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Post by thekindaguyiyam on Sept 19, 2015 12:45:34 GMT -5
I went to the Endo yesterday. He's a top notch physician who is sought out. His persona is that of a scientist and he addressed the subject of Afrezza with me during my appointment. I'd like to share a few things that he discussed while I had WebMD Fall issue opened to the Afrezza Ad. I'm still @ 6.3 and have been around this A1C # for the last 3 years. So here's how it went. I'm in N. california with a Blue Shield PPO plan btw. I mentioned that Afrezza lowers the A1C and that I could possibly lower the # by taking it. He said I wasn't a candidate because my norm is normal for me though it remains boarderline.
Then he got a bit irritated and told me what he perceived the problem to be with Afrezza. The primary issue being the time it takes to prescribe. He said for the company to be successful in delivering the product, MNKD has to fix the prescription process because most Endo's don't know how to prescribe.
He stated when prescribing an injectable it takes 5 seconds to write a script. Then he talked about the 4, 8 & 12 unit cartridges that had to be configured for each patient and find one of the 6 groupings of meds (combinations of cartridges) offered by Sonofi. This man is a scientist and at this point he is pulling his hair out telling me that it takes 10 steps to figure out what the prescription should be and to select the one of 6 package choices offered by Sonofi. In addition he said that the only samples given to him by his Rep that he sees often are 4's which limits his capacity to who he gives samps to. He's addressed this issue specifically to pass it up the chain to be addressed. At this point I mentioned that Sonofi entered a partnership with Google for apps designed for diabetes and possibly, if one of these apps applies to conversion for Doctors and Patients it will make it a lot easier. It was illuminating to hear him tell me about this being the challenge as I haven't read about this issue, though it may have been discussed, on this board.
I'd appreciate hearing from you patients who are using Afrezza as to how your doctors discussed the ease or difficulty in prescribing for you and any comments they may have had regarding the lengthly process in just writing a script. Thanks!
My finger is in a splint and it makes typing far more difficult; but at least I luckily remain pre-diabetic. It looks like there are many factors involved not immediately apparent that have gotten in the way of delivery of Afrezza to new patients. And according to the Doc... the learning curve for him has been challenging, though he didn't say that specifically. He has only given out a couple of scripts and a few samples. A couple of his patients returned to using the needle because of their difficulty in adapting to how many breaths it takes to get the right amount of meds. When he showed me the comparison by Mannkind the delivery of Insulin compared to Novo he described the better advantage of the injectable. My reply was that Afrezza is ultra rapid and out of the system quicker mimicking delivery of the pancreas eliminating chances of hypoglycemia. He told me when I left, that the company should know by now that the learning curve is something that is getting in the way of it reaching it's target. And clearly... this very intelligent man was more irritated than enthralled by the potential of this new medication.
Lastly... when he was getting uptight about the difficulty of script writing, I asked if he knew of a Doctor Bode. He said that he was once introduced to him. I mentioned that Dr. Bode was in charge of the Afrezza study and one of the biggest proponents of Afrezza and the Physician of Sam Flinta. His eyes got wider and my appointment ended.
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Post by spiro on Sept 19, 2015 14:10:12 GMT -5
thekindaguyiyam,
It's really tough for me to answer all the concerns and comments made by your Endo. I was just an early stage type 2 diabetic with an A1c of 7.1. My doctor and I decided to start treatment with drugs. Afrezza was my choice because of liver and cardiac issues. She agreed to let me try Afrezza. She initially prescribed 4 units at meals for the 1st three months and then added correction doses of 4 units should I eat a big snack ( Cruise ). My A1c dropped to 6.2 after 3 month's. I just had my 6 month blood work taken yesterday. IMO, some doctor's might be overthinking the dosing, particularly for type 2's. I talk with Blindhog quite often, he is going to have an amazing story to share with the board one day. As for the insurance issues, it's a new drug and hopefully Sanofi and MNKD will have this problem resolved soon.
John here, Spiro's watching football on TV
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Post by Deleted on Sept 19, 2015 14:20:14 GMT -5
This post is in regards to a lazy endo not making time for his patients. If he can not spend a few additional minutes to explain dosing, it is best to change endos.
BTW, it is Sanofi, not Sonofi.
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Post by mssciguy on Sept 19, 2015 14:41:53 GMT -5
This post is in regards to a lazy endo not making time for his patients. If he can not spend a few additional minutes to explain dosing, it is best to change endos. BTW, it is Sanofi, not Sonofi. That's true, but I have taken tests before involving very simple math (like how much change do you get if you buy certain items at a certain and are give a certain number of coins back, where you have to figure out which coins they are)--- very simple iq test questions, where nobody else among candidates was able to figure it out, yet they all had degrees in science. And I am nothing special, all of my childhood classmates could have done the same. I think that for sure, we are living in the Age of Distraction, where our lives are dominated by alerts from cell phones or PCs, assistants, coworkers, bosses, patients, whatever. Anything that takes more than a minute gets bumped. This includes when I go for a check up at my own doctor. I wait 45 minutes, then he and his assistant arrive, do their things, fill out the billing codes into computer, and it's all done in just a couple of minutes. In contrast, just 10-15 years ago, doctors would ask some lifestyle questions, make a compliment (or suggestion), and joke "looks like you'll make it another year" and have a laugh themselves. Time management has it's dark sides |
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Post by thekindaguyiyam on Sept 19, 2015 14:57:52 GMT -5
thekindaguyiyam, It's really tough for me to answer all the concerns and comments made by your Endo. I was just an early stage type 2 diabetic with an A1c of 7.1. My doctor and I decided to start treatment with drugs. Afrezza was my choice because of liver and cardiac issues. She agreed to let me try Afrezza. She initially prescribed 4 units at meals for the 1st three months and then added correction doses of 4 units should I eat a big snack ( Cruise ). My A1c dropped to 6.2 after 3 month's. I just had my 6 month blood work taken yesterday. IMO, some doctor's might be overthinking the dosing, particularly for type 2's. I talk with Blindhog quite often, he is going to have an amazing story to share with the board one day. As for the insurance issues, it's a new drug and hopefully Sanofi and MNKD will have this problem resolved soon. John here, Spiro's watching football on TV I guess Spiro is the lucky one. Thanks for providing your story. Sounds like the 4 unit cartridges are your norm. I wonder what percentage of the population this would work fine for. I'm in a similar situation with cardio hypothyroidism, etc. I crossed over to 6.5 and I'm wanting to be on this drug rather than take metformin which is a liver eater. I addressed these issues with the doc and he confirmed my choice regarding the consequences of taking it. So. I'm good. Still boarderline and losing weight. The question is about the process your doctor went through. Was there any talk as to your configuration... if your 4's it's probably easier. I didn't confront the guy as I know he's helping me and wants to. His willingness to open up and tell me what was bugging him about the process (the amount of time it takes someone to find the matching package challenging) getting in the way of marketing. This was news to me and something I think MNKD is aware of. My speculation is that this is where google comes in to make it easier to decipher and shorten time required to prescribe. I got from the appointment that he respected Dr. Bode. That he has issued prescriptions and he has given out 4 unit cartridges. His intent about the time it takes was letting down his walls with a patient and being honest about his experience. Meanwhile out in his waiting room is the issue of WebMD with Dr. Bode on Afrezza. I think & hope S anofi may be addressing this issue for busy doctors who are flustered and resent the 5 minutes vs 5 seconds to run a script. And yeah; in the long run I think it's short sighted to recognize that 5 minutes could make a significant difference in that persons lifetime. I have a picture of myself in the office with the WebMD advertisement. I can't wait for that inenivatable lable change and a new found attitude by doctors who slowly approach prescribing. I walked away with: 1) change is slow 2) scripting is more difficult 3) you have to have conviction in the product to prescribe. That would come with education and time. Hey John. Tell Spiro to increase your salary for being so attentive when you'd probably rather be at the game with him. GB |
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Post by thekindaguyiyam on Sept 19, 2015 15:03:41 GMT -5
This post is in regards to a lazy endo not making time for his patients. If he can not spend a few additional minutes to explain dosing, it is best to change endos. BTW, it is Sanofi, not Sonofi. Thanks for the correction regarding Sanofi. No argument about your complaint of his laziness. I'm not there to argue with him. What he revealed may be representative of many doctors short on time. It's just an issue to address.. which I think is being addressed. Do you concur that the Sanofi Google deal may make diagnosis and prescription order easier? We are going from analog to digital. The application of Technospere could be one of the biggest contributions to medical advancement. Best to you |
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Post by Deleted on Sept 19, 2015 15:04:58 GMT -5
As a tutor in math and physics mainly to pre-med students as an undergraduate, my experience leads me to believe most doctors are poor mathematicians. Asking them to solve basic algebra was challenging, you can imagine the difficulties with physics.
The sad fact is they are making far more than I could as an engineer!
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Post by thekindaguyiyam on Sept 19, 2015 15:14:53 GMT -5
As a tutor in math and physics mainly to pre-med students as an undergraduate, my experience leads me to believe most doctors are poor mathematicians. Asking them to solve basic algebra was challenging, you can imagine the difficulties with physics. The sad fact is they are making far more than I could as an engineer! My son is studying math and physics to become an engineer in san jose. So; math for dummies. make it easier. "if you build it they will come" the difficulty with physics? That would be a personal thing regarding fact. That's funny. I guess some things just require an orthodoxy of belief in the face of FUD. Sanofi has begun to market and has got to have surveys going out to prescribing physicians asking them where the hurdles are. I don't think they would market blindly. I have every confidence that the side show will disappear as the facts reveal themselves along with maybe stronger education from the Sanofi Reps. |
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Post by compound26 on Sept 19, 2015 15:23:55 GMT -5
thekindaguyiyam, It's really tough for me to answer all the concerns and comments made by your Endo. I was just an early stage type 2 diabetic with an A1c of 7.1. My doctor and I decided to start treatment with drugs. Afrezza was my choice because of liver and cardiac issues. She agreed to let me try Afrezza. She initially prescribed 4 units at meals for the 1st three months and then added correction doses of 4 units should I eat a big snack ( Cruise ). My A1c dropped to 6.2 after 3 month's. I just had my 6 month blood work taken yesterday. IMO, some doctor's might be overthinking the dosing, particularly for type 2's. I talk with Blindhog quite often, he is going to have an amazing story to share with the board one day. As for the insurance issues, it's a new drug and hopefully Sanofi and MNKD will have this problem resolved soon. John here, Spiro's watching football on TV I guess Spiro is the lucky one. Thanks for providing your story. Sounds like the 4 unit cartridges are your norm. I wonder what percentage of the population this would work fine for. I'm in a similar situation with cardio hypothyroidism, etc. I crossed over to 6.5 and I'm wanting to be on this drug rather than take metformin which is a liver eater. I addressed these issues with the doc and he confirmed my choice regarding the consequences of taking it. So. I'm good. Still boarderline and losing weight. The question is about the process your doctor went through. Was there any talk as to your configuration... if your 4's it's probably easier. I didn't confront the guy as I know he's helping me and wants to. His willingness to open up and tell me what was bugging him about the process (the amount of time it takes someone to find the matching package challenging) getting in the way of marketing. This was news to me and something I think MNKD is aware of. My speculation is that this is where google comes in to make it easier to decipher and shorten time required to prescribe. I got from the appointment that he respected Dr. Bode. That he has issued prescriptions and he has given out 4 unit cartridges. His intent about the time it takes was letting down his walls with a patient and being honest about his experience. Meanwhile out in his waiting room is the issue of WebMD with Dr. Bode on Afrezza. I think & hope S anofi may be addressing this issue for busy doctors who are flustered and resent the 5 minutes vs 5 seconds to run a script. And yeah; in the long run I think it's short sighted to recognize that 5 minutes could make a significant difference in that persons lifetime. I have a picture of myself in the office with the WebMD advertisement. I can't wait for that inenivatable lable change and a new found attitude by doctors who slowly approach prescribing. I walked away with: 1) change is slow 2) scripting is more difficult 3) you have to have conviction in the product to prescribe. That would come with education and time. Hey John. Tell Spiro to increase your salary for being so attentive when you'd probably rather be at the game with him. GB thekindaguyiyam, would the samples solves the dosage issue? I mean if the doctor gives you one or two boxes of 4Us, you can test it by yourself. You start with one 4U and watch your BG after the meal. If your BG is rising, you take another 4U. So you test your BG more frequently in the first few days until you find out how your body respond to Afrezza. I think Brian in this board has written about his experience when he first started on Afrezza. Then you can tell your doctor how many units of Afrezza you will need daily. I read it somewhere some doctors say that the doctor just needs to prescribe how many units of Afrezza a patient needs, the pharmacist will configure how how many 4Us, 8Us or 12Us to be included in the prescription. In that sense, I agree that your doctor is kindly over thinking on this. If you can take the initiative to test out your needed dosage, maybe it will help your doctor in prescribing Afrezza to you. |
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Post by thekindaguyiyam on Sept 19, 2015 15:35:48 GMT -5
Compound. That's what I'd like to do if I cross over the line. I don't want to take meds if I don't need them. What I've heard from some is that Afrezza has the potential of turning the disease around. The facts regarding that will eventually prove it or not. I'm a patient with patience. This will unfold.. I look forward to the teaser presented to us by Spiro. Interesting story.
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Post by spiro on Sept 19, 2015 15:42:32 GMT -5
Compound has got it right. My doctor told me to start with 4 units after every meal, then test my BG at 1, 2 and 3 hours after meals. After 3 days, she wanted to see my BG logs. They were great and I have been at 4 units since day one. It is important to have correction doses for huge carb meals and/or huge snacks.
John still here, Spiro is making a lot of noise watching the Cane game.
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Post by compound26 on Sept 19, 2015 15:49:37 GMT -5
thekindaguyiyam, below is the post I was referring to: Afrezza Process Takes Time!!!
Below are just a few posts in that thread. You can see that Brian was experimenting with Afrezza and taking time to find out the ideal dosage and timing of Afrezza for him. Afrezza Process Takes Time!!! Post by nccapitalist on May 27, 2015 at 6:55am Yes, I am asking the endocrinologist for one script. I requested a 60-4U and 30-8U combo pack. My idea is to cover a high carb breakfast of All Bran, nuts, seeds, fruit, whole milk and coffee with milk. That averages about 90 carbs. I may change up on the breakfast soon, as the carbs are awfully high though the nutrition value is great. The sample boxes are all 4U. I took one oral pill and called the doctor about getting on Afrezza. The side effects were too intimidating for my liking. Afrezza is the only medicine I have been on for diabetes and this is about day 10 or so. Post by nccapitalist on May 28, 2015 at 8:07am I'm on Afrezza Day 15 and I wanted to share some interesting data. Keeping a log book for your endocrinologist opened my eyes after initially thinking the data was an anomaly. I am a type II diabetic with a previous A1C of 7.6 (171 BG). Date 2 hr BG Carbs 5/19 86 100 5/20 98 50 5/21 95 25 5/22 111 40 5/23 107 30 5/24 100 60 5/26 121 40 5/27 118 121 First 5 days on Afrezza Date 2 hr BG Carbs 5/14 156 ? (didn't make note, must have been distracted by Stanley Cup playoffs) 5/15 164 40 5/16 123 30 5/17 169 80 5/18 134 100 All doses were ONLY one 4U cartridge no matter how many carbohydrates were consumed. They were all post dinner readings. For me personally, the data shows that Afrezza kicked in on Day 6. Brian also documented his testing out of Afrezza in his tweets. Here are just a few of his tweets. You can check it out: It appears it will take some time to dial in Afrezza. So please be patient. |
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Post by suebeeee1 on Sept 19, 2015 16:01:28 GMT -5
This post is in regards to a lazy endo not making time for his patients. If he can not spend a few additional minutes to explain dosing, it is best to change endos. BTW, it is Sanofi, not Sonofi. Definitely a lazy endo. We have Kaiser Permanente which will not even pay anything for the script. My husband A1c was 7.6 or 7.7 before starting Afrezza nearly two months ago. Mind you, we started requesting a script for this in March. He has had type 2 diabetes for 8 years now kept in control with a ton of oral meds, diet and exercise 6'5, 205#) many of which made him physically ill. KP told us they don't make endo referrals for people with an A1C under 10 and the gp wouldn't make the referral. We got another kp GP . She made a referral to a pulmonologist, who insisted that my husband didn't really have asthma, took him off his asthma inhaler and them told us how, as a diabetic herself, she would NEVER take Afrezza as insulin (including Afrezza) causes serous hypos and weight gain. I presented the evidence and she told us she would fight it. So I mailed her a whole package of information. Ok, back to the new gp with the clean breathing test. We convinced her to prescribe even though kp didn't pay a cent for it. My husband's am fasting bg had been in the area of 160-180 daily. It is now 110-118, much tighter range. We needed to use the coach program to get all the details correct and now he isn't using as much as he did when he started and is now off his 2000 mg/ day of metformin and onglyza. The coach program makes it easy for even ignorant docs. We will update in about 4 weeks when his next A1C is done. I'd suggest a new doc, but then again, it sounds like you may have a little bit of time. Good luck! |
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Post by thekindaguyiyam on Sept 19, 2015 16:03:30 GMT -5
Compound26
Great post. Now, how do you get Doctors who only read medical journals as this Doctor revealed; as he disregards most anything else. Maybe I'll print this out and just hand him your post on the next visit. It's a fine line to walk when treading on another's professional turf without alienating him. He's a sharp guy; he'll get it eventually. I wouldn't be surprised if he googled Bode and Afrezza only to find the article in his office.
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Post by compound26 on Sept 19, 2015 16:13:19 GMT -5
I guess Spiro is the lucky one. Thanks for providing your story. Sounds like the 4 unit cartridges are your norm. I wonder what percentage of the population this would work fine for. I'm in a similar situation with cardio hypothyroidism, etc. I crossed over to 6.5 and I'm wanting to be on this drug rather than take metformin which is a liver eater. I addressed these issues with the doc and he confirmed my choice regarding the consequences of taking it. So. I'm good. Still boarderline and losing weight. The question is about the process your doctor went through. Was there any talk as to your configuration... if your 4's it's probably easier. I didn't confront the guy as I know he's helping me and wants to. His willingness to open up and tell me what was bugging him about the process (the amount of time it takes someone to find the matching package challenging) getting in the way of marketing. This was news to me and something I think MNKD is aware of. My speculation is that this is where google comes in to make it easier to decipher and shorten time required to prescribe. I got from the appointment that he respected Dr. Bode. That he has issued prescriptions and he has given out 4 unit cartridges. His intent about the time it takes was letting down his walls with a patient and being honest about his experience. Meanwhile out in his waiting room is the issue of WebMD with Dr. Bode on Afrezza. I think & hope S anofi may be addressing this issue for busy doctors who are flustered and resent the 5 minutes vs 5 seconds to run a script. And yeah; in the long run I think it's short sighted to recognize that 5 minutes could make a significant difference in that persons lifetime. I have a picture of myself in the office with the WebMD advertisement. I can't wait for that inenivatable lable change and a new found attitude by doctors who slowly approach prescribing. I walked away with: 1) change is slow 2) scripting is more difficult 3) you have to have conviction in the product to prescribe. That would come with education and time. Hey John. Tell Spiro to increase your salary for being so attentive when you'd probably rather be at the game with him. GB thekindaguyiyam, would the samples solves the dosage issue? I mean if the doctor gives you one or two boxes of 4Us, you can test it by yourself. You start with one 4U and watch your BG after the meal. If your BG is rising, you take another 4U. So you test your BG more frequently in the first few days until you find out how your body respond to Afrezza. I think Brian in this board has written about his experience when he first started on Afrezza. Then you can tell your doctor how many units of Afrezza you will need daily. I read it somewhere some doctors say that the doctor just needs to prescribe how many units of Afrezza a patient needs, the pharmacist will configure how how many 4Us, 8Us or 12Us to be included in the prescription. In that sense, I agree that your doctor is kindly over thinking on this. If you can take the initiative to test out your needed dosage, maybe it will help your doctor in prescribing Afrezza to you. thekindaguyiyam, here is the post I was referring to above on prescription: The post was by someone with the ID "doctor.stockpicker", supposedly, he is a physician in Oklahoma who has been treating diabetics for 26 years. Feb 11, 2015: The Sanofi rep made it to my office today. Some highlights. 1. The coupons allow the patient to obtain the first month of Afrezza free of charge and then $30/month for a year if they have insurance. Surprisingly, it is already on all of the major insurance companies in my area. Of course, Part D plans have not yet included it on their formulary. They are always nortoriously slow in adopting new medications. The other surprise is that there is no limit in the amount of insulin supplied in a month. He told me to write the script as how I want to prescribe each dose and just dispense a 30 day supply. They pharmacist will the dispense the correct number of the 4 unit and 8 unit cartridges to last the month. |
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