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Post by dreamboatcruise on Feb 15, 2017 15:31:16 GMT -5
@scotta... obviously there are HIPAA compliance issues with collecting patient data. Explicit approval would need to be given for Dexcom to collect readings. And for what you are saying patients would need to volunteer additional information about what drugs they are using. I wonder what proportion of Dexcom users would want to do this.
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Post by esstan2001 on Feb 15, 2017 15:42:13 GMT -5
peppy , You're speaking my language! moiety shmoiety.... .... & parts is parts (when it comes to chicken)
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Post by Deleted on Feb 15, 2017 16:42:07 GMT -5
@scotta ... obviously there are HIPAA compliance issues with collecting patient data. Explicit approval would need to be given for Dexcom to collect readings. And for what you are saying patients would need to volunteer additional information about what drugs they are using. I wonder what proportion of Dexcom users would want to do this. Valid point. In the future, with reimbursement based on outcomes, insurance companies will need methods to measure how well patients are doing. So then, if Mary Smith decides she won't wear the Dexcom sensor that automatically downloads her blood glucose readings to her smartphone and then transmits to the Google / Verily system Mary can simply elect the opt out. Of course, her premiums may go up $350 / month but her freedom to choose remains intact. Oh, her deductible also increases by $5,000 annually.
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Post by agedhippie on Feb 16, 2017 9:12:40 GMT -5
The Dexcom still has problems with sensor poisoning if you take acetaminophen but any accuracy issues were fixed in the 505 firmware release for the G4 (it came with the G5). If it had the Libre's performance they would not allow it to be used unmasked either, and definitely not for treating. The fact it is approved to treat means this is not an issue for the G5. care.diabetesjournals.org/content/38/10/e158 In amperometric glucose biosensors, particularly those measuring hydrogen peroxide, acetaminophen’s phenolic moiety is oxidized at the sensing electrode, producing an electrochemical signal not related to glucose (1).
so H2O2 kills it?
It will recover but for about 8 hours the readings will be bad. I believe all the CGMs as well as the Libre have the same problem. Meters used to have this issue as well but a couple of years ago the FDA made them change their reagent to one that wasn't effected.
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Post by agedhippie on Feb 16, 2017 9:15:39 GMT -5
@scotta ... obviously there are HIPAA compliance issues with collecting patient data. Explicit approval would need to be given for Dexcom to collect readings. And for what you are saying patients would need to volunteer additional information about what drugs they are using. I wonder what proportion of Dexcom users would want to do this. Valid point. In the future, with reimbursement based on outcomes, insurance companies will need methods to measure how well patients are doing. So then, if Mary Smith decides she won't wear the Dexcom sensor that automatically downloads her blood glucose readings to her smartphone and then transmits to the Google / Verily system Mary can simply elect the opt out. Of course, her premiums may go up $350 / month but her freedom to choose remains intact. Oh, her deductible also increases by $5,000 annually. It would have to be opt-in, not opt-out. You would also have problems pushing up the premium selectively like that because most insured people are on employer plans.
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Post by peppy on Feb 16, 2017 9:15:53 GMT -5
care.diabetesjournals.org/content/38/10/e158 In amperometric glucose biosensors, particularly those measuring hydrogen peroxide, acetaminophen’s phenolic moiety is oxidized at the sensing electrode, producing an electrochemical signal not related to glucose (1).
so H2O2 kills it?
It will recover but for about 8 hours the readings will be bad. I believe all the CGMs as well as the Libre have the same problem. Meters used to have this issue as well but a couple of years ago the FDA made them change their reagent to one that wasn't effected. Quote: 8 hours the readings will be bad reply: yes, that is what the study said. Heh tylenol.
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Post by agedhippie on Feb 16, 2017 9:18:18 GMT -5
It will recover but for about 8 hours the readings will be bad. I believe all the CGMs as well as the Libre have the same problem. Meters used to have this issue as well but a couple of years ago the FDA made them change their reagent to one that wasn't effected. Quote: 8 hours the readings will be bad reply: yes, that is what the study said. Heh tylenol.
It scared me rigid the first time it happened with my CGM, I couldn't understand what was happening
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Post by Deleted on Feb 17, 2017 10:02:30 GMT -5
Valid point. In the future, with reimbursement based on outcomes, insurance companies will need methods to measure how well patients are doing. So then, if Mary Smith decides she won't wear the Dexcom sensor that automatically downloads her blood glucose readings to her smartphone and then transmits to the Google / Verily system Mary can simply elect the opt out. Of course, her premiums may go up $350 / month but her freedom to choose remains intact. Oh, her deductible also increases by $5,000 annually. It would have to be opt-in, not opt-out. You would also have problems pushing up the premium selectively like that because most insured people are on employer plans. A couple of decades ago they tried in CA to index premiums to patients level of health. Too much outrage and the effort was terminated. Lots of changes in todays healthcare system to include big data. If the end goal is to make patients healthier which benefits them and reduces costs, health insurers, if required to take all comers, may want to engage in activities that improve patient health while driving down costs. Diabetes, CV, Hypertension and Oncology are big ones. With big data and sensor technology, not that hard to segment high risk patients within an insured pool. The new Dexcom sensor due out later this year will be if memory serves me correctly around the size of a nickel and cost significantly less than the G5. Given Dexcom's relationship with Google / Verily, likely the new sensor will push data directly to a smartphone that has the Dex app on it and from there, to the cloud and then the AI will take over guiding and monitoring the patient. The healthcare system in its current format cannot continue. There isn't enough money to go around and what we are doing currently, as it pertains to management of diabetes is not in aggregate producing acceptable outcomes.
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Post by peppy on Feb 18, 2017 12:51:54 GMT -5
open letter to the sales team. Dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
HgA1c 5.6
Talk that over with the physician. let him know. Afrezza keeps your blood glucose from going up in the first place. Additional dosing at 120 to 130 mg/dl. Phase one insulin reaction. You do not get that with subq fast acting.
www.screencast.com/t/qHsWcjqc www.screencast.com/t/pYQ4TMFaY
twitter.com/hashtag/afrezza
Afrezza, insulin you can take.
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Post by lakon on Feb 18, 2017 13:16:15 GMT -5
open letter to the sales team. Dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
HgA1c 5.6
Talk that over with the physician. let him know. Afrezza keeps your blood glucose from going up in the first place. Additional dosing at 120 to 130 mg/dl. Phase one insulin reaction. You do not get that with subq fast acting.
www.screencast.com/t/qHsWcjqc www.screencast.com/t/pYQ4TMFaY
twitter.com/hashtag/afrezza
Afrezza, insulin you can take. I think that it is pretty easy to prove statistically that splitting the dosages is superior. The computer sim said so. Just draw two graphs. (Yes, yes, the FDA will require trials, but doctors can titrate how they see fit. Helping them with titration decisions is okay. The FDA is about to have their hands full or tied so stop fretting. The game has changed since Jan. Stop acting like it hasn't. Get the MNKD medical staff engaged.) If a patient was going to take a 12U cartridge at the beginning of a meal. Try an 8 at the beginning and a 4 at the end (+45 min). There is little safety concern. The results will likely be way better. Then, consider shifting dosing +15 minutes for both hits -- I mean puffs. They will see something amazing. Recommend that the doctors publish the results. Offer assistance if they want. For 8U, try 4 + 4. I'd bet 4 is never enough, but it'd have to be alone, just halfway through the meal, to avoid safety concerns about dose changes besides timing. Larger doses (above 12U, 1 cartridge) are easier to split up, and it may be preferable to start recommendations for timing mods with those patients due to improved patient compliance/experience. The superior results will be the kicker that tells all.
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Post by peppy on Feb 19, 2017 18:01:26 GMT -5
open letter to the sales team. Dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
HgA1c 5.6
Talk that over with the physician. let him know. Afrezza keeps your blood glucose from going up in the first place. Additional dosing at 120 to 130 mg/dl. Phase one insulin reaction. You do not get that with subq fast acting.
www.screencast.com/t/qHsWcjqc www.screencast.com/t/pYQ4TMFaY
twitter.com/hashtag/afrezza
Afrezza, insulin you can take.
Thinking the insulin dosage difference through, subq fast acting vs afrezza, I postulate we have found the problem of script renewals. Consider the people trying afrezza are type one's used to the type one units. consider, these peoples first puffs of afrezza, these people haven't gotten phase one hepatic signaling in years. then phase two. Now consider and I am postulating, these same type ones, their liver gets used to the hit of insulin and the liver wants more and they need more insulin for the phase two. Now users think it isn't working? That is what I am postulating. Remember Amy's T tweets a bit after she started afrezza? Type one's need to be told the titration/unit total differences. The CGM, the people using those to dose, some figure out the dose like, sellhighdrinklow, and adam lasher, and ..... take the units they need to manage the blood glucose level the outsulin component allows the safety and now they are giving us report.
It seems to me it would help the physician to have the following titration sample. The physicians were working too blindly regarding dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl 45 mins or more after the initial dosing.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
You can see why some people thinking it wasn't working.
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Post by sayhey24 on Feb 20, 2017 8:56:42 GMT -5
open letter to the sales team. Dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
HgA1c 5.6
Talk that over with the physician. let him know. Afrezza keeps your blood glucose from going up in the first place. Additional dosing at 120 to 130 mg/dl. Phase one insulin reaction. You do not get that with subq fast acting.
www.screencast.com/t/qHsWcjqc www.screencast.com/t/pYQ4TMFaY
twitter.com/hashtag/afrezza
Afrezza, insulin you can take.
Thinking the insulin dosage difference through, subq fast acting vs afrezza, I postulate we have found the problem of script renewals. Consider the people trying afrezza are type one's used to the type one units. consider, these peoples first puffs of afrezza, these people haven't gotten phase one hepatic signaling in years. then phase two. Now consider and I am postulating, these same type ones, their liver gets used to the hit of insulin and the liver wants more and they need more insulin for the phase two. Now users think it isn't working? That is what I am postulating. Remember Amy's T tweets a bit after she started afrezza? Type one's need to be told the titration/unit total differences. The CGM, the people using those to dose, some figure out the dose like, sellhighdrinklow, and adam lasher, and ..... take the units they need to manage the blood glucose level the outsulin component allows the safety and now they are giving us report.
It seems to me it would help the physician to have the following titration sample. The physicians were working too blindly regarding dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl 45 mins or more after the initial dosing.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
You can see why some people thinking it wasn't working.
I have always wanted to know where are the refills? I sure would like to hear from some of these PWDs to understand the problem. When Mike C. started last year he promised to get to the bottom of this but I don't remember him talking about it again. In this pdf in one of the articles it explains some problems. Actually this entire pdf should be mandatory reading for the new sales team. ajmc.s3.amazonaws.com/_media/_pdf/EBDM0916.pdfThe thing with afrezza is you need to think about what would a healthy pancreas do. It doesn't know about units or carbs. It only knows about how much insulin it had to make when you ate the last time. Some times it over doses and some times it under doses. When it over doses the liver kicks in and dumps sugar in the blood, the same with afrezza. When it under doses it makes up with the phase 2 release. Calling the afrezza cartridges units was a huge mistake but should rather be called small, medium and large. Comparing afrezza to the Analogs is the wrong approach since they are so much different. Afrezza works like the pancreas and is predictable, Analogs do not.
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Post by peppy on Feb 20, 2017 9:05:51 GMT -5
Thinking the insulin dosage difference through, subq fast acting vs afrezza, I postulate we have found the problem of script renewals. Consider the people trying afrezza are type one's used to the type one units. consider, these peoples first puffs of afrezza, these people haven't gotten phase one hepatic signaling in years. then phase two. Now consider and I am postulating, these same type ones, their liver gets used to the hit of insulin and the liver wants more and they need more insulin for the phase two. Now users think it isn't working? That is what I am postulating. Remember Amy's T tweets a bit after she started afrezza? Type one's need to be told the titration/unit total differences. The CGM, the people using those to dose, some figure out the dose like, sellhighdrinklow, and adam lasher, and ..... take the units they need to manage the blood glucose level the outsulin component allows the safety and now they are giving us report.
It seems to me it would help the physician to have the following titration sample. The physicians were working too blindly regarding dosing.
Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner= 17 units subq fast acting .......... 13 units lantus basal
Afrezza dosing breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg/dl 45 mins or more after the initial dosing.
Lunch same, dinner same = 36 units of afrezza plus 16 units lantus basal.
You can see why some people thinking it wasn't working.
I have always wanted to know where are the refills? I sure would like to hear from some of these PWDs to understand the problem. When Mike C. started last year he promised to get to the bottom of this but I don't remember him talking about it again. In this pdf in one of the articles it explains some problems. Actually this entire pdf should be mandatory reading for the new sales team. ajmc.s3.amazonaws.com/_media/_pdf/EBDM0916.pdfThe thing with afrezza is you need to think about what would a healthy pancreas do. It doesn't know about units or carbs. It only knows about how much insulin it had to make when you ate the last time. Some times it over doses and some times it under doses. When it over doses the liver kicks in and dumps sugar in the blood, the same with afrezza. When it under doses it makes up with the phase 2 release. Calling the afrezza cartridges units was a huge mistake but should rather be called small, medium and large. Comparing afrezza to the Analogs is the wrong approach since they are so much different. Afrezza works like the pancreas and is predictable, Analogs do not. This needs to be the gig then.
Afrezza technosphere insulin, keeps glucose from going high in the first place. Afrezza is insulin you can take. Dosing: take a small 4u, medium 8u or large 12u dose of afrezza depending on meal size 10 mins into your meal. additional doses 45 mins or more later at blood glucose level if 120 to 130mg/dl. Do not compare Afrezza dosing to analogs. Go by meal size and blood glucose levels.
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Post by sayhey24 on Feb 20, 2017 9:44:43 GMT -5
I have always wanted to know where are the refills? I sure would like to hear from some of these PWDs to understand the problem. When Mike C. started last year he promised to get to the bottom of this but I don't remember him talking about it again. In this pdf in one of the articles it explains some problems. Actually this entire pdf should be mandatory reading for the new sales team. ajmc.s3.amazonaws.com/_media/_pdf/EBDM0916.pdfThe thing with afrezza is you need to think about what would a healthy pancreas do. It doesn't know about units or carbs. It only knows about how much insulin it had to make when you ate the last time. Some times it over doses and some times it under doses. When it over doses the liver kicks in and dumps sugar in the blood, the same with afrezza. When it under doses it makes up with the phase 2 release. Calling the afrezza cartridges units was a huge mistake but should rather be called small, medium and large. Comparing afrezza to the Analogs is the wrong approach since they are so much different. Afrezza works like the pancreas and is predictable, Analogs do not. This needs to be the gig then.
Afrezza technosphere insulin, keeps glucose from going high in the first place. Afrezza is insulin you can take. Dosing: take a small 4u, medium 8u or large 12u dose of afrezza depending on meal size 10 mins into your meal. additional doses 45 mins or more later at blood glucose level if 120 to 130mg/dl. Do not compare Afrezza dosing to analogs. Go by meal size and blood glucose levels.
Bingo - And, you are better to over dose than under dose during a meal. Once the sugar goes high, its really hard to bring it down, especially with the T2s. The liver will prevent the hypo as it normally would because afrezza is out in the same time as pancreatic insulin. Now the 171/175 protocol called for the redosing for phase two at 90 minutes. This is something each patient will need to adjust. I suspect between 60 - 120 minutes. Some may have to re-dose twice some times but then again afrezza is NOT priced for this. Pricing and packaging is probably afrezza's biggest short fall at this point which can be easily fixed once Mike C. understands its not cheaper as he last stated. With redosing its about 2X $ of the Analogs.
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Post by peppy on Feb 20, 2017 10:05:01 GMT -5
On presidents day, let's pin it down. This needs to be the gig then.
Afrezza technosphere insulin, keeps glucose from going high in the first place. Afrezza is insulin you can take. Dosing: take a small 4u, medium 8u or large 12u dose of afrezza depending on meal size 10 mins into your meal. additional doses 45 mins or more later at blood glucose level of 120 to 130mg/dl.
Do not compare Afrezza dosing to analogs. Go by meal size and blood glucose levels.
example dosing differences Humalog dosing, 5 units breakfast, 5 units lunch, 7 units dinner = 17 units subq fast acting Humalog plus 13 units Lantus basal
Afrezza dosing, breakfast, 8 plus 4 additional given at blood glucose level of 120 to 130mg dl 45 mins to 120 mins after initial dose.
Lunch same, dinner same = 36 units of Afrezza plus 16 units Lantus basal. HgA1c 5.6
Once a patient understands his or her individual dose response (eg, “a 4-unit cartridge reduces my glucose by 30 mg/dL in 90 minutes”), ajmc.s3.amazonaws.com/_media/_pdf/EBDM0916.pdf
Here it is: Several patients on pump therapy, who achieved glycated hemoglobin (A1C) of 7.5% to 8%, gave up the pump, switched to basal insulin injections and prandial (mealtime) Afrezza, and reached their A1C goal for the first time in years. ajmc.s3.amazonaws.com/_media/_pdf/EBDM0916.pdf
Afrezza delivers insulin in a manner that makes it an ideal choice for treating type 2 diabetes (T2D). The loss of early firstphase insulin release, a hallmark of T2D,5 leads to inadequate suppression of endogenous glucose production (EGP) and early postprandial hyperglycemia.6,7 For patients early in the progression of T2D, when A1C is less than 7.3%, postprandial glucose excursions are the major component of overall hyperglycemia. Good thing Mike C decided on two sizes of titration packages. hcp.afrezza.com/afrezza-configurations/
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