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Post by agedhippie on May 10, 2016 7:57:55 GMT -5
On reflection I think it was predictable from the hospital group. The hospital group itself is very cautious but my endo isn't and has happily gone off-label with me in the past. This time he didn't want to do it though which I found concerning. His concern was lung issues and that the trial data said it was equivalent, mostly the risk of lung issues though. I would have liked to have at least tried a sample pack though. Amazing to me diabetics accepting some of these medications. Although, the nation has been schooled, have a problem see a doctor, take a pill. Don't ask questions. I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) |
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Post by lakon on May 10, 2016 10:51:46 GMT -5
Amazing to me diabetics accepting some of these medications. Although, the nation has been schooled, have a problem see a doctor, take a pill. Don't ask questions. I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) But for the love of God, think of the fish. Don't worry, the EPA will help us out eventually...  Really, insulin is the only way to go, especially if you don't need worry about needles and hypos (and cost eventually). I would not expect any investor on here to be worried about costs of a life saving medication. agedhippie: I have to say for someone who seems to always have a response no matter what is said. I am surprised that you took NO for an answer with your endo. That seems out of character so much that it makes me really wonder. I know if I was a diabetic, like some I have lost in my life, I would get on Afrezza no matter what. Nobody would stop me, certainly not myself. In fact, if MattB can get on Tresiba/Afrezza in Australia before approved there, c'mon excuses excuses excuses. If you are honest with yourself, you have to admit it, unless you haven't been completely honest. I had no reason to doubt you until you brushed off never bothering to try Afrezza. For such a seemingly knowledgeable individual on both the investment and science, it seems very odd. Don't you think that you should give it a try? After MattB, I'd try the Tresiba/Afrezza pair, and I'd start a private conversation with MattB. He's worth e-mailing for advice based on his first hand account. He has a good endo who was going to write a paper. Maybe your endo group and his could work together. Then again, maybe you are in perfect control with non-diabetic numbers already. That must be it. (Just a bit of encouragement. Please, take it as such.)  |
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Post by tripoley on May 10, 2016 11:13:27 GMT -5
Amazing to me diabetics accepting some of these medications. Although, the nation has been schooled, have a problem see a doctor, take a pill. Don't ask questions. I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) Really a T2 ought to be on Afrezza right off the bat. The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. |
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Post by lakon on May 12, 2016 14:41:49 GMT -5
I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. Exactly correct, but this is a new concept for some folks albeit old. A T2 ought to be on mealtime insulin right off the bat. The problem is that human factors got in the way of knowledge and science. Patients would not comply. Also, insulin options were dangerous so everyone was afraid to make it the first line treatment. This created a great market for all the alternatives. Now, dogma has taken over. It's a tough nut to crack again, but we built it so we can tear it down. Focus on the T1's and endos should provide the framework to relearn what we need to. Afrezza has the solutions to the original problems. Just need people to remember the truth. |
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Post by Deleted on May 12, 2016 14:45:54 GMT -5
I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) Really a T2 ought to be on Afrezza right off the bat. The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. there are few twitter.com/nccapitalisttwitter.com/SpiroHere |
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ben
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Post by ben on May 12, 2016 22:22:20 GMT -5
I really dislike all diabetes drugs except for metformin. If I was a Type 2 that is the only one I would use and then I would want to move to insulin. If doctors worry about lungs they really ought to also worry about drugs that suppress the mechanism that cleans up tumors as well (hello Januvia!) Really a T2 ought to be on Afrezza right off the bat. The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. I agree with this, but it is very far from the standard. From my understanding, the treatment is kind of like a flow chart or a bunch of if/then statements where the preferred treatment is diet and exercise, then metformin, then metformin + other drugs (eg. SGLT2 inhibitors, Sulfonylurea agents, TZDs, etc), then insulin (though insulin may be introduced sooner it is often times avoided until other oral options have been exhausted). And, once insulin is introduced, it is generally a basal insulin (lantus, touejo, levemir, etc) not a fast acting one. So, insulin, currently, is one of the last options tried for Type 2s and even when insulin therapy is started, it's not the same type as Afrezza. So, to recap, we're saying Afrezza should be one of the first medications prescribed and the medical community is saying it should be one of, if not, the last. Now, does that mean we're wrong. Well, probably. But that doesn't mean an argument can't be made still. And, I'll do my best to keep it short here, and it should be noted the battle will be an uphill one to be sure. The medical community doesn't start people out on insulin because of the risk of hypoglycemia and death. Okay, fair enough. But, Afrezza and Humalog/Novolog/Apidra/whatever are not the same and Mannkind has done a poor job driving home that point. Afrezza lasting only an hour is different than the tails of the other fast acting insulins that remain up to 4 hours later. The lack of tails for afrezza really has the ability to change the game with type 2s. Lasting only an hour will greatly diminish the risk of hypos. (Side note, I take Afrezza and it does cause lows for me, but I'm type 1 using it completely differently than post prandial spiking). Using an insulin like Afrezza would relieve the body's pancreas from having to bring down post prandial spikes. And, relieving that pressure should allow the pancreas to keep up with the glucose dumped by the liver. Further, instead of a 24 hour commitment with a basal insulin like lantus which provides no help to the post prandial spikes, patients would get an introduction to insulin via 1 hour doses that will lop the top off the highest of highs. Seems like a better option. All this with minimal modifications to diet. Now....if they can just get all the endos and pcps out there to change this well established practice, Mannkind will be in good shape. |
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Post by tayl5 on May 12, 2016 22:38:46 GMT -5
Help me out here, experts. My understanding is that the first effects of T2D arise from increasing insulin resistance, generally caused by a lipid imbalance. That lipid imbalance (excess fat in the liver and pancreas, elevated triglycerides) can often be corrected through diet and exercise. Failing that, the next step is metformin, which knocks down the level of glucose independent of the level of insulin. It's only when the beta cells in the pancreas fail, from exhaustion or because they're choked with fat, that the level of insulin declines.
If you just increase the amount of insulin (inhaled or otherwise) early on without addressing the lipid imbalance, how will that reverse the disease progression?
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Post by anderson on May 12, 2016 22:52:48 GMT -5
Help me out here, experts. My understanding is that the first effects of T2D arise from increasing insulin resistance, generally caused by a lipid imbalance. That lipid imbalance (excess fat in the liver and pancreas, elevated triglycerides) can often be corrected through diet and exercise. Failing that, the next step is metformin, which knocks down the level of glucose independent of the level of insulin. It's only when the beta cells in the pancreas fail, from exhaustion or because they're choked with fat, that the level of insulin declines. If you just increase the amount of insulin (inhaled or otherwise) early on without addressing the lipid imbalance, how will that reverse the disease progression? Tayl5 please read www.ncbi.nlm.nih.gov/pubmed/18502299Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial |
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Post by tripoley on May 13, 2016 5:26:32 GMT -5
Help me out here, experts. My understanding is that the first effects of T2D arise from increasing insulin resistance, generally caused by a lipid imbalance. That lipid imbalance (excess fat in the liver and pancreas, elevated triglycerides) can often be corrected through diet and exercise. Failing that, the next step is metformin, which knocks down the level of glucose independent of the level of insulin. It's only when the beta cells in the pancreas fail, from exhaustion or because they're choked with fat, that the level of insulin declines. If you just increase the amount of insulin (inhaled or otherwise) early on without addressing the lipid imbalance, how will that reverse the disease progression? Initially the pancreas starts losing first phase insulin secretion. So they get postprandial BS spikes. The BS remains elevated so the pancreas starts pumping out more insulin which causes a relative hyperinsulinemia. Some think this hyperinsulinemia causes insulin resistance. That insulin resistance is responsible for the metabolic syndrome (hypertension, weight gain, hypertriglyceridemia, low HDL and of course high BS). The standard of care is ass backwards other than diet, exercise and lifestyle modifications. The deficit in prediabetes and early T2 diabetes is first phase insulin which Afrezza replaces exactly. |
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Post by tripoley on May 13, 2016 5:31:59 GMT -5
Help me out here, experts. My understanding is that the first effects of T2D arise from increasing insulin resistance, generally caused by a lipid imbalance. That lipid imbalance (excess fat in the liver and pancreas, elevated triglycerides) can often be corrected through diet and exercise. Failing that, the next step is metformin, which knocks down the level of glucose independent of the level of insulin. It's only when the beta cells in the pancreas fail, from exhaustion or because they're choked with fat, that the level of insulin declines. If you just increase the amount of insulin (inhaled or otherwise) early on without addressing the lipid imbalance, how will that reverse the disease progression? Tayl5 please read www.ncbi.nlm.nih.gov/pubmed/18502299Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial Afrezza should reverse the metabolic syndrome as well in an early T2. They should lose weight, BP decrease and lipids and BS normalize. It's unfortunate the studies were done on T2s that had already failed on orals. Their pancreas is already shot. |
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Post by kball on May 13, 2016 7:14:11 GMT -5
Really a T2 ought to be on Afrezza right off the bat. The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. I agree with this, but it is very far from the standard. From my understanding, the treatment is kind of like a flow chart or a bunch of if/then statements where the preferred treatment is diet and exercise, then metformin, then metformin + other drugs (eg. SGLT2 inhibitors, Sulfonylurea agents, TZDs, etc), then insulin (though insulin may be introduced sooner it is often times avoided until other oral options have been exhausted). And, once insulin is introduced, it is generally a basal insulin (lantus, touejo, levemir, etc) not a fast acting one. So, insulin, currently, is one of the last options tried for Type 2s and even when insulin therapy is started, it's not the same type as Afrezza. So, to recap, we're saying Afrezza should be one of the first medications prescribed and the medical community is saying it should be one of, if not, the last. Now, does that mean we're wrong. Well, probably. But that doesn't mean an argument can't be made still. And, I'll do my best to keep it short here, and it should be noted the battle will be an uphill one to be sure. The medical community doesn't start people out on insulin because of the risk of hypoglycemia and death. Okay, fair enough. But, Afrezza and Humalog/Novolog/Apidra/whatever are not the same and Mannkind has done a poor job driving home that point. Afrezza lasting only an hour is different than the tails of the other fast acting insulins that remain up to 4 hours later. The lack of tails for afrezza really has the ability to change the game with type 2s. Lasting only an hour will greatly diminish the risk of hypos. (Side note, I take Afrezza and it does cause lows for me, but I'm type 1 using it completely differently than post prandial spiking). Using an insulin like Afrezza would relieve the body's pancreas from having to bring down post prandial spikes. And, relieving that pressure should allow the pancreas to keep up with the glucose dumped by the liver. Further, instead of a 24 hour commitment with a basal insulin like lantus which provides no help to the post prandial spikes, patients would get an introduction to insulin via 1 hour doses that will lop the top off the highest of highs. Seems like a better option. All this with minimal modifications to diet. Now....if they can just get all the endos and pcps out there to change this well established practice, Mannkind will be in good shape. Hey Ben, I found this part of your post somewhat unique here on this board. Other than meal spiking and corrections (often because inhaled too early), how else would a T1 be using Afrezza? And how was your dr even willing to prescribe it in such a manner? Excuse the intrusion into personal health, but it would be a nice break from focusing on the investment side of this company for a bit. Several other users are here on board but its a really small subset of forum posters. (I'd even ask the mods to consider your post to be the start of an independent thread). |
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Post by peppy on May 13, 2016 8:13:45 GMT -5
Really a T2 ought to be on Afrezza right off the bat. The pancreas has already lost half of its insulin secreting ability at diagnosis and Afrezza replaces the deficit (first phase insulin) exactly. I agree with this, but it is very far from the standard. From my understanding, the treatment is kind of like a flow chart or a bunch of if/then statements where the preferred treatment is diet and exercise, then metformin, then metformin + other drugs (eg. SGLT2 inhibitors, Sulfonylurea agents, TZDs, etc), then insulin (though insulin may be introduced sooner it is often times avoided until other oral options have been exhausted). And, once insulin is introduced, it is generally a basal insulin (lantus, touejo, levemir, etc) not a fast acting one. So, insulin, currently, is one of the last options tried for Type 2s and even when insulin therapy is started, it's not the same type as Afrezza. So, to recap, we're saying Afrezza should be one of the first medications prescribed and the medical community is saying it should be one of, if not, the last. Now, does that mean we're wrong. Well, probably. But that doesn't mean an argument can't be made still. And, I'll do my best to keep it short here, and it should be noted the battle will be an uphill one to be sure. The medical community doesn't start people out on insulin because of the risk of hypoglycemia and death. Okay, fair enough. But, Afrezza and Humalog/Novolog/Apidra/whatever are not the same and Mannkind has done a poor job driving home that point. Afrezza lasting only an hour is different than the tails of the other fast acting insulins that remain up to 4 hours later. The lack of tails for afrezza really has the ability to change the game with type 2s. Lasting only an hour will greatly diminish the risk of hypos. (Side note, I take Afrezza and it does cause lows for me, but I'm type 1 using it completely differently than post prandial spiking). Using an insulin like Afrezza would relieve the body's pancreas from having to bring down post prandial spikes. And, relieving that pressure should allow the pancreas to keep up with the glucose dumped by the liver. Further, instead of a 24 hour commitment with a basal insulin like lantus which provides no help to the post prandial spikes, patients would get an introduction to insulin via 1 hour doses that will lop the top off the highest of highs. Seems like a better option. All this with minimal modifications to diet. Now....if they can just get all the endos and pcps out there to change this well established practice, Mannkind will be in good shape. Welcome to our lovely abode. I am glad you are here. |
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ben
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Post by ben on May 13, 2016 8:37:31 GMT -5
I agree with this, but it is very far from the standard. From my understanding, the treatment is kind of like a flow chart or a bunch of if/then statements where the preferred treatment is diet and exercise, then metformin, then metformin + other drugs (eg. SGLT2 inhibitors, Sulfonylurea agents, TZDs, etc), then insulin (though insulin may be introduced sooner it is often times avoided until other oral options have been exhausted). And, once insulin is introduced, it is generally a basal insulin (lantus, touejo, levemir, etc) not a fast acting one. So, insulin, currently, is one of the last options tried for Type 2s and even when insulin therapy is started, it's not the same type as Afrezza. So, to recap, we're saying Afrezza should be one of the first medications prescribed and the medical community is saying it should be one of, if not, the last. Now, does that mean we're wrong. Well, probably. But that doesn't mean an argument can't be made still. And, I'll do my best to keep it short here, and it should be noted the battle will be an uphill one to be sure. The medical community doesn't start people out on insulin because of the risk of hypoglycemia and death. Okay, fair enough. But, Afrezza and Humalog/Novolog/Apidra/whatever are not the same and Mannkind has done a poor job driving home that point. Afrezza lasting only an hour is different than the tails of the other fast acting insulins that remain up to 4 hours later. The lack of tails for afrezza really has the ability to change the game with type 2s. Lasting only an hour will greatly diminish the risk of hypos. (Side note, I take Afrezza and it does cause lows for me, but I'm type 1 using it completely differently than post prandial spiking). Using an insulin like Afrezza would relieve the body's pancreas from having to bring down post prandial spikes. And, relieving that pressure should allow the pancreas to keep up with the glucose dumped by the liver. Further, instead of a 24 hour commitment with a basal insulin like lantus which provides no help to the post prandial spikes, patients would get an introduction to insulin via 1 hour doses that will lop the top off the highest of highs. Seems like a better option. All this with minimal modifications to diet. Now....if they can just get all the endos and pcps out there to change this well established practice, Mannkind will be in good shape. Hey Ben, I found this part of your post somewhat unique here on this board. Other than meal spiking and corrections (often because inhaled too early), how else would a T1 be using Afrezza? And how was your dr even willing to prescribe it in such a manner? Excuse the intrusion into personal health, but it would be a nice break from focusing on the investment side of this company for a bit. Several other users are here on board but its a really small subset of forum posters. (I'd even ask the mods to consider your post to be the start of an independent thread). Hey kball, don't worry about the intrusion, I love talking about this stuff and am glad I found this board! I've been t1d for a little over 18 years now in good control, so my docs just let me do what I want (at least those are the kind I seek out). At this point, I'd say my care is about 95% in my control. Dosing, timing, testing, etc are all under my control. My doc does labwork and writes the RXs. Before trying Afrezza, I got a CGM so I could see exactly what was going on. I use Afrezza for the following: corrections, sparingly for drinking sugary drinks (margaritas and old fashions mainly), and the dreaded morning phenomenon. Excluding drinking, as none of that is relevant, the 4u cartridge has caused lows from over correcting a couple times. The most glaring example came one afternoon. The CGM was showing blood glucose increasing and was up to about 170 (had been snacking on cheese and crackers). I checked with the glucometer and found this to be correct. So, I inhaled a 4u cartridge. 30 minutes later (15 minutes for Afrezza to kick in and 15 minutes for the CGM to reflect it) the CGM was still showing an increase and was up to about 200. Then 205 35 minutes later. So, I took another 4 u cartridge. 30 minutes later I was drooling on myself. The cgm was still reading 200, but when I checked the glucometer I was at 35. This was 100% my fault as I should have checked with the glucometer before taking the 2nd dose. But, with no other fast acting on board on a basal that was stable, it's tough to conclude anything other than the Afrezza caused that low. There have been other instances where a 4u cartridge took me from 140ish to 60ish as well. It's a hammer and it acts as a hammer nailing BG numbers down down down regardless of where mine are. So...take it at 100 and watch out...it's going to lower blood glucose 80 points or so. This is my experience at least. Regarding the investment side, I found this website through seeking alpha and wouldn't touch the stock right now, but that is mainly because I strongly disagree with how management is handling this. This is not an insulin that is comparable to the other fast acting options (humalog/novolog/etc) but they seem to be trying to compete with them directly. This seems to be a losing effort and I think it will continue to be. They should market it as its own classification. It acts faster and is gone faster. There is a use for that, even if it is not countering a typical dinner. Like I said, I'm pretty much in control of everything and don't rely on docs at this point. And, I want every arrow available in my quiver. Afrezza is definitely a different arrow. |
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ben
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Post by ben on May 13, 2016 9:00:41 GMT -5
Welcome to our lovely abode. I am glad you are here. Glad to be here. Thanks! |
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ben
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Post by ben on May 13, 2016 9:04:49 GMT -5
Help me out here, experts. My understanding is that the first effects of T2D arise from increasing insulin resistance, generally caused by a lipid imbalance. That lipid imbalance (excess fat in the liver and pancreas, elevated triglycerides) can often be corrected through diet and exercise. Failing that, the next step is metformin, which knocks down the level of glucose independent of the level of insulin. It's only when the beta cells in the pancreas fail, from exhaustion or because they're choked with fat, that the level of insulin declines. If you just increase the amount of insulin (inhaled or otherwise) early on without addressing the lipid imbalance, how will that reverse the disease progression? Tayl5 please read www.ncbi.nlm.nih.gov/pubmed/18502299Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial Wow, hadn't seen that before. Thanks for posting. Has that study been replicated anywhere? |
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