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Post by Deleted on Oct 26, 2015 10:01:19 GMT -5
Makes excellent sense MB - and I genuinely hope millions of T2's are using Afrezza without measurement five yours hence - but there can be only one reason we are not seeing more T2's chiming in - they just aren't using Afrezza (yet) - in spite of SNY's purported business model to slow launch Afrezza to T2's that are needle phobic or insulin naive. So I am trying to examine why it isn't happening for T2's - and speculate a little as to whether it ever will. In fact, I don't think T2's as a rule are a proactive patient with their disease. Under the current patient doctor protocol, I think most T2's once diagnosed just do as they are told - if that. Playing golf recently with two high school friends - mid 60's, type 2's and both on the needle - I asked if they ever heard of Afrezza or inhaled insulin (no), and what brand of insulin they were using (didn't know), and how they track their diabetes (fbg at doctor check-up time). Conversations like these temper my ardor as a long, and patients like these are just not going to make a leap of faith to using Afrezza. They will have to be instructed to do it. For me, this raises a serious question as to whether marketing to insulin naive T2's is the right way to establish Afrezza as the go to prandial of choice. Maybe SNY is doing some kind of 'rope-a-dope' until the ducks of insurance and doc education and label improvement are aligned - and then they will go where the insulin is being used because it has to be - T1's - and where the data re control of blood sugar will be monitored and archived and ultimately used to promote the use of he drug as best in class. Then it can migrate to T2's who may indeed not need to be as careful because they are not so relentlessly tied to managing the data and the disease. Your comment " I think most T2's once diagnosed just do as they are told - if that." hits the nail on the head. Lack of patient compliance. Now if you have a product that is easy to use like Afrezza, controls BG levels i.e.- lowers them significantly and reduces the volatility and is so consistent, that the need to test BG levels is significantly reduced, patient health improves, and the time & effort required by the patient to achieve superior control is vastly reduced. In a healthcare environment that is transitioning to payment for outcomes vs fee for service, Afrezza makes for a very enticing value proposition to practitioners, insurance companies and of course, patients.
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Post by savzak on Oct 26, 2015 10:08:13 GMT -5
Makes excellent sense MB - and I genuinely hope millions of T2's are using Afrezza without measurement five yours hence - but there can be only one reason we are not seeing more T2's chiming in - they just aren't using Afrezza (yet) - in spite of SNY's purported business model to slow launch Afrezza to T2's that are needle phobic or insulin naive. So I am trying to examine why it isn't happening for T2's - and speculate a little as to whether it ever will. In fact, I don't think T2's as a rule are a proactive patient with their disease. Under the current patient doctor protocol, I think most T2's once diagnosed just do as they are told - if that. Playing golf recently with two high school friends - mid 60's, type 2's and both on the needle - I asked if they ever heard of Afrezza or inhaled insulin (no), and what brand of insulin they were using (didn't know), and how they track their diabetes (fbg at doctor check-up time). Conversations like these temper my ardor as a long, and patients like these are just not going to make a leap of faith to using Afrezza. They will have to be instructed to do it. For me, this raises a serious question as to whether marketing to insulin naive T2's is the right way to establish Afrezza as the go to prandial of choice. Maybe SNY is doing some kind of 'rope-a-dope' until the ducks of insurance and doc education and label improvement are aligned - and then they will go where the insulin is being used because it has to be - T1's - and where the data re control of blood sugar will be monitored and archived and ultimately used to promote the use of he drug as best in class. Then it can migrate to T2's who may indeed not need to be as careful because they are not so relentlessly tied to managing the data and the disease. Assuming the payment/coverage bugs are ultimately worked out, I have a very difficult time identifying a credible scenario where huge numbers of T2's aren't ultimately using Afrezza. The near miraculous results being achieved by the few that are on it, such as Spiro and suebee's husband, can't be contained. Treating docs simply can't ignore those results once they see them first hand in one of their patients. Even without superiority studies, results like these speak for themselves. Afrezza is a wildfire waiting to happen. The key for me as a mnkd investor is that it happen while mnkd is solvent. To me, it's all about the timing of working out the payment issues vis a vis the condition of mnkd's balance sheet.
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6.1
Oct 26, 2015 11:05:28 GMT -5
Post by turk74 on Oct 26, 2015 11:05:28 GMT -5
Exactly Sav - while we are still young! So - underneath the veneer of global roll out is this sticky 'little' problem for (very experienced and savvy) SNY of how to get Afrezza to be taken up by diabetics in the US market. All the while, very experienced and savvy SNY is wending its way with other offerings to diabetics including touting to type 2's (i)its RAA Apidra, (ii) Toujeo (yes to type 2's because it is a 24 hour insulin and its testing shows it reduces night time hypos), and now (iii) Lixilan - while shoving Afrezza into the corner as the answer for insulin naive and needle phobic. There are evidently a lot of them but it is not clear when they are going to get on the radar! This creates a very BIG problem for MNKD because it has to fight for its corporate life with no genuine income from Afrezza.
Marketing partner SNY has to 'establish' Afrezza - not just 'make it available'. I am genuinely concerned that waiting for US based T2's to discover Afrezza is a failed strategy - if the objective is to establish Afrezza as the go to prandial insulin of choice. A much better strategy is to go to the user base that actively manages their disease and uses insulin at mealtime and measures the effect - that appears to me to be the T-1 patient group.
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6.1
Oct 26, 2015 18:27:58 GMT -5
Post by dreamboatcruise on Oct 26, 2015 18:27:58 GMT -5
My husband's first 90 day Afrezza blood test is in. Unlike many of our conscientious "testers", he is not so vigilant about ever testing his blood sugar. Here are the facts. Type 2 diabetic for 7 years Previously "maintained" at 7.9 and climbing, despite excellent diet, skinny, mega dose of Metformin and onglyza Begged Dr for Afrezza from Feb to July Went for pulmonary tests Other clearances Kaiser doesn't cover this, so we have to pay more than $400 monthly (after coupon) Started Afrezza three months ago He had some trouble adjusting in the beginning and used the "Coach" program After about a week, he started inhaling 10-15 minutes after starting meal (or snack) About a week after that, he stopped checking his bg starting it had regularly been under 150 with no hypos No bg tests between then and now. (I know, not the best role model) A1C results from Thursday's blood test showed 6.1 I'd like it under 6, but right now, I'm ecstatic! Is it always the same dose? Is that 4u?
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Post by suebeeee1 on Oct 27, 2015 0:35:16 GMT -5
4u for breakfast, 8 for dinner and lunch, 4 for his night time snack. This is the dosing that seemed to work out for him after the first week, after contacting the coach program. He had some trouble trying to bring down his after meal numbers in the first few days, when he was inhaling before the meals. And not taking enough., Which necessitated a second puff less than two hours later. The folks from the program made some suggestions and his numbers came down and never went down under 73. Then he got lazy with the bg testing, kept puffing in the established routine, and it has all been good. And tremendously easy. There has not been one hint or symptom of hypoglycemia.
Our goal was under 7. It is all good!
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Post by suebeeee1 on Oct 27, 2015 1:04:15 GMT -5
Exactly Sav - while we are still young! So - underneath the veneer of global roll out is this sticky 'little' problem for (very experienced and savvy) SNY of how to get Afrezza to be taken up by diabetics in the US market. All the while, very experienced and savvy SNY is wending its way with other offerings to diabetics including touting to type 2's (i)its RAA Apidra, (ii) Toujeo (yes to type 2's because it is a 24 hour insulin and its testing shows it reduces night time hypos), and now (iii) Lixilan - while shoving Afrezza into the corner as the answer for insulin naive and needle phobic. There are evidently a lot of them but it is not clear when they are going to get on the radar! This creates a very BIG problem for MNKD because it has to fight for its corporate life with no genuine income from Afrezza. Marketing partner SNY has to 'establish' Afrezza - not just 'make it available'. I am genuinely concerned that waiting for US based T2's to discover Afrezza is a failed strategy - if the objective is to establish Afrezza as the go to prandial insulin of choice. A much better strategy is to go to the user base that actively manages their disease and uses insulin at mealtime and measures the effect - that appears to me to be the T-1 patient group. I think you all underestimate how many T2s care about their numbers. We know quite a few. At parties and other gatherings, many of these guys will stand around and compare numbers and treatment. Our group consists of well educated, higher income, over 55. The reality is that the longer you are diabetic, the more your own insulin will fail and the higher your blood glucose will rise, until insulin is necessary. The whole idea of diet and exercise controlling the disease is bs. None of the people in our group of friends are significantly overweight and most are very active. They all care about their health. They all have been ribbing my husband about the puffing but all have been interested. I won't be surprised if I hear of at least one or two of the diabetics we know moving over to Afrezza after his news gets out. It's all a matter of time. Type 2 diabetics will comply(at least a substantial amount of time) with meds when they are nothing more than a pill. Afrezza will never be marketed to be used without blood testing, but once people realize that Hypos are uncommon or at least far less common than injected insulin, people will feel comfortable abandoning the many sticks each day. When they realize that their numbers can be nearly normal with minimal effort, type 2s will want this as much as type 1s. It is the T2s that are going to make this a blockbuster. Yep, it's just a matter of time (and insurance coverage).
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6.1
Oct 27, 2015 1:24:36 GMT -5
Post by dreamboatcruise on Oct 27, 2015 1:24:36 GMT -5
4u for breakfast, 8 for dinner and lunch, 4 for his night time snack. This is the dosing that seemed to work out for him after the first week, after contacting the coach program. He had some trouble trying to bring down his after meal numbers in the first few days, when he was inhaling before the meals. And not taking enough., Which necessitated a second puff less than two hours later. The folks from the program made some suggestions and his numbers came down and never went down under 73. Then he got lazy with the bg testing, kept puffing in the established routine, and it has all been good. And tremendously easy. There has not been one hint or symptom of hypoglycemia. Our goal was under 7. It is all good! To me it all seems quite excellent. Sounds like your husband is headed for basically normal A1c, and it is really good to hear the coach program is doing such a good job. If T2s across a wide range of diabetes progression can be guided to such a simple protocol by the Afrezza coaches... that will assure the blockbuster success we've been hoping for. I've been happy to see the results of all the users with Dexcoms, but a majority of the population is not going to have that luxury anytime soon.
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6.1
Oct 27, 2015 1:38:16 GMT -5
Post by peppy on Oct 27, 2015 1:38:16 GMT -5
Exactly Sav - while we are still young! So - underneath the veneer of global roll out is this sticky 'little' problem for (very experienced and savvy) SNY of how to get Afrezza to be taken up by diabetics in the US market. All the while, very experienced and savvy SNY is wending its way with other offerings to diabetics including touting to type 2's (i)its RAA Apidra, (ii) Toujeo (yes to type 2's because it is a 24 hour insulin and its testing shows it reduces night time hypos), and now (iii) Lixilan - while shoving Afrezza into the corner as the answer for insulin naive and needle phobic. There are evidently a lot of them but it is not clear when they are going to get on the radar! This creates a very BIG problem for MNKD because it has to fight for its corporate life with no genuine income from Afrezza. Marketing partner SNY has to 'establish' Afrezza - not just 'make it available'. I am genuinely concerned that waiting for US based T2's to discover Afrezza is a failed strategy - if the objective is to establish Afrezza as the go to prandial insulin of choice. A much better strategy is to go to the user base that actively manages their disease and uses insulin at mealtime and measures the effect - that appears to me to be the T-1 patient group. I think you all underestimate how many T2s care about their numbers. We know quite a few. At parties and other gatherings, many of these guys will stand around and compare numbers and treatment. Our group consists of well educated, higher income, over 55. The reality is that the longer you are diabetic, the more your own insulin will fail and the higher your blood glucose will rise, until insulin is necessary. The whole idea of diet and exercise controlling the disease is bs. None of the people in our group of friends are significantly overweight and most are very active. They all care about their health. They all have been ribbing my husband about the puffing but all have been interested. I won't be surprised if I hear of at least one or two of the diabetics we know moving over to Afrezza after his news gets out. It's all a matter of time. Type 2 diabetics will comply(at least a substantial amount of time) with meds when they are nothing more than a pill. Afrezza will never be marketed to be used without blood testing, but once people realize that Hypos are uncommon or at least far less common than injected insulin, people will feel comfortable abandoning the many sticks each day. When they realize that their numbers can be nearly normal with minimal effort, type 2s will want this as much as type 1s. It is the T2s that are going to make this a blockbuster. Yep, it's just a matter of time (and insurance coverage). I just read the existing guidelines for T2 to add insulin. 9 percent 212 mg/dL (11.8 mmol/L) Thanks sue. Plenty of people out there running that high. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. www.aafp.org/afp/2011/0715/p183.html
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Post by kball on Oct 27, 2015 9:23:25 GMT -5
I wish there was a way to get a bunch of T2 PWD together for sponsored dinners (along w some doctors) and just administer Afrezza and test the group. ANd have this happening in several places simultaneously and linked by video feed.
Out of the box thinking a little maybe.
Call it a Suckathon or some other catchy name
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Post by suebeeee1 on Oct 27, 2015 9:25:57 GMT -5
I just read the existing guidelines for T2 to add insulin. 9 percent 212 mg/dL (11.8 mmol/L) Thanks sue. Plenty of people out there running that high. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. www.aafp.org/afp/2011/0715/p183.html
Protocols for moving a T2 from oral meds to insulin always include the basal. The HUGE game changer with Afrezza is that several T2s (including us) are reporting that bg levels are coming into near perfection with Afrezza alone, used when eating. This seems far more "normal". While this doesn't reverse the disease, it sure does change the overall way that diabetes is dealt with. I don't know if his diabetes will continue to get worse with ensuing years, as is the norm for the progression of the disease, or whether Afrezza will stop the disease in its tracks....wouldn't that be AMAZING! Only time will tell.....
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6.1
Oct 27, 2015 9:26:36 GMT -5
Post by kball on Oct 27, 2015 9:26:36 GMT -5
Though maybe a Puffathon might be more agreeable.
edit: ^ Damn sue snuck hers in before i could add
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Deleted
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6.1
Oct 27, 2015 9:27:41 GMT -5
Post by Deleted on Oct 27, 2015 9:27:41 GMT -5
I just read the existing guidelines for T2 to add insulin. 9 percent 212 mg/dL (11.8 mmol/L) Thanks sue. Plenty of people out there running that high. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. www.aafp.org/afp/2011/0715/p183.html
Protocols for moving a T2 from oral meds to insulin always include the basal. The HUGE game changer with Afrezza is that several T2s (including us) are reporting that bg levels are coming into near perfection with Afrezza alone, used when eating. This seems far more "normal". While this doesn't reverse the disease, it sure does change the overall way that diabetes is dealt with. I don't know if his diabetes will continue to get worse with ensuing years, as is the norm for the progression of the disease, or whether Afrezza will stop the disease in its tracks....wouldn't that be AMAZING! Only time will tell..... what did your doc have to say about the results? Have you gotten a chance to discuss your dh results yet? How did your other T2 friends feel about this?
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Post by suebeeee1 on Oct 27, 2015 9:33:38 GMT -5
what did your doc have to say about the results? Have you gotten a chance to discuss your dh results yet? How did your other T2 friends feel about this? Results only came in on Friday afternoon on Kaiser's web access. We sent our doctor a note and sent Kaiser a letter as well as a request (again) for a formulary change on Friday. We saw one friend over the weekend who is on insulin (T2) and he told us he is going to ask for it from his doctor. Even with insulin, his bg is still higher. We'll let you know when our doctor responds.
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Post by suebeeee1 on Oct 27, 2015 9:36:53 GMT -5
One other big thing has happened....
My husband has quit bitching about my "losing" investment!
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6.1
Oct 27, 2015 9:56:06 GMT -5
via mobile
Post by bradleysbest on Oct 27, 2015 9:56:06 GMT -5
Still have not found a single SNY or Doctor sponsored event for Afrezza in the Los Angeles area. You would think this would be a prime target for Doctor & patient education.
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