|
Post by shawnonafrezza on Jun 16, 2020 12:56:14 GMT -5
Yes. Both Shawn and I have said this in the past. I am totally not buying that. But that's just me. You highly underestimate how annoying diabetes is. I already walked through a full day of what it would look like and it is the primary reason Afrezza is not my only insulin. THAT is how annoying it is.
|
|
|
Post by rockstarrick on Jun 16, 2020 16:22:34 GMT -5
This is why I say RAA’s and Afrezza are two completely different products. If Afrezza is out of the system in around 90 minutes, I’d say for most, it’s gone before sleep. RAA’s stay in the system for over 4 hours, so maybe it makes sense here. I just don’t believe that Afrezza is present and doing anything related to TIR after about 90 minutes, it’s the basal insulin that keeps a PWD in range overnight, if Afrezza was still doing anything PWD would go low at night like they do with RAA’s. Correct, but a meal is not done digesting after 90 minutes so does Afrezza just get a pass? If you ran a trial like that the outcome could only prove better TIR for the 90 minutes post meal. That would also remove the tail from RAA. You'd have to prove basal was set right and then let the bolus do what it is. Unfortunately, unless the study somehow allows ad lib bolusing for highs Afrezza would struggle there. It'd have to be written in a way where if BGL is > X and last Afrezza dose was more than 90 minutes ago the pt boluses. That is what people who are successful do but not what any trial has done. I get your point, I think they should do a trial for a 24 hr TIR, and just include a 12 hr group too. Say from 8am to 8pm, have everybody eat at 7am, 2pm, and 7pm, this way everybody gets to eat at the same time, and the insulin is allowed 60 minutes to get started. This way Afrezza gets the short end of the stick in the 24 hr arm, and RAA’s get it during the 12 hr arm, then just average the two. But at least try to design a trial that at least focuses on just mealtimes, the data would be more useful for mealtime dosing. I guess you’d need the late pm meal have enough time to digest and the stomach empty. Hell I wouldn’t care if RAA’s were even compared, just design a trial that covers just mealtime with Afrezza to help get a ball park dosing protocol. Can you tell the Music Industry hasn’t re-opened yet?? I’m so bored I’m designing mealtime insulin clinical trials in my spare time. ✌🏻🤓
|
|
|
Post by rockstarrick on Jun 16, 2020 16:47:41 GMT -5
Shawn - Looking at TIR from a marketing perspective during sleep time for closed loop systems makes sense as they should do really well when PWDs are not eating. The problem is the damn PWDs eat and when that happens, no matter how good the algorithms are varying unpredictable absorption weighs in. This is the problem Al was trying to address when he invented afrezza. Closed loop systems at meal time will never, ever be as good as afrezza. This is why the best closed loop results are when they use afrezza for the meals. At the 60-120 minute mark is about when the second dosing would occur for afrezza. Assuming diner before 7pm by the 10-11pm time range will reflect that period the PWD can act on their prandial BG. With that said few in the RAA/Close Loop business will want a TIR period which is not 24hrs. I worked with 4:20 closed loop chemical feed pumps in the Water industry, and it takes hours for those pumps to stabilize. The can’t start or stop on a dime, they continually speed up and slow down trying to hit the set points, giving a big wavy trend that eventually flatlines. The problem is, before that happens something will happen that stops the well pump from running, (reservoir full, no demand), and that stops the feed pumps, and it starts all over again. It’s a shitty way to dose chlorine for a public Water System. I can see the same problems with closed loop insulin pumps, about the time they begin to stabilize t’s time to eat again, and the cycle starts all over again. The best control they had in the APS studies were when Afrezza was used for mealtime spikes. its way better to just calculate the correct dosage with the desired residual, than to use the desired residual for a set point, or target for a closed loop pump. I imagine insulin closed loop systems have the same problems.
|
|
|
Post by shawnonafrezza on Jun 16, 2020 17:42:15 GMT -5
Shawn - Looking at TIR from a marketing perspective during sleep time for closed loop systems makes sense as they should do really well when PWDs are not eating. The problem is the damn PWDs eat and when that happens, no matter how good the algorithms are varying unpredictable absorption weighs in. This is the problem Al was trying to address when he invented afrezza. Closed loop systems at meal time will never, ever be as good as afrezza. This is why the best closed loop results are when they use afrezza for the meals. At the 60-120 minute mark is about when the second dosing would occur for afrezza. Assuming diner before 7pm by the 10-11pm time range will reflect that period the PWD can act on their prandial BG. With that said few in the RAA/Close Loop business will want a TIR period which is not 24hrs. I worked with 4:20 closed loop chemical feed pumps in the Water industry, and it takes hours for those pumps to stabilize. The can’t start or stop on a dime, they continually speed up and slow down trying to hit the set points, giving a big wavy trend that eventually flatlines. The problem is, before that happens something will happen that stops the well pump from running, (reservoir full, no demand), and that stops the feed pumps, and it starts all over again. It’s a shitty way to dose chlorine for a public Water System. I can see the same problems with closed loop insulin pumps, about the time they begin to stabilize t’s time to eat again, and the cycle starts all over again. The best control they had in the APS studies were when Afrezza was used for mealtime spikes. its way better to just calculate the correct dosage with the desired residual, than to use the desired residual for a set point, or target for a closed loop pump. I imagine insulin closed loop systems have the same problems. Except they don't. I've posted multiple graphs of users only on CL pumps with no Afrezza in my time here (one in this thread) The real problem with pumps is infusion can get blocked but that is rare enough that many consider it a non issue. If you missed it: imgur.com/a/lnhH8gW
|
|
|
Post by rockstarrick on Jun 16, 2020 18:44:02 GMT -5
I worked with 4:20 closed loop chemical feed pumps in the Water industry, and it takes hours for those pumps to stabilize. The can’t start or stop on a dime, they continually speed up and slow down trying to hit the set points, giving a big wavy trend that eventually flatlines. The problem is, before that happens something will happen that stops the well pump from running, (reservoir full, no demand), and that stops the feed pumps, and it starts all over again. It’s a shitty way to dose chlorine for a public Water System. I can see the same problems with closed loop insulin pumps, about the time they begin to stabilize t’s time to eat again, and the cycle starts all over again. The best control they had in the APS studies were when Afrezza was used for mealtime spikes. its way better to just calculate the correct dosage with the desired residual, than to use the desired residual for a set point, or target for a closed loop pump. I imagine insulin closed loop systems have the same problems. Except they don't. I've posted multiple graphs of users only on CL pumps with no Afrezza in my time here (one in this thread) The real problem with pumps is infusion can get blocked but that is rare enough that many consider it a non issue. If you missed it: imgur.com/a/lnhH8gW They can stabilize over time, so it’s not impossible to get a decent trend, but they don’t just start up and magically land on the bullseye. they miss for a bit, then stabilize. I’m not here to argue or offend. No disrespect, just sharing my experience with the closed loop systems that I’ve worked with, and I disclosed that in my original post. And like Seyhey quoting Al, that with Afrezza you don’t need the pump. That was what kind of inspired my comment. If 4ma is zero%, and 20ma is 100% you can, (in my case), calculate and exact feed rate and set the pump to that % depending on pump capacity, and the pump will start up and land on the desired target without fluctuation. If you worked on it, you could do the same with Afrezza, with regards to mealtime glucose spikes. So in my opinion, a calculated dose, (not a shot in the dark), is better than the closed loop. Just my opinion and preference. I respect your opinion too. ✌🏻😎
|
|
|
Post by sayhey24 on Jun 16, 2020 18:50:05 GMT -5
Shawn - the inventor of the closed loop system was Al Mann. Al determined he hit a brick wall due to the insulin absorption problem - it was too damn unpredictable and too damn slow. Things like hydration, physical activity and wellness in addition to other factors impact absorption. Until there is a better insulin to use in the pumps Al's brick wall still exists and remains the immovable object.
Al's solution was afrezza as the unstoppable force.
The big thing is if afrezza can do the heavy lifting which is meal time control with little effort why bother with the CL. My cousin died from a bad pump. Is it rare, sure. Is it deadly, without a doubt. Is it worth the effort when you have afrezza, I don't think so. Is their lots of money behind the pumps, you bet and thats why they will be around for awhile more.
However, with all this good news Dr. Kendall made at ADA2020 I would be surprised if he and Mike did not take a few phone calls. Better A1c, better quality of life, no hypoglycemia increase and the same TIR but with a tighter range sounds like sooner or later afrezza will catch on. How long until pediatric approval, a year or so? If I were a BP I might just give Mike a call and try and make a deal. The thing is once the kids start on afrezza they are not switching. If its safe enough for the kids, why not start more T2s on afrezza insulin sooner than later. I am still hoping Dr. Kendall was right and preaching the gospel of afrezza is the easiest job he has ever had.
|
|
|
Post by shawnonafrezza on Jun 16, 2020 18:57:10 GMT -5
Shawn - the inventor of the closed loop system was Al Mann. Al determined he hit a brick wall due to the insulin absorption problem - it was too damn unpredictable and too damn slow. Things like hydration, physical activity and wellness in addition to other factors impact absorption. Until there is a better insulin to use in the pumps Al's brick wall still exists and remains the immovable object. Al's solution was afrezza as the unstoppable force. The big thing is if afrezza can do the heavy lifting which is meal time control with little effort why bother with the CL. My cousin died from a bad pump. Is it rare, sure. Is it deadly, without a doubt. Is it worth the effort when you have afrezza, I don't think so. Is their lots of money behind the pumps, you bet and thats why they will be around for awhile more. However, with all this good news Dr. Kendall made at ADA2020 I would be surprised if he and Mike did not take a few phone calls. Better A1c, better quality of life, no hypoglycemia increase and the same TIR but with a tighter range sounds like sooner or later afrezza will catch on. How long until pediatric approval, a year or so? If I were a BP I might just give Mike a call and try and make a deal. The thing is once the kids start on afrezza they are not switching. If its safe enough for the kids, why not start more T2s on afrezza insulin sooner than later. I am still hoping Dr. Kendall was right and preaching the gospel of afrezza is the easiest job he has ever had. And others carried on. It's a very dangerous thing to think that just because one person couldn't do it at one point in time that it will never be done. If you have that mentality the world never gets better. I've posted so many pictures of the success that it really boggles my mind that people forget or are choosing to not see. Funny you mention better insulin because Lilly just did that. Maybe something will happen and I'll buy MNKD stock again but right now I'm just a user.
|
|
|
Post by cretin11 on Jun 16, 2020 19:51:41 GMT -5
Shawn - the inventor of the closed loop system was Al Mann. Al determined he hit a brick wall due to the insulin absorption problem - it was too damn unpredictable and too damn slow. Things like hydration, physical activity and wellness in addition to other factors impact absorption. Until there is a better insulin to use in the pumps Al's brick wall still exists and remains the immovable object. Al's solution was afrezza as the unstoppable force. The big thing is if afrezza can do the heavy lifting which is meal time control with little effort why bother with the CL. My cousin died from a bad pump. Is it rare, sure. Is it deadly, without a doubt. Is it worth the effort when you have afrezza, I don't think so. Is their lots of money behind the pumps, you bet and thats why they will be around for awhile more. However, with all this good news Dr. Kendall made at ADA2020 I would be surprised if he and Mike did not take a few phone calls. Better A1c, better quality of life, no hypoglycemia increase and the same TIR but with a tighter range sounds like sooner or later afrezza will catch on. How long until pediatric approval, a year or so? If I were a BP I might just give Mike a call and try and make a deal. The thing is once the kids start on afrezza they are not switching. If its safe enough for the kids, why not start more T2s on afrezza insulin sooner than later. I am still hoping Dr. Kendall was right and preaching the gospel of afrezza is the easiest job he has ever had. Feels like deja vu. How many years have we all known about the superiority of Afrezza? These new results are not surprise to any of us. Of course BP has known it too for all these years. We were speculating about BP before Kendall made his “easiest job ever” comment. When he said that we ate it up. If it were really so easy why hasn’t it happened by now? Are these latest results somehow surprising enough to BP to spur a deal? Who knows, but it would be better late than never.
|
|