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Post by peppy on Jul 11, 2016 7:48:40 GMT -5
thats why I feel sorry for your endo and you to assume since both are inhaled, there may be an issue with one since they was issue with one . Thats just an un educated way. You dont have to be an endo to make that assumption. Unfortunately he did. And when i say how they work, does he know exubera does also have sodium citrate,mannitol ,glycine ,sodium hydroxide ? they work the same lol... It's a valid approach - he says it may be an issue, you say it may not. At this point nobody knows because it hasn't been in the field long enough or widely enough. If there will be minimal progression while you wait and find out the result that is a perfect reasonable. We both think the probability of fibrosis is low but why take the risk? As to how it works - I said was that they were both inhaled not that they both worked the same (Exubera, Afrezza, and Dance all deliver inhaled insulin differently). I am looking at who has control and is making the decisions here. Is it you aged or the physician or both? As long as you are happy who cares. These physicians can be a bit like choosing a mother? to make the best decisions for us.... because we are too stupid to know and decide our whole life through. very interesting.
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Post by agedhippie on Jul 11, 2016 7:56:31 GMT -5
Forgive my ignorance on the subject, but if the issue is sustained high levels of insulin in the body doesn't the fast in/fast out profile of AFREZZA make it a better alternative than the current RAA's in which PWD often stack their insulin after meals? Yes I think Afrezza would be better than RAA for that reason. The problem is that in Type 2 you naturally run high insulin levels as your body attempts to overcome steadily increasing insulin resistance. So you are alternating between high and higher levels throughout the day. You want to keep those levels as low as possible for as long as possible and fast clearance does that. Stacking in itself isn't bad and I do it all the time - it's implicit really in MDI since you bolus when you eat so if you eat two snacks in an hour or so you just stacked even with Afrezza. Stacking and not adjusting for that stacking is where the problem is. If someone is doing that they need to be retrained on insulin ASAP.
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Post by agedhippie on Jul 11, 2016 9:00:21 GMT -5
It's a valid approach - he says it may be an issue, you say it may not. At this point nobody knows because it hasn't been in the field long enough or widely enough. If there will be minimal progression while you wait and find out the result that is a perfect reasonable. We both think the probability of fibrosis is low but why take the risk? As to how it works - I said was that they were both inhaled not that they both worked the same (Exubera, Afrezza, and Dance all deliver inhaled insulin differently). I am looking at who has control and is making the decisions here. Is it you aged or the physician or both? As long as you are happy who cares. These physicians can be a bit like choosing a mother? to make the best decisions for us.... because we are too stupid to know and decide our whole life through. very interesting.
It's a good question. It's more like a relationship really and we can always break up (I have a string of ex-endos - cue Taylor Swift Blank Space ). Like all relationships its a matter of balance with him helping me live my life how I want ('You want to do what!? Ok lets work out how to do that safely') and me not pushing him to do things he really doesn't want to do. Ultimately though if I feel I must do something and he feels he cannot be part of it then it's over and I'm back in the dating phase again (metaphorically speaking).
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Post by mannmade on Jul 11, 2016 11:48:51 GMT -5
Forgive my ignorance on the subject, but if the issue is sustained high levels of insulin in the body doesn't the fast in/fast out profile of AFREZZA make it a better alternative than the current RAA's in which PWD often stack their insulin after meals? Yes I think Afrezza would be better than RAA for that reason. The problem is that in Type 2 you naturally run high insulin levels as your body attempts to overcome steadily increasing insulin resistance. So you are alternating between high and higher levels throughout the day. You want to keep those levels as low as possible for as long as possible and fast clearance does that. Stacking in itself isn't bad and I do it all the time - it's implicit really in MDI since you bolus when you eat so if you eat two snacks in an hour or so you just stacked even with Afrezza. Stacking and not adjusting for that stacking is where the problem is. If someone is doing that they need to be retrained on insulin ASAP. Thank you Aged... So my next question is would AFREZZA also be better choice for T2's as opposed to being on a basal as their first insulin experience? With the same fast in/fast out profile it would help during the meal period where insulin is most needed. Also as I recall there is some evidence that AFREZZA may reduce insulin resistance. This would make AFREZZA a safe form of insulin for both T1 and T2 PWD.
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Post by agedhippie on Jul 11, 2016 12:27:33 GMT -5
Yes I think Afrezza would be better than RAA for that reason. The problem is that in Type 2 you naturally run high insulin levels as your body attempts to overcome steadily increasing insulin resistance. So you are alternating between high and higher levels throughout the day. You want to keep those levels as low as possible for as long as possible and fast clearance does that. Stacking in itself isn't bad and I do it all the time - it's implicit really in MDI since you bolus when you eat so if you eat two snacks in an hour or so you just stacked even with Afrezza. Stacking and not adjusting for that stacking is where the problem is. If someone is doing that they need to be retrained on insulin ASAP. Thank you Aged... So my next question is would AFREZZA also be better choice for T2's as opposed to being on a basal as their first insulin experience? With the same fast in/fast out profile it would help during the meal period where insulin is most needed. Also as I recall there is some evidence that AFREZZA may reduce insulin resistance. This would make AFREZZA a safe form of insulin for both T1 and T2 PWD. The T2 question is a good one. My gut feeling is that it would be better to use Afrezza than basal. The problem splits into two sections - glucose from food, and glucose the liver puts out 24x7 to keep the body running. The T2 has enough insulin to deal with one or the other but not both. It has been considered better to use the body's insulin to deal with meals because that was the harder problem so basal insulin frees you up to do that. Now the PK/PD of Afrezza may flip that calculation and make it better to use the body's insulin to deal with basal which while easier is still a problem as it fluctuates during the day (dawn phenomena being a case in point) and Lantus or Tresiba don't. I think there is mileage here but it's going to take a trial to change the approach. It also introduces cost and compliance challenges.
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Post by cm5 on Jul 17, 2016 16:04:52 GMT -5
To give some perspective--see below. And, insulin analogues circulate far longer, sometimes many many hours.
And, please recall that 100% of circulatory output from heart is pumped at least several times a minute through the heart. So, alveolar endothelial cells continue to be exposed to insulin for hours.
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