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Post by suebeeee1 on Sept 19, 2015 16:21:51 GMT -5
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. Sound like some improvements in just the last few months!
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Post by compound26 on Sept 19, 2015 16:41:35 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. thekindaguyiyam, totally agree, it's a fine line to walk when treading on another's professional turf without alienating him. FWIW, you can go to my blog: afrezzajustbreathe.com to see if there is anything you feel you can bring to your doctor. It also has links to Afrezzauser.com, Afrezzadownunder.com and other helpful websites. So you can check out those sites as well. I think the article in the front page of blog ( Afrezza Review: Diabetics Confirm Its Advantages), this post Journal and Magazine Articles on Afrezza, this post Videos of Medical Professionals Discussing/Reviewing Afrezza, and this article Afrezza: Less Hypos may be helpful. There was an excellent presentation (in very appealing formating) regarding less hypos of Afrezza that was posted on ESAD website a few days ago. But the link does not work anymore. The following tweet captures a part of that presentation.
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Post by thekindaguyiyam on Sept 19, 2015 16:56:23 GMT -5
Compound. That's some serious and clear communication. Again, it has much to do with the source. Beautiful presentation that makes effective argument. If my doctor who has shaken hands with Dr. Bode and has articles and advertisements about Afrezza what does that say. What grabs a doctors attention and shakes him up a bit. I'll forward him this info too at my next appointment. It's hard to get an Endo outside of Kaiser where I live (best of luck to you in that system suebeeeee), so I don't want to alienate him. I'll provide information without being a zealot about it.. and hopefully he'll catch up with the times. Keep the great information out there, and thanks. this was the article in the doctors office (it's been posted before): www.webmd.com/diabetes/news/20140630/inhaled-insulin-afrezza
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Post by peppy on Sept 19, 2015 17:11:03 GMT -5
thekindaguyiyam, may I ask, does this endo or your physician have you on oral medications to lower your blood glucose?
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Post by thekindaguyiyam on Sept 19, 2015 17:19:59 GMT -5
thekindaguyiyam, may I ask, does this endo or your physician have you on oral medications to lower your blood glucose? Peppy. My previous Endo put me on Metformin. Which I took myself off of. Much of the illness I have had has been due to conflict in medications so I'm reluctant to take more than I need. Was diagnosed with blood cancer which gave the same irregular liver results as too much advil that I was taking for fibromyalgia. Now, I take alieve as rarely as possible. If and when I get to the point where I have to make a decision about taking meds for diabetes; if this doctor isn't on board, I'll find one who is. For now... I'm good. again.. the issue isn't about me. it's about educating the physicians and making them receptive. Hey Peppy!
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Post by robsacher on Sept 19, 2015 17:38:53 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. Could it be that the good doctor is over thinking the process? Or, maybe, he has not spent enough time thinking it through… It's not that complicated. Just ask Spiro. It seems that someone needs to tell the doctor that other doctors are not having the problem that he is having and that perhaps it would be helpful if he discussed the issue with someone who is prescribing Afrezza without the difficulty that he is having...
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Post by peppy on Sept 19, 2015 17:41:49 GMT -5
At the risk of posting too much here is why I ask. I was struck by your original post that you stated, Your endo said, " He said I wasn't a candidate because my norm is normal for me though it remains boarderline." Your endo knows his guidelines. screencast.com/t/JnCs3CQhfound here. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY – CLINICAL PRACTICE GUIDELINES FOR DEVELOPING A DIABETES MELLITUS COMPREHENSIVE CARE PLAN – 2015 www.aace.com/files/dm-guidelines-ccp.pdf
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Post by blindhog1 on Sept 19, 2015 18:03:25 GMT -5
OH MY, Spiro and blindhog1 and other users. I feel honored. And yes Spiro and I have had many interesting conversations over the past 7 weeks. We are on completely different schedules and have different needs. SOOOOOOOOOOO
First things first. Every person with Diabetes is different and their situation is different. Every ENDO has a learning curve with Afrezza but they ALL want their patients to achieve success. I've been talking to my ENDO for a couple of years about Adrezza so he knows I'm the kind of patient a Dr. can trust. When I went in for my semi-annual check he told me it was time. My ENDO also talks to other doctors about prescribing. Lucky Me. On that day my A1C was 7.4. He wrote the script that day for one month and it was 60 8 units and 30 4 units. My breathing test was scheduled for the next week. When that came back he cleared me to get the Rx. I was to drop my basal from 28 units at bedtime to 20 units and to take 8 units once a day at dinner. I had read the literature and knew that this was different but I was told we will adjust as needed. The next week I was scheduled for my monthly study visit so I brought in my logs. I'd had 2 lows during the night that first week of 42 and 37. We dropped the basal to 18. I had an A1C of 7.3. (I keep excellent notes on times and readings and I include carb counts. As much for me as for him.)
During the next 4 weeks my FBG was (about) 70-95 but my bedtime levels were hovering around 100-120. I was adding 10-15 carbs to make sure I didn't go to low in the night. My monthly study check was supposed to be by phone, but I went in and brought my logs. He dropped the basal to 14 Units. Remember that I'm still only taking 8 Units of Afrezza at only 1 meal. (I can email my log but I prefer giving my nurse her own copy for my file and she can call me with any changes if needed.) Now I'm in my 7th week. My numbers morning and evening are very good....but that meal time and 1 hour later are AMAZING, there is no spiking.
I'll go out on a limb here and say Afrezza isn't a one dose live or die drug. It takes a little time to get it right but when you've got it fine tuned it's makes all the difference in the world. I think Doctors need to know that.
Finally, we are all trusting our Dr. to take care of our health needs. If my Dr. or his/her staff doesn't realize that, it's my duty to find one that does. I told you I was LUCKY. Not really. I make good decisions. November is my 90 day A1C.
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Post by prosper on Sept 19, 2015 18:47:09 GMT -5
Thank you govt for not allowing insurance to cross state borders!
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Post by spiro on Sept 19, 2015 19:23:52 GMT -5
Blindhog, nice post. Any type 2 with an A1c of 6.9 or higher has an average BG over 151. It is such a no brainer to give that person 4 units of Afrezza at each meal, that it is frightening. The worst that could happen to them is that their A1c will only go down to 5.9 in three months, or an average BG of 123.
Spiro here
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Post by thekindaguyiyam on Sept 19, 2015 20:16:41 GMT -5
Rob. I do think he is over thinking the process. I also wonder when a person's ego is involved they are unlikely to ask questions when they don't understand the answer. I'm glad to hear you say that most doctors do understand.. that's what I'm invested in.
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Post by thekindaguyiyam on Sept 19, 2015 20:22:50 GMT -5
OH MY, Spiro and blindhog1 and other users. I feel honored. And yes Spiro and I have had many interesting conversations over the past 7 weeks. We are on completely different schedules and have different needs. SOOOOOOOOOOO
First things first. Every person with Diabetes is different and their situation is different. Every ENDO has a learning curve with Afrezza but they ALL want their patients to achieve success. I've been talking to my ENDO for a couple of years about Adrezza so he knows I'm the kind of patient a Dr. can trust. When I went in for my semi-annual check he told me it was time. My ENDO also talks to other doctors about prescribing. Lucky Me. On that day my A1C was 7.4. He wrote the script that day for one month and it was 60 8 units and 30 4 units. My breathing test was scheduled for the next week. When that came back he cleared me to get the Rx. I was to drop my basal from 28 units at bedtime to 20 units and to take 8 units once a day at dinner. I had read the literature and knew that this was different but I was told we will adjust as needed. The next week I was scheduled for my monthly study visit so I brought in my logs. I'd had 2 lows during the night that first week of 42 and 37. We dropped the basal to 18. I had an A1C of 7.3. (I keep excellent notes on times and readings and I include carb counts. As much for me as for him.)
During the next 4 weeks my FBG was (about) 70-95 but my bedtime levels were hovering around 100-120. I was adding 10-15 carbs to make sure I didn't go to low in the night. My monthly study check was supposed to be by phone, but I went in and brought my logs. He dropped the basal to 14 Units. Remember that I'm still only taking 8 Units of Afrezza at only 1 meal. (I can email my log but I prefer giving my nurse her own copy for my file and she can call me with any changes if needed.) Now I'm in my 7th week. My numbers morning and evening are very good....but that meal time and 1 hour later are AMAZING, there is no spiking.
I'll go out on a limb here and say Afrezza isn't a one dose live or die drug. It takes a little time to get it right but when you've got it fine tuned it's makes all the difference in the world. I think Doctors need to know that.
Finally, we are all trusting our Dr. to take care of our health needs. If my Dr. or his/her staff doesn't realize that, it's my duty to find one that does. I told you I was LUCKY. Not really. I make good decisions. November is my 90 day A1C. I'm glad you feel honored Blindhog1. I think many of us here on the board have greatly appreciated the posts from Afrezza users. Your efforts and communications are key to my confidence as an investor and make me more comfortable as a potential user. The learning curve is what it is, kind of like a new language; the more it's spoken the better it's understood. Thanks for your ongoing contributions. Like Spiro, you too are a character I enjoy reading.
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Post by ezrasfund on Sept 19, 2015 20:36:30 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. This is a very interesting thread discussing the problem of educating doctors about Afrezza. IMO the answer is Dr. Bode and word of mouth from Key Opinion Leaders among endocrinologists. When doctors begin sharing success stories their colleagues will begin to write prescriptions. Thankfully, those success stories do not seem to be in short supply.
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Post by robsacher on Sept 20, 2015 18:27:12 GMT -5
Rob. I do think he is over thinking the process. I also wonder when a person's ego is involved they are unlikely to ask questions when they don't understand the answer. I'm glad to hear you say that most doctors do understand.. that's what I'm invested in. I wrote that "other" doctors understand, not "most" doctors. That being written, here's a post from SA that all here may find encouraging and may put your doctor's point of view within some sort of balance: "I had a doctor email me this the other day about drugs, in this case Afrezza, on clinical trials he is NOT involved with big pharma. "Real user experiences are likely to be MORE informative than many studies!" He is a diabetes specialist for children, he is from world renown Florida University institute for diabetes." And, "I talked to a Young Doctor who is a diabetes specialist at the world renown Diabetes Institute of Florida. He feels very much the opposite of your YOUNG doctor. As a matter of fact he is looking forward to the pediatric trials (the university is one of the clinical testing sites for children) to see if will be good for children his one comment and I will cut and paste it here so as not to mis-quote "The main concerns are related to potential changes in lung function that were not felt to be clinically significant but were noted with the previous inhaled insulin that was sold by Pfizer (Exhubera). In addition, we need to figure out if the dosing packets for the Afrezza will be small enough to allow appropriate dosing for smaller kids". This doctor stated it [Afrezza] is a faster insulin then current insulin. So I am not sure how your doctors says there are better treatments. As a matter fact I will put the rest of his comments here "There are a growing number of adults who are using it successfully and they seem to be happy. The main advantage I see with it is that it is much more rapid acting than current “rapid” insulins and it is cleared from the body quickly as well. This allows for “tune up” doses and more aggressive corrections that should provide for better control with less “insulin stacking” and post insulin lows." So maybe your doctor should do more research."
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Post by peppy on Sept 20, 2015 19:15:41 GMT -5
Thank you all. Here is what I learned. Spiro said, "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.
Spiro you told me how physicians can use this in their type 2 patients.
======================================================================================================================
Blindhog said; I was to drop my basal from 28 units at bedtime to 20 units and to take 8 units once a day at dinner. I had read the literature and knew that this was different but I was told we will adjust as needed. The next week I was scheduled for my monthly study visit so I brought in my logs. I'd had 2 lows during the night that first week of 42 and 37. We dropped the basal to 18. I had an A1C of 7.3. (I keep excellent notes on times and readings and I include carb counts. As much for me as for him.)
During the next 4 weeks my FBG was (about) 70-95 but my bedtime levels were hovering around 100-120. I was adding 10-15 carbs to make sure I didn't go to low in the night. My monthly study check was supposed to be by phone, but I went in and brought my logs. He dropped the basal to 14 Units. Remember that I'm still only taking 8 Units of Afrezza at only 1 meal. (I can email my log but I prefer giving my nurse her own copy for my file and she can call me with any changes if needed.) Now I'm in my 7th week. My numbers morning and evening are very good....but that meal time and 1 hour later are AMAZING, there is no spiking.
Blindhog told me how his endo is using it, basal and fast acting. =========================================================================================================================
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