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Post by nadathing on Aug 19, 2016 12:34:49 GMT -5
The dawn phenomenon was the most frustrating experience I have had with my diabetes. Absolutely nothing would help. Recommendations included eating protein prior to going to bed and then trying carbohydrates. Neither worked. One of the things we experience as diabetics is burn out from attempting to control something that we have no control over and we give up trying. As we have read from many Afrezza users, they now have control over meal time spikes. I truly believe that Afrezza will lead to more diabetics staying compliant with their regiment. It is a life saver.
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Post by mnholdem on Aug 19, 2016 12:46:24 GMT -5
My diabetes is tightly controlled. A1c is 5.8. Not insulin dependent. My blood sugar spikes between 3:00 AM and 5:00 AM (wore a meter that checked every 5 minutes. Wore it for 2 weeks during the study). Readings when I woke up were between 200-220 every morning while on Glipizide. My before meal and after meal readings were within range and continue to stay in range. Afrezza is a meal time insulin. Morning readings on Bydureon and Trulicity are between 90 120. Why would I take it? I doubt many doctors are willing to prescribe a meal time insulin (Afrezza or otherwise) for a T2 with tight control under their current regiment. I was a regular poster on the YMB for years, but quit regular posting after being attacked by several posters who think that every T2 should be on Afrezza. I am fully aware of the potential health issues associated with GLP-1's. I have to weigh out the risk/benefit to the drugs I take. I have absolutely no concerns about the safety of Afrezza, but I will not request it until I become insulin dependent. Most T2's will become insulin dependent if they live long enough according to my endo. This is where the legendary Alfred Mann may have disagreed with your endo, arguing the merits of Afrezza as a first line treatment in that it can result in a healing of the pancreas and remission of the disease if administered BEFORE the pancreas gets damaged beyond repair and no longer has healthy beta-cells to produce insulin, thus leaving the patient to become insulin dependent.
Of course, your endo is only advocating that which s/he was taught for two decades by the academic community and big pharmaceutical companies.
Source: www.diabetesincontrol.com/an-exclusive-interview-with-al-mann-founder-and-ceo-mannkind-corp/
Claims/evidence of drug-free remission of diabetes mellitus following short-term intensive insulin (STII) therapy: onlinelibrary.wiley.com/doi/10.1002/dmrr.2603/full
---
I'm not suggesting that you not follow your doctor's advice. I am merely in total agreement with Alfred Mann that Afrezza represents a paradigm shift in the treatment of diabetes and, as disruptive medicine, will face an arduous journey of convincing the medical community on its way to becoming the gold standard of early diabetes treatment.
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Post by mannmade on Aug 19, 2016 12:51:01 GMT -5
The dawn phenomenon was the most frustrating experience I have had with my diabetes. Absolutely nothing would help. Recommendations included eating protein prior to going to bed and then trying carbohydrates. Neither worked. One of the things we experience as diabetics is burn out from attempting to control something that we have no control over and we give up trying. As we have read from many Afrezza users, they now have control over meal time spikes. I truly believe that Afrezza will lead to more diabetics staying compliant with their regiment. It is a life saver. No personal comment here one way or the other as I am not a diabetic. Just want to point out that those currently using AFREZZA have pointed out that it eliminates the "dawn effect" for many.
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Post by end2war on Aug 19, 2016 13:04:58 GMT -5
I don't have diabetes, but needed to lose weight and started reading the WFPB doctors (stands for "whole food, plant based") including DR. Michael Greger, Dr. Joel Furman, Dr. Dean Ornish, Dr. John A. McDougall, and also the teachings of Esalen. The common thread for diabetics is that the diets recommended appear to bring about lower weights, lower cholesterol, lower A1C scores and lower incidences of diabetic and heart health problems. There is a mass of data supporting their WFPB diets including such books as the China Study and some of the doctors have authored their own well researched books. One problem in considering the recommendations for diets from this group is that it probably will require a fairly large change in what you are used to eating. They all talk about the "sad American diet" or SAD and they all recommend major reductions in animal fat, dairy, salt and increases in whole plant based foods like vegetables and fruits. Some, like McDougall favor rice and potatoes, while most suggest high nutrient low calorie foods.
I have been trying this method of diet for 3 months and dropped weight WITHOUT counting calories, when nothing else would work including Adkins diet, because what you eat is more filling and low calorie. My blood pressure fell to very good levels, and my LDL has dropped to my target zone. This was not being achieved with statins alone, and I have now found in an experiment on myself that food is a very good medicine for me to resolve these issues WITH NO SIDE EFFECTS that comes from taking medications prescribed by doctors.
From what I have read, anyone that is borderline diabetic should read these authors and make up their own mind about whether to give these diet choices a chance. This group believes that the Adkins diet is the worst thing you can do, even though it will help some lose weight.
All of the above people have web sites, and if you start with any one of them, I have found that Dr Michael Greger is one of the best sources of information on diet you can find anywhere. He has a current best selling book out called, "How Not to Die" and he does not make money from the book (all proceeds are donated) and he has thousands of short videos and blogs on every conceivable diet subject. Plus, I find him to be quite funny at times, which is a plus for me. He has literally read and digested just about everything there is in the field, so his latest lectures, books, blogs and videos are really cutting edge, IMO.
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Post by Deleted on Aug 19, 2016 14:13:57 GMT -5
end2war I view your points as one taking personal responsibility for their health and change the things they can change to better their situation. For those that can still have a positive impact on their health, this should be the first line of defense. Those that don't or can't because of their health, such as T1s, need medical intervention. I have read many posts over the years from diabetics talking about their food choices and I'm always shocked to hear so much about desserts. Diabetics talk up desserts like its the holy grail. I'm old now and I don't have diabetes but I also work out for an hour per day and never touch added processed sugar - never. I don't drink soda's, I don't eat cakes and sweets. And before someone says it - my life is not boring. Far from it. My life is full of fun and activity and not weighed down by all the processed foods being served up by our industrial food conglomerates. Simple proteins with mostly raw veges, plenty of fresh air and water, and a small daily dose of rotated carbs (amaranth, quinoa, rice, sweet potatos) and I've never been overweight, sick, without energy, etc. I have plenty of old friends who eat all the industrial junk and they are paying for it in poor health and expensive healthcare interventions. I prefer personal responsibility when possible.
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Post by nadathing on Aug 19, 2016 14:42:21 GMT -5
I agree. I had to tell my endo I wanted Bydureon and she was reluctant to prescribe it. Keep in mind that my endo is in the same building where The International Diabetes Center is located and I participated in the 3 year trial. She was not a part of the trial team yet she knew I was on Bydureon and still had no real knowledge of it. She told me she would hold off prescribing it until she had done some research on it. She later called me to read the black box warning and said she would reluctantly prescribe it for me.
I truly believe that endo's are going to be reluctant to prescribe Afrezza. Old habits die hard. I think patient demand is necessary. I thought the ramp up period by Sanofi to educate doctors was necessary, but they did a piss poor job. I thought that after the endo's were educated they would launch a direct to consumer advertising campaign. That would drive patients to demand Afrezza and endo's most endo's would rather write the script rather than argue with patients or risk losing them. I understand Matt's reasoning for doing targeted mailings, but a large ad campaign would take Afrezza sales to blockbuster status IMO. If only MNKD had they money to do it...
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Post by kc on Aug 19, 2016 14:49:13 GMT -5
I received a letter from MNKD today telling me about new Savings Card Program. It says the new program copay may be as little as $15 for a maximum of 24 benefits per calendar year. The card has a $150 max benefit per fill. The mailing also includes information on the use of Afrezza as well as the black box warning information, which is no surprise. I am T2 and have never contacted MNKD. I am not insulin dependent and do not use Afrezza. How they obtained my name is unknown. I am thrilled to see them targeting diabetics directly through mailings. What medications are you on being a T2? They must be mailing letters to people who had requested information from Sanofi. I got such a letter two days ago. It had the letter and a big insert about Afrezza and how to use it. Great colorful piece that was about 18'X 24" below are shots of the insert and the letter. It was sent from the fulfillment company McKesson who also did the work for Sanofi.
Mailer insert side one:
Insert side two:
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Post by agedhippie on Aug 19, 2016 15:16:38 GMT -5
Two data points; you don't become diabetic until you have lost 40% of your beta cells, and rats are a poor model for humans (there are currently two cures for Type 1 diabetes in rats - neither work in humans).
The early use of insulin produces what is known as the honeymoon effect. Part of the loss of beta cells is not real but rather due to being stressed. Insulin removes the stress and allows the beta cells to recover which can bump you above that 40% line. The problem is that the underlying deficiency, which is genetic, continues to accumulate and you will hit the 40% line in the end (my guess is 2 to 5 years later). The rate of decline varies from person to person.
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Post by flatrock on Aug 19, 2016 16:29:31 GMT -5
What medications are you on being a T2? They must be mailing letters to people who had requested information from Sanofi. I got such a letter two days ago. It had the letter and a big insert about Afrezza and how to use it. Great colorful piece that was about 18'X 24" below are shots of the insert and the letter. It was sent from the fulfillment company McKesson who also did the work for Sanofi.
Mailer insert side one:
Insert side two:
That really doesn't look like a direct mail ad, does it? It looks more like something the company might send to someone already on afrezza and already using a card.
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Post by Deleted on Aug 19, 2016 16:39:32 GMT -5
I don't have diabetes, but needed to lose weight and started reading the WFPB doctors (stands for "whole food, plant based") including DR. Michael Greger, Dr. Joel Furman, Dr. Dean Ornish, Dr. John A. McDougall, and also the teachings of Esalen. The common thread for diabetics is that the diets recommended appear to bring about lower weights, lower cholesterol, lower A1C scores and lower incidences of diabetic and heart health problems. There is a mass of data supporting their WFPB diets including such books as the China Study and some of the doctors have authored their own well researched books. One problem in considering the recommendations for diets from this group is that it probably will require a fairly large change in what you are used to eating. They all talk about the "sad American diet" or SAD and they all recommend major reductions in animal fat, dairy, salt and increases in whole plant based foods like vegetables and fruits. Some, like McDougall favor rice and potatoes, while most suggest high nutrient low calorie foods. I have been trying this method of diet for 3 months and dropped weight WITHOUT counting calories, when nothing else would work including Adkins diet, because what you eat is more filling and low calorie. My blood pressure fell to very good levels, and my LDL has dropped to my target zone. This was not being achieved with statins alone, and I have now found in an experiment on myself that food is a very good medicine for me to resolve these issues WITH NO SIDE EFFECTS that comes from taking medications prescribed by doctors. From what I have read, anyone that is borderline diabetic should read these authors and make up their own mind about whether to give these diet choices a chance. This group believes that the Adkins diet is the worst thing you can do, even though it will help some lose weight. All of the above people have web sites, and if you start with any one of them, I have found that Dr Michael Greger is one of the best sources of information on diet you can find anywhere. He has a current best selling book out called, "How Not to Die" and he does not make money from the book (all proceeds are donated) and he has thousands of short videos and blogs on every conceivable diet subject. Plus, I find him to be quite funny at times, which is a plus for me. He has literally read and digested just about everything there is in the field, so his latest lectures, books, blogs and videos are really cutting edge, IMO. If you go into Super Markets most have meat and veggies along outer walls of store. All the crap is on the inside shelves. Thus comes the saying never buy food on the inside only the perimeter. If you are in the middle you are in the wrong place
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Post by od on Aug 19, 2016 16:48:40 GMT -5
What medications are you on being a T2? They must be mailing letters to people who had requested information from Sanofi. I got such a letter two days ago. It had the letter and a big insert about Afrezza and how to use it. Great colorful piece that was about 18'X 24" below are shots of the insert and the letter. It was sent from the fulfillment company McKesson who also did the work for Sanofi.
Mailer insert side one:
Insert side two:
The PI was included to be compliant with FDA regulations. (I am not suggesting MNKD would not include it if it was not a requirement. -- Excuse the double negative.)
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Post by uvula on Aug 19, 2016 21:15:22 GMT -5
Two data points; you don't become diabetic until you have lost 40% of your beta cells, and rats are a poor model for humans (there are currently two cures for Type 1 diabetes in rats - neither work in humans). The early use of insulin produces what is known as the honeymoon effect. Part of the loss of beta cells is not real but rather due to being stressed. Insulin removes the stress and allows the beta cells to recover which can bump you above that 40% line. The problem is that the underlying deficiency, which is genetic, continues to accumulate and you will hit the 40% line in the end (my guess is 2 to 5 years later). The rate of decline varies from person to person. Hippie, I respect your opinion and comments very much and you are much more knowledgeable than I am. Is it safe to say that we don't really know if early insulin treatment will prevent further beta cell damage because the study has never been done? Others here have claimed that it was not possible to do the study before afrezza was created. (Sorry if we're getting off topic.)
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Post by beardawg on Aug 19, 2016 22:12:50 GMT -5
Two data points; you don't become diabetic until you have lost 40% of your beta cells, and rats are a poor model for humans (there are currently two cures for Type 1 diabetes in rats - neither work in humans). The early use of insulin produces what is known as the honeymoon effect. Part of the loss of beta cells is not real but rather due to being stressed. Insulin removes the stress and allows the beta cells to recover which can bump you above that 40% line. The problem is that the underlying deficiency, which is genetic, continues to accumulate and you will hit the 40% line in the end (my guess is 2 to 5 years later). The rate of decline varies from person to person. Hippie, I respect your opinion and comments very much and you are much more knowledgeable than I am. Is it safe to say that we don't really know if early insulin treatment will prevent further beta cell damage because the study has never been done? Others here have claimed that it was not possible to do the study before afrezza was created. (Sorry if we're getting off topic.) I think they were talking about reversing T2D, which is usually non-genetic and generally occurs when beta cells work harder and harder until they give out, while T1D occurs because the immune system attacks the beta cells until they are gone (the ones left during this process give out because they try to pick up the slack).
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Post by uvula on Aug 19, 2016 23:01:40 GMT -5
Beardawg, aged hippie was also talking about t2d.
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