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Post by agedhippie on Mar 14, 2024 12:30:15 GMT -5
Following on from my last post...
I don't really like to say this because it sounds bad, but if you have gestational diabetes there is a strong chance that you will get Type 2 later in life so if you were treated earlier with Afrezza there would may be a strong preference for Afrezza if diabetes returned.
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Post by sayhey24 on Mar 14, 2024 18:11:20 GMT -5
From ST...... Did anyone catch Mike mention they will be seeking approval for Gestational Diabetes and HOSPITAL CARE??? Once PEDS is approved I’m sure they will be going for a MAJOR LABEL CHANGE. Can you imagine a diabetic going to the ER with a 800 BG and staying there for 2 hours instead of 12 hours??? How much of a SAVINGS is that?? Gestational diabetes would be an interesting as while by no means all women with gestational diabetes are put on insulin those that are currently put on RAA would be strong candidates for Afrezza instead. It would require trials but there is an additional benefit in doing a proper trials which is T1 pregnancies. Doctors want very tight control while you are pregnant and that is a lot of work. I could see a definite role for Afrezza there if it was approved. The ER example wouldn't work for a few reasons. The likelihood if you are in the 800s without DKA and are in ER it's because you cannot afford insulin and almost certainly don't have insurance. This happens more commonly than you would think with a cycle of about a month or so. The biggest problem though is that if you dropped someone from 800 to 100 in the space of a couple of hours there is a strong chance you will kill them with hypokalemia. High insulin doses suck potassium out of the blood so you have to drop that sort of level relatively slowly to void cardiac issues. If they are 800 with DKA then getting their level down is literally the last thing you do. High levels will not kill you, but the electrolyte imbalance caused by DKA will and fast. That means an IV is required and used for everything including insulin. DKA is fatal in about 1:300 cases in the west, couple that with virtually all kids being diagnosed with Type 1 because they are in DKA... In the list of things that scare T1 diabetics DKA is usually top. Everyone I knew who has died from diabetes died because of DKA, never hypos. I 100% agree. There would be a good chance of killing the patient. However, it would be really nice to send them home with a CGM and afrezza and icodec. Next month should be approval. |
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Post by agedhippie on Mar 14, 2024 20:31:34 GMT -5
Gestational diabetes would be an interesting as while by no means all women with gestational diabetes are put on insulin those that are currently put on RAA would be strong candidates for Afrezza instead. It would require trials but there is an additional benefit in doing a proper trials which is T1 pregnancies. Doctors want very tight control while you are pregnant and that is a lot of work. I could see a definite role for Afrezza there if it was approved. The ER example wouldn't work for a few reasons. The likelihood if you are in the 800s without DKA and are in ER it's because you cannot afford insulin and almost certainly don't have insurance. This happens more commonly than you would think with a cycle of about a month or so. The biggest problem though is that if you dropped someone from 800 to 100 in the space of a couple of hours there is a strong chance you will kill them with hypokalemia. High insulin doses suck potassium out of the blood so you have to drop that sort of level relatively slowly to void cardiac issues. If they are 800 with DKA then getting their level down is literally the last thing you do. High levels will not kill you, but the electrolyte imbalance caused by DKA will and fast. That means an IV is required and used for everything including insulin. DKA is fatal in about 1:300 cases in the west, couple that with virtually all kids being diagnosed with Type 1 because they are in DKA... In the list of things that scare T1 diabetics DKA is usually top. Everyone I knew who has died from diabetes died because of DKA, never hypos. I 100% agree. There would be a good chance of killing the patient. However, it would be really nice to send them home with a CGM and afrezza and icodec. Next month should be approval. I am not sure which part you agreeing with but the "next month" part leads me to think it's kids in DKA. The problem is not insulin killing the child (that is all IV delivered so ultra fast acting and clearing), but the electrolyte imbalance and dehydration caused by their blood turning acidic. The first thing they do is give the patient fluids and electrolytes for at least an hour. If you don't do that they absolutely will die. After that they will start to introduce insulin via the IV *slowly*. If the level drops fast the patient will lose all the electrolytes you have carefully been replacing and be critical again. The insulin stops the ketoacidosis and now you just leave the patient on an IV mix of saline, glucose, and insulin and observe. |
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