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Post by hopingandwilling on Feb 4, 2017 13:33:15 GMT -5
Seyhay,
It appears you know a lot about the issues diabetics confront daily. However, I'm confused when you stated---"Once on afrezza I would continue the 10 measurements until I saw the trends and make sure I was second dosing when needed after meals to mimic 2nd phase pancreatic insulin release - this second dosing is key and they may even require a 3rd dose 90 minutes after 2nd dose." Consider the lowest unit cartridges are 4-units of insulin, if users are having to follow up with not one but two doses this would imply they are dosing 12-units to get their BG levels to normal. Assume this happens with three meals a day we are talking 36-units of insulin. We already know that Afrezza is presenting an issue with the cost to the patients, so wouldn't the economics of the cost be impacting the ultimate use of the product. I just don't understand why the normal 4-units isn't doing the job! Thanks for replying!
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Post by rockstarrick on Feb 4, 2017 14:12:20 GMT -5
Seyhay, It appears you know a lot about the issues diabetics confront daily. However, I'm confused when you stated---"Once on afrezza I would continue the 10 measurements until I saw the trends and make sure I was second dosing when needed after meals to mimic 2nd phase pancreatic insulin release - this second dosing is key and they may even require a 3rd dose 90 minutes after 2nd dose." Consider the lowest unit cartridges are 4-units of insulin, if users are having to follow up with not one but two doses this would imply they are dosing 12-units to get their BG levels to normal. Assume this happens with three meals a day we are talking 36-units of insulin. We already know that Afrezza is presenting an issue with the cost to the patients, so wouldn't the economics of the cost be impacting the ultimate use of the product. I just don't understand why the normal 4-units isn't doing the job! Thanks for replying! Just guessing here, but I would think the follow up dose is required because afrezza is in and out of your system before digestion is complete. other factors could be, how fast or slow a person eats, the type of carbs or fat in the meal 🥘. like I said, I'm just guessing
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Post by Deleted on Feb 4, 2017 16:15:51 GMT -5
agedhippie he has been a diabetic for decades, he is very aware what his numbers are. I'm sure he is not alone with such numbers.
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Post by agedhippie on Feb 4, 2017 17:45:58 GMT -5
agedhippie he has been a diabetic for decades, he is very aware what his numbers are. I'm sure he is not alone with such numbers. I'm not saying he is wrong about his numbers. I am saying there may well be something else at work there because a fasting number of 220 implies a far higher A1c than 6.1 and if I was him I would very much want to find out the reason for the mismatch. Those are very much not normal numbers.
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Post by agedhippie on Feb 4, 2017 17:49:22 GMT -5
Seyhay, It appears you know a lot about the issues diabetics confront daily. However, I'm confused when you stated---"Once on afrezza I would continue the 10 measurements until I saw the trends and make sure I was second dosing when needed after meals to mimic 2nd phase pancreatic insulin release - this second dosing is key and they may even require a 3rd dose 90 minutes after 2nd dose." Consider the lowest unit cartridges are 4-units of insulin, if users are having to follow up with not one but two doses this would imply they are dosing 12-units to get their BG levels to normal. Assume this happens with three meals a day we are talking 36-units of insulin. We already know that Afrezza is presenting an issue with the cost to the patients, so wouldn't the economics of the cost be impacting the ultimate use of the product. I just don't understand why the normal 4-units isn't doing the job! Thanks for replying! Just guessing here, but I would think the follow up dose is required because afrezza is in and out of your system before digestion is complete. other factors could be, how fast or slow a person eats, the type of carbs or fat in the meal 🥘. like I said, I'm just guessing That's exactly right. The poster child for this effect is pizza.
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Post by nadathing on Feb 4, 2017 19:03:51 GMT -5
I was diagnosed T2 about 15 years ago. I was on Metformin and Glucotrol for about 8 years and had fasting readings of 190 - 210 every morning. Readings during the say would be between 90 - 120. Diet and exercise helped a lot, but my A1c was always over 7.0. I started on Bydureon 7 years ago in a 3 year P3 trial. My morning readings went down to 100 - 115 within a week or two. My A1c dropped to the low 6's. A side affect of Bydureon ( once weekly Byetta) was that appetite was suppressed. I lost 45 pounds within 3 years. My A1c was 5.6 at my check up in December. Diabetes management is not an exact science and takes a while to figure out. I can see why many try Afrezza and quit before knowing how to use it properly.
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Post by Deleted on Feb 4, 2017 22:47:23 GMT -5
nadathing has there been any changes of your pancreatic insulin output over the years while on bydureon?
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Post by Deleted on Feb 4, 2017 23:42:31 GMT -5
nadathing has there been any changes of your pancreatic insulin output over the years while on bydureon? People lose the insulin burst required to normalize post meal sugars. by taking bydureon which slows down how quickly the stomach digests food, to send sugar into the blood more slowly,
he is possibly avoiding high sugars and his loss of insulin burst is accounted for in an alternate way. Best solution would be supplementing with Afrezza for the first phase as I am not sure how slowing the digestion process affects a person.
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Post by Deleted on Feb 5, 2017 7:44:30 GMT -5
Just to put things in perspective: My last blood-work fasting numbers were
HbA1c 5.5 Estimated average glucose 111 Panel 80
Quite a difference between estimated average and measured.
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Post by agedhippie on Feb 5, 2017 8:32:43 GMT -5
nadathing has there been any changes of your pancreatic insulin output over the years while on bydureon? People lose the insulin burst required to normalize post meal sugars. by taking bydureon which slows down how quickly the stomach digests food, to send sugar into the blood more slowly,
he is possibly avoiding high sugars and his loss of insulin burst is accounted for in an alternate way. Best solution would be supplementing with Afrezza for the first phase as I am not sure how slowing the digestion process affects a person. Non-diabetics have a hormone, amylin that performs that function as well. It is produced by the beta cells so when you lose them you lose amylin production as well (as well as insulin production obviously). There is a synthetic amylin available, Symlin, but it is not widely used as it's an additional injection.
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Post by agedhippie on Feb 5, 2017 8:39:46 GMT -5
Just to put things in perspective: My last blood-work fasting numbers were HbA1c 5.5 Estimated average glucose 111 Metabolic 80 Quite a difference between estimated average and measured. That's not really surprising at all. An A1c is an average of the last three months - not single fasted number. I am not sure what metabolic is, a wake up fasting number from a glucose meter? If it was a fasting number from during the day then I would say your numbers are exactly what I would expect.
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Post by nadathing on Feb 5, 2017 9:57:27 GMT -5
nadathing has there been any changes of your pancreatic insulin output over the years while on bydureon? I'm not sure how that is measured or can be measured. What test is used for it? Thanks.
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Post by Deleted on Feb 5, 2017 10:01:17 GMT -5
agedhippie I made a mistake: metabolic are HbA1c and average; routine panel is actual. The numbers measured came from blood samples taken the same day and time. The same lab measured my coworker's numbers; so evidently one can have low HbA1c and high panel number. I believe panel means the actual value; not an average.
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Post by Deleted on Feb 5, 2017 10:03:58 GMT -5
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Post by sayhey24 on Feb 5, 2017 10:23:59 GMT -5
Just guessing here, but I would think the follow up dose is required because afrezza is in and out of your system before digestion is complete. other factors could be, how fast or slow a person eats, the type of carbs or fat in the meal 🥘. like I said, I'm just guessing That's exactly right. The poster child for this effect is pizza. You guys have it. Think of the pancreas and the liver as state machines. The pancreas works in one of three states; as you eat for phase 1 release; an hour later for phase 2(and will stay in this mode while BG >100; fasting state where is pulses every few minutes with low insulin secretion. Until afrezza NO RAA or other med could provide phase 1. Phase 1 is very important because it shuts off the liver from dumping sugar in the blood. Now the pancreas does not have artificial intelligence. It has no idea how much food you are going to eat. So, it works on a LIFO method and dumps the last insulin made from your last meal. Its does NOT carb count. It monitors and about an hour later sees what the BG is. If its >100 then a phase 2 release happens. If its less it goes into fasting mode. Natural insulin and afrezza are exactly the same. They are pretty much in and out of your system in about 60-90 minutes. If you under-dosed for phase 1, you need to mimic the pancreas with phase 2. afrezza allows this because it is the exact same insulin as the pancreas and acts exactly the same. If you over-dose for phase 1, no big deal. The pancreas does this too. Thats when the liver kicks in at <80 and dumps sugar in the blood. Thats the soft lows afrezza PWDs report. This is why Al had that laminated pharmacokinetic chart ever where he went. He keep trying to tell people that with afrezza you can mimic the pancreas. But if you are JUST mimicing phase 1 release, you are doing half the job. Its all in the 171 and 175 studies but MOST did not understand the importance of phase 2 dosing and did not do it. Thats why the result did not exceed the RAAs. This is what I tried to explain to Mike C. last year but he was not understanding it yet or thought I was a nut. I told him CGM technology is the key. 10 finger pricks a day is too many. One for me is more than enough and no one is going to do 10. I think Stefan Schwarz got it but we will need to wait and see. Also some T2s today have to use huge amounts of insulin for meals. The biggest problem is the RAA does mimic the pancreas for phase 1 and the BG soars. Their pancreas would blunt this rise as afrazza does but once your BG is so high they incur huge insulin resistance. There are some youtubes demonstrating this.
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