|
|
Post by sportsrancho on Dec 31, 2021 14:01:50 GMT -5
Highly unlikely they’re going to transfer out of direct sales, that’s why AG was brought on board. Let’s see what he can accomplish. They are ramping up reps in territories all over. I sure hope they are successful because the cost burden is high. But I think if we go with a global sales partner, they will want the US also. Right… I just seen no evidence of that whatsoever. Not until we prove we can scale here in the US. |
|
|
|
Post by prcgorman2 on Dec 31, 2021 15:26:45 GMT -5
I disagree that the issue is marketing. Bill McCullough’s excellent missive about the fear psychology of doctors really resonated with me. “Do no harm” is their motto. Common people wielding hypodermics full of a potentially deadly hormone scares the buhjeezus out of them. And it should. Lots of diabetics die of hypoglycemia. One of my wife’s cousins, a T1 in her 20s, died of “complications” from diabetes. I assume a deadly hypo. And, it’s why folks have seen me preach SAFETY, SAFETY SAFETY when it comes to Afrezza. It’s the SAFETY, stupid. All of us know, we can feel it in our bones, Afrezza is the best prandial insulin on the market bar none.
My opinion is, when doctors become confident, “Afrezza is the safe choice”, Mannkind won’t even need a marketing department.
|
|
|
|
Post by sayhey24 on Dec 31, 2021 15:40:03 GMT -5
I sure hope they are successful because the cost burden is high. But I think if we go with a global sales partner, they will want the US also. Right… I just seen no evidence of that whatsoever. Not until we prove we can scale here in the US. I think Mike is on a path to sign the global partner. He wants to do new drug development and be the manufacturer for the partnered products. He has mentioned signing the global partner on several calls. Thats the only hard evidence I can give you now. Until the partner is signed they will hedge and continue on the current path and try and expand sales. IMO, MNKD can never scale as long as they have the boot of the ADA/BP on their neck. Maybe Al could have brute forced things but its near impossible without Al. We don't even have Dave Kendall who had a chance. Dave thought it was going to be a piece of cake. They need a partner with the technology and resources to pull this off and is willing to give the current diabetes medical community the middle finger. The latest SoC is so confusing they tried to flow chart things out. Its such a mess. Whoever the partner is needs to be willing to steamroll this mess. CGM technology has proven afrezza is the real deal, As Mango said, the Holy Grail of Diabetes. |
|
|
|
Post by georgethenight2 on Jan 3, 2022 0:24:42 GMT -5
My opinion is, when doctors become confident, “Afrezza is the safe choice”, Mannkind won’t even need a marketing department. Don't always see eye to eye with pc. But, this statement IMO is right on. Doctors are only human, why should 100 years of diabetic medicine be changed. If it works, it works, is probably what they think. Used to have a heart surgeon friend turned PCP here in Japan, and I would often talk shop with him about drug cos and the like. I remember when Afrezza was first approved oh so long ago, I was so eager for him to understand its unique profile and time in range and yadayada... He simply stated that he would be very reluctant to break protocol. He also mentioned that Japanese socialized healthcare would probably not be able to get a "good" group discount as most new treatments are not always affordable. And here we sit, 7 years gone bye and still waiting for that the damn hockey stick. |
|
|
|
Post by falconquest on Jan 3, 2022 12:03:24 GMT -5
This whole thread reminds me of ground hog day.
|
|
|
|
Post by caesar on Jan 3, 2022 12:18:11 GMT -5
Seems that Afrezza and the Endo's (Doctors) believing that it's the Holy Grail is summed up by Max Planck's quote "A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it."
|
|
|
|
Post by castlerockchris on Jan 3, 2022 14:54:23 GMT -5
This whole thread reminds me of ground hog day.
(Just trying to help Falcon)
|
|
|
|
Post by stanleyttu on Jan 3, 2022 15:35:28 GMT -5
The reality is that not all patients receive Afrezza well.
I am a long (more than I like to admit these days) as well as a type 1 diabetic, and I enthusiastically tried Afrezza once it became available. I very often would cough up the powder, and was left wondering what kind of dose I then needed to take in order to make up for what may have been coughed up.
Further, Afrezza behaved differently between bringing down an existing high blood sugar vs preventing a high blood sugar during a meal. For example, the amount needed if my blood sugar was already high was considerable - enough that it was causing me to cough up additional powder because I had to take multiple inhalations to have effect, which ultimately left me needing to rely on my pump for additional bolus. Afrezza did work very well to prevent the initial spike in blood sugar if my blood sugar was already in a good range pre-meal. Unfortunately, the issues with the coughing up powder and the uncertainty of how Afrezza would drive down high blood sugars led me to stop carrying it around in addition to my pump (which is another drawback, as there is no basal version of Afrezza, meaning I still had to have the pump or take a basal injection daily).
Afrezza is not the "holy grail" of diabetes or glucose control. Its one of many different options available to diabetics today that may or may not work for them, and one that doctors may be reticent to prescribe because of the mixed results. I have stayed long in my position with MNKD because I believe in the technology delivery system (despite massive valuation loss currently), but this iteration of Afrezza is NOT likely to ever catch on mainstream - especially not with insulins like Lyumjev hitting the market that have much faster uptake speeds but use conventional delivery systems (pump/pen).
I'm just putting this out there for those that are still hoping on Afrezza. Technosphere has promise, and there may be ways to improve Afrezza into something better - but Afrezza as it is will not be MNKD's savior.
|
|
|
|
Post by akemp3000 on Jan 3, 2022 15:47:48 GMT -5
After reading this anecdotal perspective, the forthcoming pediatric approval and anticipated test data results proving "superiority" seem that much more significant to show once and for all that Afrezza really is the "holy grail" for diabetics, glucose control and especially quality of life. We'll see.
|
|
|
|
Post by dh4mizzou on Jan 3, 2022 15:52:47 GMT -5
The reality is that not all patients receive Afrezza well. I am a long (more than I like to admit these days) as well as a type 1 diabetic, and I enthusiastically tried Afrezza once it became available. I very often would cough up the powder, and was left wondering what kind of dose I then needed to take in order to make up for what may have been coughed up. Further, Afrezza behaved differently between bringing down an existing high blood sugar vs preventing a high blood sugar during a meal. For example, the amount needed if my blood sugar was already high was considerable - enough that it was causing me to cough up additional powder because I had to take multiple inhalations to have effect, which ultimately left me needing to rely on my pump for additional bolus. Afrezza did work very well to prevent the initial spike in blood sugar if my blood sugar was already in a good range pre-meal. Unfortunately, the issues with the coughing up powder and the uncertainty of how Afrezza would drive down high blood sugars led me to stop carrying it around in addition to my pump (which is another drawback, as there is no basal version of Afrezza, meaning I still had to have the pump or take a basal injection daily). Afrezza is not the "holy grail" of diabetes or glucose control. Its one of many different options available to diabetics today that may or may not work for them, and one that doctors may be reticent to prescribe because of the mixed results. I have stayed long in my position with MNKD because I believe in the technology delivery system (despite massive valuation loss currently), but this iteration of Afrezza is NOT likely to ever catch on mainstream - especially not with insulins like Lyumjev hitting the market that have much faster uptake speeds but use conventional delivery systems (pump/pen). I'm just putting this out there for those that are still hoping on Afrezza. Technosphere has promise, and there may be ways to improve Afrezza into something better - but Afrezza as it is will not be MNKD's savior. Calling @sportsrancho !!!! |
|
|
|
Post by cedafuntennis on Jan 3, 2022 16:04:22 GMT -5
I am not a specialist by any means but I am wondering if you used a CGM device. That in my mind would have alerted you if your glucose level was already too high and if you were not in range even if the pump you were apparently wearing did not prevent it from getting there. Just one of the novice questions I had from reading your post.
|
|
|
|
Post by peppy on Jan 3, 2022 16:08:27 GMT -5
The reality is that not all patients receive Afrezza well. I am a long (more than I like to admit these days) as well as a type 1 diabetic, and I enthusiastically tried Afrezza once it became available. I very often would cough up the powder, and was left wondering what kind of dose I then needed to take in order to make up for what may have been coughed up. Further, Afrezza behaved differently between bringing down an existing high blood sugar vs preventing a high blood sugar during a meal. For example, the amount needed if my blood sugar was already high was considerable - enough that it was causing me to cough up additional powder because I had to take multiple inhalations to have effect, which ultimately left me needing to rely on my pump for additional bolus. Afrezza did work very well to prevent the initial spike in blood sugar if my blood sugar was already in a good range pre-meal. Unfortunately, the issues with the coughing up powder and the uncertainty of how Afrezza would drive down high blood sugars led me to stop carrying it around in addition to my pump (which is another drawback, as there is no basal version of Afrezza, meaning I still had to have the pump or take a basal injection daily). Afrezza is not the "holy grail" of diabetes or glucose control. Its one of many different options available to diabetics today that may or may not work for them, and one that doctors may be reticent to prescribe because of the mixed results. I have stayed long in my position with MNKD because I believe in the technology delivery system (despite massive valuation loss currently), but this iteration of Afrezza is NOT likely to ever catch on mainstream - especially not with insulins like Lyumjev hitting the market that have much faster uptake speeds but use conventional delivery systems (pump/pen).I'm just putting this out there for those that are still hoping on Afrezza. Technosphere has promise, and there may be ways to improve Afrezza into something better - but Afrezza as it is will not be MNKD's savior.  www.diabetesnet.com/insulins/lyumjev-a-new-fast-acting-insulin/ |
|
|
|
Post by stanleyttu on Jan 3, 2022 16:12:53 GMT -5
Yes I wear a Dexcom and did at the time I used Afrezza as well (G5 then vs a G6 now).
Managing diabetes is not as simple as using Afrezza and having a CGM. There are all sorts of factors at play that affect blood glucose, and just because you've been alerted to a high blood sugar doesn't mean you can do much about it depending on what you are doing at the time.
Getting a high blood sugar down (say, from 280) would require multiple inhalations of Afrezza and create the problems with coughing it up. I can't imagine anyone with the experience of coughing up the drug and therefore not knowing how much more (if any) to take would be very thrilled with that.
I am not purporting that my experience is equivalent to everyone's - just pointing out the fallacy of calling Afrezza the "holy grail" because it is not and will not be. It needs improvements before it can have a label like that.
|
|
|
|
Post by peppy on Jan 3, 2022 16:28:42 GMT -5
Yes I wear a Dexcom and did at the time I used Afrezza as well (G5 then vs a G6 now). Managing diabetes is not as simple as using Afrezza and having a CGM. There are all sorts of factors at play that affect blood glucose, and just because you've been alerted to a high blood sugar doesn't mean you can do much about it depending on what you are doing at the time. Getting a high blood sugar down (say, from 280) would require multiple inhalations of Afrezza and create the problems with coughing it up. I can't imagine anyone with the experience of coughing up the drug and therefore not knowing how much more (if any) to take would be very thrilled with that. I am not purporting that my experience is equivalent to everyone's - just pointing out the fallacy of calling Afrezza the "holy grail" because it is not and will not be. It needs improvements before it can have a label like that. The reason Mango sees afrezza as the holy grail is the time action profile.  I hear you, you were coughing. I think it is like this, over time, the body and lungs get used to it, and the coughing subsides. Afrezza isn't for everyone and that is ok. Some people love afrezza. Different strokes for different folks. |
|
|
|
Post by sayhey24 on Jan 3, 2022 16:34:07 GMT -5
The reality is that not all patients receive Afrezza well. I am a long (more than I like to admit these days) as well as a type 1 diabetic, and I enthusiastically tried Afrezza once it became available. I very often would cough up the powder, and was left wondering what kind of dose I then needed to take in order to make up for what may have been coughed up. Further, Afrezza behaved differently between bringing down an existing high blood sugar vs preventing a high blood sugar during a meal. For example, the amount needed if my blood sugar was already high was considerable - enough that it was causing me to cough up additional powder because I had to take multiple inhalations to have effect, which ultimately left me needing to rely on my pump for additional bolus. Afrezza did work very well to prevent the initial spike in blood sugar if my blood sugar was already in a good range pre-meal. Unfortunately, the issues with the coughing up powder and the uncertainty of how Afrezza would drive down high blood sugars led me to stop carrying it around in addition to my pump (which is another drawback, as there is no basal version of Afrezza, meaning I still had to have the pump or take a basal injection daily). Afrezza is not the "holy grail" of diabetes or glucose control. Its one of many different options available to diabetics today that may or may not work for them, and one that doctors may be reticent to prescribe because of the mixed results. I have stayed long in my position with MNKD because I believe in the technology delivery system (despite massive valuation loss currently), but this iteration of Afrezza is NOT likely to ever catch on mainstream - especially not with insulins like Lyumjev hitting the market that have much faster uptake speeds but use conventional delivery systems (pump/pen). I'm just putting this out there for those that are still hoping on Afrezza. Technosphere has promise, and there may be ways to improve Afrezza into something better - but Afrezza as it is will not be MNKD's savior. Afrezza as the holy grail is not in the T1 space. Its in the T2 space. Stacking afrezza with other insulins or other T2 meds creates complexities. If you can get the T2 early in the treatment process and not using other meds many should see excellent results and many should see the liver working near normal preventing dangerous lows as Mango discusses. If you can get the T2 on afrezza early in their diagnosis many should see the T2 progress stop and some might see a reversal. Once you start adding insulin absorption of a basal into the equation you have a random variable. Al thought the best approach was use of a simple patch pump with afrezza for the T1s. Many T1s use afrezza as a high BG rescue device. Lyumjev as a subq still has all the subq issues and will never be as fast as afrezza. It does not sound like you were using a CGM when you first tried afrezza back in 2015. You may want to give it another try with the CGM so you can see whats happening and when you may need a follow-up doses. If the powder hits a dry throat you are going to cough especially if you are breathing in too fast. A sip of water and a slow steady inhalation may help with the cough. As with anything, afrezza is not for everyone but for many who have never even heard of it it could be life changing if they did. You can get a box for $99 at insulinsavings.com You may also want to get some advice from VDex. As a side note on the coughing - it was not mentioned much during the TreT study and was not seen as much of an issue. Its still raised as an afrezza issue now that after 6+ years, the original main objection which was decreased lung function and cancer have not been realized. |
|
