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Post by sayhey24 on Jan 23, 2024 7:13:38 GMT -5
Where did you get this - "Viruses have been around as long as humans have- they just now started to cause diabetes?!" Of course not. You are the one which said T2 diabetes did not exist 50 years ago. Of course it did and I provided research from 20 years ago about Joslins work a long time ago about their virus work. Covid is just one virus and as we saw and continue to see the covid virus keeps mutating. Maybe Fauci's engineered virus presented something to our body's which we just did not have natural immunity and it was really good at attacking the pancreas. There was a reason Fauci was paid more than the President and our Generals and Admirals. The thing about Covid is the diabetes community could not hide the viral impact and all this Covid money flowed in to research it. Thats the last thing the diabetes community wanted. Those damn outsiders. Now you highlight my point - obesity is not the root cause of diabetes. If it were your 4.8 A1c patient would have diabetes along with the other 80% of obese. They don't. Why? Probably because of the reason Covid affected us all differently. We are individuals and our anti-bodies are different. Why is it with identical twins, they can look the same but one will have diabetes and the other one won't? What we do know is your obese patient needs more insulin than if they were 100 pounds less and from autopsy we know that 4.8 person has grown a lot of beta cells. A healthy body will adapt. A sick pancreas won't and why you need to take the load off the pancreas and give it a chance to heal. My maternal grandmother had no genetic relationship to my father from NYC. However my grandmother was from the "hot spot" area around Pottville PA - the home of Yuengling beer and where Geisinger has their diabetes center. Now do diabetics have trouble after they get diabetes to control weight. Yep. Companies like "levels" give out CGMs and through food do their best to control the post meal spike. I think I sent them this at one point. archive.org/stream/diabeticcookeryr00oppeiala#page/34/mode/2up Now, I know you think my basic science is off and yes maybe I listened too much to Al Mann but I do know that Covid did not come from an under-cooked batburger with a side of pangolin fries. However, if I believed what I was told for 3 years I would sure believe it. I am pretty sure I was told that was settled science. |
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Post by uvula on Jan 23, 2024 8:48:20 GMT -5
Good grief. First sayhey started badgering the aged one. Now sayhey is going after one of the few actual doctors on this forum. This is exhausting for me and must be worse for them.
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Post by hellodolly on Jan 23, 2024 9:17:35 GMT -5
Good grief. First sayhey started badgering the aged one. Now sayhey is going after one of the few actual doctors on this forum. This is exhausting for me and must be worse for them. I find it very fascinating and can't get enough. Differing points of view, some backed by research and more backed by personal experiences. As an investor not diagnosed with any level of diabetes, yet...I appreciate all of it. The issue with some people is they want to add their own tone and color to the comments, as they read the thread. |
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Post by uvula on Jan 23, 2024 9:28:57 GMT -5
Good grief. First sayhey started badgering the aged one. Now sayhey is going after one of the few actual doctors on this forum. This is exhausting for me and must be worse for them. I find it very fascinating and can't get enough. Differing points of view, some backed by research and more backed by personal experiences. As an investor not diagnosed with any level of diabetes, yet...I appreciate all of it. The issue with some people is they want to add their own tone and color to the comments, as they read the thread. I can appreciate your point of view. And I have to admit sayhey adds a lot more to this group than I do. |
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Post by sayhey24 on Jan 24, 2024 7:32:55 GMT -5
uvula - the solution is simple, just put me on ignore.
I will admit I am a pain in the ass. For me, things need to make sense. The medical experts tell me a virus with a very specific DNA sequence magically came from an under-cooked batburger and infected the world just never made any sense. Especially when the guy saying this is the highest paid government employee getting paid more than whats on the general schedule. How is that possible? Does that make sense?
When someone "a doctor" tells me the T2 SoC makes a lot of sense and the first step is to use metformin, yet the guy who 30 years ago who promoted and got metformin FDA approved now says its the biggest waste of time in diabetes care - yet its step 1 in the SoC - Does that make sense?
I don't know what Bill's SoC is but mine is simple - Step 1 put the PWD on a CGM for at least a week and get their AGP with a food profile and tell them to take a daily walk / After we know that some decisions can be made but in most T2 cases Step 2 is put them on afrezza. The thing is most can not afford afrezza which is the problem Bill faces today. Assuming they get afrezza Step 3 is monitor and adjust dosing. Step 4 - if weight is a real issue add the Ozempic but better yet the Saxenda DPI, if it existed.
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Post by agedhippie on Jan 24, 2024 11:58:53 GMT -5
... When someone "a doctor" tells me the T2 SoC makes a lot of sense and the first step is to use metformin, yet the guy who 30 years ago who promoted and got metformin FDA approved now says its the biggest waste of time in diabetes care - yet its step 1 in the SoC - Does that make sense? ... TBH I want to be treated by a doctor using data rather than a random anonymous individual on the internet using anecdote. But to each their own. DeFronzo's position is that you should use GLP-1 as the first line treatment, insulin doesn't get a look in. There are equally respected voices on the metformin side of the argument, especially as metformin is all some people will ever need. DeFronzo identifies eight disfunctions forming Type 2 diabetes (this is pretty well understood) and GLP-1 hits them where as metformin only handles the hepatic glucose disfunction so GLP-1 is more efficient at stopping progression. There is an paper where he argues the case here: diabetesjournals.org/care/article/40/8/1121/36799/Is-It-Time-to-Change-the-Type-2-Diabetes-TreatmentAnd the rebuttal here: diabetesjournals.org/care/article/40/8/1128/36824/Is-It-Time-to-Change-the-Type-2-Diabetes-Treatment(No, they aren't the same link, it just looks like it is!) These papers are worth reading because they explain part of the pathology of Type 2 so you can see why there is a drift away from insulin as a treatment for Type 2 diabetes - it's more complex than just glucose levels. As to the SoC; no trial data, no SoC change. The SoC is evidenced based and the grading of evidence is spelt out. |
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Post by sportsrancho on Jan 24, 2024 14:15:00 GMT -5
uvula - the solution is simple, just put me on ignore. I will admit I am a pain in the ass. For me, things need to make sense. The medical experts tell me a virus with a very specific DNA sequence magically came from an under-cooked batburger and infected the world just never made any sense. Especially when the guy saying this is the highest paid government employee getting paid more than whats on the general schedule. How is that possible? Does that make sense? When someone "a doctor" tells me the T2 SoC makes a lot of sense and the first step is to use metformin, yet the guy who 30 years ago who promoted and got metformin FDA approved now says its the biggest waste of time in diabetes care - yet its step 1 in the SoC - Does that make sense? I don't know what Bill's SoC is but mine is simple - Step 1 put the PWD on a CGM for at least a week and get their AGP with a food profile and tell them to take a daily walk / After we know that some decisions can be made but in most T2 cases Step 2 is put them on afrezza. The thing is most can not afford afrezza which is the problem Bill faces today. Assuming they get afrezza Step 3 is monitor and adjust dosing. Step 4 - if weight is a real issue add the Ozempic but better yet the Saxenda DPI, if it existed. Nobody would put you on ignore:-) This is 99% correct except we stand against Ozempic.. the weight loss drugs. And I’m sure you saw Bill‘s video on Metformin. fb.watch/pN7_rjuA3K/?mibextid=v7YzmG |
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Post by sayhey24 on Jan 24, 2024 15:17:53 GMT -5
uvula - the solution is simple, just put me on ignore. I will admit I am a pain in the ass. For me, things need to make sense. The medical experts tell me a virus with a very specific DNA sequence magically came from an under-cooked batburger and infected the world just never made any sense. Especially when the guy saying this is the highest paid government employee getting paid more than whats on the general schedule. How is that possible? Does that make sense? When someone "a doctor" tells me the T2 SoC makes a lot of sense and the first step is to use metformin, yet the guy who 30 years ago who promoted and got metformin FDA approved now says its the biggest waste of time in diabetes care - yet its step 1 in the SoC - Does that make sense? I don't know what Bill's SoC is but mine is simple - Step 1 put the PWD on a CGM for at least a week and get their AGP with a food profile and tell them to take a daily walk / After we know that some decisions can be made but in most T2 cases Step 2 is put them on afrezza. The thing is most can not afford afrezza which is the problem Bill faces today. Assuming they get afrezza Step 3 is monitor and adjust dosing. Step 4 - if weight is a real issue add the Ozempic but better yet the Saxenda DPI, if it existed. Nobody would put you on ignore:-) This is 99% correct except we stand against Ozempic.. the weight loss drugs. And I’m sure you saw Bill‘s video on Metformin. fb.watch/pN7_rjuA3K/?mibextid=v7YzmGI get the Ozempic/Mounjarno feeling. I feel the same but its such a huge market and these people are going to use it. Is it going to cause other issues - yep but they still are not going to stop. I would rather have them have a better alternative in a Saxenda DPI where its lower dose but may work as well or even better. What I do know is Pfizer was working on their daily pill and gave up on one and announced high discontinuation rates, greater than 50% last month for the other. Still - it should not be used as a diabetes medication when we have afrezza. www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-topline-phase-2b-results-oral-glp-1 |
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Post by sayhey24 on Jan 24, 2024 15:45:57 GMT -5
... When someone "a doctor" tells me the T2 SoC makes a lot of sense and the first step is to use metformin, yet the guy who 30 years ago who promoted and got metformin FDA approved now says its the biggest waste of time in diabetes care - yet its step 1 in the SoC - Does that make sense? ... TBH I want to be treated by a doctor using data rather than a random anonymous individual on the internet using anecdote. But to each their own. DeFronzo's position is that you should use GLP-1 as the first line treatment, insulin doesn't get a look in. There are equally respected voices on the metformin side of the argument, especially as metformin is all some people will ever need. DeFronzo identifies eight disfunctions forming Type 2 diabetes (this is pretty well understood) and GLP-1 hits them where as metformin only handles the hepatic glucose disfunction so GLP-1 is more efficient at stopping progression. There is an paper where he argues the case here: diabetesjournals.org/care/article/40/8/1121/36799/Is-It-Time-to-Change-the-Type-2-Diabetes-TreatmentAnd the rebuttal here: diabetesjournals.org/care/article/40/8/1128/36824/Is-It-Time-to-Change-the-Type-2-Diabetes-Treatment(No, they aren't the same link, it just looks like it is!) These papers are worth reading because they explain part of the pathology of Type 2 so you can see why there is a drift away from insulin as a treatment for Type 2 diabetes - it's more complex than just glucose levels. As to the SoC; no trial data, no SoC change. The SoC is evidenced based and the grading of evidence is spelt out. You should have been at the "discussion" between Al and Ralph. It was a beauty. If it was not a 1st round TKO, it was clearly 2nd round and it was not Al on the mat. Have I mentioned Al was not a doctor? BTW - I think I have read most of Ralph's stuff. I am sticking with Al. You know what they say about fool me once. This is not hard. The SoC's step 1 is metformin. The guy who did the trials and pushed for this now says metformin is the greatest waste of time. Square that circle for me. Why is metformin step 1 when we know its going to fail and Ralph has already told us its a waste of time? It freaking fails. In my experience you will get better night time hepatic control with a shot or 2 of Dickel. If you don't like George then Jack or Evan will do too. Right now we have a "Treat to Fail" SoC. After everything else fails and we know they will and the SoC plans for failure, we go to the gold standard - insulin. Now we have the gold standard - afrezza in addressing post prandial glucose which is the issue T2s have. How about we use the gold standard first and then we will not need the Rube Goldberg approach to T2 diabetes treatment. Hopefully Cipla will provide the data which "in theory" should change the SoC but I doubt it will. Getting changes to the SoC is more than trial data. If Mike stays to his plan my hope is we can at least get afrezza mentioned in step 2 but it will probably be in parentheses. In parentheses we may not get the insurance coverage. |
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Post by agedhippie on Jan 24, 2024 15:58:02 GMT -5
Nobody would put you on ignore:-) This is 99% correct except we stand against Ozempic.. the weight loss drugs. And I’m sure you saw Bill‘s video on Metformin. fb.watch/pN7_rjuA3K/?mibextid=v7YzmGBill is not wrong there. The problem is that while Type 2 is progressive (I agree with him on that) the speed of progression varies quite widely. If the progression is slow enough then metformin may be all they need. Equally you could blow though metformin and be on insulin (using the current SoC) in a couple of years. Personally I don't like GLP-1 and wouldn't take it (I actually have samples sitting in my fridge), but for some people it seems to be what they need. And with weight leading to increased insulin resistance the associated weight loss can put the person into remission. As with metformin, how long that lasts depends on how aggressive the progression is, but also how fast they regain the weight lost. As with all this I am in favor of going with the best option the patient thinks they can manage. Stevil mentioned a patient he got onto Afrezza who asked to be put on GLP-1 not because Afrezza was bad or he had side effects, but because he knew he wouldn't be able to manage the dosing schedule. I want diabetics to have options, including Afrezza. |
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Post by agedhippie on Jan 24, 2024 16:13:17 GMT -5
You should have been at the "discussion" between Al and Ralph. It was a beauty. If it was not a 1st round TKO, it was clearly 2nd round and it was not Al on the mat. Have I mentioned Al was not a doctor? BTW - I think I have read most of Ralph's stuff. I am sticking with Al. You know what they say about fool me once. ... Getting changes to the SoC is more than trial data. ... Given the choice between DeFronzo and Al I would go with DeFronzo in a heart beat. One is a respected and highly experienced endo and the other is an brilliant engineer. If I want a pump designed I am not going to DeFronzo, equally if I want to understand the intricacies of the endocrine system I am not going to Al Mann. To be clear on this; in approving metformin in 1994 the FDA was woefully behind as usual. Metformin had been in use in Europe and Canada for over 20 years at that point. DeFronzo may have been responsible for metformin in the US, but the work had been done in Europe literally decades earlier (it was approved in the UK in 1958.) The work done in the UK, specifically the huge UKDPS trial, forms the basis of the use of metformin by producing hard outcomes data. You are right in trial data alone not being sufficient, cost is also an important consideration because of the scale of the problem. |
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Post by sayhey24 on Jan 24, 2024 18:38:50 GMT -5
Nobody would put you on ignore:-) This is 99% correct except we stand against Ozempic.. the weight loss drugs. And I’m sure you saw Bill‘s video on Metformin. fb.watch/pN7_rjuA3K/?mibextid=v7YzmGBill is not wrong there. The problem is that while Type 2 is progressive (I agree with him on that) the speed of progression varies quite widely. If the progression is slow enough then metformin may be all they need. Equally you could blow though metformin and be on insulin (using the current SoC) in a couple of years. Personally I don't like GLP-1 and wouldn't take it (I actually have samples sitting in my fridge), but for some people it seems to be what they need. And with weight leading to increased insulin resistance the associated weight loss can put the person into remission. As with metformin, how long that lasts depends on how aggressive the progression is, but also how fast they regain the weight lost. As with all this I am in favor of going with the best option the patient thinks they can manage. Stevil mentioned a patient he got onto Afrezza who asked to be put on GLP-1 not because Afrezza was bad or he had side effects, but because he knew he wouldn't be able to manage the dosing schedule. I want diabetics to have options, including Afrezza. Wrong |
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Post by sayhey24 on Jan 24, 2024 18:45:29 GMT -5
You should have been at the "discussion" between Al and Ralph. It was a beauty. If it was not a 1st round TKO, it was clearly 2nd round and it was not Al on the mat. Have I mentioned Al was not a doctor? BTW - I think I have read most of Ralph's stuff. I am sticking with Al. You know what they say about fool me once. ... Getting changes to the SoC is more than trial data. ... Given the choice between DeFronzo and Al I would go with DeFronzo in a heart beat. One is a respected and highly experienced endo and the other is an brilliant engineer. If I want a pump designed I am not going to DeFronzo, equally if I want to understand the intricacies of the endocrine system I am not going to Al Mann. To be clear on this; in approving metformin in 1994 the FDA was woefully behind as usual. Metformin had been in use in Europe and Canada for over 20 years at that point. DeFronzo may have been responsible for metformin in the US, but the work had been done in Europe literally decades earlier (it was approved in the UK in 1958.) The work done in the UK, specifically the huge UKDPS trial, forms the basis of the use of metformin by producing hard outcomes data. You are right in trial data alone not being sufficient, cost is also an important consideration because of the scale of the problem. Wrong again but you keep going with Ralph and metformin and his GLP1 junk. Thats as good as believing Dr. Fauci "America's leading infectious disease expert" that covid came from an under-cooked batburger. |
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