|
|
Post by cjm18 on Oct 22, 2016 15:31:49 GMT -5
I was talking to a friend over 60 that's type 2 the other day and he was telling me his doctor says anything under 170 is fine for his age, he is averaging around 140 most days. He is on metamophine and was told by his doctor the use of meal time insulin would only further reduce the the production of insulin by his own pancreas. Does this sound like the norm to those in the know here. It's hard for me to say for sure that the doctor is wrong since I'm not a doctor, but from my understanding of the matter, decreasing the pancreas' workload for a type 2 will allow the beta cells of the pancreas to relax, which would eventually end up increasing their function (lookup pancreas beta exhaustion for reference). I know this to be the case for the majority of people, but there may be some reason for this person that it might not be true. I just don't know of any reasons why it wouldn't be true for him. The doctors opinion contradicts the study (where is it?) of starting intensive insulin early can put diabetes into remission... Would it be diabetes or the insulin that causes less insulin production? I read spikes in blood sugar aka soda can causes diabetes because of too high of spike in insulin produced. Nevertheless, there's plenty of diabetics on insulin. Humalog and the like sell billions of dollars a year. Afrezza doesn't have to replace pills to be successful. |
|
|
|
Post by mnkdnut on Oct 22, 2016 15:43:28 GMT -5
Sarcasm? Why aren't endos writing Afrezza?  ? Endos are not listening. They do not seem to be looking at evidence of CGM, improved a1c and/or patient feelings of well being. They seem to be sticking to the script. screencast.com/t/nOwBa4aaA The physicians are not thinking afrezza through. screencast.com/t/qHsWcjqc screencast.com/t/ZytPXkO7 afrezzadownunder.com/
No Endo worth his/her own salt would decide to prescribe based on "listening" to anecdotal evidence presented on social media. If they have the time to investigate it, they may find it a bit intriguing, but they have to ask "why does their clinical trial data show it's not any better?" and "if it's so good, why would Sanofi launch it but then give up on it so quickly?" Mike's sales force has the unenviable challenge of approaching endos one by one and answering these (and other) tough questions acceptably within FDA guidelines - and then, if they are successful, the endo will still proceed with caution. Like it or not, doctors have to think about the potential of being sued for trying something new that doesn't turn out well. Controlled clinical trials have the scientific rigor to cover them, whereas the reports we see on social media do not. It's not so much the endos fault for "not listening" (although they may not be listening to their patients very well sometimes) , it's more MNKD's fault for failing to demonstrate the benefits with enough scientific rigor to be listened to. Matt needs to buy more time for them to do so (pediatric study). And this time, they need to have sufficient knowledge of their own titration rules to create a protocol that actually demonstrates the difference. Sanofi has already shown that left with minimal instructions like "take X-dose at meal-time", new patients' refill rates are miserable. |
|
|
|
Post by sophie on Oct 22, 2016 15:51:36 GMT -5
It's hard for me to say for sure that the doctor is wrong since I'm not a doctor, but from my understanding of the matter, decreasing the pancreas' workload for a type 2 will allow the beta cells of the pancreas to relax, which would eventually end up increasing their function (lookup pancreas beta exhaustion for reference). I know this to be the case for the majority of people, but there may be some reason for this person that it might not be true. I just don't know of any reasons why it wouldn't be true for him. The doctors opinion contradicts the study (where is it?) of starting intensive insulin early can put diabetes into remission... Would it be diabetes or the insulin that causes less insulin production? I read spikes in blood sugar aka soda can causes diabetes because of too high of spike in insulin produced. Nevertheless, there's plenty of diabetics on insulin. Humalog and the like sell billions of dollars a year. Afrezza doesn't have to replace pills to be successful. |
|
|
|
Post by prvs on Oct 22, 2016 16:04:33 GMT -5
With refills rising above NRx, the titration packs are now stating to enter the data. After the titration packs are exhausted the NRx start. Thus the refills involving new patient titration packs are driving script growth. This seesaw action will continue and cause that sudden rise in scripts that we are looking for. Id like to see further evidence of this in the next three weeks as we approach the time for the CC
|
|
|
|
Post by cjm18 on Oct 22, 2016 16:05:23 GMT -5
Endos are not listening. They do not seem to be looking at evidence of CGM, improved a1c and/or patient feelings of well being. They seem to be sticking to the script. screencast.com/t/nOwBa4aaA The physicians are not thinking afrezza through. screencast.com/t/qHsWcjqc screencast.com/t/ZytPXkO7 afrezzadownunder.com/
No Endo worth his/her own salt would decide to prescribe based on "listening" to anecdotal evidence presented on social media. If they have the time to investigate it, they may find it a bit intriguing, but they have to ask "why does their clinical trial data show it's not any better?" and "if it's so good, why would Sanofi launch it but then give up on it so quickly?" Mike's sales force has the unenviable challenge of approaching endos one by one and answering these (and other) tough questions acceptably within FDA guidelines - and then, if they are successful, the endo will still proceed with caution. Like it or not, doctors have to think about the potential of being sued for trying something new that doesn't turn out well. Controlled clinical trials have the scientific rigor to cover them, whereas the reports we see on social media do not. It's not so much the endos fault for "not listening" (although they may not be listening to their patients very well sometimes) , it's more MNKD's fault for failing to demonstrate the benefits with enough scientific rigor to be listened to. Matt needs to buy more time for them to do so (pediatric study). And this time, they need to have sufficient knowledge of their own titration rules to create a protocol that actually demonstrates the difference. Sanofi has already shown that left with minimal instructions like "take X-dose at meal-time", new patients' refill rates are miserable. Couldn't agree more. It just doesn't make sense that there are 1100 doctors listed on afrezza website. Did they all put one patient on it and saw no results? |
|
|
|
Post by cjm18 on Oct 22, 2016 16:09:53 GMT -5
With refills rising above NRx, the titration packs are now stating to enter the data. After the titration packs are exhausted the NRx start. Thus the refills involving new patient titration packs are driving script growth. This seesaw action will continue and cause that sudden rise in scripts that we are looking for. Id like to see further evidence of this in the next three weeks as we approach the time for the CC I'm of the understanding that titration packs are nrx. |
|
|
|
Post by bwills on Oct 22, 2016 17:46:09 GMT -5
With refills rising above NRx, the titration packs are now stating to enter the data. After the titration packs are exhausted the NRx start. Thus the refills involving new patient titration packs are driving script growth. This seesaw action will continue and cause that sudden rise in scripts that we are looking for. Id like to see further evidence of this in the next three weeks as we approach the time for the CC I'm of the understanding that titration packs are nrx. Maybe someone could clarify this. My understanding was that titration packs were being given out free with each Nrx, at least partly because confusion over the NDC led to some sort of error either with with stocking the titration packs or with how insurers classified them. |
|
|
|
Post by rockstarrick on Oct 22, 2016 18:40:00 GMT -5
I'm of the understanding that titration packs are nrx. Maybe someone could clarify this. My understanding was that titration packs were being given out free with each Nrx, at least partly because confusion over the NDC led to some sort of error either with with stocking the titration packs or with how insurers classified them. I found this |
|
|
|
Post by rockstarrick on Oct 22, 2016 18:43:51 GMT -5
Maybe someone could clarify this. My understanding was that titration packs were being given out free with each Nrx, at least partly because confusion over the NDC led to some sort of error either with with stocking the titration packs or with how insurers classified them. I found this It's sounds like they are handed out with prescriptions, so if you get a monthly rx + titration pack it could delay the need for the new rx, not sure though. maybe Mike C could explain better. Hope this was helpful. |
|
|
|
Post by sweedee79 on Oct 22, 2016 18:57:06 GMT -5
I was talking to a friend over 60 that's type 2 the other day and he was telling me his doctor says anything under 170 is fine for his age, he is averaging around 140 most days. He is on metamophine and was told by his doctor the use of meal time insulin would only further reduce the the production of insulin by his own pancreas. Does this sound like the norm to those in the know here. My dad is 75 and the docs tell him that an A1C between 7 and 8 is acceptable for his age.... He is insulin dependent .. it appears that the older the patient is(at least for those on insulin) they don't want to push for a lower A1C becuz they are more fearful of a hypo, as the older you are the more dangerous it is. This is the standard of care for older patients.
Also, my dad is actually diagnosed as T2(misdiagnosed) even though his pancreas just up and quit working when he was in his 50s .. he was hospitalized and very ill, almost died... and has always been insulin dependent... it is actually LADA (Latent Autoimmune Disease in Adults) or T1.5... Docs call it T2 because he developed diabetes as an adult which is ridiculous in IMO .. and I tell them this..  While he does have insulin resistance now after so many years of taking insulin (double diabetes) .. that isn't his main problem...
www.diabetesforecast.org/2010/may/the-other-diabetes-lada-or-type-1-5.html
When a new drug comes along that is better ... perhaps changes the "standard of care" ... many docs wont be the first ones to prescribe it... they will wait for others to stick their necks out first... One of my dads docs flat out told him this.. the GPs and PAs will be the last ones to prescribe a new drug...
Our health care system is lacking to say the least .. it is a slow moving machine that has a lot to do with docs protecting themselves.. insurance companies trying to save to a buck.. etc etc etc... and so yes... what your friend says sounds like the norm to me...
|
|
|
|
Post by sophie on Oct 22, 2016 18:59:30 GMT -5
It's sounds like they are handed out with prescriptions, so if you get a monthly rx + titration pack it could delay the need for the new rx, not sure though. maybe Mike C could explain better. Hope this was helpful. Rx means you have to go to the pharmacy to get it. |
|
|
|
Post by sophie on Oct 22, 2016 19:08:48 GMT -5
Our health care system is lacking to say the least .. it is a slow moving machine that has a lot to do with docs protecting themselves.. insurance companies trying to save to a buck.. etc etc etc... and so yes... what your friend says sounds like the norm to me... I know many will say that they're here for medical advancement, but it's this same system that brings us all here as stock investors. If biotech and pharma weren't so lucrative, there probably wouldn't be as many investors. Certainly not as much money to be made. This is one of the biggest reasons I'm against a single payor system. It would be difficult to have such great R/D if the government set the pricing for medication. That, along with decreased physician salaries; unless tort reform negates the difference. But I'll leave politics out of this. |
|
|
|
Post by rockstarrick on Oct 22, 2016 19:10:58 GMT -5
I believe when your Dr hands you your prescription, he also gives you the titration pak, the rx is filled at the pharmacy.
Does this make sense ??
|
|
|
|
Post by agedhippie on Oct 22, 2016 19:46:44 GMT -5
Our health care system is lacking to say the least .. it is a slow moving machine that has a lot to do with docs protecting themselves.. insurance companies trying to save to a buck.. etc etc etc... and so yes... what your friend says sounds like the norm to me... I know many will say that they're here for medical advancement, but it's this same system that brings us all here as stock investors. If biotech and pharma weren't so lucrative, there probably wouldn't be as many investors. Certainly not as much money to be made. This is one of the biggest reasons I'm against a single payor system. It would be difficult to have such great R/D if the government set the pricing for medication. That, along with decreased physician salaries; unless tort reform negates the difference. But I'll leave politics out of this. Mylan would be upset for a start - a pair of Epipens retail from a pharmacy in Europe costs 20% of the US cost so the US is paying 5 x UK price. Humalog costs 10% of the US price in the UK. Price gouging is far harder in a single payer system. Where there are high cost drugs, cancer treatments for example, then price gets linked to results so if you make an effetive drug you are going to make money but come up with anything else and you are go nowhere. The whole trick of minor tinkering to produce a new medicine by combining two common drugs into a single pill (for example Janumet - Januvia and Metformin) is DOA. |
|
|
|
Post by mnkdfann on Oct 22, 2016 19:51:17 GMT -5
I believe when your Dr hands you your prescription, he also gives you the titration pak, the rx is filled at the pharmacy. Does this make sense ?? Castagna said the titration packs are given via an Rx. It does not sound to me as though the doctor is handing the packs out physically. Rather, that patients get them via an Rx they have to fill at a pharmacy. In a conference call, Castagna said: "The other thing you’ll hear us launch which is just a short term pilot is a voucher program. This voucher program will be good for one month sample of the titration pack and this is meant to drive demand pull through to the wholesale channel to ensure the local pharmacies are stocking it as well as a supplement for our current sample program. See: mnkd.proboards.com/thread/5978/pairing-afrezza-basalIt sounds to me like the doctor writes a prescription for the pack and gives the patient a voucher to use in conjunction with it, to cover the cost. And that the titration packs will be picked up from the local pharmacy. |
|
?
While he does have insulin resistance now after so many years of taking insulin (double diabetes) .. that isn't his main problem... 
