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Post by uvula on Jul 30, 2019 8:01:38 GMT -5
Steve's comment makes sense to me and is good news and bad news. The basil affects the prandial and they need to be addressed as a team. Mnkd should have known this and should have provided guidance to doctors. This could explain the bad retention rate.
The good news is that maybe vdex has figured out the perfect combination.
The bad news is that mnkd needs to tell doctors what basil to use and I don't think they can do this. And as basil insulins change it will affect how afrezza is used. Maybe the only solution is to sell off afrezza to a basil insulin company that can supply a complete insulin solution to patients.
(Disclaimer: not a doctor. Not a diabetic.)
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Post by sweedee79 on Jul 30, 2019 8:08:34 GMT -5
I got my dad on Tresiba and he started having hypos.. we ended up lowering his Novolog by half.. so yeah Tresiba is some amazing basal insulin.
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Post by agedhippie on Jul 30, 2019 8:30:04 GMT -5
That makes no sense to me. Why would tresiba lasting 40 hours cause more hypos? It seems like all you would need is to just adjust the dose to cause less hypos. How would you adjust any size dose to last 24 hours instead of 40? That's the problem in a nutshell the problem is the overlap. You take basal every 24 hours so Tresiba stacks because it lasts longer than 24 hours. However, if you reduce your basal to account for the stacking then you are not going to have enough for the non-overlapping period. The best way I have found (and probably why people can reduce their mealtime insulin when using Tresiba) is to take it in the morning and then the stacking happens during the day and you can adjust your mealtime insulin rather than basal. This is a bit problematic because it's not good practice to cover food with basal as if you don't eat the basal is going to catch you. The best thing for basal is a pump, it's just that I hate the things. |
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Post by rtmd on Jul 30, 2019 9:07:05 GMT -5
That makes no sense to me. Why would tresiba lasting 40 hours cause more hypos? It seems like all you would need is to just adjust the dose to cause less hypos. How would you adjust any size dose to last 24 hours instead of 40? You don't adjust the size of the dose to last 24 hours. You adjust the size of the dose to maintain a lower basal for 40 hours. |
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Post by wgreystone on Jul 30, 2019 9:37:47 GMT -5
How would you adjust any size dose to last 24 hours instead of 40? You don't adjust the size of the dose to last 24 hours. You adjust the size of the dose to maintain a lower basal for 40 hours. I think the problem is basal level is not a straight line over the 40 hrs. Now a patient would have two days with different level of basal and he needs to adjust prandial insulin accordingly. This makes things more complicated. |
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Post by shawnonafrezza on Jul 30, 2019 9:57:00 GMT -5
You don't adjust the size of the dose to last 24 hours. You adjust the size of the dose to maintain a lower basal for 40 hours. I think the problem is basal level is not a straight line over the 40 hrs. Now a patient would have two days with different level of basal and he needs to adjust prandial insulin accordingly. This makes things more complicated. But that's not what happens. First day lower, second day higher, but then you're on day 2 every day for the next forever. I mean, lantus isn't even a flat basal on it's own without stacking! It's peaky and even taking a shower after injecting it can kill you. Ask me how I know that. The problem is diabetics and endos don't realize that Lantus vs Tojeou vs Tresiba are not 1:1 on dose or timing. |
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Post by agedhippie on Jul 30, 2019 11:06:49 GMT -5
I think the problem is basal level is not a straight line over the 40 hrs. Now a patient would have two days with different level of basal and he needs to adjust prandial insulin accordingly. This makes things more complicated. But that's not what happens. First day lower, second day higher, but then you're on day 2 every day for the next forever. I mean, lantus isn't even a flat basal on it's own without stacking! It's peaky and even taking a shower after injecting it can kill you. Ask me how I know that. The problem is diabetics and endos don't realize that Lantus vs Tojeou vs Tresiba are not 1:1 on dose or timing. Lantus seems to have a peak around five hours for me. If I take it at bed time that coincides with the 3am low point for basal glucose with predictable results. Taking it in the morning fixed that, but then it's tailing off when dawn phenomenon hits. Diabetes is a joy. |
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rwp
Newbie
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Sentiment: Long
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Post by rwp on Jul 30, 2019 11:21:06 GMT -5
I think the problem is basal level is not a straight line over the 40 hrs. Now a patient would have two days with different level of basal and he needs to adjust prandial insulin accordingly. This makes things more complicated. But that's not what happens. First day lower, second day higher, but then you're on day 2 every day for the next forever. I mean, lantus isn't even a flat basal on it's own without stacking! It's peaky and even taking a shower after injecting it can kill you. Ask me how I know that. The problem is diabetics and endos don't realize that Lantus vs Tojeou vs Tresiba are not 1:1 on dose or timing. That's interesting, what kind of effect does taking a shower have on BG? |
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Post by shawnonafrezza on Jul 30, 2019 11:27:48 GMT -5
But that's not what happens. First day lower, second day higher, but then you're on day 2 every day for the next forever. I mean, lantus isn't even a flat basal on it's own without stacking! It's peaky and even taking a shower after injecting it can kill you. Ask me how I know that. The problem is diabetics and endos don't realize that Lantus vs Tojeou vs Tresiba are not 1:1 on dose or timing. That's interesting, what kind of effect does taking a shower have on BG? Showers don't, they have an effect on Lantus. For the first hour post injection Lantus is **very** unstable. If memory serves how it works is Lantus kind of crystalizes in you and that dissipates over "24 hours" to achieve its profile. You can see why that makes it a very peak heavy drug, how so you stabilize that? Anyways, during that first hour everything is still forming so if you do anything that will results in rapid blood flow or induce heat (sports, showers, hot tub, sauna) you're probably going to find yourself absorbing all 24 hours worth of basal over the course of 1 hour. This is true of most insulins because of the vasodilation in heat but Lantus is by far the worst offender. |
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Post by prcgorman2 on Jul 30, 2019 11:28:40 GMT -5
Probably the skin softens and absorbs the basal insulin faster. Purely a guess.
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Post by uvula on Jul 30, 2019 12:02:21 GMT -5
This stuff is scaring me (and scarring me) as a mnkd investor. Insurance won't solve this. Better sales reps won't solve this. It sounds like the best way to make most T1s compliant with the least effort is using a pump.
Afrezza would be great for T2s that might not need basil at all if they have afrezza for meals.
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Post by shawnonafrezza on Jul 30, 2019 12:12:32 GMT -5
This stuff is scaring me (and scarring me) as a mnkd investor. Insurance won't solve this. Better sales reps won't solve this. It sounds like the best way to make most T1s compliant with the least effort is using a pump. Afrezza would be great for T2s that might not need basil at all if they have afrezza for meals. Yes/no. The best way is to make diabetes simple. Afrezza can do that but it's not something that can have a label. |
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Post by sellhighdrinklow on Jul 30, 2019 12:35:30 GMT -5
That's interesting, what kind of effect does taking a shower have on BG? Showers don't, they have an effect on Lantus. For the first hour post injection Lantus is **very** unstable. If memory serves how it works is Lantus kind of crystalizes in you and that dissipates over "24 hours" to achieve its profile. You can see why that makes it a very peak heavy drug, how so you stabilize that? Anyways, during that first hour everything is still forming so if you do anything that will results in rapid blood flow or induce heat (sports, showers, hot tub, sauna) you're probably going to find yourself absorbing all 24 hours worth of basal over the course of 1 hour. This is true of most insulins because of the vasodilation in heat but Lantus is by far the worst offender. I have never heard of this and I have never experienced this. I have sat in many hot tubs after my 8:30 PM Lantus injection with nothing happening as you describe. Is this on the label for Lantus? |
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Post by shawnonafrezza on Jul 30, 2019 12:41:42 GMT -5
Showers don't, they have an effect on Lantus. For the first hour post injection Lantus is **very** unstable. If memory serves how it works is Lantus kind of crystalizes in you and that dissipates over "24 hours" to achieve its profile. You can see why that makes it a very peak heavy drug, how so you stabilize that? Anyways, during that first hour everything is still forming so if you do anything that will results in rapid blood flow or induce heat (sports, showers, hot tub, sauna) you're probably going to find yourself absorbing all 24 hours worth of basal over the course of 1 hour. This is true of most insulins because of the vasodilation in heat but Lantus is by far the worst offender. I have never heard of this and I have never experienced this. I have sat in many hot tubs after my 8:30 PM Lantus injection with nothing happening as you describe. Is this on the label for Lantus? Different places teach it, I was but forgot about it when I had my incident. I don't think it's on the label but if you believe in Afrezza you should know how great labels are. |
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Post by liane on Jul 30, 2019 13:00:59 GMT -5
What's good for the goose is good for the gander.
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