shots, potential sever hypos, etc. Afrezza requires none of that. Afrezza has just shown to remove all those issues and now Dr. Kendall has the initial ammunition to start the SOC discussion. This same protocal will be used in India with a larger population but the results will be the same as in this trial, the same which has been seem in clinical use for the last 4 years and the same which would have been seen in Affinity 2 if they didn't have people on TZDs and properly titrated. Shots are not considered dangerous, they are considered the highest burden. Is a patient more likely to take one shot a week in the case of GLP-1, or an insulin dose or two every time they eat if they are on Afrezza? That's the calculation. The same applies to RAA - one shot a week, or a shot every time the eat. I am leaving out the need for correction shots as well. And Afrezza still requires variable dosing, it's not like a pill where you simply take the same dose every time. Compliance, compliance, compliance. Aged - RAAs are considered dangerous. Thats the way it is. Every early T2 should be taking insulin but the benefits have out weighed the risk according to the medical community. As a result we have a Rube Goldberg SOC. If afrezza was available in the 1950s it would be included as part of Step One in the SOC. In addition to diet and exercise adding the afrezza as soon as early diabetes is determined is a huge benefit, HUGE! Taking a puff or two of afrezza is night and day different than taking shots at mealtime. As more and more T2s have CGMs and they can get the immediate feedback they will want to take the puff to stay in range which drives compliance. Afrezza feedback with the CGM is immediate. Taking the SGLT2 or GLP1 does little for the mealtime spike and CGMs expose the fraud they are. Not only that gangrene of the balls is not a big selling point for the SGLT2s or pancreatic cancer with the GLP1s. Lets get back to the importance of Levin's results. The results obsolete the need for Steps 3 and 4 of the SOC and simply Step 2 to "take the afrezza". The protocol is now set for the India study and as we have been talking about for years on this board, CGMs don't lie. The medical community can no longer hide behind the A1c 3 month average and say its good enough. Levin has taken the first step in providing the needed study information for real changes to the SOC which we have have been talking about on this board for years. Lets see if this study has made Dr. Kendall's job even easier now.
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Post by mango on Jun 8, 2019 8:10:41 GMT -5
True. But if glucose was needed then you'd be dead after not eating for 3 days or anyone who has ever done a marathon. The human body will happily made all needed glucose from amino acids hence why fasting doesn't kill you. Calories are only half of the equation as well because what matters in terms of overeating is satiety which comes both from a stretch reflex (which is why low cal things like veggies are great) and hormone signaling. I maintain quite a lean physique even though I eat over 180 (1600 calories) of fat a day. Not lacking energy or I'd find deadlifting 3x my body weight impossible. Food isn't black and white. Quote: satiety which comes both from a stretch reflex you are so CORRECT. Rice and Beans. oatmeal. foods that soak up the water. high fiber. I ran across an interesting observation. we eat approximately the same weight of food every day. I love oatmeal have an entire shelf full of it
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Post by mnkdfann on Jun 8, 2019 8:16:31 GMT -5
The protocol is now set for the India study and as we have been talking about for years on this board, CGMs don't lie. The medical community can no longer hide behind the A1c 3 month average and say its good enough. Is it now set? I thought it was still (as of about a month ago) being decided. Where can we find this protocol?
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Post by prcgorman2 on Jun 8, 2019 9:16:33 GMT -5
Sayhey may have been speaking figuratively, but I figure you know that. :-)
Sayhey, I’m pretty sure I literally heard a microphone drop at the end of your last post. Very powerful.
Your most compelling comment was, “The medical community can no longer hide behind the A1C 3 month average and say its good enough”.
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Post by shawnonafrezza on Jun 8, 2019 10:04:39 GMT -5
Your most compelling comment was, “The medical community can no longer hide behind the A1C 3 month average and say its good enough”. Dr. Aaron Kowalski has been pretty vocal about this for some time now and using Loop + Afrezza I'm sure he has strong opinion of what "good enough" should be.
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