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Post by rfogel on Dec 6, 2019 8:42:01 GMT -5
www.eventscribe.com/2019/posters/AACE/SplitViewer.asp?PID=Mzk3NzExMjgzMjk#First, why did they choose to compare 10U of lispro to 16U and 24U? It seems like it would have been more appropriate to compare 16 and 24 units of lispro as well. Second, from about 2.5 hours out the change in PPG is about the same for lispro as it is for afrezza. Does this not contradict the notion that afrezza is "fast out" since by 2.5 hours there shouldn't have been any further afrezza effect while lispro should have been still working.
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Post by sayhey24 on Dec 6, 2019 18:46:38 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro.
At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro.
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Post by shawnonafrezza on Dec 6, 2019 19:10:48 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro.I like to live dangerously  |
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Post by rfogel on Dec 6, 2019 19:27:09 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro. Okay, but they should have explained that 1/.4 difference in the poster, otherwise the first inclination is to wonder what would have been the result of using a matching dose of lispro. As regards the second question, the afrezza and lispro graphs are virtually identical from 2.5 hours on. That implies either both stopped working at 2.5 hours and the patients other meds took over or else they both had similar glucose lowering effect from 2.5 hours on. However, lispro allegedly doesn't stop at 2.5 hours while afrezza allegedly doesn't work past 1.5 hours. That leaves the question as to what makes the graph look as it does from 2.5 hours on. There appears to be some sort of contradiction in the data. Also, while I'm here, I may as well ask whether Dr. Kendall ever makes presentations anywhere. Are there any recorded presentations available anywhere? |
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Post by mnholdem on Dec 6, 2019 20:07:34 GMT -5
Google "presentation by david kendall md diabetes" and select videos. There are quite a few, including this one of Dr Kendall from ADA 2018.  vimeo.com/292936650 |
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Post by peppy on Dec 6, 2019 20:50:09 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro. Okay, but they should have explained that 1/.4 difference in the poster, otherwise the first inclination is to wonder what would have been the result of using a matching dose of lispro. As regards the second question, the afrezza and lispro graphs are virtually identical from 2.5 hours on. That implies either both stopped working at 2.5 hours and the patients other meds took over or else they both had similar glucose lowering effect from 2.5 hours on. However, lispro allegedly doesn't stop at 2.5 hours while afrezza allegedly doesn't work past 1.5 hours. That leaves the question as to what makes the graph look as it does from 2.5 hours on. There appears to be some sort of contradiction in the data. Also, while I'm here, I may as well ask whether Dr. Kendall ever makes presentations anywhere. Are there any recorded presentations available anywhere? I do not have the study graphs in front of me and I did not bring them up. I looked at Lispro/Humalog. 1. The time course of action of insulin and insulin analogs, such as Humalog, may vary considerably in different individuals or within the same individual. 2.  www.accessdata.fda.gov/drugsatfda_docs/label/2007/020563s075,021017s040,021018s034lbl.pdf Humalog (insulin lispro) is a fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours.
like any insulin, the users need to learn to dose.
With afrezza, people can dose to keep blood glucose levels more stable as seen here
Humalog seen here.
People need to learn to dose Afrezza.
The study you are looking at was type one fast acting insulin users that were given the dosing instructions for afrezza which means follow up dosing.
Some of the experienced subq insulin users were too afraid to take the second dose, especially the one after dinner.
Allow me to show you their fear. it is here.
rfogel, I have answered some of your questions.
The physicians do not seem to care or ...... their hands are tied.
care.diabetesjournals.org/content/diacare/suppl/2018/12/17/42.Supplement_1.DC1/DC_42_S1_2019_UPDATED.pdf
I pulled them up.
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Post by agedhippie on Dec 6, 2019 22:25:44 GMT -5
Okay, but they should have explained that 1/.4 difference in the poster, otherwise the first inclination is to wonder what would have been the result of using a matching dose of lispro. As regards the second question, the afrezza and lispro graphs are virtually identical from 2.5 hours on. That implies either both stopped working at 2.5 hours and the patients other meds took over or else they both had similar glucose lowering effect from 2.5 hours on. However, lispro allegedly doesn't stop at 2.5 hours while afrezza allegedly doesn't work past 1.5 hours. That leaves the question as to what makes the graph look as it does from 2.5 hours on. There appears to be some sort of contradiction in the data. Also, while I'm here, I may as well ask whether Dr. Kendall ever makes presentations anywhere. Are there any recorded presentations available anywhere?
Some of the experienced subq insulin users were too afraid to take the second dose, especially the one after dinner.
Allow me to show you their fear. it is here.Seriously, that is simply not true. Pumps are even programmed to do staged doses, looped systems do it routinely although 10s of doses rather than just two. That people don't do this more often with injections is down to laziness (guilty!) rather than fear. There are a lot of myths around insulin and this is just one of them, along with the idea that stacking insulin is horribly dangerous. Yet diabetics seem survive doing all of them regularly. |
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Post by rfogel on Dec 6, 2019 23:14:28 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro. I think I'm understanding it a bit better now. So the middle graph from the link in my original post indicates afrezza controlled well the first 90 minutes but then glucose started rising. It also implies to maintain that really good control would require another dose at the end of that 90 minutes and maybe yet another dose 90 minutes after that -- is that about right? I wish they would have used a higher dose of lispro for comparison. The dose they used doesn't appear to have had any effect whatsoever. Also, thanks to mnholdem for the vimeo links to Dr. Kendall discussing afrezza. I was hoping to find a real presentation to some group. I was wanting to assess his ability as a "pitchman" for the drug. On vimeo he seems a bit sluggish, like maybe jet lagged a bit. Is he better on stage? |
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Post by brotherm1 on Dec 7, 2019 0:57:30 GMT -5
He speaks endo
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Post by brentie on Dec 7, 2019 6:32:23 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro. I think I'm understanding it a bit better now. So the middle graph from the link in my original post indicates afrezza controlled well the first 90 minutes but then glucose started rising. It also implies to maintain that really good control would require another dose at the end of that 90 minutes and maybe yet another dose 90 minutes after that -- is that about right? I wish they would have used a higher dose of lispro for comparison. The dose they used doesn't appear to have had any effect whatsoever. Also, thanks to mnholdem for the vimeo links to Dr. Kendall discussing afrezza. I was hoping to find a real presentation to some group. I was wanting to assess his ability as a "pitchman" for the drug. On vimeo he seems a bit sluggish, like maybe jet lagged a bit. Is he better on stage? This is before he worked for MannKind and not on stage but it may help answer your question... www.youtube.com/watch?v=3Wp9_TAkiME |
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Post by peppy on Dec 7, 2019 8:08:39 GMT -5
...
Some of the experienced subq insulin users were too afraid to take the second dose, especially the one after dinner.
Allow me to show you their fear. it is here. Seriously, that is simply not true. Pumps are even programmed to do staged doses, looped systems do it routinely although 10s of doses rather than just two. That people don't do this more often with injections is down to laziness (guilty!) rather than fear. There are a lot of myths around insulin and this is just one of them, along with the idea that stacking insulin is horribly dangerous. Yet diabetics seem survive doing all of them regularly. Aged, I am not making these graphs up. People are posting them and I am capturing them. So, let's talk. Regarding trials let's say: we need to stuff to work the same for everyone? The body and all the hormones etc, this person is having difficult time explaining this to herself. The stuff doesn't work the same all the time? absorption and all. Which food? Absorption of food, those little intestinal villi, Absorption of insulin.  |
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Post by sayhey24 on Dec 7, 2019 8:28:25 GMT -5
1 unit affreza equates "kinda" to about .4u lispro. 24u of afrezza would be about 10u Lispro. At about 1.5 mark hours afrezza is done. At the 2.5 mark you would hope Lispro would be done too but it is clearly not. As the poster says if the BG is rising at the 2hr mark just take another hit of afrezza. The PWD would stay near baseline. Don't dare try doing that with the lispro. I think I'm understanding it a bit better now. So the middle graph from the link in my original post indicates afrezza controlled well the first 90 minutes but then glucose started rising. It also implies to maintain that really good control would require another dose at the end of that 90 minutes and maybe yet another dose 90 minutes after that -- is that about right? I wish they would have used a higher dose of lispro for comparison. The dose they used doesn't appear to have had any effect whatsoever. Also, thanks to mnholdem for the vimeo links to Dr. Kendall discussing afrezza. I was hoping to find a real presentation to some group. I was wanting to assess his ability as a "pitchman" for the drug. On vimeo he seems a bit sluggish, like maybe jet lagged a bit. Is he better on stage? Dr. Kendall is a polished presenter. He is presenting the 5 to 7 studies which form the basis of the new "ultra acting" class in February if what MC said this week is correct. His focus has been getting the new class and changing the SoC. When you are talking afrezza, it makes no sense to look at the effect after 2.5 hours. The graphs are meaningless. It is out of the system. It is done working which is it beauty. Lispro is not. Its still hanging around. If you believe what Aged says thats the benefit of the RAAs which is ridiculous. What do they say about a house guest after 3 days - its beginning to smell like dead fish? We have a whole industry trying to make AI pumps to figure out how much RAA is still hanging around so they can properly continue to dose. afrezza obsoletes the need for any of this. With afrezza if you BG is rising at 2hr, take another puff - simple and repeatable with little chance of a server hypo. Of course prior to CGMs this was not obvious to most. Mike talked about a connected care service in last weeks talk so it will be interesting what they do; OneDrop; Onduo; something else. The second dosing is more a T1 thing. With a T2 the pancreas is probably still making enough insulin so in most cases there is little need for second dosing. IMO, afrezza should be prescribed as part of the Step 1 in the SoC. Take a walk, lose a few pounds and take the afrezza for 3 months and then go back to the doctor. Maybe after the 3 or 6 months there is no longer a need for the afrezza with some early stage T2s. |
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Post by agedhippie on Dec 7, 2019 8:52:41 GMT -5
Seriously, that is simply not true. Pumps are even programmed to do staged doses, looped systems do it routinely although 10s of doses rather than just two. That people don't do this more often with injections is down to laziness (guilty!) rather than fear. There are a lot of myths around insulin and this is just one of them, along with the idea that stacking insulin is horribly dangerous. Yet diabetics seem survive doing all of them regularly. Aged, I am not making these graphs up. People are posting them and I am capturing them. So, let's talk. Regarding trials let's say: we need to stuff to work the same for everyone? The body and all the hormones etc, this person is having difficult time explaining this to herself. The stuff doesn't work the same all the time? absorption and all. Which food? Absorption of food, those little intestinal villi, Absorption of insulin. I know the graphs are not made up, the CGM photo is from a link I sent you  , and I am quite happy to believe the Afrezza flatline since I can just as easily find the same thing with people using RAA. People tend to post good and bad pictures, but not the boring halfway ones. It would be really nice if it worked the same for everyone, or even consistently for one person! There are a ton of variables when you take insulin. The big ones for me are temperature, exercise (cardio, not strength), and illness (often the first indication that anything is wrong is my insulin sensitivity changes). Some times there is no visible reason at all! For a lot of women their cycle causes problems. Absorption can be an issue and as I have always said I would have promoted reliable absorption way ahead of no needles or even fast action. I care less about how fast my insulin will kick in since I can adjust for that than I do about absorption. If I changed to Afrezza that would be the chief reason. Food screws with everything. If you are non-diabetic it's possible to get a hypo from lettuce if you eat enough of it fast enough despite it having essentially zero carbs because your duodenum triggers insulin in response to volume (there was actually a case of this!) From a diabetic standpoint it's the volume of fat, this delays glucose, and type of carbs, white starches are bad. Even then it's not consistent - I do pretty well with pasta for example, but for most diabetics it's a non-starter. As a new diabetic the advice you are given is to eat to your meter (CGM these days I suppose). |
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Post by agedhippie on Dec 7, 2019 9:08:05 GMT -5
... Lispro is not. Its still hanging around. If you believe what Aged says thats the benefit of the RAAs which is ridiculous. What do they say about a house guest after 3 days - its beginning to smell like dead fish? We have a whole industry trying to make AI pumps to figure out how much RAA is still hanging around so they can properly continue to dose. afrezza obsoletes the need for any of this. With afrezza if you BG is rising at 2hr, take another puff - simple and repeatable with little chance of a server hypo. Of course prior to CGMs this was not obvious to most. Mike talked about a connected care service in last weeks talk so it will be interesting what they do; OneDrop; Onduo; something else. The second dosing is more a T1 thing. With a T2 the pancreas is probably still making enough insulin so in most cases there is little need for second dosing. IMO, afrezza should be prescribed as part of the Step 1 in the SoC. Take a walk, lose a few pounds and take the afrezza for 3 months and then go back to the doctor. Maybe after the 3 or 6 months there is no longer a need for the afrezza with some early stage T2s. Each to their own. I let the insulin create the tail for me, you would rather take a second dose and create the tail that way. My way is less work Calculating insulin onboard has been a solved problem for years so it's not an issue. Other than in the US (thank you FDA) even meters do this. I get all this information as a nice graph on my phone with predictive curves so I can see what should happen in the future. This isn't as difficult as people seem to think. When you drive a car around a corner you don't swing the wheel violently, you do it more incrementally - think of what the pump (and your pancreas) are doing and it's the same incremental action. RAA and Afrezza is not incremental, it's a lump. This is why pumps like the Medtronics 780G gets better results than the compliant Afrezza group did in the STAT trial. |
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Post by shawnonafrezza on Dec 7, 2019 11:53:31 GMT -5
I think I'm understanding it a bit better now. So the middle graph from the link in my original post indicates afrezza controlled well the first 90 minutes but then glucose started rising. It also implies to maintain that really good control would require another dose at the end of that 90 minutes and maybe yet another dose 90 minutes after that -- is that about right? I wish they would have used a higher dose of lispro for comparison. The dose they used doesn't appear to have had any effect whatsoever. Also, thanks to mnholdem for the vimeo links to Dr. Kendall discussing afrezza. I was hoping to find a real presentation to some group. I was wanting to assess his ability as a "pitchman" for the drug. On vimeo he seems a bit sluggish, like maybe jet lagged a bit. Is he better on stage? We have a whole industry trying to make AI pumps to figure out how much RAA is still hanging around so they can properly continue to dose. afrezza obsoletes the need for any of this. I think you greatly misunderstand why they are trying to close the loop. It's not to make RAA usable, it's to make the diabetic not have to interact with the disease. "No decision" beats "it's just a follow up dose" every time. I think I did a huge post here on that. There was some study that the average T1D makes an extra 100 decisions a day; that is what they're trying to solve. And in conjunction with a LC diet I know some people who literally do not press any button or give any concern to the disease for days at a time. Afrezza is the option for those who don't want to be connected. Options is good, I don't know why anyone would argue otherwise. You can post all the roller coaster blgs you want, that doesn't make them the rule. /photo/1 /photo/1 /photo/1 If you have to beat down a different approach to make yours look good that can make one wonder how good it really is. Fortunately I think Afrezza is a good option but it should not be the only. |
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, and I am quite happy to believe the Afrezza flatline since I can just as easily find the same thing with people using RAA. People tend to post good and bad pictures, but not the boring halfway ones.