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Post by Charlie on Jan 16, 2020 20:06:43 GMT -5
There has been discussion of power left in the container after inhalation. The answer that was given to this was something like "all of the powered doesn't have to be inhaled" for it work correctly.
My brother told me that the way he uses it all is to take the dosage the way described; then turn the unit over; tap it a couple of times and then inhale again with the unit upside down. In this way "all" of the medicine is taken.
fwiw
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Post by ktim on Jan 17, 2020 15:08:24 GMT -5
I think PWD titrate to their own body's response, and as long as their routine is the same, then the titration takes care of it.
I take a medication every morning. It's absorption can be altered quite a bit depending on whether I take it on empty stomach or depending on what food I take it with. As long as my routine is the same each morning it doesn't matter, the titration accounts for it.
So tap or no tap, a patient likely learns what one cartridge does for them and acts accordingly. I doubt MNKD, or most clinicians, would want to complicate the inhalation instructions by adding steps.
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Post by buyitonsale on Jan 17, 2020 15:53:02 GMT -5
When the label says take 1 table spoon of cough syrup, do you fill the spoon and then take less and discard the rest, let's say if taking the whole thing at once is not comfortable ?
If I were Afrezza user I would always make sure there is no powder left in the cartridge and inhale as many times as needed.
Especially since Afrezza is expensive for some with no coverage and titration is based on many factors... so being as precise and efficient with the dose is important.
Why wouldn't a patient always want to inhale all powder ?
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Post by rfogel on Jan 17, 2020 15:59:11 GMT -5
Did the FDA take into account residual powder when it made the dosing decisions?
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Post by ktim on Jan 17, 2020 16:22:29 GMT -5
Did the FDA take into account residual powder when it made the dosing decisions? I think the conversion factor into pseudo units was derived from actual trials using the current inhaler. If that is correct, and presuming people followed the inhalation instructions, then this leftover powder effect would have been taken into account. Though we do know the conversion factor seems to be low for almost everyone. Regardless, people are very different. Titration is important regardless of how the conversion factor was determined. There are factors that affect peoples' absorption of SQ, that would have no correlation with the differences in how people respond to Afrezza, so there was never going to be a single conversion factor that would be perfect for everyone. And the timing of when one inhales, alters how the curve of insulin interacts with the curve of the BG.
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Post by ktim on Jan 17, 2020 16:45:50 GMT -5
When the label says take 1 table spoon of cough syrup, do you fill the spoon and then take less and discard the rest, let's say if taking the whole thing at once is not comfortable ? If I were Afrezza user I would always make sure there is no powder left in the cartridge and inhale as many times as needed. Especially since Afrezza is expensive for some with no coverage and titration is based on many factors... so being as precise and efficient with the dose is important. Why wouldn't a patient always want to inhale all powder ? Some people squeeze a tube of toothpaste until it's as flat as a piece of paper. Knew one person that even cut them open to scrape out more. Can't argue with frugality. As for something like cough syrup, I realize their dosing directions are by necessity hugely generalized in a manner that doesn't reflect the pharmacodynamics. I mean most cough syrups are one dose for a child and another for an adult. Really, you hit some particular age and all of a sudden the ideal dose is doubled? And a 110lb adult women's ideal dose is the same as a 220lb man? I tend to do my own titration of things like cough syrup... take less to start and see if it alleviates my symptoms enough, and if not take more. You can be "precise" and take exactly 1 table spoon, licking the spoon to make sure there isn't a fraction of a gram left, but that's a false precision because in reality the ideal dose might be larger or smaller. If the drugs came with instructions for dosing by body weight and gender (important for some but not all drugs) there might be more of an argument for precision in dosing. But drug manufacturers and the FDA realize people can't be bothered with doing math to dose OTC products, so the dosing of all of that is hugely imprecise by definition... and skewed to under dosing, since most of these products have side effects from being overdosed of more serious consequence than the effects of under dosing.
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Post by mango on Jan 17, 2020 16:51:23 GMT -5
I take Dr. Ethan Russo’s advice when it comes to titration—
Start low and go slow.
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Post by mytakeonit on Jan 17, 2020 17:03:23 GMT -5
Hard to get residual powder from a tube of toothpaste ... even if you cut it open. Ha!
As for cough syrup, don't take of give extra doses to your child. I believe it has alcohol in it and/or is addictive. That's what got me into drinking hard wines. Ha!
But, that's mytakeonit
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Post by ktim on Jan 17, 2020 17:21:50 GMT -5
Correct, you'd need to be using Toothpowder instead and then you'd need tin snips to cut it open. All that pharma stuff is bad for kids. Just do like our great grandmother's did and for a cough give the tykes a shot of whisky with some honey.
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Post by mango on Jan 17, 2020 17:42:09 GMT -5
Correct, you'd need to be using Toothpowder instead and then you'd need tin snips to cut it open. All that pharma stuff is bad for kids. Just do like our great grandmother's did and for a cough give the tykes a shot of whisky with some honey. Studies have proven Tooth Powder to be superior to Toothpaste in every aspect. 👍
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Post by sayhey24 on Jan 17, 2020 19:36:29 GMT -5
A shot of whiskey and some honey got me thinking of Boston. A few years back I walked the freedom trail in Boston. While on the trail you pass many small cemeteries and as a general observation many of the people lived into their 70's and 80's. I was really surprised especially since none had a computer to sign up for Obomacare.
I thought maybe it was because many drank whiskey prior to bed which reduced their overnight BG. I have no idea if the whiskey added to their longevity but who knows. What I do know is why take the risk. I will have some old #7 tonight, just in case.
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Post by sayhey24 on Jan 17, 2020 19:41:13 GMT -5
Charlie - btw, in a 4 unit cartridge are 10 units of insulin. An 8 has 20 and a 12 has 30. It is assumed "about" 60% will never make it to the deep lung. Of course the more insulin you take to more it will lower you BG. Some people take the cartridge apart of save the left over to make smaller doses.
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Post by mytakeonit on Jan 17, 2020 20:27:11 GMT -5
A shot of whiskey and some honey got me thinking of Boston. A few years back I walked the freedom trail in Boston. While on the trail you pass many small cemeteries and as a general observation many of the people lived into their 70's and 80's. I was really surprised especially since none had a computer to sign up for Obomacare. I thought maybe it was because many drank whiskey prior to bed which reduced their overnight BG. I have no idea if the whiskey added to their longevity but who knows. What I do know is why take the risk. I will have some old #7 tonight, just in case. sayhey ... what does living people in their 70's and 80's got to do with cemeteries. They don't bury live people. AND you assume the whiskey reduced their BG? Maybe it was the honey. Ha! But, the theory is fairly good ... so I'll drink to that. I have some Stagg Jr in the cabinet and I use milk and honey in my coffee everyday. But, I think I'd prefer wine tonight.
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Post by Charlie on Jan 17, 2020 21:56:05 GMT -5
Charlie - btw, in a 4 unit cartridge are 10 units of insulin. An 8 has 20 and a 12 has 30. It is assumed "about" 60% will never make it to the deep lung. Of course the more insulin you take to more it will lower you BG. Some people take the cartridge apart of save the left over to make smaller doses. SayHey That answers the question for me which "was" is it a one strength power and it is only volume of it that creates the additional units. That would make sense because "one strength" would make manufacturing cheaper even if the patient has to inhail 3 times as much volumn of it. Personally if it were me I would not split them due to contamination. thanks
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Post by agedhippie on Jan 17, 2020 22:30:13 GMT -5
The powder that remains is not likely to make a material difference to the outcome unless there is a lot. With injected insulin you are +/- 0.5U anyway (pumps are another matter and can happily deliver tiny doses). The only time this is really a problem is with young children because they tend to be very insulin sensitive so small variations produce big swings (pediatric insulin pens work in 0.5U graduations rather that 1u with adults for that reason).
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