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Post by Clement on Jul 22, 2020 16:14:37 GMT -5
MC said we will now focus on T1D. Suppose mnkd concentrates on T1s with HCL or AID systems. How big is that market?
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Post by shawnonafrezza on Jul 22, 2020 16:21:03 GMT -5
Last number I saw was 400k PWD in America are on a pump. We are by FAR the most pump heavy country (also have the worst A1Cs funny enough). Most of those will not be HCL since they're too new. But all new pumps (780g, X2, and Omnipod5) are HCL so over the next few years the number of users will increase rapidly assuming they can also afford the CGM.
Children are more likely to be on a pump compared to adults. Women more likely than men.
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Post by uvula on Jul 22, 2020 16:34:04 GMT -5
Did we ever get a source for the kendal leaving info? Or is it unconfirmed?
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Post by agedhippie on Jul 22, 2020 16:42:04 GMT -5
Aged - the RAAs are made up of monomers , dimmers and hexamers. The uptake of the monomers is very fast but the dimmers and hexamers not so much. The problem is stability. This is the problem monomer human insulin also has in liquid form. Its too damn unstable. FDKP solves that problem but makes it a powder. Human interaction during mealtime is a natural occurrence. Taking a puff of afrezza after taking a bite is no big deal. The problem are times like when sleeping. Thats the benefit of the HCL. Its not during meals. Ok. Let's drive a stake through this myth's heart. A hexamer will disassociate in seconds, arguably in milliseconds, once it hits the blood stream. We know this because people have measured it, and empirically because you can see it every time someone is put on an IV with human insulin. If the myth about hexamers was true then human insulin like Humalin or Novolin would be incredibly slow because they are very hexamer heavy, but in an IV the performance is very rapid. Afrezza is fast because it hits the bloodstream fast, just like IV Novolin. RAA is slow because it has to makes it's way through the subcutaneous layer. Doctors know about insulin states which is why the whole monomer debate is silly and why I usually stay out of it, it's an article of faith. This is also why RAA like the new insulins are adding incipients to get the insulin through the subcutaneous layer faster. Trust me, human interaction is not a natural occurrence at meal times. I don't remember ever seeing a non-diabetic having a quick word with their pancreas about the amount of insulin it should dispense (I do rather like the idea though  The other thing you are overlooking is snacks, meals aren't the only time you eat. Coffee? Better bolus for any milk. Ice cream (to pick a previous example), better suck down another cartridge. Or would you rather have something that means you can be like everyone else and eat whenever and whatever you want without doing anything? |
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Post by awesomo on Jul 22, 2020 16:44:29 GMT -5
Did we ever get a source for the kendal leaving info? Or is it unconfirmed? 1. The source has been reliable on this kind of info before. 2. We wouldn't get any confirmation from the company itself. 3. Someone on ST emailed Mike about it, but didn't get an answer. I would assume if it was completely false he would have squashed the rumor quickly. 4. Silence is this company's specialty. |
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Post by falconquest on Jul 22, 2020 17:36:09 GMT -5
With all this discussion about technology in the diabetes space, can anyone explain whatever happened with OneDrop?
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Post by kc on Jul 22, 2020 17:54:20 GMT -5
I hope he is here for more than a pay-check. The slides KC posted and Galindo pitched in 2016 laid out a vision. Galindo was delivering double digit growth with that vision but it ended with Sugar IQ. Then what? The missing link with Sugar IQ is afrezza. Then again the missing link with the 780g is also afrezza. Maybe they will hit gold. Afrezza the golden goose just keeps laying eggs and they have not been gold, at least not yet. BINGO! WINNNER WINNER CHICKEN DINNER.... |
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Post by sayhey24 on Jul 22, 2020 18:06:01 GMT -5
Aged - I couldn't stop laughing over "its not hard predicting RAA behavior". Thanks, I needed a good laugh. I guess thats why the 670g set the baseline to 120. Maybe the solution is PWDs just stop eating because thats when RAAs are predictable. We all know the 670g works best at mealtime when used with afrezza so we have solved the RAA mealtime issue.
I don't know anything about Galindo but in 6 years a good general manager makes a lot of contacts. I also have to say the slides he pitched four years ago painted a vision few in the industry were talking about 4 years ago. We were talking about that vision here but many were laughing at us. In fact I think Kendall was still hawking GLP1s at that point.
The bottom line is we all had great hope for Kendall but the results are not obvious, at least not yet. Why he is leaving I have no idea but if it is because Galindo is coming and Galindo sees a way to augment his 2016 slides with afrezza and make Al's vision that afrezza will be the greatest selling drug of all time, let me be the first to welcome Galindo. If Galindo needs to bring in some of his own guys to make Al's vision a reality, I will offer to hold the door for Dave. Its nothing personal but Al's vision coming true is way over do.
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Post by letitride on Jul 22, 2020 18:16:04 GMT -5
I called Mannkind and asked about Dr Kendall. Was told he was still there but on his way out. Its a verbal but the guy made no effort to sidetrack me. That was yesterday.
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Post by sayhey24 on Jul 22, 2020 18:20:11 GMT -5
Aged - the RAAs are made up of monomers , dimmers and hexamers. The uptake of the monomers is very fast but the dimmers and hexamers not so much. The problem is stability. This is the problem monomer human insulin also has in liquid form. Its too damn unstable. FDKP solves that problem but makes it a powder. Human interaction during mealtime is a natural occurrence. Taking a puff of afrezza after taking a bite is no big deal. The problem are times like when sleeping. Thats the benefit of the HCL. Its not during meals. Ok. Let's drive a stake through this myth's heart. A hexamer will disassociate in seconds, arguably in milliseconds, once it hits the blood stream. We know this because people have measured it, and empirically because you can see it every time someone is put on an IV with human insulin. If the myth about hexamers was true then human insulin like Humalin or Novolin would be incredibly slow because they are very hexamer heavy, but in an IV the performance is very rapid. Afrezza is fast because it hits the bloodstream fast, just like IV Novolin. RAA is slow because it has to makes it's way through the subcutaneous layer. Doctors know about insulin states which is why the whole monomer debate is silly and why I usually stay out of it, it's an article of faith. This is also why RAA like the new insulins are adding incipients to get the insulin through the subcutaneous layer faster. Trust me, human interaction is not a natural occurrence at meal times. I don't remember ever seeing a non-diabetic having a quick word with their pancreas about the amount of insulin it should dispense (I do rather like the idea though The other thing you are overlooking is snacks, meals aren't the only time you eat. Coffee? Better bolus for any milk. Ice cream (to pick a previous example), better suck down another cartridge. Or would you rather have something that means you can be like everyone else and eat whenever and whatever you want without doing anything? Aged - I think you are confusing a couple of things. The problem is the hexamer has to break down into a monomer to get adsorbed through the capillary. If it could push itself into the blood as a hexamer you would be correct but thats not the way it works. Here is a high level discussion on absoption. www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/When you add in things like hydration levels this whole absorption thing gets a bit complicated. When people eat all the predictability prior to eating/drinking gets thrown out the window. This is why afrezza will always beat an HCL during meals. Afrezza not only stops the spike but will work with the liver if you go too low. As I have said before the HCL and afrezza are like peanut butter and Jelly and I think Galindo thinks this too. |
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Post by shawnonafrezza on Jul 22, 2020 18:52:45 GMT -5
I think you're vastly underestimating the level of care gotten with unpredictable insulis at mealtime. imgur.com/a/LCJcKm9imgur.com/a/cSViFrmimgur.com/a/7E5fKwdAfrezzas strength lays outside of the pumping world because its strength is untethered both in body and in calculations. After the cost of a pump, cgm, and insulin I don't see people also paying for Afrezza f they already have those results. And those are not Fiasp or Lyumjev which would be marginally faster/better at meals. The problem is marketing and knowledge and nothing here fixes either. They still market it like people care that it's inhaled and not a syringe. That is it's least impressive quality. I don't see the point for Medtronic to make this partnership either. They are not an insulin company and they're pushing hard with the 780g and it's algorithm to fight the X2. |
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Post by sportsrancho on Jul 22, 2020 19:02:50 GMT -5
David Kendall steps down to pursue other interests Thank you for your accurate information as always. |
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Post by sportsrancho on Jul 22, 2020 19:05:04 GMT -5
I called Mannkind and asked about Dr Kendall. Was told he was still there but on his way out. Its a verbal but the guy made no effort to sidetrack me. That was yesterday. Thank you letit.... Someone else got it confirmed by MC. |
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Post by mango on Jul 22, 2020 19:10:28 GMT -5
Aged - the RAAs are made up of monomers , dimmers and hexamers. The uptake of the monomers is very fast but the dimmers and hexamers not so much. The problem is stability. This is the problem monomer human insulin also has in liquid form. Its too damn unstable. FDKP solves that problem but makes it a powder. Human interaction during mealtime is a natural occurrence. Taking a puff of afrezza after taking a bite is no big deal. The problem are times like when sleeping. Thats the benefit of the HCL. Its not during meals. Ok. Let's drive a stake through this myth's heart. A hexamer will disassociate in seconds, arguably in milliseconds, once it hits the blood stream. We know this because people have measured it, and empirically because you can see it every time someone is put on an IV with human insulin. If the myth about hexamers was true then human insulin like Humalin or Novolin would be incredibly slow because they are very hexamer heavy, but in an IV the performance is very rapid. Afrezza is fast because it hits the bloodstream fast, just like IV Novolin. RAA is slow because it has to makes it's way through the subcutaneous layer. Doctors know about insulin states which is why the whole monomer debate is silly and why I usually stay out of it, it's an article of faith. This is also why RAA like the new insulins are adding incipients to get the insulin through the subcutaneous layer faster. Trust me, human interaction is not a natural occurrence at meal times. I don't remember ever seeing a non-diabetic having a quick word with their pancreas about the amount of insulin it should dispense (I do rather like the idea though The other thing you are overlooking is snacks, meals aren't the only time you eat. Coffee? Better bolus for any milk. Ice cream (to pick a previous example), better suck down another cartridge. Or would you rather have something that means you can be like everyone else and eat whenever and whatever you want without doing anything? Hexameric insulin molecules do not dissociate when they hit the blood stream. It must happen before that, they are too big. The hexamers need zinc, and so their dissociation happens when the zinc in the insulin depot has dispersed away, allowing for dissociation into dimers and monomers, both of which can be absorbed into the blood stream. |
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Post by bradleysbest on Jul 22, 2020 20:11:48 GMT -5
So much for DK’s “Veins of gold” comments at the ASM in 2018.....
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The other thing you are overlooking is snacks, meals aren't the only time you eat. Coffee? Better bolus for any milk. Ice cream (to pick a previous example), better suck down another cartridge. Or would you rather have something that means you can be like everyone else and eat whenever and whatever you want without doing anything?
