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Post by Deleted on Feb 5, 2017 10:46:37 GMT -5
sayhey24 I find it difficult to believe Castagna would not understand some aspect of pancreatic insulin output; is the pancreas really generating insulin in phases or is it continually adjusting to actual glucose levels? Homeostasis? Liane feel free to chime in.
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Post by agedhippie on Feb 5, 2017 11:07:48 GMT -5
You are thinking of c-peptide. It is produced when proinsulin is split to form insulin so you can tell the amount of insulin from the amount of c-peptide. Why not measure insulin directly? That's very hard to do because the levels fluctuate (contrary to what people think insulin isn't simply released into the blood stream it is delivered in pulses which interacts with the liver and pancreas). On the other hand c-peptide reflects the insulin that has been produced and has a longer half life so it is easy to measure. Originally c-peptide was thought to be a waste product but there is some thought now that it does more but that's still at the research stage.
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Post by agedhippie on Feb 5, 2017 12:15:23 GMT -5
sayhey24 I find it difficult to believe Castagna would not understand some aspect of pancreatic insulin output; is the pancreas really generating insulin in phases or is it continually adjusting to actual glucose levels? Homeostasis? Liane feel free to chime in. He was close but not quite right The whole 1st phase argument is a bit suspect and doesn't really work the way it is assumed to here, but I don't usually get into that argument. This is the paper that started the current way of thinking; that although biphasic exists (although there are at least three phases for meals) the classic biphasic is rather an artifact of the way studies were conducted. The description of the processes is excellent - First-phase insulin secretion: does it exist in real life? Considerations on shape and function. The paper looks at the real world meal insulin responses versus glucose challenge response and finds that classic fist phase doesn't really exist as previously thought. For those who don't want to read the whole paper the answer is no.
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Post by Deleted on Feb 5, 2017 16:44:23 GMT -5
I learned my coworker's clinic does see sales reps; the best the rep could do was leave literature. I will update tomorrow.
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Post by Deleted on Feb 6, 2017 14:06:25 GMT -5
Okay, so my coworker's doctor would NOT write a script for Afrezza, "too new" for her to prescribe despite his HbA1c rising to 8.1 and BG 243. Her solution: double the metformin.
He is going to change doctors, he will pick an endo from the Afrezza website.
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Post by Deleted on Feb 6, 2017 14:29:10 GMT -5
Okay, so my coworker's doctor would NOT write a script for Afrezza, "too new" for her to prescribe despite his HbA1c rising to 8.1 and BG 243. Her solution: double the metformin. He is going to change doctors, he will pick an endo from the Afrezza website. ensure he verifies with endo on Afrezza before making an appointment. not every endo listed on Afrezza.com gives Afrezza rx. some one here made an appt , waited 4 months and got turned down. I am guessing most docs would put him on basal if it comes to insulin unless its something like vdex ( i would suggest vdex if its logistically possible or even get a script called in )
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Post by sportsrancho on Feb 6, 2017 14:36:56 GMT -5
Okay, so my coworker's doctor would NOT write a script for Afrezza, "too new" for her to prescribe despite his HbA1c rising to 8.1 and BG 243. Her solution: double the metformin. He is going to change doctors, he will pick an endo from the Afrezza website. ensure he verifies with endo on Afrezza before making an appointment. not every endo listed on Afrezza.com gives Afrezza rx. some one here made an appt , waited 4 months and got turned down. I am guessing most docs would put him on basal if it comes to insulin unless its something like vdex ( i would suggest vdex if its logistically possible or even get a script called in ) Yes agree! Why wait for a appointment, go stright to VDex.
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Post by Deleted on Feb 6, 2017 14:55:19 GMT -5
That would be quite a drive from Illinois to California!
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Post by zuegirdor on Feb 6, 2017 15:04:48 GMT -5
Our HMO (Kaiser) now regularly requests My wife and I schedule checkups with physicians through phone appointments.
Why should a VDEX appointment be any different? First visit to do spirometry etc, sure you want to be there in person. But followups, even with spirometry, could easily be done via Skype.
Worth the one time round trip flight to get the care you need, IMHO.
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Post by Deleted on Feb 6, 2017 15:12:41 GMT -5
Our HMO (Kaiser) now regularly requests My wife and I schedule checkups with physicians through phone appointments. Why should a VDEX appointment be any different? First visit to do spirometry etc, sure you want to be there in person. But followups, even with spirometry, could easily be done via Skype. Worth the one time round trip flight to get the care you need, IMHO. yep. .Agreed. Based on the video testimonials, I can understand , they go in depth in regards to diabetes, sugar control. so it will be eye opening, rather than the usual 15 min
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Post by mbseeking on Feb 6, 2017 15:55:57 GMT -5
Folk.. my thanks to you all for this thread. Hands down the best I have seen so far about T2s , in general, plus afrezza. I'd summarize what I've taken from it so far:
1. For T2s there is a complex hierarchy of protocol that today does not include Afrezza (re Peppy). 2. Some have postulated (and may have tried) a protocol that mimics phase 1 & 2 pancreatic response with Afrezza (Sayhey) ie immediately after meal, BG > 100, BG <100. Though: 2.1 This is dependent on being able to measure BG profile extensively 2.2 There is some contention on how the pancreas works (Agehippie) 3. An extremely expensive trial is needed to legitimize the protocol #2 (ref??) 4. Meantime a Dr can actually do whatever he/she wants to (subject to their risk aversion), hence some (eg Kastanes and his co-workers) are pushing to see if they can find drs who will follow a protocal akin to #2.
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Post by peppy on Feb 6, 2017 16:04:28 GMT -5
Okay, so my coworker's doctor would NOT write a script for Afrezza, "too new" for her to prescribe despite his HbA1c rising to 8.1 and BG 243. Her solution: double the metformin. He is going to change doctors, he will pick an endo from the Afrezza website. History: quote: my coworker has quite a bit of blood-work because his kidneys are indicating signs of damage and his doctor reduced his metformin from twice a day to once a day. So obviously, metformin is not managing his diabetes well
quote: he does not have high blood pressure; he works out regularly, is thin and eats well. He was taking metformin twice daily for years, but recently reduced to once a day.
Quote: her reply was 'your numbers are good enough'!
The physician table says to lower the dose. Those steps now accomplished. packageinserts.bms.com/pi/pi_glucophage_xr.pdf
Renal Insufficiency In patients with decreased renal function (based on measured creatinine clearance), the plasma and blood half-life of metformin is prolonged and the renal clearance is decreased in proportion to the decrease in creatinine clearance (see Table 1; also see WARNINGS).
Metabolism and Elimination Intravenous single-dose studies in normal subjects demonstrate that metformin is excreted unchanged in the urine and does not undergo hepatic metabolism
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Post by sportsrancho on Feb 6, 2017 17:01:33 GMT -5
That would be quite a drive from Illinois to California! I believe he can call them for a phone interview. Then if all goes well he will need to go and get a breath test. Then VDex could mail him a script. Steve had to have his son see them in person because that was off-label. Anyway it's worth a try. It least they will head him in the right direction.
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Post by Deleted on Feb 6, 2017 18:28:23 GMT -5
@sportsrancho he will try one of the doctors on the Afrezza list, hopefully she is within the network of doctors covered by our insurance. If not I will recommend VDex to him.
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Post by sayhey24 on Feb 6, 2017 20:21:32 GMT -5
Wow, this is a classic. An A1c 8.1 and the answer is more metformin. Lets do the same thing which has not worked and double down. It sounds like insanity to me. So, this is the situation Mike C. and his staff face with the medical community. I know this endo is not unique but is probably more typical than not. I sure hope that the new staff can tell the story. I looked at the starter kit and I saw no where that it is explained how afrezza is different and what to expect. The daily log in the kit is interesting as someone had in mind testing before and after meals and before bed. No where does it explain what to do or why second dosing is often needed. I sure hope they straighten out the documentation for the new guys so they can tell a compelling story of how different afrezza is from the RAAs and how similar it is to natural insulin release. www.afrezza.com/wp-content/uploads/2016/08/Afrezza-Patient-Starter-Kit.pdf
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