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Post by prcgorman2 on Mar 26, 2023 10:15:14 GMT -5
visionary’s.. i like that,.MNKD only hope. i said it dont shoot. Only hope? No shooting needed. Cheer up! MNKD is doing better now than they have in the last 8 years, and things are getting better with plenty of actions going on that we know about to improve things, and it isn’t unreasonable to assume there are other things going on which we don’t know about which can help too. |
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Post by mango on Mar 27, 2023 5:28:33 GMT -5
I think BluHale may add to the debt but I can never see it being a consumer product. I see it being used for in office patient training and as Mike said during studies. The Dexcom API as Mike has said is publicly available - developer.dexcom.com/homeDexcom wants to sell CGMs. If afrezza can help sell them and we know it can at least in the Medicare space Kevin Sayer will be interested in supporting MNKD's efforts with BluHale but a simple UI button on a phone app to answer the question what size did you take small, medium, or large would provide a similar capability. It may not be as techno-flashy but would be good enough. If it can help in any trials, great. As a money maker, I don't see it. Agree. Ironically, it is called BlueHale which implies exphiration, not inspiration. Make the little bugger capable of reading BG on exhale and dose reading on inhale, and it could be a lot more interesting to consumers. BlueHale being capable of measuring BG would be awesome, but at some point we have to realize that the more data points you give a patient to collect, the more likely they are to develop “analysis paralysis.” I have always appreciated the fact that Afrezza really eliminates any need to constantly monitor your BG. Once you have it dialed in, there’s really no need to know what your BG is because you already know it’s within range or good enough. The whole point of Afrezza is freedom to live your life! |
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Post by uvula on Mar 27, 2023 9:28:56 GMT -5
"have always appreciated the fact that Afrezza really eliminates any need to constantly monitor your BG. Once you have it dialed in, there’s really no need to know what your BG is because you already know it’s within range or good enough. The whole point of Afrezza is freedom to live your life!"
I am not a diabetic, so I am not qualified to say this, but I would bet that no T1d would ever make that statement. Afrezza might be great for mealtime BG, but does nothing for nonmealtime BG. Basal insulin, exercise, stress, etc. can affect BG.
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Post by sayhey24 on Mar 27, 2023 10:24:10 GMT -5
Why is that interesting? We know Dexcom wants to sell CGMs. Aside from needing insulin treated patients for Medicare payment they want to sell to everyone including Wegovy users which may become a big market. It's interesting because traditionally their page has focused on T1 diabetics - insulin users. The current page has broadened that to all diabetics. This is their messaging about CGMs not just being for insulin users. OK - I guess since we have been talking about this for years it was just a matter of time. Who knows maybe the next thing they will say for the T2s is their CGM can be more than a rearview mirror. When they add afrezza they get forward looking radar. |
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Post by sayhey24 on Mar 27, 2023 10:30:32 GMT -5
"have always appreciated the fact that Afrezza really eliminates any need to constantly monitor your BG. Once you have it dialed in, there’s really no need to know what your BG is because you already know it’s within range or good enough. The whole point of Afrezza is freedom to live your life!" I am not a diabetic, so I am not qualified to say this, but I would bet that no T1d would ever make that statement. Afrezza might be great for mealtime BG, but does nothing for nonmealtime BG. Basal insulin, exercise, stress, etc. can affect BG. I think this is directed to T2s not on other subq insulin. It is interesting to see a growing number of T1s only using afrezza now with their CGMs. Its not a large number but it is trending. Of course others combine it in all different ways with their RAA and basal. |
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Post by agedhippie on Mar 27, 2023 11:41:09 GMT -5
It's interesting because traditionally their page has focused on T1 diabetics - insulin users. The current page has broadened that to all diabetics. This is their messaging about CGMs not just being for insulin users. OK - I guess since we have been talking about this for years it was just a matter of time. Who knows maybe the next thing they will say for the T2s is their CGM can be more than a rearview mirror. When they add afrezza they get forward looking radar. CGMs are by definition backward looking since they are recording devices. Their role is in letting you make an informed decision on your next step based on that data, that's the forward looking part of using a CGM, not the insulin used. This is the mechanism for the artificial pancreas (as well as manual management) - combine the trend from the CGM with a knowledge of the insulin curve to decide what needs to be dosed. The only difference between Afrezza and RAA is the curve. The "rearview mirror" and "forward looking radar" comes over as marketing-speak and is counter-productive in this context. While there are contexts where that sort of approach would work this is not one of them. You could use them, but they would require a more extensive explanation as to what they mean and how the evidence supports that. It risks sounding like an over-simplification and given the stakes people are probably looking for more than a slogan (that may be my T1 bias showing.) |
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Post by prcgorman2 on Mar 27, 2023 12:00:10 GMT -5
"The only difference between Afrezza and RAA is the curve."
I agree about your concern about marketing-speak, but I also think you also indulged in oversimplification. The "curve" is decidedly different between RAA and Afrezza, but the differences are definitely not just the graph. The graph is different because of the primary differences in the RAA and Afrezza formulas and administration paths.
Other kinds of marketing speak may be more appropriate. CGMs illustrate the bumpy ride of a PWD. CGMs used in combination with Afrezza should illustrate a smoother ride.
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Post by sayhey24 on Mar 27, 2023 13:32:59 GMT -5
OK - I guess since we have been talking about this for years it was just a matter of time. Who knows maybe the next thing they will say for the T2s is their CGM can be more than a rearview mirror. When they add afrezza they get forward looking radar. CGMs are by definition backward looking since they are recording devices. Their role is in letting you make an informed decision on your next step based on that data, that's the forward looking part of using a CGM, not the insulin used. This is the mechanism for the artificial pancreas (as well as manual management) - combine the trend from the CGM with a knowledge of the insulin curve to decide what needs to be dosed. The only difference between Afrezza and RAA is the curve. The "rearview mirror" and "forward looking radar" comes over as marketing-speak and is counter-productive in this context. While there are contexts where that sort of approach would work this is not one of them. You could use them, but they would require a more extensive explanation as to what they mean and how the evidence supports that. It risks sounding like an over-simplification and given the stakes people are probably looking for more than a slogan (that may be my T1 bias showing.) I think you are missing the point. A T2 on an antiglycemic can not do much except learn from the situation such as food eaten etc. and try and do things better tomorrow. This is how Robert Ford described the use of the CGM to CMS even for the basal insulin. Robert Ford owns "rearview mirror" not me. If you want to call it marketing talk - OK. He seems pretty good at selling CGMs and a bunch of other stuff. A T2 using afrezza can adjust near real time and make corrections now, not tomorrow. Its very similar to the radar cars now have providing warning so you can make corrections. With afrezza you can do that. With metformin, GLP1, SGLT2, etc. its a wait until tomorrow after the accident "Forward Looking Radar" is my term. If you want to call that a marketing term I would agree and I sure hope it sells more afrezza. If Mike wants to use it he certainly can. If you don't like it, what can I say. I like it as people can associate it with something they know like driving a car. |
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Post by prcgorman2 on Mar 27, 2023 14:55:57 GMT -5
"The only difference between Afrezza and RAA is the curve." I agree about your concern about marketing-speak, but I also think you also indulged in oversimplification. The "curve" is decidedly different between RAA and Afrezza, but the differences are definitely not just the graph. The graph is different because of the primary differences in the RAA and Afrezza formulas and administration paths. Other kinds of marketing speak may be more appropriate. CGMs illustrate the bumpy ride of a PWD. CGMs used in combination with Afrezza should illustrate a smoother ride. Maybe sayhey can come up with a nice phrase or idea associated with seismographs. "Why get slammed by a magnitude 7 glucose quake when instead you can smoothly glide along on Afrezza?". "Afrezza - the SAFE choice." |
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Post by agedhippie on Mar 27, 2023 15:45:16 GMT -5
I think you are missing the point. A T2 on an antiglycemic can not do much except learn from the situation such as food eaten etc. and try and do things better tomorrow. This is how Robert Ford described the use of the CGM to CMS even for the basal insulin. Robert Ford owns "rearview mirror" not me. If you want to call it marketing talk - OK. He seems pretty good at selling CGMs and a bunch of other stuff. A T2 using afrezza can adjust near real time and make corrections now, not tomorrow. Its very similar to the radar cars now have providing warning so you can make corrections. With afrezza you can do that. With metformin, GLP1, SGLT2, etc. its a wait until tomorrow after the accident "Forward Looking Radar" is my term. If you want to call that a marketing term I would agree and I sure hope it sells more afrezza. If Mike wants to use it he certainly can. If you don't like it, what can I say. I like it as people can associate it with something they know like driving a car. TBH there is a bigger problem in the T2 non-insulin world and that's compliance. Stevil gave an example a few weeks ago of a person who he had prescribed Afrezza for coming back and asking for a weekly shot instead because he knew he would do the shot, but not meal time insulin. It's all very well coming up with cute marketing phrases, but that's not going to change things. The problem is compliance in chronic diseases that have no immediate consequences. To stick to your analogy the person isn't looking in their rearview mirror, nor looking at their forward radar, but have their foot to the floor while chatting to the passenger rather than paying attention. In a couple of minutes this will end badly when they slam into a truck, but right now they are fine. That's compliance in chronic disease in general, diabetes amongst them, where there is no immediate consequence people pay less attention than they should. A lot of things have been tried to fix this, but in the end entropy always prevails until they hit that truck. |
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Post by sayhey24 on Mar 27, 2023 16:26:41 GMT -5
I think you are missing the point. A T2 on an antiglycemic can not do much except learn from the situation such as food eaten etc. and try and do things better tomorrow. This is how Robert Ford described the use of the CGM to CMS even for the basal insulin. Robert Ford owns "rearview mirror" not me. If you want to call it marketing talk - OK. He seems pretty good at selling CGMs and a bunch of other stuff. A T2 using afrezza can adjust near real time and make corrections now, not tomorrow. Its very similar to the radar cars now have providing warning so you can make corrections. With afrezza you can do that. With metformin, GLP1, SGLT2, etc. its a wait until tomorrow after the accident "Forward Looking Radar" is my term. If you want to call that a marketing term I would agree and I sure hope it sells more afrezza. If Mike wants to use it he certainly can. If you don't like it, what can I say. I like it as people can associate it with something they know like driving a car. TBH there is a bigger problem in the T2 non-insulin world and that's compliance. Stevil gave an example a few weeks ago of a person who he had prescribed Afrezza for coming back and asking for a weekly shot instead because he knew he would do the shot, but not meal time insulin. It's all very well coming up with cute marketing phrases, but that's not going to change things. The problem is compliance in chronic diseases that have no immediate consequences. To stick to your analogy the person isn't looking in their rearview mirror, nor looking at their forward radar, but have their foot to the floor while chatting to the passenger rather than paying attention. In a couple of minutes this will end badly when they slam into a truck, but right now they are fine. That's compliance in chronic disease in general, diabetes amongst them, where there is no immediate consequence people pay less attention than they should. A lot of things have been tried to fix this, but in the end entropy always prevails until they hit that truck. Why is there a compliance problem? What feedback do they get? How can you change the compliance issue? We can all complain and say there is a compliance problem but what happens when they can get immediate feedback and can actually have some control? I am sure not all will change but some will. That guy whose wife can now see the CGM numbers and knows its time for him to take a puff - he will change because she will make sure he does. Right now they take their metformin and things just get worse. They go to the doctor every 3 months and get another A1c which is probably not better. How depressing is that? |
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Post by longliner on Mar 27, 2023 16:56:01 GMT -5
I always liked Winnie The Pooh, Eeyore was so consistent! Now what was his signature phrase? Oh yes, "It'll never work"  I believe this is perfectly on topic!  |
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Post by sr71 on Mar 27, 2023 17:33:33 GMT -5
IMHO, CGM data-points can provide the "educated" diabetes patient with "forward-looking radar".
Afrezza is the only prandial product for PWD's that can best-utilize that data and education to maximum advantage for controlling TIR and A1C.
The only organization that I'm aware of that guides each individual patient through the entire process is VDEX.
I personally think Bill McCullough should give Mannkind's new EVP/COO Lauren Sabella a call to make introductions.
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Post by cretin11 on Mar 27, 2023 17:41:37 GMT -5
The only organization that I'm aware of that guides each individual patient through the entire process is VDEX. I personally think Bill McCullough should give Mannkind's new EVP/COO Lauren Sabella a call to make introductions. Correct (although more appropriately the phone call would be going the opposite direction). |
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Post by agedhippie on Mar 28, 2023 8:56:46 GMT -5
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