|
|
Post by peppy on Dec 6, 2023 14:45:14 GMT -5
Peppy, I assume you are saying the school nurse is not going to determine what insulin to give, he or she will simply follow the Parent/Doctor directive for that child. That's right with the exception that the school nurse and the school administration are influential in determining what the school and the nurse will support (or prefer).
School nurses receive training and education on diabetes management, including insulin administration, blood glucose monitoring, and recognizing symptoms of hypo- and hyperglycemia.
School nurses collaborate with healthcare providers and families to develop Individualized Healthcare Plans (IHPs) and/or Section 504 (of the Rehabilitation Act of 1973) plans that outline the specific care and accommodations needed for students with diabetes.
If I understand correctly, doctors develop a Diabetes Medical Management Plan (DMMP). e.g., diabetes.org/DMMP. School nurses and administrations develop IHPs and/or Section 504 Plans. e.g., diabetes.org/504plan.
"The DMMP is an individualized diabetes medical plan developed by the student's treating provider that lays out the prescribed diabetes regimen for the school setting. The Section 504 Plan sets forth the accommodations, education aides and services needed for the student with diabetes." i.e., the DMMP is what the doctor does for the student with diabetes to provide guidance to the school nurse and the IHP is based on the DMMP and the Section 504 plan if there is one.
The point to all this is that diabetes care within the school setting is far more organized than what I think people were assuming and that if the results of the Pediatric study of Afrezza is compelling enough to persuade prescribers, Afrezza should also be showing up in DMMP, IHP, and 504 plans, and it would be a good thing if MannKind is, or gets, prepared to leverage those resources.
Only one person orders the insulin. The physician or their nurse practitioner. The people can develop what ever plan they want. The physician orders it. The nurse follows the physicians order. I believe how and when the insulin is given is decided my the instructions on the package insert. It is a bit like you are in the Army now, not behind a plow. |
|
|
|
Post by prcgorman2 on Dec 6, 2023 15:05:22 GMT -5
If prescribers get persuaded to prescribe Afrezza, school nurses will see it in the DMMP. The IHP and the Section 504 plan is influenced by school nurses. There are opportunities to influence what is in these. If we think updating the Standard of Care is possible and important, then influencing DMMPs, IHPs and 504s is possible and important too. The doctor prescribes. That's a given regardless of whether they prescribe Afrezza or Humalog. Schools can say, "we prefer the doctor prescribe Afrezza because of the SAFETY and reduced likelihood of hypoglycemia".
I'm not sure it needs to get more complicated than that. If I was a MannKind rep, and the results of the Pediatric study say Afrezza is safer and superior, than I'm going to tell it to whoever will listen and can influence prescribers and I would target getting in front of my state's school nurse association to let them know safer, superior, convenient.
|
|
|
|
Post by akemp3000 on Dec 6, 2023 16:25:18 GMT -5
If prescribers get persuaded to prescribe Afrezza, school nurses will see it in the DMMP. The IHP and the Section 504 plan is influenced by school nurses. There are opportunities to influence what is in these. If we think updating the Standard of Care is possible and important, then influencing DMMPs, IHPs and 504s is possible and important too. The doctor prescribes. That's a given regardless of whether they prescribe Afrezza or Humalog. Schools can say, "we prefer the doctor prescribe Afrezza because of the SAFETY and reduced likelihood of hypoglycemia". I'm not sure it needs to get more complicated than that. If I was a MannKind rep, and the results of the Pediatric study say Afrezza is safer and superior, than I'm going to tell it to whoever will listen and can influence prescribers and I would target getting in front of my state's school nurse association to let them know safer, superior, convenient. Yes. There are numerous annual and semi-annual conventions where the host needs guest speakers, especially for new products and services. Not all are restricted by the presentation legalities associated with presenting a new drug. A family member is the Executive Director of a sizeable medical association and one who is often looking for speakers with new information to present to the organization. |
|
|
|
Post by sayhey24 on Dec 7, 2023 18:54:14 GMT -5
If prescribers get persuaded to prescribe Afrezza, school nurses will see it in the DMMP. The IHP and the Section 504 plan is influenced by school nurses. There are opportunities to influence what is in these. If we think updating the Standard of Care is possible and important, then influencing DMMPs, IHPs and 504s is possible and important too. The doctor prescribes. That's a given regardless of whether they prescribe Afrezza or Humalog. Schools can say, "we prefer the doctor prescribe Afrezza because of the SAFETY and reduced likelihood of hypoglycemia". I'm not sure it needs to get more complicated than that. If I was a MannKind rep, and the results of the Pediatric study say Afrezza is safer and superior, than I'm going to tell it to whoever will listen and can influence prescribers and I would target getting in front of my state's school nurse association to let them know safer, superior, convenient. Yes. There are numerous annual and semi-annual conventions where the host needs guest speakers, especially for new products and services. Not all are restricted by the presentation legalities associated with presenting a new drug. A family member is the Executive Director of a sizeable medical association and one who is often looking for speakers with new information to present to the organization. I was thinking simple. My local school district has 8 nurses. Doing a lunch info session may be hard as thats probably prime time for them but a breakfast or dinner info session and maybe you would get 5 or 6. Who knows if the dinner was good with some nice wine and they can bring a friend you might get all eight. I would invite the administration and even board members. |
|
|
|
Post by prcgorman2 on Dec 7, 2023 19:28:01 GMT -5
Yes. There are numerous annual and semi-annual conventions where the host needs guest speakers, especially for new products and services. Not all are restricted by the presentation legalities associated with presenting a new drug. A family member is the Executive Director of a sizeable medical association and one who is often looking for speakers with new information to present to the organization. I was thinking simple. My local school district has 8 nurses. Doing a lunch info session may be hard as thats probably prime time for them but a breakfast or dinner info session and maybe you would get 5 or 6. Who knows if the dinner was good with some nice wine and they can bring a friend you might get all eight. I would invite the administration and even board members. I think that's good too but I'm saying get in front of the state association for school nurses. Most states have one. Then if you want to get to districts, cherry-pick the largest and most influential. Doesn't have to be a singular focus. Work it in when you're not working doctors or clinics. |
|
|
|
Post by daisyz on Dec 7, 2023 21:58:33 GMT -5
As a long time type 1 and 7+/- years Afrezza user, I split 8s into 4 twos and it's part of my everyday insulin to keep on top on blood sugar level. The kids may be more active ( recess at school, etc).and find more hypos depending on circumstances. Aftezza is a better insulin, no doubt. It changed my life but Type 1 folks need to be committed and dialed in w their Dexcom to keep
BS proper. Younger kids will be an issue. Teens can could handle it. My opinion. Majority of youth aren't going to split their 8s into four
|
|
|
|
Post by daisyz on Dec 7, 2023 21:59:16 GMT -5
As a long time type 1 and 7+/- years Afrezza user, I split 8s into 4 twos and it's part of my everyday insulin to keep on top on blood sugar level. The kids may be more active ( recess at school, etc).and find more hypos depending on circumstances. Aftezza is a better insulin, no doubt. It changed my life but Type 1 folks need to be committed and dialed in w their Dexcom to keep BS proper. Younger kids will be an issue. Teens can could handle it. My opinion. Majority of youth aren't going to split their 8s into four ...into four 2s. Hope I'm wrong. |
|
|
|
Post by sportsrancho on Dec 8, 2023 2:16:43 GMT -5
Four’s shouldn’t be a problem unless they’re not consuming very much food at all and then they might not need any insulin.
Or if necessary, their parents can split the units up before hand.
Remember, it doesn’t expire.
|
|
|
|
Post by prcgorman2 on Dec 8, 2023 8:26:04 GMT -5
As a long time type 1 and 7+/- years Afrezza user, I split 8s into 4 twos and it's part of my everyday insulin to keep on top on blood sugar level. The kids may be more active ( recess at school, etc).and find more hypos depending on circumstances. Aftezza is a better insulin, no doubt. It changed my life but Type 1 folks need to be committed and dialed in w their Dexcom to keep BS proper. Younger kids will be an issue. Teens can could handle it. My opinion. Majority of youth aren't going to split their 8s into four ...into four 2s. Hope I'm wrong. Thank you very much for sharing your experiences and thoughts daisyz. Years ago there were remarks by MannKind management and here on the board discussing the value or importance of 2U (or what sayhey24 might call “extra small”) cartridges. Your comments remind me that one of the valuable things that may be learned from the on-going Pediatric trial is an answer to the question of, “how important and desirable are 2U cartridges?”. |
|
|
|
Post by prcgorman2 on Dec 8, 2023 8:37:21 GMT -5
I was thinking simple. My local school district has 8 nurses. Doing a lunch info session may be hard as thats probably prime time for them but a breakfast or dinner info session and maybe you would get 5 or 6. Who knows if the dinner was good with some nice wine and they can bring a friend you might get all eight. I would invite the administration and even board members. I think that's good too but I'm saying get in front of the state association for school nurses. Most states have one. Then if you want to get to districts, cherry-pick the largest and most influential. Doesn't have to be a singular focus. Work it in when you're not working doctors or clinics. One other comment on this idea of focusing on school-age children and their school nurse healthcare providers. Older investors in Apple will likely remember that Steve Jobs made it a focus of their marketing to put Apple computers in schools. It wasn’t just altruism. It was to capture mindshare and create lifelong Apple customers. Mike Castagna has also mentioned the importance of serving children for the same marketing reasons. I think that is probably true in both cases, but what will also please me is the thought of the relative safety and superiority (I assume) of Afrezza will provide greater emotional and physical health benefits than current treatments. |
|
|
|
Post by cretin11 on Dec 8, 2023 9:40:54 GMT -5
Gonna need a BP partner for that noble dream to come true.
|
|
|
|
Post by agedhippie on Dec 8, 2023 10:58:12 GMT -5
... Your comments remind me that one of the valuable things that may be learned from the on-going Pediatric trial is an answer to the question of, “how important and desirable are 2U cartridges?”. Oddly this is one of the places where the fact that unit for unit Afrezza is a lot weaker than RAA will work to it's advantage. You are not going to need 2u Afrezza cartridges because the 4u will approximate to that. For pediatrics that will be good. |
|
|
|
Post by prcgorman2 on Dec 8, 2023 12:05:41 GMT -5
Gonna need a BP partner for that noble dream to come true. There's more than 50 reps and only 50 states. You're dreaming if you think we'll need a major BP partner to be able to get in front of 50 state school nurse associations (and a handful of school districts in each state).
You do make me wonder, do school nurses have "emergency" insulin supplies, or do they 100% rely on whatever a child or their parent provided? Just wondering if a few cartridges and inhalers could be in a school nurse diabetes care safety kit.
|
|
|
|
Post by agedhippie on Dec 8, 2023 13:30:08 GMT -5
...
You do make me wonder, do school nurses have "emergency" insulin supplies, or do they 100% rely on whatever a child or their parent provided? Just wondering if a few cartridges and inhalers could be in a school nurse diabetes care safety kit.
In my (limited) experience the nurse will store whatever the patient gives them, but cannot substitute insulin or deviate from the pupil's treatment plan. They are there to administer the plan. This is the ADA advice, but who can administer insulin and if they can vary the dose varies wildly from state to state. Anyone can administer glucagon thankfully. diabetes.org/advocacy/safe-at-school-state-laws/tips-for-school-nurses |
|
|
|
Post by cretin11 on Dec 8, 2023 13:36:35 GMT -5
Gonna need a BP partner for that noble dream to come true. There's more than 50 reps and only 50 states. You're dreaming if you think we'll need a major BP partner to be able to get in front of 50 state school nurse associations (and a handful of school districts in each state). With all due respect, you’re dreaming if you expect MNKD to successfully pursue such a sales/marketing initiative going it alone. Your “let’s pitch the school nurses” idea is nice, but it would at best be a secondary strategy. We have yet to prove we can successfully execute a primary strategy, after six years it still hasn’t been accomplished. There’s nothing wrong with dreaming, but it doesn’t necessarily result in revenue. |
|
