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Post by peppy on Mar 7, 2023 23:07:57 GMT -5
The mechanism of blood glucose lowering also involves a minor delay in gastric emptying in the early postprandial phase. You say tomato I say tomato. Nausea Vomiting Diarrhea Abdominal pain Constipation www.novo-pi.com/ozempic.pdfAnd yet Ozempic is the 6th largest seller by revenue in the US. You could ask Ginger Vieira who uses it if it's worthwhile. aged, why would Ginger Vieira be using Ozempic? Ginger is a type one diabetic beyondtype1.org/getting-inhaled-insulin/Is Ginger doing the Sayhey study? I went to a website, Ginger uses metformin? Aged, do you think Ginger is on to something? Are you going to jump on the band wagon? Load em?
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Post by stevil on Mar 7, 2023 23:19:23 GMT -5
@sayhey
It still would not surprise me regarding non diabetics getting small bowel obstructions. Again, delayed gastric emptying was a known mechanism. I’d be semi surprised if SBOs didn’t happen for some.
Obese people don’t often have the healthiest of diets. If you slow the transit of low fiber/highly processed food, I’d be shocked if the mud didn’t get stuck.
On that note, I’ve had a dozen or so obese patients come in with IBS just in the past couple weeks. They are already having all the symptoms listed on the side effect list of GLP-1s/GIPs. For many/most, it’s a normal day.
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Post by peppy on Mar 7, 2023 23:31:17 GMT -5
@sayhey It still would not surprise me regarding non diabetics getting small bowel obstructions. Again, delayed gastric emptying was a known mechanism. I’d be semi surprised if SBOs didn’t happen for some. Obese people don’t often have the healthiest of diets. If you slow the transit of low fiber/highly processed food, I’d be shocked if the mud didn’t get stuck. On that note, I’ve had a dozen or so obese patients come in with IBS just in the past couple weeks. They are already having all the symptoms listed on the side effect list of GLP-1s/GIPs. For many/most, it’s a normal day. What are the possible side effects of OZEMPIC®? OZEMPIC® may cause serious side effects, including: • See “What is the most important information I should know about OZEMPIC®?” • inflammationofyourpancreas(pancreatitis).StopusingOZEMPIC®andcallyour healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back. • changes in vision. Tell your healthcare provider if you have changes in vision during treatment with OZEMPIC®. • low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use OZEMPIC® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: • dizziness or light-headedness • sweating • confusion or drowsiness • headache • blurred vision • slurred speech • shakiness • fast heartbeat • anxiety, irritability, or mood changes • hunger • weakness • feeling jittery • kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration. • serious allergic reactions. Stop using OZEMPIC® and get medical help right away, if you have any symptoms of a serious allergic reaction including: • swelling of your face, lips, tongue or throat • problems breathing or swallowing • severe rash or itching • fainting or feeling dizzy • very rapid heartbeat • gallbladder problems. Gallbladder problems have happened in some people who take OZEMPIC®. Tell your healthcare provider right away if you get symptoms of gallbladder problems which may include: • pain in your upper stomach (abdomen) • yellowing of skin or eyes (jaundice) • fever • clay-colored stools The most common side effects of OZEMPIC® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
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Post by MnkdWASmyRtrmntPlan on Mar 8, 2023 9:04:11 GMT -5
... nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
maybe from your stomach tying itself in knots???
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Post by sayhey24 on Mar 8, 2023 12:11:46 GMT -5
@sayhey It still would not surprise me regarding non diabetics getting small bowel obstructions. Again, delayed gastric emptying was a known mechanism. I’d be semi surprised if SBOs didn’t happen for some. Obese people don’t often have the healthiest of diets. If you slow the transit of low fiber/highly processed food, I’d be shocked if the mud didn’t get stuck. On that note, I’ve had a dozen or so obese patients come in with IBS just in the past couple weeks. They are already having all the symptoms listed on the side effect list of GLP-1s/GIPs. For many/most, it’s a normal day. I saw where 30k are dying in the U.S. per year. I guess just another day. What are your thoughts on the CMS decision to pay for CGMs for "insulin treated" PWDs? Assuming in 2024 afrezza is on the formularity and you have a Medicare Plan D metformin patient and the Abbott rep buys you a nice lunch and says forget the SoC we need to get your patients CGMs so they need to be "insulin treated" - 1. would you lean toward prescribing a once a day shot of basal or 2. prescribe afrezza as an after meal correction?
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Post by agedhippie on Mar 8, 2023 20:06:20 GMT -5
And yet Ozempic is the 6th largest seller by revenue in the US. You could ask Ginger Vieira who uses it if it's worthwhile. aged, why would Ginger Vieira be using Ozempic? Ginger is a type one diabetic beyondtype1.org/getting-inhaled-insulin/Is Ginger doing the Sayhey study? I went to a website, Ginger uses metformin? Aged, do you think Ginger is on to something? Are you going to jump on the band wagon? Load em? My endo has already tried to get me to jump on that particular bandwagon and I politely declined. There is a case to be made for Type 1 diabetics taking GLP-1, and Ginger talks about why she uses it here - t1dexchange.org/semaglutide-type-1-diabetes/A lot of Type 1 use metformin although that didn't used to be the case because of the risk of lactic acidosis. Once they understood that it wasn't a viable risk (you need a lot of stars to align before you could get it) it got prescribed quite widely. It's good for insulin sensitivity, lipids, and is even protective against some cancers. My endo has various of us using it off-label before it became mainstream.
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Post by agedhippie on Mar 8, 2023 20:30:08 GMT -5
@sayhey It still would not surprise me regarding non diabetics getting small bowel obstructions. Again, delayed gastric emptying was a known mechanism. I’d be semi surprised if SBOs didn’t happen for some. Obese people don’t often have the healthiest of diets. If you slow the transit of low fiber/highly processed food, I’d be shocked if the mud didn’t get stuck. On that note, I’ve had a dozen or so obese patients come in with IBS just in the past couple weeks. They are already having all the symptoms listed on the side effect list of GLP-1s/GIPs. For many/most, it’s a normal day. ... The most common side effects of OZEMPIC® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.Yet there is a queue around the block for this drug and people are refilling their prescriptions. If you read that article I linked in my last post for Ginger you will see that in most cases it's bad for a month or so and then settles (this is true of metformin as well btw.) If it doesn't settle you are going to drop it, if it does settle then you are staying with it (like Ginger). Does it have side effects? Sure, but so do all drugs. You just decide if the risk is worth the reward, and to Stevil's point if you are already obese and have IBS you are likely suffering these symptoms before you ever go near GLP-1 so there really is little down side from their standpoint.
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Post by agedhippie on Mar 8, 2023 20:42:15 GMT -5
@sayhey It still would not surprise me regarding non diabetics getting small bowel obstructions. Again, delayed gastric emptying was a known mechanism. I’d be semi surprised if SBOs didn’t happen for some. Obese people don’t often have the healthiest of diets. If you slow the transit of low fiber/highly processed food, I’d be shocked if the mud didn’t get stuck. On that note, I’ve had a dozen or so obese patients come in with IBS just in the past couple weeks. They are already having all the symptoms listed on the side effect list of GLP-1s/GIPs. For many/most, it’s a normal day. I saw where 30k are dying in the U.S. per year. I guess just another day. What are your thoughts on the CMS decision to pay for CGMs for "insulin treated" PWDs? Assuming in 2024 afrezza is on the formularity and you have a Medicare Plan D metformin patient and the Abbott rep buys you a nice lunch and says forget the SoC we need to get your patients CGMs so they need to be "insulin treated" - 1. would you lean toward prescribing a once a day shot of basal or 2. prescribe afrezza as an after meal correction? I am curious, how many deaths are you attributing to GLP-1, and on what basis? Mayo clinic gives a laundry list of causes so I hardly think GLP-1 will change much. You probably ought to read the underlying papers, and not just the abstracts, because there are a lot of disclaimers about co-morbidities in them. Long story short - this will have zero impact on GLP-1 because the benefits are significantly greater than the risks and for doctors that's an easy choice. The CVD benefits alone more than offset it, before you even go near the diabetes benefits. The idea that a doctor is going take the risk of ignoring the SoC in exchange for a lunch is a joke I take it? Nobody risks their medical license and career for a lunch. The SoC is clear - you want to change it then do the work like the CGM makers did. I will take a chance and answer the last bit for Stevil. I suspect that he evaluates the patient and makes what he considers the best treatment is on balance.
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Post by stevil on Mar 8, 2023 23:11:12 GMT -5
@ say hey
Regarding once daily basal vs Afrezza.
My preference would be for Afrezza since it would be safer and address PPGE, but to be honest, the correct answer is “whatever the patient is willing to do”.
I think part of your problem when analyzing human behavior is you seem to have difficulty seeing life through others’ eyes. While this is an unfair generalization, there are still multitudes of truth in it. The vast majority of people with (type 2) diabetes could treat their disease with diet and exercise. It was bad habits that led them to the present day with their diagnosis. Asking someone that doesn’t have the best self control to do even more work to treat their disease is a huge ask and is not only irresponsible on my part for asking them to do that, but it also borderlines on negligence when I keep forcing a square peg into a round hole. I think this is the biggest reason for poor outcomes. Once people get on insulin, it’s not necessarily the insulin that is the issue… it’s the burden of having to deal with their disease multiple times a day. It’s not hard for you to pick up an inhaler and inhale 3-5 times a day. I get that. For a lot of people it is. Not the picking up an inhaler and breathing. The part where they have to interrupt everything they’re doing to check on their health and make a decision and act on it. I agree, it shouldn’t be hard. But I see time and time again that it is. So if I have to pick between a once weekly shot or a 3-5 times/day treatment regimen, I don’t make the decision based on what I think will give them the best potential results. I make a plan that will REALIZE the best results.
I fully agree with agedhippie on nearly anything, but especially “the more options the better”. It is my opinion that there will not be a one size fits all treatment for diabetes unless and until there is a cure.
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Post by sayhey24 on Mar 9, 2023 8:24:32 GMT -5
I saw where 30k are dying in the U.S. per year. I guess just another day. What are your thoughts on the CMS decision to pay for CGMs for "insulin treated" PWDs? Assuming in 2024 afrezza is on the formularity and you have a Medicare Plan D metformin patient and the Abbott rep buys you a nice lunch and says forget the SoC we need to get your patients CGMs so they need to be "insulin treated" - 1. would you lean toward prescribing a once a day shot of basal or 2. prescribe afrezza as an after meal correction? I am curious, how many deaths are you attributing to GLP-1, and on what basis? Mayo clinic gives a laundry list of causes so I hardly think GLP-1 will change much. You probably ought to read the underlying papers, and not just the abstracts, because there are a lot of disclaimers about co-morbidities in them. Long story short - this will have zero impact on GLP-1 because the benefits are significantly greater than the risks and for doctors that's an easy choice. The CVD benefits alone more than offset it, before you even go near the diabetes benefits. The idea that a doctor is going take the risk of ignoring the SoC in exchange for a lunch is a joke I take it? Nobody risks their medical license and career for a lunch. The SoC is clear - you want to change it then do the work like the CGM makers did. I will take a chance and answer the last bit for Stevil. I suspect that he evaluates the patient and makes what he considers the best treatment is on balance. I am not attributing any deaths specifically to GLP1s. The article say 4x greater risk of blockage. The mice go bad after 20 months and the GLP1 study ended at 16. 30k people in the U.S die from blockage each year. How many use GLP1s? Was it a contributing factor? We know there are issues with GLP1s just like we knew there were issues with smoking and we know smoking pot is even worse for the lungs. When money is involved a lot of things get brushed under the rug and GLP1s for weight loss is the hot new thing. Concerning the SoC - I don't think, I know the CGM vendors are clearly going to ask the doctors to ignore the SoC. They have to to sell the CGMs. Do you think Robert Ford put all that effort into getting the CMS to change the CGM coverage just to have the SoC stand in his way? Abbott is not MNKD. Stevil already told us lunches are really important and I am sure Abbott will buy great lunches. I will be shocked if his team is not already working on SoC changes and I know Abbott has a zillion studies. To be honest it seems MNKD may have just stumbled on the lost gold from Royal Merchant and the CGM vendors are just going to pile it on their doorstep if afrezza is on the 2024 formularity. What MNKD has proven to us for 8 years is they can't get the job done selling afrezza and now they may not have to. Can they screw this up? There is that chance. Its not a question of "if" but rather do they push the "once daily basal" or "afrezza for corrections". Stevil is some what correct. It will be the patients decision but also the doctors on whats easier for them. Do they want to deal with hypos and needles. Also, how good was the lunch when the rep says OK - just prescribe the afrezza and if they don't take it after each meal no big deal. From the patient perspective what Stevil is missing is he is not giving the doctors enough credit. People do what their doctors say to do. If it ends up being too much work they stop doing it. As Stevil says taking a few puffs of afrezza after meals is not a big thing. No needles, no hypos but they get a CGM and more important Robert Ford gets a sale. If they miss a meal or so, who cares? Afrezza is an add on and they will be no worse than they are today but will see the spike on the CGM. What Stevil did not mention was if they choose the basal and they see the spike there is nothing they can do about it. As Robert Ford said the CGM is a "Rearview Mirror". Now that the CMS changed the language to allow afrezza, the PWD has the option of having "Forward Looking Radar" which can not only alert to the spike but they can make real time adjusts. Of course as I have said before - this all comes down to the 2024 formularity. The thing is if afrezza is on it, did Robert Ford just blow up the T2 industry??? PWD adding afrezza to meformin will never add an SGLT2 or the other junk and will never need the basal. If they want Wegovy for the diet OK and thats why we need the study.
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Post by sayhey24 on Mar 9, 2023 11:08:58 GMT -5
@ say hey Regarding once daily basal vs Afrezza. My preference would be for Afrezza since it would be safer and address PPGE, but to be honest, the correct answer is “whatever the patient is willing to do”. I think part of your problem when analyzing human behavior is you seem to have difficulty seeing life through others’ eyes. While this is an unfair generalization, there are still multitudes of truth in it. The vast majority of people with (type 2) diabetes could treat their disease with diet and exercise. It was bad habits that led them to the present day with their diagnosis. Asking someone that doesn’t have the best self control to do even more work to treat their disease is a huge ask and is not only irresponsible on my part for asking them to do that, but it also borderlines on negligence when I keep forcing a square peg into a round hole. I think this is the biggest reason for poor outcomes. Once people get on insulin, it’s not necessarily the insulin that is the issue… it’s the burden of having to deal with their disease multiple times a day. It’s not hard for you to pick up an inhaler and inhale 3-5 times a day. I get that. For a lot of people it is. Not the picking up an inhaler and breathing. The part where they have to interrupt everything they’re doing to check on their health and make a decision and act on it. I agree, it shouldn’t be hard. But I see time and time again that it is. So if I have to pick between a once weekly shot or a 3-5 times/day treatment regimen, I don’t make the decision based on what I think will give them the best potential results. I make a plan that will REALIZE the best results. I fully agree with agedhippie on nearly anything, but especially “the more options the better”. It is my opinion that there will not be a one size fits all treatment for diabetes unless and until there is a cure. Stevil - my eye sight is not as great as it once was but its not too bad. When I take the Strenghtfinder evaluation and I have taken it several times my top strength is always "Command". Empathy never makes my list. However I try to listen and when I am wrong I will admit it. If I get new info and a position I have needs to change, I will change it. I think you are underestimating the influence the doctor has on the patient. Most people will do what the doctor says. Some will stop when it becomes a hassle or they see no value but many will probably keep following doctors orders - maybe more so women. When I go to T2 seminars its usually 70%+ female. We are going to differ on this statement - "The vast majority of people with (type 2) diabetes could treat their disease with diet and exercise." As we have seen with Covid there is a viral linkage to diabetes. Diet and exercise will reduce the body's insulin needs and will improve insulin uptake but what we do know from all the early insulin intervention studies is the earlier we can help take the load off the pancreas the better outcome we will have. The big problem is as a general rule and according to the SoC we don't do that today. What you may also not fully appreciate is as we get older dieting gets harder because the weight seems to stay as you continue to reduce calories. There is also the chicken and egg discussion the tech diet companies are having - did the weight come before the diabetes or did they loose post prandial control first and then the weight gain. With afrezza they have already interrupted their day to eat so all they need to do is; take sip of the water; take a puff; eat the sandwich. I am not buying Aged's using afrezza is a big ask. Then again if I am a CGM sales rep and my goal is to sell CGMs I really don't care if they use it as long as they are prescribed it and get the CGM until of course they don't improve and when they "go to the tape" the will see on the CGM it was never taken. I think what you are seeing is people not seeing benefit so they stop doing something. Immediate feedback it HUGE. With afrezza and the CGM they get immediate feedback. They can see they are in control and they can make a difference. With the basal be it daily or weekly they have no control, their post prandial numbers will still spike and they will see little benefit to the CGM.
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Post by stevil on Mar 9, 2023 15:02:52 GMT -5
Stevil - my eye sight is not as great as it once was but its not too bad. When I take the Strenghtfinder evaluation and I have taken it several times my top strength is always "Command". Empathy never makes my list. However I try to listen and when I am wrong I will admit it. If I get new info and a position I have needs to change, I will change it. I think you are underestimating the influence the doctor has on the patient. Most people will do what the doctor says. Some will stop when it becomes a hassle or they see no value but many will probably keep following doctors orders - maybe more so women. When I go to T2 seminars its usually 70%+ female. We are going to differ on this statement - "The vast majority of people with (type 2) diabetes could treat their disease with diet and exercise." As we have seen with Covid there is a viral linkage to diabetes. Diet and exercise will reduce the body's insulin needs and will improve insulin uptake but what we do know from all the early insulin intervention studies is the earlier we can help take the load off the pancreas the better outcome we will have. The big problem is as a general rule and according to the SoC we don't do that today. What you may also not fully appreciate is as we get older dieting gets harder because the weight seems to stay as you continue to reduce calories. There is also the chicken and egg discussion the tech diet companies are having - did the weight come before the diabetes or did they loose post prandial control first and then the weight gain. With afrezza they have already interrupted their day to eat so all they need to do is; take sip of the water; take a puff; eat the sandwich. I am not buying Aged's using afrezza is a big ask. Then again if I am a CGM sales rep and my goal is to sell CGMs I really don't care if they use it as long as they are prescribed it and get the CGM until of course they don't improve and when they "go to the tape" the will see on the CGM it was never taken. I think what you are seeing is people not seeing benefit so they stop doing something. Immediate feedback it HUGE. With afrezza and the CGM they get immediate feedback. They can see they are in control and they can make a difference. With the basal be it daily or weekly they have no control, their post prandial numbers will still spike and they will see little benefit to the CGM #1. I'm sorry, but it's a bit amusing to me that you're a non doctor telling a doctor what MY experience is like. I can unequivocally tell you that you are absolutely 100089857% incorrect in the red statement. Patient compliance/adherence is a MAJOR issue. Again, it doesn't take a huge leap in logic to understand why. These people didn't get this disease by eating fish and salad. They're not even able to do the things THEY want to do, let alone the things I'm asking them to do. #2. What have I said or not said to lead you to that assumption? Again, it is so bizzare and fantastical that people on this board think they know more than me. I don't know everything, but I never walk up to an expert on something and immediately assume I know more than them. It's really quite fascinating. #3. Ironically, I had a patient show up today. I prescribed Afrezza for him. He was insulin naive. He literally came into the office today and told me, "I have friends who take one shot a day of insulin. Can I just do that so I don't have to check my blood sugar 3 times a day?" I kid you not. He even has a prescription for a CGM. He told me he knows himself and he's going to forget to do what he's supposed to do. If you want, I can ask him if I can give him your contact information so you can convince him to take Afrezza. I see this ALL. THE. TIME. #4. See #1.
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Post by sportsrancho on Mar 9, 2023 16:47:06 GMT -5
... nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
maybe from your stomach tying itself in knots??? When I was a personal trainer, my clients would ask me if they could take diet pills, “Fen fen” for instance, and I said absolutely not. I will not recommend that, there is no magic pill, because it always turns out that the side effects affected your body negatively in some other form. The magic pill is beginning to trust yourself, find out what works for you. Make your own rules and then keep them.
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Post by sayhey24 on Mar 9, 2023 17:36:05 GMT -5
Stevil - my eye sight is not as great as it once was but its not too bad. When I take the Strenghtfinder evaluation and I have taken it several times my top strength is always "Command". Empathy never makes my list. However I try to listen and when I am wrong I will admit it. If I get new info and a position I have needs to change, I will change it. I think you are underestimating the influence the doctor has on the patient. Most people will do what the doctor says. Some will stop when it becomes a hassle or they see no value but many will probably keep following doctors orders - maybe more so women. When I go to T2 seminars its usually 70%+ female. We are going to differ on this statement - "The vast majority of people with (type 2) diabetes could treat their disease with diet and exercise." As we have seen with Covid there is a viral linkage to diabetes. Diet and exercise will reduce the body's insulin needs and will improve insulin uptake but what we do know from all the early insulin intervention studies is the earlier we can help take the load off the pancreas the better outcome we will have. The big problem is as a general rule and according to the SoC we don't do that today. What you may also not fully appreciate is as we get older dieting gets harder because the weight seems to stay as you continue to reduce calories. There is also the chicken and egg discussion the tech diet companies are having - did the weight come before the diabetes or did they loose post prandial control first and then the weight gain. With afrezza they have already interrupted their day to eat so all they need to do is; take sip of the water; take a puff; eat the sandwich. I am not buying Aged's using afrezza is a big ask. Then again if I am a CGM sales rep and my goal is to sell CGMs I really don't care if they use it as long as they are prescribed it and get the CGM until of course they don't improve and when they "go to the tape" the will see on the CGM it was never taken. I think what you are seeing is people not seeing benefit so they stop doing something. Immediate feedback it HUGE. With afrezza and the CGM they get immediate feedback. They can see they are in control and they can make a difference. With the basal be it daily or weekly they have no control, their post prandial numbers will still spike and they will see little benefit to the CGM #1. I'm sorry, but it's a bit amusing to me that you're a non doctor telling a doctor what MY experience is like. I can unequivocally tell you that you are absolutely 100089857% incorrect in the red statement. Patient compliance/adherence is a MAJOR issue. Again, it doesn't take a huge leap in logic to understand why. These people didn't get this disease by eating fish and salad. They're not even able to do the things THEY want to do, let alone the things I'm asking them to do. #2. What have I said or not said to lead you to that assumption? Again, it is so bizzare and fantastical that people on this board think they know more than me. I don't know everything, but I never walk up to an expert on something and immediately assume I know more than them. It's really quite fascinating. #3. Ironically, I had a patient show up today. I prescribed Afrezza for him. He was insulin naive. He literally came into the office today and told me, "I have friends who take one shot a day of insulin. Can I just do that so I don't have to check my blood sugar 3 times a day?" I kid you not. He even has a prescription for a CGM. He told me he knows himself and he's going to forget to do what he's supposed to do. If you want, I can ask him if I can give him your contact information so you can convince him to take Afrezza. I see this ALL. THE. TIME. #4. See #1. Stevil - sorry if I hurt your feelings on points 1 2 and 3. I thought you were a young guy/gal? One thing you will learn is with age comes wisdom. I can definitely understand your new patient. First off he is a guy and he wants to totally ignore he has a health issue. I would think this is not unusual for T2s. Its a guy thing. Maybe not as much for the under 40 crowd but 50+ I would see it more the norm. I have already mentioned these T2 seminars are 70%+ women maybe closer to 80%. He can definitely contact me if you want. I can talk about my dad and how he thought having a coke at lunch gave him diabetes. I can also tell this guy how he had his first "known" heart attack at 62 and was gone by 70.
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Post by agedhippie on Mar 9, 2023 18:14:18 GMT -5
Stevil - sorry if I hurt your feelings on points 1 2 and 3. I thought you were a young guy/gal? One thing you will learn is with age comes wisdom.There is a second half to that quote. The full version is "With age comes wisdom, but sometimes age comes alone." Oscar Wilde.
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