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Post by agedhippie on Oct 21, 2019 18:32:25 GMT -5
Al was very much in the APS game. He funded and founded, Medical Research Group, an artificial pancreas developer. His foundation, the Alfred E Mann Foundation, has been dedicated to an APS. aemf.org/item/diabetes/TIL. Ahead of his time. I remember that design and the whole implant idea that never took off. Would've been nice. I know someone who has an implanted insulin pump, but they had to get it implanted in Europe and go back periodically to get it refilled. The PK/PD seems to be very fast because the insulin is dripped directly into the peritoneal cavity which is extremely effective at absorbing the insulin. |
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Post by ktim on Oct 21, 2019 18:47:03 GMT -5
TIL. Ahead of his time. I remember that design and the whole implant idea that never took off. Would've been nice. I know someone who has an implanted insulin pump, but they had to get it implanted in Europe and go back periodically to get it refilled. The PK/PD seems to be very fast because the insulin is dripped directly into the peritoneal cavity which is extremely effective at absorbing the insulin. Hopefully those pumps don't suffer some of the security flaws widespread in RTOS (some one of which they likely use). I'd hate for someone to take over my internal insulin pump. No option to yank the infusion set. www.ivenix.com/news/fda-issues-warning-about-urgent-11-vulnerabilities-putting-critical-medical-devices-at-risk/ |
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Post by sayhey24 on Oct 21, 2019 18:47:07 GMT -5
sayhey24 URLI insulin is due for 2020 which is faster than Fiasp and the trials were done in pump. I know Al made pumps, don't think he was in the APS game. That didn't start until he was busy with Afrezza. I'm still not convinced Afrezza should be first line for T2. I'm 100% in diet camp unless I can find the papers that Afrezza can fix beta cell function. I forgot about URLI mostly because I never thought much of it. I am not sure how they are going to dose it. It peaks in about 2 1/2 hours slower than Lispro. I guess they are expecting the PWDs to be eating a lot of pizza. diabetes.diabetesjournals.org/content/68/Supplement_1/1107-PWhen making the APS, Al knew it would never work as well as he had hoped and started looking for a faster insulin. The technology was not the problem, the speed of the insulin was. Look at the graph from the link above and tell me how you are going to put that in an APS and develop proper algorithms providing a repeatable result? That's a hard problem as I suspect the absorption profile is too variable. Afrezza on the other hand is very predictable and fast enough to stop the spike. 100% diet camp? Think of what the problem is. The pancreas has lost the ability to produce enough insulin for the body's needs and if you believe Joslin due to a viral attack which has killed off some amount of Beta cells. The more you can take the load off the pancreas especially at meal time the better chance for cell regeneration or at-least stopping further cell loss. Why would you not want to supplement the pancreas as needed with insulin. Doing the diet and exercise is good but adding the afrezza is even better, much better. Stopping the meal time BG spike is huge. This is why I think the way it should be marketed to T2s is through Health and Wellness centers and not through a single focus VDex diabetes clinic. Diet, exercise plus afrezza gives the T2 the best approach. Additionally, think of all those over weight people coming into the Health and Wellness Center who don't even know they are T2s. I bet most. Are you listening Oprah? Who knows maybe Mike has called her. IMO, Lilly should do themselves and mankind a huge service and buy Mannkind and turn the diabetes industry on its ear by getting afrezza to all PWDs. If they don't someone will. Its a matter of time as scripts slowly rise. |
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Post by ktim on Oct 21, 2019 20:53:59 GMT -5
sayhey24 URLI insulin is due for 2020 which is faster than Fiasp and the trials were done in pump. I know Al made pumps, don't think he was in the APS game. That didn't start until he was busy with Afrezza. I'm still not convinced Afrezza should be first line for T2. I'm 100% in diet camp unless I can find the papers that Afrezza can fix beta cell function. I forgot about URLI mostly because I never thought much of it. I am not sure how they are going to dose it. It peaks in about 2 1/2 hours slower than Lispro. I guess they are expecting the PWDs to be eating a lot of pizza. diabetes.diabetesjournals.org/content/68/Supplement_1/1107-PWhen making the APS, Al knew it would never work as well as he had hoped and started looking for a faster insulin. The technology was not the problem, the speed of the insulin was. Look at the graph from the link above and tell me how you are going to put that in an APS and develop proper algorithms providing a repeatable result? That's a hard problem as I suspect the absorption profile is too variable. Afrezza on the other hand is very predictable and fast enough to stop the spike. 100% diet camp? Think of what the problem is. The pancreas has lost the ability to produce enough insulin for the body's needs and if you believe Joslin due to a viral attack which has killed off some amount of Beta cells. The more you can take the load off the pancreas especially at meal time the better chance for cell regeneration or at-least stopping further cell loss. Why would you not want to supplement the pancreas as needed with insulin. Doing the diet and exercise is good but adding the afrezza is even better, much better. Stopping the meal time BG spike is huge. This is why I think the way it should be marketed to T2s is through Health and Wellness centers and not through a single focus VDex diabetes clinic. Diet, exercise plus afrezza gives the T2 the best approach. Additionally, think of all those over weight people coming into the Health and Wellness Center who don't even know they are T2s. I bet most. Are you listening Oprah? Who knows maybe Mike has called her. IMO, Lilly should do themselves and mankind a huge service and buy Mannkind and turn the diabetes industry on its ear by getting afrezza to all PWDs. If they don't someone will. Its a matter of time as scripts slowly rise. Given that it rises rapidly and plateaus, I don't think that's clinically significant that the absolute peak is delayed. At unit for unit equivalency it beats Lispro pd action even when Lispro has hit it's "earlier" peak. When comparing the onset with Lispro, what likely matters most is the area under the curve at any point post meal... i.e. the cumulative insulin effect at 1 hr, 1.5 hr, etc. Due to URLI's very quick rise, I'm sure it has larger area under the curve for the entire first 2 hours even if the units of URLI were scaled back to match the peak of standard Lispro... doing that would also reduce the time to return to baseline. An APS algorithm would likely bolus less URLI than Lispro when it detected start of meal induced BG rise. To me that intuitively seems like it could have significant advantage in an APS compared to standard Lispro... or FIASP. Return to baseline is good, especially if less is needed in the bolus to blunt the early BG rise. Will be interesting what sort of TIR start getting reported as people will undoubtedly use it in Loop as soon as it hits the market. |
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Post by shawnonafrezza on Oct 21, 2019 20:57:33 GMT -5
sayhey24 URLI insulin is due for 2020 which is faster than Fiasp and the trials were done in pump. I know Al made pumps, don't think he was in the APS game. That didn't start until he was busy with Afrezza. I'm still not convinced Afrezza should be first line for T2. I'm 100% in diet camp unless I can find the papers that Afrezza can fix beta cell function. I forgot about URLI mostly because I never thought much of it. I am not sure how they are going to dose it. It peaks in about 2 1/2 hours slower than Lispro. I guess they are expecting the PWDs to be eating a lot of pizza. diabetes.diabetesjournals.org/content/68/Supplement_1/1107-P Look at the graph from the link above and tell me how you are going to put that in an APS and develop proper algorithms providing a repeatable result? 100% diet camp? Think of what the problem is. The pancreas has lost the ability to produce enough insulin for the body's needs and if you believe Joslin due to a viral attack which has killed off some amount of Beta cells. The more you can take the load off the pancreas especially at meal time the better chance for cell regeneration or at-least stopping further cell loss. Why would you not want to supplement the pancreas as needed with insulin. Doing the diet and exercise is good but adding the afrezza is even better, much better. Stopping the meal time BG spike is huge. 2.5 hours slower? That graph shows it being 2x as fast. As far as making it repeatable in an algorithm? That has been done. They do it with plain on RAA and better results with Fiasp (if the pt tolerates it). Who knows how well this will go, we'll know in about a year but since we have people eating without bolusing already I can't see worse results happening. And yes, 100% diet camp. The problem is the body can't produce sufficient insulin so why would you demand it take in foods you cannot tolerate? Do you give a peanut allergy person more epi every time they eat peanuts? No, you tell them to not eat peanuts! Personally I don't get where the whole high carb madness started but if I look at what my grandma ate growing up and I look at what people eat now I'm going to say it was in the last 60 years. Put most people on a low carb diet and you see c reactive protein drop, hdl raise, ldl drop, trigs drop, bp drop, sleep improve, cravings drop, etc. No drug does that. If a patient needs insulin like in the case of T1 yes Afrezza is the answer. If a patient can be corrected with diet and exercise that is then, IMO, then answer and Virta shows why. Lifestyle and diet beat most drugs and most drugs should be a last resort. I mean with proper diet a T1 doesn't even need an APS and that lack of pump is great. |
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