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Post by suebeeee1 on Feb 27, 2016 16:59:08 GMT -5
I watched specialist for years specializing in intensive cares. A physician with an MD generalized can do the job. You have a human being. Increasing urine output, peeing all the time. Thirsty, so thirsty, losing weight..... finally you end up in an urgent care center, They take a glucose level from your finger. a blood sugar, it is 400 or 500. Physicians in urgent care center have to treat the hypoglycemia from other insulin. That seems to be ok with you.
This is not rocket science.
Anyone with first aid knowledge can treat hypoglycemia - it's glucose gel if they can swallow (that stuff is disgusting), or a glucagon shot if they cannot. If you are insulin dependent your insurer will provide a glucagon kit for you to keep with you. Hyperglycemia is more of a problem because depending on the circumstances you may need an IV and that is where an endo making the decision is a good idea. Any doctor could do it but I have had enough bad experiences with doctors (including in hospitals) to want an endo. I am trying to figure out their market. I do not think Type 1 diabetics will use it because if it is an emergency you are either going to ER or your endo, urgent care may treat you but they are sending you to the ER at the end of it anyway so you may as well go straight in. If it is not an emergency then it's a scheduled visit and you want your endo for consistency. I could see a role for Type 2 diabetics who have been on metformin for a while and it is beginning to fail. That would be a good fit. Sorry Hippie, you're way off base here. The ADA revised its target goals about a year ago stating that people over agreed 60 should have a target A1c between 6.5 and 7 due to severe risk of HYPOGLYCEMIA. The problem is that many older people live alone and do not necessarily recognize when they become hypoglycemic. These states often occur after exercise and can even occur while sleeping. One of the symptoms of hypoglycemia is even sleepiness. Once you are asleep, unless someone else is aware enough to rouse you and give you glucose.... you could die. Afrezza doesn't have this serious side effect. In eight months, with a lazy diabetic using it many times a day here, there have been no bg levels near those levels. Have you seen all the YouTube and other assundry reports of users purposefully trying to induce hypoglycemissions without success? A better A1c for everyone will be under 6. Here's to making that happen universally!. To you Al, wherever you may be!
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Post by kball on Feb 27, 2016 17:33:45 GMT -5
That mannmade guy sure is liking a lot of posts in this thread
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Post by stevil on Feb 27, 2016 18:26:14 GMT -5
After reading through this thread, I wanted to address a few things. It seems like a lot of people are talking past each other ( peppy , agedhippie , suebeeee1 ) General physicians are fine for urgent care settings. It's usually just about stabilizing the patient and sending them home for a later follow up with either their PC or Endo, whichever they deem necessary or patient preference. The more demanding cases would obviously be handled by the endo on call, but a vast majority of them are easily handled by a general physician. agedhippie was correct in regards to ease of treatment of hypoglycemia. It's as simple as taking glucose. Problem solved in most cases, unless there is a different underlying issue. Suebeeee1 was also correct in her response, but you're arguing a different point than agedhippie was. Suebeeee's point is more relevant to long term care, whereas aged hippie was talking more about urgent care (if I'm understanding you correctly) A1c levels are an average blood glucose measurement over 3 months, not indicative of an emergent crisis. Truly, A1c and hypoglycemia aren't really all that related, unless you're chronically hypoglycemic. But that's hard to do as it's not really all that conducive to health. Hyperglycemia is more of a concern with A1c because higher levels of glucose over 3 months will lead to higher A1c levels, even if there are periods of hypoglycemia mixed in. Again, it's an average, not a one time event. The idea is to reduce hyperglycemia which will then lead to lower A1c levels. I'm pretty sure you already knew this and I'm not sure if the ADA adjusted their A1c protocols up or down. Based on what you're saying, I'd assume they raised the range to prevent hypos? Is that what you're saying? Haha suddenly I don't feel like I'm clarifying anything The clinics are aimed at hyperglycemic patients, although I'd imagine they're equipped to handle hypos also, relating to peppy's point. As suebeeee said, usually hypoglycemic people present with sleepiness, delirium, anxiety, nausea, etc. Those patients are usually treated with oral or iv glucose and generally improve fairly quickly, depending on severity. With the focus on hyperglycemia in mind, obviously insulin will be needed to decrease BG levels. In a state of ketoacidosis or hyperosmolar hyperglycemic state, time is of the essence. I'd imagine IV glucose would be used in those situations, although hopefully Afrezza will prove to be just as effective in the not so distant future and will be an alternative during those times if the patient is still alert and oriented (which was aggedhippie's point). One final thing I'd like to add- I think "young" people are featured on the website for a couple reasons 1. DKA is most common in people under 65 years old. This seems like it'd be one of the highest reasons for a visit 2. They're appealing to a younger audience- which I actually like a lot. Younger people are probably more apt to try an alternative insulin than someone who is set in their ways. Also, it's better to get a younger person hooked on your insulin therapy than an older person. More miles...
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Post by LosingMyBullishness on Feb 27, 2016 18:42:00 GMT -5
After reading through this thread, I wanted to address a few things. It seems like a lot of people are talking past each other ( peppy , agedhippie , suebeeee1 ) General physicians are fine for urgent care settings. It's usually just about stabilizing the patient and sending them home for a later follow up with either their PC or Endo, whichever they deem necessary or patient preference. The more demanding cases would obviously be handled by the endo on call, but a vast majority of them are easily handled by general physician. agedhippie was correct in regards to ease of treatment of hypoglycemia. It's as simple as taking glucose. Problem solved in most cases, unless there is a different underlying issue. Suebeeee1 was also correct in her response, but you're arguing a different point than agedhippie was. Suebeeee's point is more relevant to long term care, whereas these clinics are more of a one-and-done proposition (or at least should be ha) A1c levels are an average blood glucose measurement over 3 months, not an emergent crisis. Truly, A1c and hypoglycemia aren't really all that related, unless you're chronically hypoglycemic. But that's hard to do as it's not really all that conducive to health. Hyperglycemia is more of a concern with A1c because higher levels of glucose over 3 months will lead to higher A1c levels, even if there are periods of hypoglycemia mixed in. Again, it's an average, not a one time event. The clinics are aimed at hyperglycemic patients, although I'd imagine they're equipped to handle hypos also, relating to peppy's point. As suebeeee said, usually hypoglycemic people present with sleepiness, delirium, anxiety, nausea, etc. Those patients are usually treated with oral or iv glucose and generally improve fairly quickly, depending on severity. With the focus on hyperglycemia in mind, obviously insulin will be needed to decrease BG levels. In a state of ketoacidosis or hyperosmolar hyperglycemic state, time is of the essence. I'd imagine IV glucose would be used in those situations, although hopefully Afrezza will prove to be just as effective in the not so distant future and will be an alternative during those times if the patient is still alert and oriented (which was aggedhippie's point). One final thing I'd like to add- I think "young" people are featured on the website for a couple reasons 1. DKA is most common in people under 65 years old. This seems like it'd be one of the highest reasons for a visit 2. They're appealing to a younger audience- which I actually like a lot. Younger people are probably more apt to try an alternative insulin than someone who is set in their ways. Also, it's better to get a younger person hooked on your insulin therapy than an older person. More miles... You wrote that these diabetics shop in shop (courtesy of Lakers) are a one and done. On their website they point to a new routine, a better control. Sounds more like more frequent revisits (easier and cheaper for the patients than a visit at the endo) but more focussed than a GP.
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Post by stevil on Feb 27, 2016 18:44:10 GMT -5
Thanks for the correction. I haven't researched the clinic much. I just assumed based on all the comments about it that it was more for urgent care than continuing therapy. Guess I'll have to educate myself better before talking
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Post by agedhippie on Feb 27, 2016 18:47:11 GMT -5
Anyone with first aid knowledge can treat hypoglycemia - it's glucose gel if they can swallow (that stuff is disgusting), or a glucagon shot if they cannot. If you are insulin dependent your insurer will provide a glucagon kit for you to keep with you. Hyperglycemia is more of a problem because depending on the circumstances you may need an IV and that is where an endo making the decision is a good idea. Any doctor could do it but I have had enough bad experiences with doctors (including in hospitals) to want an endo. I am trying to figure out their market. I do not think Type 1 diabetics will use it because if it is an emergency you are either going to ER or your endo, urgent care may treat you but they are sending you to the ER at the end of it anyway so you may as well go straight in. If it is not an emergency then it's a scheduled visit and you want your endo for consistency. I could see a role for Type 2 diabetics who have been on metformin for a while and it is beginning to fail. That would be a good fit. Sorry Hippie, you're way off base here. The ADA revised its target goals about a year ago stating that people over agreed 60 should have a target A1c between 6.5 and 7 due to severe risk of HYPOGLYCEMIA. The problem is that many older people live alone and do not necessarily recognize when they become hypoglycemic. These states often occur after exercise and can even occur while sleeping. One of the symptoms of hypoglycemia is even sleepiness. Once you are asleep, unless someone else is aware enough to rouse you and give you glucose.... you could die. Afrezza doesn't have this serious side effect. In eight months, with a lazy diabetic using it many times a day here, there have been no bg levels near those levels. Have you seen all the YouTube and other assundry reports of users purposefully trying to induce hypoglycemissions without success? A better A1c for everyone will be under 6. Here's to making that happen universally!. To you Al, wherever you may be! I thought they had revised the A1c range to a lot higher than although on the basis of comorbidities. Also it avoids hypo unawareness since running consistently low numbers can lead to you not getting the warning signs. The fix is to run higher numbers for a week or so periodically to restore the sensitivity. Almost invariably your body will rescue you if you have a hypo by dumping glucose but the risk is that a succession of hypos will leave you with insufficient reserves, or a heart arrhythmia (when I was first diagnosed I was convinced I was going to die in my sleep, I got over that in the ensuing decades!) There are two parts to hypoglycemia - there is the adrenaline rush as your body dumps adrenaline to make your liver dump glucose, and if you drop low enough there is the impaired cognitive function as random bits of your brain, which requires glucose to work, shuts down (not being able to talk as happened once was scary). I suspect the sleepiness is the cognitive function part. A CGM going off in the middle of the night with a false alarm is one of life's little joys The problem with the hypos assertion is that the data doesn't support it. What it says is that you will get 25% less severe hypos in a trial population. The size of the trial was only a few hundred so it may be that the results have a noticeable margin of error. I am not against Afrezza even if it seems like that and if it has a clean bill of health in a couple of years I will probably use it. I think there is a market (or I wouldn't hold the stock) but I am not sure it is as large or where people think it is. There are also odd arguments that people haven't thought of - in some countries insulin is a semi-controlled drug (the UK is an example) because it is easy to kill people with it and difficult to detect. Inhaled insulin is immune to that risk so there is a safety argument there.
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Post by agedhippie on Feb 27, 2016 22:40:31 GMT -5
You wrote that these diabetics shop in shop (courtesy of Lakers) are a one and done. On their website they point to a new routine, a better control. Sounds more like more frequent revisits (easier and cheaper for the patients than a visit at the endo) but more focussed than a GP. Will my insurance hit me for an urgent care fee or do the doctors offer non-urgent care services from within the urgent care center? On my insurance an endo and a doctor have the same co-pay.
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Post by dreamboatcruise on Feb 28, 2016 15:40:47 GMT -5
You wrote that these diabetics shop in shop (courtesy of Lakers) are a one and done. On their website they point to a new routine, a better control. Sounds more like more frequent revisits (easier and cheaper for the patients than a visit at the endo) but more focussed than a GP. Will my insurance hit me for an urgent care fee or do the doctors offer non-urgent care services from within the urgent care center? On my insurance an endo and a doctor have the same co-pay. With the insurance I have it is likely they wouldn't cover any of the cost. I have an HMO and the particular physician group I am with has only signed up one urgent care clinic out of the many in the area. I thought this style of coverage was becoming more the norm than the exception but others have chimed in that there are still large segments of the population that are open to choose. If by chance the urgent care within my physician group had VDex, I'm sure I'd be charged the double co-pay unless my primary care physician had referred me. That's the world of HMOs.
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Post by agedhippie on Feb 28, 2016 18:57:12 GMT -5
Will my insurance hit me for an urgent care fee or do the doctors offer non-urgent care services from within the urgent care center? On my insurance an endo and a doctor have the same co-pay. With the insurance I have it is likely they wouldn't cover any of the cost. I have an HMO and the particular physician group I am with has only signed up one urgent care clinic out of the many in the area. I thought this style of coverage was becoming more the norm than the exception but others have chimed in that there are still large segments of the population that are open to choose. If by chance the urgent care within my physician group had VDex, I'm sure I'd be charged the double co-pay unless my primary care physician had referred me. That's the world of HMOs. At work the majority are on HMO policies because they are the cheapest policies and if you have no conditions they can be good value. Also the PPO policies are restricted to in-network doctors.
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Post by patten1962 on Mar 3, 2016 16:20:37 GMT -5
Few questions. 1. Why New Jersey? 2. How is this profitable for this company? Don't most people with diabetes already get treated by their Endo or pcp?....3. If it is profitable why can't any hospital or medical group do the same thing?
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Post by omeshrin on Mar 3, 2016 16:53:24 GMT -5
Few questions. 1. Why New Jersey? 2. How is this profitable for this company? Don't most people with diabetes already get treated by their Endo or pcp?....3. If it is profitable why can't any hospital or medical group do the same thing? I think the answer to #2 will give us an indication of who is behind VDex Diabetes. If this company works on sales commissions for MannKind and/or Dexcom, they may receive perks. The origin of the funding for VDex are also unknown and may also help answer some of those questions. Unfortunately I think those things are confidential right now.
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Post by dictatorsaurus on Mar 3, 2016 16:53:28 GMT -5
Few questions. 1. Why New Jersey? 2. How is this profitable for this company? Don't most people with diabetes already get treated by their Endo or pcp?....3. If it is profitable why can't any hospital or medical group do the same thing? NJ is a fairly rich and fat state. We have lots of diabetics and the state is very congested and dense. A fast paced lifestyle similar to NY, people here want plug-n-play, point n' shoot kind of services. Visiting endo and PCP offices are very time consuming. Often the visits are redundant. Quick look at the chart and write rx. I'm assuming hospitals and medical centers are not free to host their services and often operate as a middle man. Independent practices have much more control over their business and profit margins.
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Post by xoxoxoxo on Mar 3, 2016 18:46:06 GMT -5
Few questions. 1. Why New Jersey? 2. How is this profitable for this company? Don't most people with diabetes already get treated by their Endo or pcp?....3. If it is profitable why can't any hospital or medical group do the same thing? NJ is a fairly rich and fat state. We have lots of diabetics and the state is very congested and dense. A fast paced lifestyle similar to NY, people here want plug-n-play, point n' shoot kind of services. Visiting endo and PCP offices are very time consuming. Often the visits are redundant. Quick look at the chart and write rx. I'm assuming hospitals and medical centers are not free to host their services and often operate as a middle man. Independent practices have much more control over their business and profit margins. Is it legal for them to get kickbacks based on selling afrezza prescriptions?
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Post by dreamboatcruise on Mar 3, 2016 22:59:25 GMT -5
NJ is a fairly rich and fat state. We have lots of diabetics and the state is very congested and dense. A fast paced lifestyle similar to NY, people here want plug-n-play, point n' shoot kind of services. Visiting endo and PCP offices are very time consuming. Often the visits are redundant. Quick look at the chart and write rx. I'm assuming hospitals and medical centers are not free to host their services and often operate as a middle man. Independent practices have much more control over their business and profit margins. Is it legal for them to get kickbacks based on selling afrezza prescriptions? Very illegal... even if you try calling it a commission. Of course if the owners of the clinic are heavily invested in MNKD, they could make money even if the clinic loses money... perhaps. That seems sort of a loophole. There has been many stories of doctors having financial interests in companies where they use the drug/device of the company. To my knowledge that is still legal.
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Post by LosingMyBullishness on Mar 4, 2016 4:36:52 GMT -5
Few questions. 1. Why New Jersey? 2. How is this profitable for this company? Don't most people with diabetes already get treated by their Endo or pcp?....3. If it is profitable why can't any hospital or medical group do the same thing? NJ is a fairly rich and fat state. We have lots of diabetics and the state is very congested and dense. A fast paced lifestyle similar to NY, people here want plug-n-play, point n' shoot kind of services. Visiting endo and PCP offices are very time consuming. Often the visits are redundant. Quick look at the chart and write rx. I'm assuming hospitals and medical centers are not free to host their services and often operate as a middle man. Independent practices have much more control over their business and profit margins. Dictatorsaurus, Did you had a chance for a quick drive-by photo shooting?
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