|
|
Post by madog365 on Dec 9, 2016 15:57:22 GMT -5
In another thread today, there was a question about why many people who tried Afrezza did not end up sticking with it. Obviously we know that titration is an issue that is being addressed but is there something else? Let's keep the cost/insurance issues out of discussion for a moment.
One similarity i have noticed between all of the successful afrezza users was that they have a CGM.
Here is a quote from tudiabetes:
"Seriously you kinda have to unlearn the regimented stuff you do with novolog/humalog, carb counting, and all that. If I do take novolog with it then I do have to estimate carbs. There's a big margin for error though, you just have to get in the ballpark. I can't imagine doing it without a cgm though. Maybe that's why I almost gave up on my first try until I got my Dexcom. My precious...."
With a CGM, Afrezza benefits are clearly demonstrated to users. They see the fast action and results in real time. However without it, things seem a bit confusing and i can see how some users can't get dialed in.
As CGM continue to gain insurance coverage and market penetration i think we will see much larger afrezza growth. I was trying to see what percentage of PWD currently use CGM - I believe this is the real target market the Mannkind should be marketing to.
|
|
|
|
Post by dreamboatcruise on Dec 9, 2016 16:25:17 GMT -5
In another thread today, there was a question about why many people who tried Afrezza did not end up sticking with it. Obviously we know that titration is an issue that is being addressed but is there something else? Let's keep the cost/insurance issues out of discussion for a moment. One similarity i have noticed between all of the successful afrezza users was that they have a CGM. Here is a quote from tudiabetes: "Seriously you kinda have to unlearn the regimented stuff you do with novolog/humalog, carb counting, and all that. If I do take novolog with it then I do have to estimate carbs. There's a big margin for error though, you just have to get in the ballpark. I can't imagine doing it without a cgm though. Maybe that's why I almost gave up on my first try until I got my Dexcom. My precious...." With a CGM, Afrezza benefits are clearly demonstrated to users. They see the fast action and results in real time. However without it, things seem a bit confusing and i can see how some users can't get dialed in. As CGM continue to gain insurance coverage and market penetration i think we will see much larger afrezza growth. I was trying to see what percentage of PWD currently use CGM - I believe this is the real target market the Mannkind should be marketing to. CGMs will probably be limited to the Type 1 market, both for cost reasons and because of convenience/stigma/etc. With an early diagnose in life, Type 1 PWD often are the ones that are super motivated to do whatever they can to remain healthy even if it means a sensor burried under the skin all the time... and fighting to get insurance to pay for it. For the larger Type 2 market, it will likely need to be a moderately priced noninvasive BG meter to get payer and patient acceptance. That still appears some way off. |
|
|
|
Post by peppy on Dec 9, 2016 16:57:00 GMT -5
two things.
there is a group at tudiabetes that is as stated above in the opening, using subq fast acting and afrezza.
It may be Afrezza is easier on a subq fast acting vacation.
secondly, The Mike H question about afrezza becoming less effective for him over time? He asked on twitter, sports posted. Mike using afrezza and fast acting.
REmember back to Amy asking if was any one having a problem with afrezza, she too using it with fast acting.
So I am asking myself, what could it be they are talking about.
Here is my thinking.
When a type one, first starts using afrezza, and they get the first "first phase insulin hit to the liver, they have had for a long time, they are all getting results, the first phase kicking in. Gluconeogenesis shuts down and the phase two takes over.
My thinking is over time, "Is the liver getting used to, or more accustom to," the large glucose hit. In that cause, what they may be saying is the units they need increases." Then they think it is not working.
Just trying to think it through. Success, may be, taking the units needed per small, medium and large meal and not being afraid to take enough units, or having the titration pack by any name, the glucose monitor helping.
I am sure people had to work hard at learning their subq insulin.
|
|
|
|
Post by hillsave on Dec 9, 2016 17:02:22 GMT -5
In another thread today, there was a question about why many people who tried Afrezza did not end up sticking with it. Obviously we know that titration is an issue that is being addressed but is there something else? Let's keep the cost/insurance issues out of discussion for a moment. One similarity i have noticed between all of the successful afrezza users was that they have a CGM. Here is a quote from tudiabetes: "Seriously you kinda have to unlearn the regimented stuff you do with novolog/humalog, carb counting, and all that. If I do take novolog with it then I do have to estimate carbs. There's a big margin for error though, you just have to get in the ballpark. I can't imagine doing it without a cgm though. Maybe that's why I almost gave up on my first try until I got my Dexcom. My precious...." With a CGM, Afrezza benefits are clearly demonstrated to users. They see the fast action and results in real time. However without it, things seem a bit confusing and i can see how some users can't get dialed in. As CGM continue to gain insurance coverage and market penetration i think we will see much larger afrezza growth. I was trying to see what percentage of PWD currently use CGM - I believe this is the real target market the Mannkind should be marketing to. Both myself and my son who are using Afrezza for the past 20 plus months are not using a CGM. Once you get the hang of it (Afrezza) it is so predictable. It would be nice to see real time BG levels but not necessary. Sort of like driving a car. You don't necessarily have to look at the speedometer to know how fast or slow you are going. As long as you've had a drivers license for more than a week  |
|
|
|
Post by hillsave on Dec 9, 2016 17:23:59 GMT -5
two things.
there is a group at tudiabetes that is as stated above in the opening, using subq fast acting and afrezza.
It may be Afrezza is easier on a subq fast acting vacation.
secondly, The Mike H question about afrezza becoming less effective for him over time? He asked on twitter, sports posted. Mike using afrezza and fast acting.
REmember back to Amy asking if was any one having a problem with afrezza, she too using it with fast acting.
So I am asking myself, what could it be they are talking about.
Here is my thinking.
When a type one, first starts using afrezza, and they get the first "first phase insulin hit to the liver, they have had for a long time, they are all getting results, the first phase kicking in. Gluconeogenesis shuts down and the phase two takes over.
My thinking is over time, "Is the liver getting used to, or more accustom to," the large glucose hit. In that cause, what they may be saying is the units they need increases." Then they think it is not working.
Just trying to think it through. Success, may be, taking the units needed per small, medium and large meal and not being afraid to take enough units, or having the titration pack by any name, the glucose monitor helping.
I am sure people had to work hard at learning their subq insulin.
I believe that Stress had a major impact on how much Afrezza you need to take. The body (at least mine) seems to need less when I'm not stressed. I also believe that the people who did not have early success and quit (including some Endo's I know) were following the rules of the clinical trials which were faulty at best. Once they realized after going back on how forgiving Afrezza is they began to have immediate success and taking the proper doses including a follow dose, which I take most of the time when I'm having desert after dinner. It's really so simple to keep yourself in the proper range. Granted a CGM would really fine tune your numbers or pricking your finger which I hate to do and do MAYBE 2x's PER DAY. I am saving my insurance co a bundle over time because I don't need as many supplies. Testing strips,etc. A box of test strips without insurance could run $50. Even if the insurance companies are paying $10, multiply $120 per patient by millions of diabetics who test 2-6 xs a day because their injecting and their numbers are all over the place. The numbers$$$$$$ add up fast. The insurance companies will catch on soon. I know I have spoken to mine and informed them of my success with Afrezza. The nurse that called me had me on the phone for 30 minutes while I explained to her how I use Afrezza and she couldn't stop thanking me and said she was going to tell all her colleagues and her Medical Director. My GP who prescribed Afrezza for me is now a Medical Director at Aetna. I email him all the time telling him of my success with Afrezza. |
|
|
|
Post by brotherm1 on Dec 9, 2016 18:03:52 GMT -5
Nice thread Madog. Though perhaps a question mark behind your title might be more suitable? You said: "One similarity I have noticed between all of the successful afrezza users was that they have a CGM".
How many successful users are you talking about? I would not doubt that at least most successful users of Afrezza have a CGM, but I also would not doubt that many do not such as hillsave and his son.
Would love to hear from or about other successful users without CGM's
|
|
|
|
Post by compound26 on Dec 9, 2016 18:13:09 GMT -5
Nice thread Madog. Though you said: "One similarity i have noticed between all of the successful afrezza users was that they have a CGM". How many successful users are you talking about? I would not doubt that at least most successful users of Afrezza have a CGM, but I also would not doubt that many do not such as Hillsave and his son. Would love to hear from or about other successful users without CGM's Spiro does not use a CGM. Sam in the tudiabetes.org does not user a CGM. Robyn Jarrell does not seem to use a CGM. And I think there are other members in Sam Finta's report group that does not use a CGM. |
|
|
|
Post by babaoriley on Dec 9, 2016 18:24:34 GMT -5
Madog, how long will you be with us till you have to head to the Pentagon?
|
|
|
|
Post by brotherm1 on Dec 9, 2016 18:30:44 GMT -5
madog stated, "As CGM continue to gain insurance coverage and market penetration i think we will see much larger afrezza growth. I was trying to see what percentage of PWD currently use CGM - I believe this is the real target market the Mannkind should be marketing to."
MNKD is targeting type ones and I would not at all doubt they are targeting CGM users - at least at the current time while its difficult to get insurance to cover Aftezza (Mike did recently say it works best with CGM's). I would think Mike is also showing insurance companies the results obtained from patients on Afrezza and CGM's to get insurance companies to better cover Afrezza. I don't remember the name of the cloud based database (correction: web based I believe through Asembia) MNKD implemented this year, but I would think that in addition to having the data on it for the patients, the data is also there for the insurance companies.
In fact, now that I think about it, the main reason for the database is probably to show the Afrezza related data to insurance companies in the effort to gain better coverage.
|
|
|
|
Post by mannmade on Dec 9, 2016 18:36:41 GMT -5
Madog, how long will you be with us till you have to head to the Pentagon?Baba, I get you...
|
|
|
|
Post by madog365 on Dec 9, 2016 18:37:33 GMT -5
Madog, how long will you be with us till you have to head to the Pentagon? You must have me confused with THE mad dog, I am but a simple og although also mad (mostly about our lack of scripts to date) Hill, happy for you and your son and thanks for being a great advocate for afrezza. I have no quantitative proof that majority of successful users are also cgm users at this time but I do see this correlation quite often. I have no doubt afrezza works in either case but I'm worried many users without cgm do not see The benefits right away and drop off. Hill you did say "once you get the hang of it" how long does that take? Not everyone may be as dedicated as you to stick around and find out. |
|
|
|
Post by agedhippie on Dec 9, 2016 18:40:33 GMT -5
In the US there are 1.25 million Type 1 diabetics. Globally Dexcom have 140,000 users and on the basis of no information at all I would guess that about 100,000 of those are in the US. Medtronics probably has a few less (a lot of Medtronics pump users have Dexcom CGMs because they are better than Medtronics CGM) so say a generous 200,000 CGM users in the US total. Of the Type 1 population you lose CGM coverage when you go onto Medicare so the numbers age out and you need to be continually recruiting new users.
|
|
|
|
Post by madog365 on Dec 9, 2016 18:46:38 GMT -5
In the US there are 1.25 million Type 1 diabetics. Globally Dexcom have 140,000 users and on the basis of no information at all I would guess that about 100,000 of those are in the US. Medtronics probably has a few less (a lot of Medtronics pump users have Dexcom CGMs because they are better than Medtronics CGM) so say a generous 200,000 CGM users in the US total. Of the Type 1 population you lose CGM coverage when you go onto Medicare so the numbers age out and you need to be continually recruiting new users. Wasn't there a panel recently to have dexcom covered by medicare for t1? To me this is the group/ market mnkd should be targeting. They will see the benefits of afrezza immediately , they have already shown to be early adopters , actively manage their diabetes, and probably have good coverage. |
|
|
|
Post by agedhippie on Dec 9, 2016 18:57:08 GMT -5
In the US there are 1.25 million Type 1 diabetics. Globally Dexcom have 140,000 users and on the basis of no information at all I would guess that about 100,000 of those are in the US. Medtronics probably has a few less (a lot of Medtronics pump users have Dexcom CGMs because they are better than Medtronics CGM) so say a generous 200,000 CGM users in the US total. Of the Type 1 population you lose CGM coverage when you go onto Medicare so the numbers age out and you need to be continually recruiting new users. Wasn't there a panel recently to have dexcom covered by medicare for t1? To me this is the group/ market mnkd should be targeting. They will see the benefits of afrezza immediately , they have already shown to be early adopters , actively manage their diabetes, and probably have good coverage. I don't think they are there yet. The panel was to permit Dexcom G5 to be used for dosing insulin. That was important because Medicare does not pay for adjunct treatments and not being able to dose made Dexcom an adjunct treatment. They need to get Medicare to approve the use of Dexcom CGMs and that may take a while but they have removed a significant roadblock. |
|
|
|
Post by agedhippie on Dec 9, 2016 19:10:22 GMT -5
In the US there are 1.25 million Type 1 diabetics. Globally Dexcom have 140,000 users and on the basis of no information at all I would guess that about 100,000 of those are in the US. Medtronics probably has a few less (a lot of Medtronics pump users have Dexcom CGMs because they are better than Medtronics CGM) so say a generous 200,000 CGM users in the US total. Of the Type 1 population you lose CGM coverage when you go onto Medicare so the numbers age out and you need to be continually recruiting new users. Wasn't there a panel recently to have dexcom covered by medicare for t1? To me this is the group/ market mnkd should be targeting. They will see the benefits of afrezza immediately , they have already shown to be early adopters , actively manage their diabetes, and probably have good coverage. Whoops, missed the second part. Endos actively push CGMs because the trials data show people have better numbers if you use one consequently Dexcom users tend to be patients with more pro-active endos - try getting out of my endo's office as a Type 1 without a prescription for a pump and a CGM, I'm sure it can be done but I haven't seen it happen  Even so insurers try to limit the number of users who get them but the trials data is compelling. The bottom line though is that if you are Type 1 and don't mind paying the co-pays you can get one (unless you are on Medicare). If Medicare supplies CGMs then the insurers are done because everyone matches Medicare for DME. |
|
