|
|
Post by prcgorman2 on Mar 4, 2020 7:09:36 GMT -5
I agree. I think good tier placement won’t be until 2022 or 2023. I do expect it’s coming though. Afrezza is the shiznits and it won’t be denied forever. It will be denied until it either gets competitive on the cost to treat (if you need twice the insulin it had better cost half the price), or there are large scale trials proving that it is better and how - TIR, HbA1c, and hypos (all three of which should be doable). Without those two, especially the first, expect the insurance cover to be exactly where it is today. “Price is what you pay. Value is what you get.” - W. Buffet I do expect discounts to PBMs will be required, but how much is an open question. |
|
|
|
Post by golfeveryday on Mar 4, 2020 7:19:23 GMT -5
I don't know how Peds will go... I pray that Mnkd markets it in a way that the kids will want it.. However, we do NOT have Endos on board.. nor do we have a lot of money to advertise so we are always at a disadvantage.. It is possible BP will want to partner for the peds population... But I don't know enough about it to say.. how large is that population? It's all about $$$$$!!!! Regarding our current marketing plan.. it isn't working.. it's been how many years now? Time is money.. our retention rate is dismal.. I for one don't want to be diluted into Oblivion.. or wake up one morning and find our company has filed BK.. sticking our heads into the sand isn't a good investment strategy IMO.. All of the problems have been spelled out to us and it's obvious our management has no plan to address any of it. My money is on Vdex.. and because I know how good Afrezza is. Mnkd needs to team up with Vdex.. and work together.. that is how we will see hockey stick growth!!!! I see what the problem is. You guys like to talk about the HERE AND NOW. I am talking about the the next 3-5 years. Where will the insurers be when PEDS is approved in 2021 and ramping starts in mid-2021? Insurers will be onboard by then. Also Diabetics are not stupid. If they see they are dosing too early and need a follow up dose....Maybe they will delay there dosing and wait until they are half way through their meal. Everyone is different and every meal is different. They need to figure out on their own and now with CGMs they can actually see in realtime the impact foods have on their BG levels. I got the Libre for my 90 year old Type 2 Mom and for the first time in her life she realizes how certain foods increase her levels. This is evolving and you have to look at the big picture. VDEX is DEAD. Come on people....Let that HORSE DIE.....Did I hear they closed one of their locations? my son waits until after he eats to take his dose most of the time. Limits multiple post meal doses. He was also in the diabetic honeymoon period and using Afrezza so he had to adjust over time. He raised his tresiba dose little by little which helps and he did go from 4 units to 8 units for some meals. A lot can adjust as they go due to how fast acting it is. Humalog and novolog just simply hang around so long diabetics eat to counteract the insulin where Afrezza is so fast they need to adjust their thinking to dose to counteract their food/sugar. |
|
|
|
Post by Charlie on Mar 4, 2020 14:23:49 GMT -5
A thread for personal experiences/ family/ close friends etc. I'll put out the first one. I've been on Afrezza for 6 months and at the last Endo appointment I was asked to do another Spirometry test. Last time it, was at the Endo's office; so convenient. Since that time, the doctor tells me that legislation has been passed to help eliminate $ for referral to Pharamaceutical companies to prescribing physicians. I was given an order requisition to have one taken by a third party, in this case a hospital. After three frustrating phone calls to schedule I got a call back to get my test. My endo listened to my airflow and stated it sounded very clear, but on the order he writes "patient with cough using Afrezza inhaled insulin. And adds "ICD10=r05". I didn't read this until I got home. Made me kind of angry that he wrote this, in all probability to cover his liability. I have had a botched Apnea surgery (large whole in septum) which creates a constant drain which is the reason for the cough. I do not cough when I take the Afrezza. My endo is a good guy and really trying to make it work for me BUT the ENT who I saw today said infatically that the cough was a result of nasel drain. Since I can exhale enough breath to fill a balloon and am not too concerned about it as the ENT said he'd gladly give explaination to the Endo if I happen to run into a problem. One more hurdle. So here is one more issue that may have an affect on retention of patients using Afrezza. Thank you for whoever posted about taking another cartridge half through a meal. Some agreed it is a 2nd dose? I'm just curious how other people interpret it. If at 45 minutes into the initial inhalation I'd be looking at Peppy's chart I'd "expect" an "echo" or another peak with similar exit. I'd call it one dose including the bumper 1 dose. But of course these are guidelines and if you want time in range you have to do what you need to do. Comments welcome. |
|
|
|
Post by peppy on Mar 4, 2020 14:48:02 GMT -5
A thread for personal experiences/ family/ close friends etc. I'll put out the first one. I've been on Afrezza for 6 months and at the last Endo appointment I was asked to do another Spirometry test. Last time it, was at the Endo's office; so convenient. Since that time, the doctor tells me that legislation has been passed to help eliminate $ for referral to Pharamaceutical companies to prescribing physicians. I was given an order requisition to have one taken by a third party, in this case a hospital. After three frustrating phone calls to schedule I got a call back to get my test. My endo listened to my airflow and stated it sounded very clear, but on the order he writes "patient with cough using Afrezza inhaled insulin. And adds "ICD10=r05". I didn't read this until I got home. Made me kind of angry that he wrote this, in all probability to cover his liability. I have had a botched Apnea surgery (large whole in septum) which creates a constant drain which is the reason for the cough. I do not cough when I take the Afrezza. My endo is a good guy and really trying to make it work for me BUT the ENT who I saw today said infatically that the cough was a result of nasel drain. Since I can exhale enough breath to fill a balloon and am not too concerned about it as the ENT said he'd gladly give explaination to the Endo if I happen to run into a problem. One more hurdle. So here is one more issue that may have an affect on retention of patients using Afrezza. Thank you for whoever posted about taking another cartridge half through a meal. Some agreed it is a 2nd dose? I'm just curious how other people interpret it. If at 45 minutes into the initial inhalation I'd be looking at Peppy's chart I'd "expect" an "echo" or another peak with similar exit. I'd call it one dose including the bumper 1 dose.
But of course these are guidelines and if you want time in range you have to do what you need to do. Comments welcome. Matt B said to look at the CMG after 45 mins. Matt has all his video's on you tube now. You need to find the one where he talks about that www.youtube.com/channel/UC7EV3DuK0vfGbnoA6NZotCAYou will be impressed by Matt. He figured out afrezza and told me. *** Matt and you differ, he is a type one. however his words will work for type two. |
|
|
|
Post by ktim on Mar 4, 2020 20:31:46 GMT -5
For what it's worth (I take at face value), Mike just said that drop out rate (2 month) is only 50% for T2 and less for T1. Again, emphasis is on one to two months. He wisely did not say what the drop out rate is after that. I'd think most patients would drop within 2 months if it weren't working for them or they simply didn't like it, or even if insurance weren't approving it. Seems there would still be some drop outs at the beginning of each year if patients switched insurance and the new plan forced them to switch. I would think that wouldn't be a very high percentage. Still would be helpful for them to give a annual drop rate. |
|
|
|
Post by brotherm1 on Mar 4, 2020 20:41:38 GMT -5
So you are thinking for about every 1 or 2 that try Afrezza stay with it?
|
|
|
|
Post by prcgorman2 on Mar 4, 2020 21:06:27 GMT -5
MC said in the annual earnings CC that T2 drop out rate was high, but that T1 retention was much better. I think 1 out of 2 on T2 might be correct. My assumption is the T2’s try it, but don’t get insurance coverage and won’t pay out of pocket.
|
|
|
|
Post by Charlie on Mar 5, 2020 16:16:18 GMT -5
I honing in on this dosing with your help. If required by adding a bumper dose if required it's keeping me time in range.
Most often I would wake up with a blood glucose reading of 138 to 155.
On wakeup
3/2/20 117
3/3/20 119
3/4/20 95
3/5/20 98
this is helping me navigate how I am learning to use Afreeze which is a freaking miracle drug.
I could'n help myself and while on a tight budget bout 300 more shares @1.27
I'm feeling good. My memory is getting better.
Wondering if the improvement represented by my numbers being lower will have a cumulative affect. The wake up #'s were always higher a few at 180 before improving in this learning curve.
|
|
|
|
Post by sweedee79 on Mar 5, 2020 16:20:29 GMT -5
This is amazing Charlie.. Thank you so much for sharing.. can't wait to hear how you feel better as time goes on.
|
|
|
|
Post by peppy on Mar 5, 2020 16:23:49 GMT -5
I honing in on this dosing with your help. If required by adding a bumper dose if required it's keeping me time in range. Most often I would wake up with a blood glucose reading of 138 to 155. On wakeup 3/2/20 117 3/3/20 119 3/4/20 95 3/5/20 98 this is helping me navigate how I am learning to use Afreeze which is a freaking miracle drug. I could'n help myself and while on a tight budget bout 300 more shares @1.27 I'm feeling good. My memory is getting better.
Wondering if the improvement represented by my numbers being lower will have a cumulative affect. The wake up #'s were always higher a few at 180 before improving in this learning curve. Our type's one's, some of them have said, they feel better. Yippee. |
|
|
|
Post by Charlie on Mar 6, 2020 1:16:13 GMT -5
golfeveryday
"my son waits until after he eats to take his dose most of the time. Limits multiple post meal doses. He was also in the diabetic honeymoon period and using Afrezza so he had to adjust over time. He raised his tresiba dose little by little which helps and he did go from 4 units to 8 units for some meals. A lot can adjust as they go due to how fast acting it is. Humalog and novolog just simply hang around so long diabetics eat to counteract the insulin where Afrezza is so fast they need to adjust their thinking to dose to counteract their food/sugar."
I would think in part it could be how fast a person eats with regard to your son. My son eats quickly; 1/3 the time that I do. So what Peppy's charts show that the Afrezza peaks quickly with food intake and then trails off. I was of the understanding that Afrezza getss up to where the glucose starts to peak, when Afrezza slows down the maybe caps the glucose from rising higher and escorts the glucose down to acceptable range targets. (if you dose correctly). I'm now taking a mid meal test to evaluate
how to find balance. Tonight was a large meal with my son. The 24 units I took was a miscalculation when mid way my reading was 55. Had a few pieces of dried fruit and was back up to 127; but when the time elapsed the Afrezza of my system my final # was 94. Pretty damn cool resolve to too low of a # which included surf & turf and a med.
russet potato. I'm feeling more confident daily that I'm getting a handle on this. Blows me away that the share price on this huge advancement is at a buck and a quarter! People just don't know. Including many people in the medical community. I sure hope it's soon than late that this Dream Boat delivers the momentum and excitement many of us feel.
Being a stock holder is one thing. Knowing the success of the medication personally is an amazing affirmation.
|
|
|
|
Post by peppy on Mar 6, 2020 5:12:15 GMT -5
golfeveryday "my son waits until after he eats to take his dose most of the time. Limits multiple post meal doses. He was also in the diabetic honeymoon period and using Afrezza so he had to adjust over time. He raised his tresiba dose little by little which helps and he did go from 4 units to 8 units for some meals. A lot can adjust as they go due to how fast acting it is. Humalog and novolog just simply hang around so long diabetics eat to counteract the insulin where Afrezza is so fast they need to adjust their thinking to dose to counteract their food/sugar." I would think in part it could be how fast a person eats with regard to your son. My son eats quickly; 1/3 the time that I do. So what Peppy's charts show that the Afrezza peaks quickly with food intake and then trails off. I was of the understanding that Afrezza getss up to where the glucose starts to peak, when Afrezza slows down the maybe caps the glucose from rising higher and escorts the glucose down to acceptable range targets. (if you dose correctly). I'm now taking a mid meal test to evaluate how to find balance. Tonight was a large meal with my son. The 24 units I took was a miscalculation when mid way my reading was 55. Had a few pieces of dried fruit and was back up to 127; but when the time elapsed the Afrezza of my system my final # was 94. Pretty damn cool resolve to too low of a # which included surf & turf and a med. russet potato. I'm feeling more confident daily that I'm getting a handle on this. Blows me away that the share price on this huge advancement is at a buck and a quarter! People just don't know. Including many people in the medical community. I sure hope it's soon than late that this Dream Boat delivers the momentum and excitement many of us feel. Being a stock holder is one thing. Knowing the success of the medication personally is an amazing affirmation. The 24 units I took was a miscalculation when mid way my reading was 55. Had a few pieces of dried fruit and was back up to 127; Had a few pieces of dried fruit and was back up to 127; good problem solving. The 24 units I took was a miscalculation when mid way my reading was 55. : The nice thing about afrezza is it is easy to second dose, and it will not kill you. Perhaps with the first phase, you don't need that much? www.seventhform.com/vdexdownloads/vdex-whitepaper-072817.pdfComments Afrezza’s speed of action is both a blessing and a curse. Clearly, it is a large factor in the safety of the product, but for longer meals, you may need more Afrezza to keep the post prandial levels in check. We recommend follow-on doses. For example, we advise with a standard meal to dose Afrezza 15-20 minutes after the start of the meal, and then another dose of the same size about 45 minutes later. With very long meals, we have even advised patients to administer two follow-on doses, for very tight control. |
|
|
|
Post by Charlie on Mar 6, 2020 14:39:26 GMT -5
Thanks Peppy.
I have come to the conclusion that unless I'm totally certain, I need a mid meal test which is necessary for me to determine how to stay in range. That 55 blood glucose level told me to take less. A potato is far less carbs than bread. I consider this all an experimentation with myself as the subject, patient and shareholder. The pattern of success proves and supports why I invested in MNKD.
The ENT made no mention at any time with more than 6 visits regarding mid meal testing and correction. And I think he is a great doctor. But it's clear to me that the medical prescribing physicians are not up to date in their directives to their patients.
After hitting a new low of 55 mid meal last night and making an adjustment for the low number reaffirms Alfred Mann's statement about it being difficult to go hypoglycemic. Last reading before going to bed was 94. Woke up with 104. Made me smile all over the place.
90 day average 142 2.2 readings per day
30 day average 127 2.4 readings per day
14 day average 120 2.2 readings per day
Funny how I had to go from pre-diabetic over a period of 5 years to full on diabetic with the medical system slow in permitting me to use Afrezza which strongly confirms the effectiveness of my investment.
|
|
|
|
Post by sayhey24 on Mar 6, 2020 19:21:33 GMT -5
golfeveryday "my son waits until after he eats to take his dose most of the time. Limits multiple post meal doses. He was also in the diabetic honeymoon period and using Afrezza so he had to adjust over time. He raised his tresiba dose little by little which helps and he did go from 4 units to 8 units for some meals. A lot can adjust as they go due to how fast acting it is. Humalog and novolog just simply hang around so long diabetics eat to counteract the insulin where Afrezza is so fast they need to adjust their thinking to dose to counteract their food/sugar." I would think in part it could be how fast a person eats with regard to your son. My son eats quickly; 1/3 the time that I do. So what Peppy's charts show that the Afrezza peaks quickly with food intake and then trails off. I was of the understanding that Afrezza getss up to where the glucose starts to peak, when Afrezza slows down the maybe caps the glucose from rising higher and escorts the glucose down to acceptable range targets. (if you dose correctly). I'm now taking a mid meal test to evaluate how to find balance. Tonight was a large meal with my son. The 24 units I took was a miscalculation when mid way my reading was 55. Had a few pieces of dried fruit and was back up to 127; but when the time elapsed the Afrezza of my system my final # was 94. Pretty damn cool resolve to too low of a # which included surf & turf and a med. russet potato. I'm feeling more confident daily that I'm getting a handle on this. Blows me away that the share price on this huge advancement is at a buck and a quarter! People just don't know. Including many people in the medical community. I sure hope it's soon than late that this Dream Boat delivers the momentum and excitement many of us feel. Being a stock holder is one thing. Knowing the success of the medication personally is an amazing affirmation. Charlie - welcome to the world of MannKind and afrezza. I think it would be fair to say that the lack of sales success of afrezza "Blows" most long-timers on this board away. Al Mann once told me he believed afrezza would be the greatest selling drug of all time. Al was not wrong about much but was always years ahead of the market with everything he did. I still think Al was correct. Its not clear to me from your posts if you are using some type of CGM. Its a huge help dialing in afrezza and after 1 to 3 months most T2s have no great need for them but in the beginning they make things so much easier. I got my first Libre on Ebay from Germany before they were readily available in the US. In working with new afrezza users I recommend they do an AGP with the Libre and keep a food log before they take their first puff of afrezza. That provides the baseline to dial in the afrezza. Over time there is a good chance you should see your insulin resistant decrease if you are keeping your 2 hour PPG under 140 and your FBG under 100. A good daily walk and a few less carbs will only help too. I wish you the best with your afrezza experimentation. |
|
|
|
Post by ktim on Mar 6, 2020 20:38:09 GMT -5
golfeveryday "my son waits until after he eats to take his dose most of the time. Limits multiple post meal doses. He was also in the diabetic honeymoon period and using Afrezza so he had to adjust over time. He raised his tresiba dose little by little which helps and he did go from 4 units to 8 units for some meals. A lot can adjust as they go due to how fast acting it is. Humalog and novolog just simply hang around so long diabetics eat to counteract the insulin where Afrezza is so fast they need to adjust their thinking to dose to counteract their food/sugar." I would think in part it could be how fast a person eats with regard to your son. My son eats quickly; 1/3 the time that I do. So what Peppy's charts show that the Afrezza peaks quickly with food intake and then trails off. I was of the understanding that Afrezza getss up to where the glucose starts to peak, when Afrezza slows down the maybe caps the glucose from rising higher and escorts the glucose down to acceptable range targets. (if you dose correctly). I'm now taking a mid meal test to evaluate how to find balance. Tonight was a large meal with my son. The 24 units I took was a miscalculation when mid way my reading was 55. Had a few pieces of dried fruit and was back up to 127; but when the time elapsed the Afrezza of my system my final # was 94. Pretty damn cool resolve to too low of a # which included surf & turf and a med. russet potato. I'm feeling more confident daily that I'm getting a handle on this. Blows me away that the share price on this huge advancement is at a buck and a quarter! People just don't know. Including many people in the medical community. I sure hope it's soon than late that this Dream Boat delivers the momentum and excitement many of us feel. Being a stock holder is one thing. Knowing the success of the medication personally is an amazing affirmation. Charlie - welcome to the world of MannKind and afrezza. I think it would be fair to say that the lack of sales success of afrezza "Blows" most long-timers on this board away. Al Mann once told me he believed afrezza would be the greatest selling drug of all time. Al was not wrong about much but was always years ahead of the market with everything he did. I still think Al was correct. Its not clear to me from your posts if you are using some type of CGM. Its a huge help dialing in afrezza and after 1 to 3 months most T2s have no great need for them but in the beginning they make things so much easier. I got my first Libre on Ebay from Germany before they were readily available in the US. In working with new afrezza users I recommend they do an AGP with the Libre and keep a food log before they take their first puff of afrezza. That provides the baseline to dial in the afrezza. Over time there is a good chance you should see your insulin resistant decrease if you are keeping your 2 hour PPG under 140 and your FBG under 100. A good daily walk and a few less carbs will only help too. I wish you the best with your afrezza experimentation. Minimed might have taken awhile to take off, but his early ventures did not. Mannkind was definitely an outlier. I think even Al realized he'd misjudged the uphill battle Afrezza would face. In fact I think that realization contributed to his rapid decline in health. |
|
