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Post by sportsrancho on Mar 4, 2018 16:02:56 GMT -5
Google....says: The average meal is 11 minutes long – with some breakfasts and lunches lasting barely 2 minutes. Personally, my breakfast falls into the 2-minute category. Thanks Joey, don’t know what we do without you! Sweetie, your average meals are 11 mins long. I read what you eat. I do not know how you are alive, slim. Yes, I have seen men eat hamburgers in three bites. 11 mins average. No not mine, that’s just what Google says:-)..I’m kind of a slow eater. Although I guess it takes me two minutes to down a protein drink. Ha
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Post by peppy on Mar 4, 2018 16:35:12 GMT -5
Regarding the paper from VDEX, they are spot on regarding the meal and dosing relationship...the Endo I went to suggested I take 8u at mealtime and if still high 1-2hrs after to take a 4u. You can't do a standard regimen like that with everyone especially T2's depending on what else is going on with other meds etc. That is why the real time mgmt. is key with using a sensor unless the T2 is going to stick themselves 20+ times a day. There are days when depending on meals, time of day, and activity I could use anywhere from 16u to 48u (since my prescription avg's out to 48u/day I am conscious of meal selectivity to make sure it balances out). The days I eat closer to a "rabbit diet" I rarely have any spike and use much less. The biggest takeaway is that most individuals that are either pre-diabetic and/or T2's that don't realize it yet or are in denial, given the option would take Afrezza with a much less non-invasive manner of monitoring their BG. Case in point, I recently wrote about the two business associates that claimed they would love to get their dads on it, well one of them I am fairly confident is either going to be a candidate or already is just from the questions he was asking me and answers to some of my questions. He was going to schedule to get his blood work done after our conversation. Another friend of mine recently went back to visit his folks in MN. and his mom is diabetic, she asked him if he has had his blood work checked, he is one that is more in denial I believe but when we were out the night we went to dinner and Spiro joined us you could tell he was very interested in both Afrezza and since has seen my use of the Libre when we've been at lunch. Back on topic with regard to the "non-scientific" white paper, that comment from Mike doesn't surprise me one iota...he is a PharmD and that was the politically correct statement from his training. What he also knows is that physicians are trained and held to work within the realm of what is published professionally and that is why they need the official "studies" to get published. When looking back at the outset of product launch to where we are now, it is blatantly obvious to why the scripts, refills, and salespersons have struggled. With the addition of an extremely credible voice in Kendall, the baby steps of having more/better insurance coverage, the approval of the Libre here in the US, the long elusive pathway to the eventual shift continues to get shorter especially with continued satisfied user experiences being logged and shared. Bottom line, the VDEX paper is worth far more to the patients currently then it is to physicians (as far as their limitations in using it)...having read it, it made me much more confident in my dosing relative to what the Endo had suggested at my first visit and he's been subscribing it pretty much since it's been on the market. I am sure his 8/4 regimen works for some and not so much for others depending on their individual needs...my plan is to wake him up a little bit at my next visit with the stellar results as I'm sure he scratches his head with different results he sees with different patients I am so grateful you are here. It sounds like what we want is the vdex dosing regiment. When Mike can, this needs to be the push. Let's see what we get on the stat trial regiment. The stat trial- Patients who are randomized into the TI arm will be instructed to dose before the meals and take necessary corrections at 1- and 2-hours after meals to optimize PPBG (Table 1B). There will be a total of 7 study visits (screening visit, randomization visit, 2 clinic, and 3 phone visits). What we want, we advise with a standard meal to dose Afrezza 15-20 minutes after the start of the meal, and then another dose of the same size about 45 minutes later.With very long meals, we have even advised patients to administer two follow-on doses, for very tight control. The other thing about the vdex paper, no hypoglycemia. Afrezza the insulin you can take. www.seventhform.com/vdexdownloads/vdex-whitepaper-072817.pdfHeh, thanks Joey. Oh additionally, On a facebook Dexcom site, some talk if the difference between Dexcom and Libre. Pointed out to me, libra interstitial. Isn't Dexcom interstitial? (I have some study information and the vdex paper stashed in resources. Thank you Liane.) There really isn't that much difference between STAT and VDEX. (?) stat - instructed to dose before the meals vdex - a standard meal to dose Afrezza 15-20 minutes after the start of the meal, stat - take necessary corrections at 1 hour after meal. vdex - another dose of the same size about 45 minutes later. stat- and 2 hours after meals vdex- With very long meals, we have even advised patients to administer two follow-on doses, for very tight control. It will be interesting to see what the Dexcom and time in range shows. the stat study dosing does not look to bad. (?)
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Post by liane on Mar 4, 2018 16:38:33 GMT -5
Back on topic with regard to the "non-scientific" white paper, that comment from Mike doesn't surprise me one iota...he is a PharmD and that was the politically correct statement from his training. What he also knows is that physicians are trained and held to work within the realm of what is published professionally and that is why they need the official "studies" to get published. When looking back at the outset of product launch to where we are now, it is blatantly obvious to why the scripts, refills, and salespersons have struggled. With the addition of an extremely credible voice in Kendall, the baby steps of having more/better insurance coverage, the approval of the Libre here in the US, the long elusive pathway to the eventual shift continues to get shorter especially with continued satisfied user experiences being logged and shared. Exactly right joeypotsandpans. Mike "knows" what we all "know", but in the world of medicine, we have to abide by the peer-reviewed published studies. It will come to pass, just slower than any of us would like.
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Post by sportsrancho on Mar 4, 2018 16:43:47 GMT -5
Peppy, OK I just timed it. For lunch I had a yogurt with 15 grams of protein and oatmeal mixed in, blueberries, almonds and whip cream on top. It took me eight minutes to eat it. Probably about as long as it takes manmade to eat a fajita pita:-) This dosing thing really drives me crazy... that there is such a wide range of times with the studies?
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Post by peppy on Mar 4, 2018 17:05:26 GMT -5
Peppy, OK I just timed it. For lunch I had a yogurt with 15 grams of protein and oatmeal mixed in, blueberries, almonds and whip cream on top. It took me eight minutes to eat it. Probably about as long as it takes manmade to eat a fajita pita:-) This dosing thing really drives me crazy... that there is such a wide range of times with the studies? I see what you are saying. dosing at the start, doesn't sound wrong. a double negative. dosing at the start sounds right for this meal. consider a quarter pounder and fries meal deal. a man could eat that in 5 minutes. 3 minutes? twenty mins to hit the blood stream if a diet cola? it is meal dependent at some point? It will be interesting to see. June 8 and 9?
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Post by joeypotsandpans on Mar 4, 2018 17:09:46 GMT -5
Sunday brunches in Vegas requires a whole separate regimen unto itself and trust me they last a lot longer than 11 minutes (the better brunch buffet's that is)...just sayin, I save the under average inventory of units allotment for Sunday's
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Post by peppy on Mar 4, 2018 17:42:41 GMT -5
I remember Matt B from Mattdownunder (Type One) saying, for lunch he made a toasted cheese sandwich. Two slices of buttered bread, two slices of cheese. He said, 4 units and a follow up in 45 mins. I think he was doing 4 unit doses.
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Post by agedhippie on Mar 4, 2018 17:49:01 GMT -5
I remember Matt B from Mattdownunder (Type One) saying, for lunch he made a toasted cheese sandwich. Two slices of buttered bread, two slices of cheese. He said, 4 units and a follow up in 45 mins. I think he was doing 4 unit doses. For comparison that is about 4u of RAA insulin for me. It's also quite good because the fat in the cheese flattens the spike from the bread (and it's wonderful ).
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Post by peppy on Mar 4, 2018 18:06:33 GMT -5
I remember Matt B from Mattdownunder (Type One) saying, for lunch he made a toasted cheese sandwich. Two slices of buttered bread, two slices of cheese. He said, 4 units and a follow up in 45 mins. I think he was doing 4 unit doses. For comparison that is about 4u of RAA insulin for me. It's also quite good because the fat in the cheese flattens the spike from the bread (and it's wonderful ). Aged! So glad to hear from you! I remember the film, Matt showed the sandwich cooking on the stove. A type one favorite perhaps. Afrezza, the insulin you can take. These dexcoms are going to be interesting to see. I have seen some pretty controlled blood glucose levels on Dexcom"s now on facebook on RAA's. It will be interesting to see the data. Primary endpoints, Improved time in range (70-180 mg/dl) with TI on CGM [ Time Frame: 4 weeks ] Better post-prandial glucose excursion (1-4 hours after meals) with TI [ Time Frame: 4 weeks ] Secondary endpoints, Less glucose variability (GV) (standard deviation and/or coefficient variation) [ Time Frame: 4 weeks ] The area under the curve calculation (AUC) in the PPBG and PPGE, [ Time Frame: 4 weeks ] Change in HbA1c in one-month treatment [ Time Frame: 4 weeks ] above the target time (>180 mg/dl) on CGM [ Time Frame: 4 weeks ] hypoglycemia frequency (below the target <70, <60, <50 mg/dl) on CGM [ Time Frame: 4 weeks ] clinicaltrials.gov/ct2/show/record/NCT03143816stat - instructed to dose before the meals vdex - a standard meal to dose Afrezza 15-20 minutes after the start of the meal, stat - take necessary corrections at 1 hour after meal. vdex - another dose of the same size about 45 minutes later. stat- and 2 hours after meals vdex- With very long meals, we have even advised patients to administer two follow-on doses, for very tight control. The RAA arm: Patients who are randomized into the NL arm will continue using their usual prandial insulin dose before meals. What do you think?
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Post by sportsrancho on Mar 4, 2018 19:36:44 GMT -5
Sunday brunches in Vegas requires a whole separate regimen unto itself and trust me they last a lot longer than 11 minutes (the better brunch buffet's that is)...just sayin, I save the under average inventory of units allotment for Sunday's Joey, ever been to the Sterling brunch? Pretty awesome:-)
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Post by agedhippie on Mar 4, 2018 19:56:03 GMT -5
stat - instructed to dose before the meals vdex - a standard meal to dose Afrezza 15-20 minutes after the start of the meal, stat - take necessary corrections at 1 hour after meal. vdex - another dose of the same size about 45 minutes later. stat- and 2 hours after meals vdex- With very long meals, we have even advised patients to administer two follow-on doses, for very tight control. The RAA arm: Patients who are randomized into the NL arm will continue using their usual prandial insulin dose before meals. What do you think? I think if the Afrezza arm follows the instructions they should win hands down. The Stat protocol varies from the Vdex but the spacing between doses is the same. My suspicion is that in real life follow up doses will not happen - RAA is meant to have follow up doses after 2 hours but nobody I know does.
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Post by joeypotsandpans on Mar 4, 2018 20:04:16 GMT -5
Sunday brunches in Vegas requires a whole separate regimen unto itself and trust me they last a lot longer than 11 minutes (the better brunch buffet's that is)...just sayin, I save the under average inventory of units allotment for Sunday's Joey, ever been to the Sterling brunch? Pretty awesome:-) Absolutely, the Wynn's is also top notch if you get a chance to visit....on me, just let me know ahead of time ....bagels are my kryptonite, add the smoked salmon, cream cheese, tomatoes and sweet red onions and that alone is a unit burner....
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Post by brotherm1 on Mar 4, 2018 20:11:28 GMT -5
Reading the 60 “ Dead Sea Scrolls”, was perhaps a dosing formula recently discovered ? Mike and the new Dr. mentioned these studies recently. Something’s up and perhaps it’s insight or clinical stats for dosing variables and formulas?
PS Sports, I’m a Sunday brunch aficionado. What do they have and how much does it cost? Holiday Inn, Grantville PA, $25 with tip: prime rib, ham, salmon or always another broiled fish, smoked salmon, stuffed poultry, crab imperial, salmon, shrimp, different potatos, cheeses, pasta, different salads, all types breakfast food, mixed fruit, deserts such as different pies and cakes and almost always carrot cake, different cooked vegetables, great coffee.... (had some mozzarella brussel sprouts today, or maybe they were parmesan)
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Post by falconquest on Mar 4, 2018 20:24:34 GMT -5
Peppy, OK I just timed it. For lunch I had a yogurt with 15 grams of protein and oatmeal mixed in, blueberries, almonds and whip cream on top. It took me eight minutes to eat it. Probably about as long as it takes manmade to eat a fajita pita:-) This dosing thing really drives me crazy... that there is such a wide range of times with the studies? Wait a minute......oatmeal (check), blueberries (check), almonds (check), WHIPPED CREAM? So do the healthy ingredients offset the whipped cream? (LOL) Btw, I eat yogurt with granola as a mid morning snack at work every day (w/o whipped cream) .
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Post by liane on Mar 4, 2018 20:35:43 GMT -5
Peppy, OK I just timed it. For lunch I had a yogurt with 15 grams of protein and oatmeal mixed in, blueberries, almonds and whip cream on top. It took me eight minutes to eat it. Probably about as long as it takes manmade to eat a fajita pita:-) This dosing thing really drives me crazy... that there is such a wide range of times with the studies? Wait a minute......oatmeal (check), blueberries (check), almonds (check), WHIPPED CREAM? So do the healthy ingredients offset the whipped cream? (LOL) Btw, I eat yogurt with granola as a mid morning snack at work every day (w/o whipped cream) . Sports just blew her cover.
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