Aged you say "Insulin will lower high glucose levels effectively, but it won't stop the problem from reoccurring" How is a GPL1 doing this? It clearly won't. We know the ADA SoC plans for it to fail.
What did Phil Holme recently write - after you take all the crap including GLP1s "Indeed, after 5-15 years, it is very common to need insulin anyway to manage your glucose levels and to stay healthy for another 20-plus years"
diatribe.org/type-2-diabetes-start-earlyOK so what does a GLP1 do anyway
1. It does not stop the post meal glucose spike. It might try to flatten it but it won't stop it - afrezza will
2. It will send a signal to the brain to drink less and eat less - but by stopping the spike and getting the PWD's BG down really fast they will also eat less which is what afrezza does.
3. GLP1 dampens the need to drink leading to dehydration - not a issue with afrezza
4. It stimulates gluconeogenesis - its basically a poor mans TZD and messes with the muscle - afrezza does not need to do this
5. It triggers the pancreas to secrete more insulin - why would we ever want to do this? We want to take the load off the pancreas
6. It lowers hepatic glucose output - afrezza does a better job syncing the liver with first phase insulin release which afrezza mimics
7. It decreases both the secretion of acid in the stomach and how quickly food is emptied from the stomach - in other words it makes you feel bloated.
It pretty much looks like what the GLP1 does is a mess. As I said before if someone is dehydrated, give them water not a tomato. If someone is not producing enough insulin because they have a bum pancreas give them monomer human insulin which is what the body needs. Don't give them a "jack of all trades" which does all these things above and can't address the issue - lack of insulin. In fact it doesn't even work as well as metformin for decreasing sugar release from the liver or a TZD for muscle uptake or a sulphonylureas for releasing insulin. You have convinced me the GLP1 is not the "Tomato" of diabetes treatments it is the "Rotten Tomato".
Now - you say "The cause is not the loss of first phase response, that's a consequence of high glucose" - that is provable false. The pancreas goes bad, beta cell mass decreases, insulin production then decreases, the robust first phase is lost and receptor blockage occurs and then comes the weight gain. The tech diet companies are seeing it and struggling to control it with diet alone.
Actually - your words "The cause is not the loss of first phase response, that's a consequence of high glucose" almost sounds like the words of Ralph DeFronzo and we know what Al thought of them. I wish I had the video.
We already know GLP1s are a treat to fail approach and have proven to be so. Since we have never before been able to replicate first phase release and stop the spike, it seems like the logical next step and lets see if Al Mann was right and Richard Berstein was right thinking high blood sugars are the cause of all diabetic complications and that by tightly controlling blood sugar we will eliminate complications.
I think the next big step for afrezza is the head to head trial against Mounjaro for A1C. I keep checking my email for MNKD's announcement, maybe one day. The "Community" especially Lilly may not like the results but we know the medically correct way to treat post prandial glucose loss is not giving the PWD a rotten tomato but rather giving them the monomer human insulin the body wants and needs. Hey man, just give them the afrezza.
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