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Post by sportsrancho on Sept 18, 2016 19:36:55 GMT -5
On this note....my husband's endo would not prescribe Afrezza for him. (we are in NJ). Took the list that showed MD's by state that are prescribing Afrezza. Waited 4 months for an appointment for a doctor listed that is part of a "diabetes and endocrine specialty practice." During his appointment, never stated that we were investors. Just asked about Afrezza. He gave a sneer, and said, I am not prescribing Afrezza. We went over the fact that several of our friends are on it and how great they feel, and all the attributes. He wanted to hear nothing. He wants to prescribe a once weekly shot instead. Left the appointment very depressed. It is so obvious that patients have to be the drive. These guys are so in bed with big pharma that it does not matter UNLESS enough patients demand it. Thanks for posting snow. That's awfull. Can you e-mail Mike, or find a GP on the list? I know what my client went through getting his teenagers on Afrezza. But wow was it worth it! Freedom! To really eat what you want and feel in control! Good luck:-) |
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Post by mnholdem on Sept 18, 2016 20:05:23 GMT -5
On this note....my husband's endo would not prescribe Afrezza for him. (we are in NJ). Took the list that showed MD's by state that are prescribing Afrezza. Waited 4 months for an appointment for a doctor listed that is part of a "diabetes and endocrine specialty practice." During his appointment, never stated that we were investors. Just asked about Afrezza. He gave a sneer, and said, I am not prescribing Afrezza. We went over the fact that several of our friends are on it and how great they feel, and all the attributes. He wanted to hear nothing. He wants to prescribe a once weekly shot instead. Left the appointment very depressed. It is so obvious that patients have to be the drive. These guys are so in bed with big pharma that it does not matter UNLESS enough patients demand it. I'm not surprised. Afrezza is insulin. I am on Trulicity and my A1c is 5.7. Until I am insulin dependent or unable to control my blood sugars, I will not be using Afrezza. I would imagine that most endos prescribe insulin only after other treatments fail to adequately control diabetes. Afrezza may or may not be a better choice for your husband than Trulicty or another GLP-1, but his endo is not inclined to prescribe it for him. It would be interesting to hear from other T2's who have tight control over their diabetes using more traditional treatment and yet were precribed Afrezza as an alternative. I am also aware of the potential risks of using a GLP-1, but I can also say that convenience of a once weekly injection, which is relatively painless, outweighs using an inhaler 3 times a day. I am a staunch supporter of MNKD and I've been invested 7+ years, but I also know that not everyone is a candidate for Afrezza. By the time "other treatments fail to adequately control diabetes" the patient's pancreas will be damaged beyond repair. Recently Diabetes in Control republished trial data that provides evidence that early short-term intensive insulin (STII) treatment can repair the beta cells in the pancreas and result in remission of the disease. I, myself, have posted a meta-analysis of over 800 patients that provided empirical evidence that nearly half the patients who received STII therapy remained in drug free remission for up to two years. Endos who ignore this evidence are condemning their patients to a life-sentence of battling diabetes, IMHO. Ignorance is no excuse and the names of these narrow-minded endocrinologist "specialists" should be published. |
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Post by agedhippie on Sept 18, 2016 20:43:45 GMT -5
On this note....my husband's endo would not prescribe Afrezza for him. (we are in NJ). Took the list that showed MD's by state that are prescribing Afrezza. Waited 4 months for an appointment for a doctor listed that is part of a "diabetes and endocrine specialty practice." During his appointment, never stated that we were investors. Just asked about Afrezza. He gave a sneer, and said, I am not prescribing Afrezza. We went over the fact that several of our friends are on it and how great they feel, and all the attributes. He wanted to hear nothing. He wants to prescribe a once weekly shot instead. Left the appointment very depressed. It is so obvious that patients have to be the drive. These guys are so in bed with big pharma that it does not matter UNLESS enough patients demand it. Based on the weekly shot I guess your husband is a Type 2. In that case the endo is going to pick treatment based on where he is on the diabetes cycle. I am not sure what he is being offered but it sounds like a GLP-1 which according to the Standard of Care would be the next step after metformin fails. The endo is not going to want to prescribe Afrezza until the GLP-1 has failed and basal insulin has also failed. A lot of the problem is that it's insulin and US providers are notoriously reluctant to prescribe insulin (the DAWN studies confirmed this). There is a perception that insulin is difficult to use and disruptive leading to poor compliance and so to poor effectiveness. Patients can demand whatever they want, but getting doctors to ignore the Standard of Care can be difficult. Insurers are not going to want this to happen either - insulin is expensive, the associated test strips are expensive, and the increased number of hypos will be expensive. All of that said you can get to insulin if you game the system. The endo will put you on a GLP-1 but if it has persistent side effects he will often move you straight to basal. After six months if your numbers are still not good (now is the time to go on a carb heavy diet), he will be a lot more receptive to the idea of a bolus insulin and Afrezza. That's the route for the Standard of Care. |
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Post by Deleted on Sept 18, 2016 20:56:59 GMT -5
On this note....my husband's endo would not prescribe Afrezza for him. (we are in NJ). Took the list that showed MD's by state that are prescribing Afrezza. Waited 4 months for an appointment for a doctor listed that is part of a "diabetes and endocrine specialty practice." During his appointment, never stated that we were investors. Just asked about Afrezza. He gave a sneer, and said, I am not prescribing Afrezza. We went over the fact that several of our friends are on it and how great they feel, and all the attributes. He wanted to hear nothing. He wants to prescribe a once weekly shot instead. Left the appointment very depressed. It is so obvious that patients have to be the drive. These guys are so in bed with big pharma that it does not matter UNLESS enough patients demand it. Based on the weekly shot I guess your husband is a Type 2. In that case the endo is going to pick treatment based on where he is on the diabetes cycle. I am not sure what he is being offered but it sounds like a GLP-1 which according to the Standard of Care would be the next step after metformin fails. The endo is not going to want to prescribe Afrezza until the GLP-1 has failed and basal insulin has also failed. A lot of the problem is that it's insulin and US providers are notoriously reluctant to prescribe insulin (the DAWN studies confirmed this). There is a perception that insulin is difficult to use and disruptive leading to poor compliance and so to poor effectiveness. Patients can demand whatever they want, but getting doctors to ignore the Standard of Care can be difficult. Insurers are not going to want this to happen either - insulin is expensive, the associated test strips are expensive, and the increased number of hypos will be expensive. All of that said you can get to insulin if you game the system. The endo will put you on a GLP-1 but if it has persistent side effects he will often move you straight to basal. After six months if your numbers are still not good (now is the time to go on a carb heavy diet), he will be a lot more receptive to the idea of a bolus insulin and Afrezza. That's the route for the Standard of Care. You forgot to add "and in the process make so much damage" making your comment incomplete. |
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Post by agedhippie on Sept 18, 2016 21:14:52 GMT -5
Based on the weekly shot I guess your husband is a Type 2. In that case the endo is going to pick treatment based on where he is on the diabetes cycle. I am not sure what he is being offered but it sounds like a GLP-1 which according to the Standard of Care would be the next step after metformin fails. The endo is not going to want to prescribe Afrezza until the GLP-1 has failed and basal insulin has also failed. A lot of the problem is that it's insulin and US providers are notoriously reluctant to prescribe insulin (the DAWN studies confirmed this). There is a perception that insulin is difficult to use and disruptive leading to poor compliance and so to poor effectiveness. Patients can demand whatever they want, but getting doctors to ignore the Standard of Care can be difficult. Insurers are not going to want this to happen either - insulin is expensive, the associated test strips are expensive, and the increased number of hypos will be expensive. All of that said you can get to insulin if you game the system. The endo will put you on a GLP-1 but if it has persistent side effects he will often move you straight to basal. After six months if your numbers are still not good (now is the time to go on a carb heavy diet), he will be a lot more receptive to the idea of a bolus insulin and Afrezza. That's the route for the Standard of Care. You forgot to add "and in the process make so much damage" making your comment incomplete. Not really. It takes years of persistent high numbers to cause much damage and we are talking about a few months. It was tongue in cheek though and I wouldn't advise it as an approach (although I did it to get a CGM), but it forces the issue. It is simpler to just swap endos in this case. |
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Post by nadathing on Sept 18, 2016 21:15:01 GMT -5
I'm not surprised. Afrezza is insulin. I am on Trulicity and my A1c is 5.7. Until I am insulin dependent or unable to control my blood sugars, I will not be using Afrezza. I would imagine that most endos prescribe insulin only after other treatments fail to adequately control diabetes. Afrezza may or may not be a better choice for your husband than Trulicty or another GLP-1, but his endo is not inclined to prescribe it for him. It would be interesting to hear from other T2's who have tight control over their diabetes using more traditional treatment and yet were precribed Afrezza as an alternative. I am also aware of the potential risks of using a GLP-1, but I can also say that convenience of a once weekly injection, which is relatively painless, outweighs using an inhaler 3 times a day. I am a staunch supporter of MNKD and I've been invested 7+ years, but I also know that not everyone is a candidate for Afrezza. By the time "other treatments fail to adequately control diabetes" the patient's pancreas will be damaged beyond repair. Recently Diabetes in Control republished trial data that provides evidence that early short-term intensive insulin (STII) treatment can repair the beta cells in the pancreas and result in remission of the disease. I, myself, have posted a meta-analysis of over 800 patients that provided empirical evidence that nearly half the patients who received STII therapy remained in drug free remission for up to two years. Endos who ignore this evidence are condemning their patients to a life-sentence of battling diabetes, IMHO. Ignorance is no excuse and the names of these narrow-minded endocrinologist "specialists" should be published. Are you suggesting that all T2's be started on Afrezza? |
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Post by gamblerjag on Sept 18, 2016 21:15:02 GMT -5
Snowball .... report that Dr. to the Medical Board.. and let him know your doing it. Many will change their tune. Dr.'s sometimes like to play God. It's malpractice to not prescribe something where the science is behind it. Side note: Whenever I go to the Dentist, (I work for the Dental Board of California). get my car fixed. ( I work for Consumer Affairs Automobile Bureau, a new Dr. (Medical board of CA.).. yes it's not true.. but I did work for two of those Agencies.. and you know what? They take that much better care of you. Good Luck. |
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Post by nadathing on Sept 18, 2016 21:19:19 GMT -5
You forgot to add "and in the process make so much damage" making your comment incomplete. Not really. It takes years of persistent high numbers to cause much damage and we are talking about a few months. It was tongue in cheek though and I wouldn't advise it as an approach (although I did it to get a CGM), but it forces the issue. It is simpler to just swap endos in this case. I agree that if a patient is adamant about being on Afrezza they should doctor shop. I was on a 3 year trial with Bydureon and was unable to use it between the trial ending and approval (1 year). When it was approved, I told my doctor I wanted it and she was unaware of it, even though the clinic was where the trial was held. She researched it and advised against it due to the label. I made it clear I wanted it and she wrote the script. Had she refused the script I would have changed doctors. |
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Post by agedhippie on Sept 18, 2016 21:29:52 GMT -5
Snowball .... report that Dr. to the Medical Board.. and let him know your doing it. Many will change their tune. Dr.'s sometimes like to play God. It's malpractice to not prescribe something where the science is behind it That's not going to bother him in the slightest. He is following the Standard of Care so he is fireproof in that regard. |
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Post by broncolife on Sept 18, 2016 21:57:32 GMT -5
Snow, please notify Matt or Mannkind about the issue. They need to determine whether he is anti-Afrezza or following appropriate standard of care.
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Post by Deleted on Sept 18, 2016 23:38:33 GMT -5
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Post by Deleted on Sept 19, 2016 0:08:16 GMT -5
Standard does not equal best and there is always a better and more simple/convienent way of doing something. I am glad there are people wanting and willing to go beyond standard.
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Post by anderson on Sept 19, 2016 19:38:51 GMT -5
By the time "other treatments fail to adequately control diabetes" the patient's pancreas will be damaged beyond repair. Recently Diabetes in Control republished trial data that provides evidence that early short-term intensive insulin (STII) treatment can repair the beta cells in the pancreas and result in remission of the disease. I, myself, have posted a meta-analysis of over 800 patients that provided empirical evidence that nearly half the patients who received STII therapy remained in drug free remission for up to two years. Endos who ignore this evidence are condemning their patients to a life-sentence of battling diabetes, IMHO. Ignorance is no excuse and the names of these narrow-minded endocrinologist "specialists" should be published. Are you suggesting that all T2's be started on Afrezza? Al Mann suggest as much way back in 2011 and this has been talked about an posted on the board before mnkd.proboards.com/post/34424 |
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Post by mnkdfann on Jan 14, 2017 20:08:57 GMT -5
I was going over the old threads and just came across the above post. The request for logo was for: "A large "V", smaller case "dex" and a horizontal line (which represents well-controlled blood sugar - you don't want blood sugar bouncing up and down)" So what did they go for? A dotted line bouncing up and down suggesting two highs and a low.   |
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Post by straightly on Jan 15, 2017 23:12:13 GMT -5
On this note....my husband's endo would not prescribe Afrezza for him. (we are in NJ). Took the list that showed MD's by state that are prescribing Afrezza. Waited 4 months for an appointment for a doctor listed that is part of a "diabetes and endocrine specialty practice." During his appointment, never stated that we were investors. Just asked about Afrezza. He gave a sneer, and said, I am not prescribing Afrezza. We went over the fact that several of our friends are on it and how great they feel, and all the attributes. He wanted to hear nothing. He wants to prescribe a once weekly shot instead. Left the appointment very depressed. It is so obvious that patients have to be the drive. These guys are so in bed with big pharma that it does not matter UNLESS enough patients demand it. Thanks for posting snow. That's awfull. Can you e-mail Mike, or find a GP on the list? I know what my client went through getting his teenagers on Afrezza. But wow was it worth it! Freedom! To really eat what you want and feel in control! Good luck:-) "Took the list that showed MD's by state that are prescribing Afrezza " Can we please, if possible, add an indicator there to mark doctors who had actually prescribed Afrezza before? I suspect this list comes from sales people telling Mike. |
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