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Post by StevieRay on Aug 23, 2013 21:09:48 GMT -5
Looking at the different types of insulin I think it's interesting to compare their PK profiles. Here's the link to insulin types currently on the market: diabetes.niddk.nih.gov/dm/pubs/medicines_ez/insert_C.aspxBelow is the main chart from the link above: Attachment DeletedAnd below is the Afrezza chart: Attachment DeletedNow, note the onset, peak and duration values. Afrezza gets in faster, peaks faster and gets out of the system faster. I'll see if I can find the MannKind chart that illustrates the PK profile of a normal pancreas. As I recall the chart is very impressive as to how similar Afrezza is to a normal pancreas. I thought the had a chart that showed them together. Liane found the chart below:  |
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Post by liane on Aug 23, 2013 21:28:54 GMT -5
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Post by StevieRay on Aug 23, 2013 21:42:17 GMT -5
Thanks Liane! I added the chart I was looking for to my post. |
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Post by StevieRay on Aug 23, 2013 22:57:58 GMT -5
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Post by jpg on Aug 24, 2013 0:20:09 GMT -5
Afrezza has amazing first stage physiological mimetics. The tail is not fat enough. As we mentioned in another post adding in some hexametric insulin to the monomeric insulin and you have something which looks almost like a normal pancreatic secretion. Maybe something better then hexametric could be added to shorten the tail a bit. Hexametric probably wouldn't be perfect but the best available to fatten the curve. I repeat this but have no clue if this even possible...
Some smart BP will figure this out. Hopefully...
JPG
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Post by StevieRay on Aug 24, 2013 8:02:31 GMT -5
Afrezza has amazing first stage physiological mimetics. The tail is not fat enough. As we mentioned in another post adding in some hexametric insulin to the monomeric insulin and you have something which looks almost like a normal pancreatic secretion. Maybe something better then hexametric could be added to shorten the tail a bit. Hexametric probably wouldn't be perfect but the best available to fatten the curve. I repeat this but have no clue if this even possible... Some smart BP will figure this out. Hopefully... JPG From my very limited understanding, basal insulin provides the slow long lasting low & steady level of insulin which has a peakless profile such as Lantus (Sanofi-Aventis). And Afrezza would be used at meal times in conjunction with a daily basal insulin dose. So are you suggesting adding a less potent basal insulin into Afrezza to extend the tail up to the next meal? |
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Post by jpg on Aug 24, 2013 13:07:41 GMT -5
To take a small detour...
As you know once a day or 'ideally' twice a day basal is the way insuline is introduced because of histrionics and practical reasons. Then the next step is adding in mealtime 'rapid' on top of that with all it's pitfalls. In obstertrics peak and morning fasting are what really count. You get an outcome in 9 months which is an increadible model. In non gestational type 2s you get sn outcome in 10-20 years... I firmly think the obstetrics diabetic management approach is the model to follow but this is a huge paradigm shift obviously. The paradigm shift is starting though. The realization that aggressive normalization of HbA1c is bad for outcome (or at least not good) is a start... HbA1c measures averages (and maybe not so well but that is another unrelated issue) and doesn't capture the maybe more important parks and valleys caused by hyper and hypos at all. A 2 hour low can raise your epinephrine and cortisol levels through the roof and nightly without being captured by A1c obviously. High post prandial glucose levels make big babies but don't have a huge impact on A1c levels.
No insulin is perfect. None will ever match a well functioning pancreas but that Afrezza has the most important part of the spectrum going for it. The initial post prandial surge is where the control matters. As you get on with your diabetic (type 2) progression you need the same peak but also probably a fatter and longer tail. Current rapid acting sc insulins need to be given in big doses to get some initial control going to help post prandial glucose levels but get stuck with a ling and fat tail.
What I am trying to say is that a smart BP hopefully will figure out the huge opportunity to mix and match across the spectrum inhaled monomeric (Afrezza) and hexagon to disease profession and forget about the basal (type 2). This is a huge paradigm shift obviously but for the taker of the scientific risk goes the spoils of no competition for a generation in one of the biggest markets in the world. Early diabetics get pure Afrezza and as the disease progresses (progression might be slowed down also with Afrezza?) they add in 10% or 20% or something hexametric insulin to their inhaled insulin. Basal becomes a very late stage need.
This may all seem like 'strange' to many but not so strange to diabetic experts who deal with obstetrics I am certain. Again most experts agree we don't have a good handle on the use and purpose of HbA1c. High HbA1c means poor control. Normalization of HbA1c seems to be a poor marker for improving outcome though... A. Mann seems to understand this. Afrezza is a valuable tool and will play a leading role in this paradigm shift if Mannkind plays it's cards well (which isn't certain obviously but Deerfield and Greenhill might help find a suitable partner that gets the potential of Afrezza).
I am trying to explain in anfew lines something which might be a bit hard to condense so much so there are a few omissions in the 'logic' so be kind...
JPG
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