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Post by agedhippie on Jun 16, 2023 9:55:17 GMT -5
Sayhey, you are simultaneously arguing that, for T1s, Afrezza+basal is better than an AID because of mealtime speed and an AID is better than Afrezza+basal because of nighttime control. Both can't be true. The absolute best for T1s is probably AID+Afrezza. STAT-1 trial gave a TIR of 62.5% for Afrezza + basal, the Medtronics 780g (an AID pump) real world data for 4000+ people ( www.ncbi.nlm.nih.gov/pmc/articles/PMC8817690/) gave a TIR of 76.2%. Afrezza + basal needs to get to that ballpark number or endos will keep prescribing pumps. As an aside Medtronics is a good example of what Mannkind should be doing - gathering data and publishing. |
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Post by sayhey24 on Jun 16, 2023 10:17:40 GMT -5
Sayhey, you are simultaneously arguing that, for T1s, Afrezza+basal is better than an AID because of mealtime speed and an AID is better than Afrezza+basal because of nighttime control. Both can't be true. The absolute best for T1s is probably AID+Afrezza. STAT-1 trial gave a TIR of 62.5% for Afrezza + basal, the Medtronics 780g (an AID pump) real world data for 4000+ people ( www.ncbi.nlm.nih.gov/pmc/articles/PMC8817690/) gave a TIR of 76.2%. Afrezza + basal needs to get to that ballpark number or endos will keep prescribing pumps. As an aside Medtronics is a good example of what Mannkind should be doing - gathering data and publishing. Yes - we have heard this before. The AID does much better than the basal when they are sleeping. When you factor out the sleeping hours and just look at the waking hours i.e 8am - 10pm afrezza wins. I think at this point we just need to wait until we see the kids trial numbers and it get approved. Assuming the kids really like afrezza, then it will be the "Moms vs the endos". It will be our own version of a cage match and we will see who wins. IMO, MNKD needs to do a bunch of social media promotions including the TikTcos or whatever works best to contact the Moms. In my corner we have the "Moms" and in your corner we have the "Endos pushing pumps" |
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Post by sayhey24 on Jun 16, 2023 10:24:51 GMT -5
Aged - I 100% agree "As an aside Medtronics is a good example of what Mannkind should be doing - gathering data and publishing." Why Mike has not been doing this is a head-scratcher. For 7 years they should have been doing this. Kendall's little study is all we got. We never even got much updated analysis of the "veins of gold".
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Post by uvula on Jun 16, 2023 10:55:47 GMT -5
" The AID does much better than the basal when they are sleeping. When you factor out the sleeping hours and just look at the waking hours i.e 8am - 10pm afrezza wins."
You keep saying this but it doesn't seem like a useful point. It is equivalent to saying that the mnkd stock price is always going up if you factor out the days in which it goes down.
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Post by sayhey24 on Jun 16, 2023 14:15:10 GMT -5
" The AID does much better than the basal when they are sleeping. When you factor out the sleeping hours and just look at the waking hours i.e 8am - 10pm afrezza wins." You keep saying this but it doesn't seem like a useful point. It is equivalent to saying that the mnkd stock price is always going up if you factor out the days in which it goes down. What I keep saying is a basic principle of how the body handles blood sugar. In simple terms you have two states; fasting state; and prandial state. The pancreas works very differently for each state and so does the liver. The current accepted TIR is like saying lets take two stocks MNKD and Amazon and add their rate of return together for the last ten years and divide by 2. Thats a lot different than looking at MNKD and Amazon separately. What I am saying is lets look at each state separately and what is the best insulin for each state. As a T1 diabetic you need the basal insulin for the fasting state. As a T2 diabetic your pancreas will provide enough insulin for the fasting state. As a T1 and a T2 your body is not making enough insulin for the prandial state. afrezza is a prandial insulin. During sleeping you are in the fasting state and need a basal insulin. Its like driving on the highway and you speed up and slow down a little but its not a drag race. afrezza is not involved while fasting. You can use a pump or a long acting insulin like Tresiba but not afrezza. However you are in a pretty stable state with glucose needs. The AID handles this very well as the RAA its using has time to address fasting insulin needs. If your BG starts trending low the AID will pause RAA release giving it an advantage over Tresiba. If you BG starts going high it release more RAA. When you eat your BG spikes and you need a prandial insulin. You are in a drag race. To replicate the pancreas insulin release, you need afrezza. Nothing else is fast enough to address the spike and signal the liver to shut down glucose release. RAA insulins are not fast enough for this and the AID is using an RAA. The thing is when you are on the highway your speed is usually pretty constant so while the AID is better, the basal like Tresiba is usually good enough in TIR for most people. The thing is, is good enough good enough during sleeping? If you read a lot of the social media discussion these days, there are a lot of people using a pump and then adding afrezza. Technically, the AID plus afrezza for meals is the best technical 24hr approach. However, a lot of people don't want to wear pumps. There seems to be a trend of pump users adding afrezza for meals and then over time switching to Tresiba and dropping the pump. IDK how big this trend is but it seems to be growing. |
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Post by agedhippie on Jun 16, 2023 14:24:25 GMT -5
As a T2 diabetic your pancreas will provide enough insulin for the fasting state. I don't know why you keep saying that - it's flatly wrong. The testing for elevated glucose levels on waking is literally the test for pre-diabetes (and diabetes). |
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Post by sayhey24 on Jun 16, 2023 19:26:22 GMT -5
As a T2 diabetic your pancreas will provide enough insulin for the fasting state. I don't know why you keep saying that - it's flatly wrong. The testing for elevated glucose levels on waking is literally the test for pre-diabetes (and diabetes). Aged - they test on waking BG to allow the pancreas to catch up over night. The problem is because it can't handle the post meal demand, it never does. Eating is causing the spike and you have lost proper first phase response. The non-diabetic will be back to baseline in about 2 hours. Whats your BG when you went to bed? Probably not 87? Maybe 200+? It should be 87 according to Bernstein. What is it when you wake up 150? If it was 87 when you went to bed, when you wake it will be around 87 not the 150. The pancreas is like the little engine that kept trying get up the hill. It got a little way up the hill but not all the way. If we really want to identify the T2s lets look at post meal glucose control with a CGM. If you are going over 140 thats concerning. If you are staying over 140 for more than 2 hours we have an issue. If you are diabetic and went to bed at 90 because afrezza got you there by handling the post prandial spike, you are going to be around 90 when you wake. The pancreas for the T2 will handle the fasting state if you properly handle the prandial state. |
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Post by agedhippie on Jun 16, 2023 21:46:53 GMT -5
I don't know why you keep saying that - it's flatly wrong. The testing for elevated glucose levels on waking is literally the test for pre-diabetes (and diabetes). ... If you are diabetic and went to bed at 90 because afrezza got you there by handling the post prandial spike, you are going to be around 90 when you wake. The pancreas for the T2 will handle the fasting state if you properly handle the prandial state. Sorry, that is still medically incorrect. |
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Post by sayhey24 on Jun 17, 2023 6:27:07 GMT -5
... If you are diabetic and went to bed at 90 because afrezza got you there by handling the post prandial spike, you are going to be around 90 when you wake. The pancreas for the T2 will handle the fasting state if you properly handle the prandial state. Sorry, that is still medically incorrect. Now you want to argue with CGMs? Will it be perfectly 90, come on but it will be close. They should be at their baseline even with morning adrenaline release. They should have enough pancreatic function to handle the liver. This was why Al Mann always talked about the medically correct way to treat a T2 is to address post prandial sugar spikes. Through their testing they also found that with the speed of afrezza it got the liver back in sync. This is what Mango is always talking about. What Bill has seen is if you get them back to baseline after eating over time you will see reversal. This is also what Al and his team were seeing. What is medically incorrect is the way we currently treat T2s. First we let the BG spike which increases "resistance" and with metformin slow down fasting glucose release from the liver and have the pancreas work day and night to catch up. Then we add the SGLT2 to piss out the sugar when they go over 180 and try to at least keep them around 170. Then we add the glp-1 to decrease food in-take and make the pancreas work harder. The medically correct thing to do is add afrezza first and address the post prandial first phase loss and take the load off the pancreas. Its all about addressing first phase insulin loss. The goal is to "Stop the Spike" and get them back to baseline within 2 hours. Whats this thread called - ADA2023? I have offered to do some "Seeing is Believing" demos. Mike cancelled the booth but the above could be a 2 day live demo. The thing is with CGMs it is exactly what I told Mike the first time I met him. With CGMs you can't hide the numbers and you can't make up stories. I told him in 2016, the only thing which would save afrezza were CGMs and remote monitoring. |
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Post by lennymnkd on Jun 17, 2023 7:13:47 GMT -5
And I always called it (CGM) the lie detector test ! If it’s as accurate as it’s supposed .. I can’t believe these conversations
Aren’t to a point of more understanding… I know it’s a complex subject but it’s mostly all in the numbers.that you can’t argue
With .
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Post by agedhippie on Jun 17, 2023 8:13:09 GMT -5
And I always called it (CGM) the lie detector test ! If it’s as accurate as it’s supposed .. I can’t believe these conversations Aren’t to a point of more understanding… I know it’s a complex subject but it’s mostly all in the numbers.that you can’t argue With . There is no evidence from CGMs to support the idea that the overnight numbers are flat for diabetics, and that would have been huge news. Yet here we are over a decade after CGMs became widely available and nobody has noticed! TBH you don't even need a CGM, just a meter reading last thing at night and first thing in the morning. |
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Post by uvula on Jun 17, 2023 8:14:23 GMT -5
This whole discussion is off topic but who cares. This is the best discussion here that I can remember. Sayhey and aged (and others) should be advisors to mnkd.
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Post by sayhey24 on Jun 17, 2023 13:40:03 GMT -5
And I always called it (CGM) the lie detector test ! If it’s as accurate as it’s supposed .. I can’t believe these conversations Aren’t to a point of more understanding… I know it’s a complex subject but it’s mostly all in the numbers.that you can’t argue With . There is no evidence from CGMs to support the idea that the overnight numbers are flat for diabetics, and that would have been huge news. Yet here we are over a decade after CGMs became widely available and nobody has noticed! TBH you don't even need a CGM, just a meter reading last thing at night and first thing in the morning. Exactly how I did it prior to getting my first CGM on ebay before the Libre was available in the U.S. I used the Freestyle meter I never liked finger pricks and I was trying to see the profile. I think I still have a few old sensors from Germany. My morning check was nearly always 93. Before going to sleep was usually around 95. So unless my Abbott meter was broken it is what it is. For the T2 community I really don't think I am making news. The problem is most T2s are told by their doctors they don't need to check and how many are getting to 95 after meals? Jenny Ruhl was happy to be in the 5s let alone sub 5 for A1c. As I told her years ago very hard without afrezza. I know Bernstein wrote some recommendations in her books. To stay on topic we could do this for ADA2023 as live demos. The coke challenge with a T1. The post prandial rise with the T2 on an antiglycemic. Treating the T2 with afrezza to "Stop the Spike". I know Mike said he spent $60M on his "Seeing is Believing" campaign. I can't drive my 10' ladder to San Diego but we can get one for $250 and I have a megaphone. It would be nice to have a big screen monitor but I can get a white board and do this old school to track the numbers. I don't think we would come close to $60M and we probably would be making news as the ADA staff would probably kick me out. |
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Post by lennymnkd on Jun 17, 2023 13:58:20 GMT -5
I know this might sound silly buy hey it’s Saturday… no pun intended.. but how about this …
I’m always receiving free dinners somewhere from financial firms in the mail to listen to investment
Advice.. how about dinner and your live demonstration for doctors/ endocrinologists
At a Marriott or some other high end hotel parlor room …. Think they would bite …
Lot of locations out there 🤔
not to mention we would not have to lug a ladder around 😀
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Post by sayhey24 on Jun 18, 2023 6:48:27 GMT -5
I think we need to understand what Mike tried to do with his "Seeing is Believing" campaign which he said they spent $60M on and it crashed and burned.
What are the lessons learned from that? I can't remember him ever saying what exactly they tried to do.
I think the VDex model is a good one and with Medicare covering CGMs and afrezza with pre auths maybe there is a lane to expand. It would be nice to see them partner with corporate GPs. In the Pottstown PA "T2 hot spot" Geisinger is a good example. Of course the issue still goes back to the T2 SoC. If the India numbers are great and SoC changes can be justified then we have some progress. If we have "No" pre auths requirement in 2024 Medicare maybe we can get some help lobbying the ADA as a few companies want to sell CGMs to T2s.
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