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Post by agedhippie on Mar 9, 2017 21:08:48 GMT -5
What makes afrezza work faster is that it is the exact same monomer insulin the pancreas secretes. Now, the pancreas must think fast action to provide that phase 1 insulin release to signal the liver is a good thing and is a must during meals for the body to work correctly. Quick clearance is also needed for the liver to work correctly to counter over dosing the amount of insulin needed. Having some analog hanging around is like that guest who came for a day and is still there a week later. What makes Afrezza faster than Exubera is the encapsulation - they both used Regular insulin, in fact Mannkind has it stockpiled. Techosphere encpasulation is hugely superior to the Exubera encapsulation which was essentially dust that settle in the lungs and dissolved (hopefully). I never took Exubera for exactly that reason. Quick clearence is not necessary for the liver to correct insulin over dosing, that is done by the pancreas which releases glucagon. Glucagon does several things but the chief one is to cause the liver to release stored glucose. It's a feedback loop so the pancreas will ask for more glucose until the levels are correct regardless of other conditions. In other words if there is a heap of active insulin out there the pancreas doesn't care, it just asks for more glucose.
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Post by sayhey24 on Mar 10, 2017 6:30:24 GMT -5
What makes afrezza work faster is that it is the exact same monomer insulin the pancreas secretes. Now, the pancreas must think fast action to provide that phase 1 insulin release to signal the liver is a good thing and is a must during meals for the body to work correctly. Quick clearance is also needed for the liver to work correctly to counter over dosing the amount of insulin needed. Having some analog hanging around is like that guest who came for a day and is still there a week later. What makes Afrezza faster than Exubera is the encapsulation - they both used Regular insulin, in fact Mannkind has it stockpiled. Techosphere encpasulation is hugely superior to the Exubera encapsulation which was essentially dust that settle in the lungs and dissolved (hopefully). I never took Exubera for exactly that reason. Quick clearence is not necessary for the liver to correct insulin over dosing, that is done by the pancreas which releases glucagon. Glucagon does several things but the chief one is to cause the liver to release stored glucose. It's a feedback loop so the pancreas will ask for more glucose until the levels are correct regardless of other conditions. In other words if there is a heap of active insulin out there the pancreas doesn't care, it just asks for more glucose. I am not sure what you are trying to say. The pancreas releases glucagon when the concentration of glucose in the bloodstream falls too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. If you affect liver function with things like metformin the liver does not work as it should and why some people see hypoglycemia when combining with insulin producing drugs. Now if you have all that Ananlog stuff hanging around when the liver is trying to correct, it gets in the way. Its like 3 day old fish, it stinks. The Techosphere encpasulation process is actually the way they stabilize the monomer insulin. Part of the process was actually licensed from an ice cream company. Think of dripping chocolate on a frozen piece of ice cream. Exubera was a hexamer and thats why is was too damn slam. Afrezza being the same natural monomer is why it is just like the pancreas.
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Post by radgray68 on Mar 10, 2017 14:25:55 GMT -5
"Capsule in a bottle" says it all. WTF passes as an expert these days? Has anyone forwarded this to Mannkind Management? This is another wonderful example for the invisible SEC investigation that supposedly gives a tiny rats arse.
And, if management says something about "oh, well SEC has been........ and we can't comment about an ongoing investigation.....mehhhhh." I will be forced to join the multitudes who blame management at every turn if nothing is done soon to stop this crap from being published once and for all. Our in-house counsel is non-existent. They should be in the news today, crying foul and calling for a proper correction of these falsehoods. That would be a form of free advertising as well. ARRRGHHH ! It's sooo frustrating when bullies run roughshod over the weak. Time to stand up and at least give the appearance that we are going to fight these guys or continue to die like they want us to, slow and painfully. I still love this product, but holy cartel Batman!
And, BTW, growth hormones flow throughout the body already, in the blood. The lungs contain the most blood in the body at any given point, all day, every day. Always has. Suffice it to say, the growth hormone argument is a reach at best. It does not fly with me.
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Post by kc on Mar 10, 2017 15:14:21 GMT -5
"Capsule in a bottle" says it all. WTF passes as an expert these days? Has anyone forwarded this to Mannkind Management? This is another wonderful example for the invisible SEC investigation that supposedly gives a tiny rats arse.
And, if management says something about "oh, well SEC has been........ and we can't comment about an ongoing investigation.....mehhhhh." I will be forced to join the multitudes who blame management at every turn if nothing is done soon to stop this crap from being published once and for all. Our in-house counsel is non-existent. They should be in the news today, crying foul and calling for a proper correction of these falsehoods. That would be a form of free advertising as well. ARRRGHHH ! It's sooo frustrating when bullies run roughshod over the weak. Time to stand up and at least give the appearance that we are going to fight these guys or continue to die like they want us to, slow and painfully. I still love this product, but holy cartel Batman!
And, BTW, growth hormones flow throughout the body already, in the blood. The lungs contain the most blood in the body at any given point, all day, every day. Always has. Suffice it to say, the growth hormone argument is a reach at best. It does not fly with me. You can bet that MannKind is on top of it and will contact the doctor and KDKA and provide some additional information. If we see it then you know that MannKind saw it too and will have somebody contact the Doctor and help him to understand how Afrezza works. This is really part of the entire education issue of the Endo / Doctor community and the public.
Actually Mike C. did a great job of education on this 29 min long pod cast. www.diabeticlifestyle.com/podcasts/diabetes-dish/episode-9-mannkind-corps-cco-talks-about-benefits-afrezza-inhalable-insulin-2 Hopefully the company will reach out and provide some better education to the Doctor and to the TV Station. Its a great opportunity to use the MannKind staff with both of the parties.
Information and education takes time and a lot of staff. So don't jump to conclusion that MannKind isn't responsive. They are learning as they are moving at 100 MPH.
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Post by surplusvalue on Mar 10, 2017 15:16:13 GMT -5
Here is another perfect reason why MNKD management has dropped the ball on communication and advertising. MNKD more than year ago knew that Sanofi had poisoned the well and that misinformation about Afrezza was circulating. This doctors discussion is full of half truths falsehoods and innuendo. So much for educating the profession after all this time. MNKD needs correct information about the product in heavy circulation to counter this kind of thing and this means ADVERTISING. Not only is the public unaware of Afrezza but many of those who are aware of the products existence know very little accurate information. And once the misinformation gets out there its very hard to correct misperceptions created by it; the damage is already done. This is what I meant. in another post regarding the listing issue, by MNKDs management following not leading approach which has them reacting to problems instead of largely preventing them in the first place
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Post by kc on Mar 10, 2017 15:24:13 GMT -5
Here is another perfect reason why MNKD management has dropped the ball on communication and advertising. MNKD more than year ago that Sanofi had poisoned the well and that misinformation about Afrezza was circulating. This doctors discussion is full of half truths falsehoods and innuendo. So much for educating the profession after all this time. MNKD needs correct information about the product in heavy circulation to counter this kind of thing and this means ADVERTISING. Not only is the public unaware of Afrezza but many of those who are aware of the products existence know very little accurate information. Believe me they are working hard to correct the issues you mention above. But they are limited with resources and time so they are playing "Whack A Mole" As issues come up they are dealing with them. They can't be expected to get 100% of them correct or know what a Dr. Says to media unless they knew ahead of time. But I can bet you they will address it and learn from it to hopefully get better information to Doctors. Remember they have to provide to the Dr what is in the FDA approved documents.
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Post by surplusvalue on Mar 10, 2017 15:38:27 GMT -5
Here is another perfect reason why MNKD management has dropped the ball on communication and advertising. MNKD more than year ago that Sanofi had poisoned the well and that misinformation about Afrezza was circulating. This doctors discussion is full of half truths falsehoods and innuendo. So much for educating the profession after all this time. MNKD needs correct information about the product in heavy circulation to counter this kind of thing and this means ADVERTISING. Not only is the public unaware of Afrezza but many of those who are aware of the products existence know very little accurate information. Believe me they are working hard to correct the issues you mention above. But they are limited resources and time so they are playing "Whack A Mole" As issues come up they are dealing with them. They can't be expected to get 100% of them correct or know what a Dr. Says to media unless they knew ahead of time. But I can bet you they will address it and learn from it to hopefully get better information to Doctors. Remember they have to provide to the Dr what is in the FDA approved documents.
What you are saying may be true but it reinforces what I am stating. MNKD always seems to be scrambling to react (playing whack a mole) to issues and problems that they to a larger extent could have prevented in the first place. MNKD has left a huge vacuum for misinformation to circulate in and did very little in the way of advertising to circumvent it. It may have not eliminated all of it but might have prevented a larger portion from becoming predominant.
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Post by nylefty on Mar 10, 2017 15:40:19 GMT -5
And, if management says something about "oh, well SEC has been........ and we can't comment about an ongoing investigation.....mehhhhh." I will be forced to join the multitudes who blame management at every turn if nothing is done soon to stop this crap from being published once and for all. Our in-house counsel is non-existent. They should be in the news today, crying foul and calling for a proper correction of these falsehoods. That would be a form of free advertising as well. ARRRGHHH ! It's sooo frustrating when bullies run roughshod over the weak. Time to stand up and at least give the appearance that we are going to fight these guys or continue to die like they want us to, slow and painfully. I still love this product, but holy cartel Batman! After a working lifetime in the news business I can only shake my head at MNKD investors who assume that all the company has to do is put out a PR release and get instant coverage. Even more absurd is the suggestion that the company "should go on 60 Minutes" or "go on Ellen." If only it were that easy.
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Post by kc on Mar 10, 2017 15:54:00 GMT -5
Exactly! Nylefty.....
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Post by radgray68 on Mar 10, 2017 15:54:57 GMT -5
And, if management says something about "oh, well SEC has been........ and we can't comment about an ongoing investigation.....mehhhhh." I will be forced to join the multitudes who blame management at every turn if nothing is done soon to stop this crap from being published once and for all. Our in-house counsel is non-existent. They should be in the news today, crying foul and calling for a proper correction of these falsehoods. That would be a form of free advertising as well. ARRRGHHH ! It's sooo frustrating when bullies run roughshod over the weak. Time to stand up and at least give the appearance that we are going to fight these guys or continue to die like they want us to, slow and painfully. I still love this product, but holy cartel Batman! After a working lifetime in the news business I can only shake my head at MNKD investors who assume that all the company has to do is put out a PR release and get instant coverage. Even more absurd is the suggestion that the company "should go on 60 Minutes" or "go on Ellen." If only it were that easy. It seems to me they do have a friendly local news station that will get the word out. The one who reported on Hakan becoming CEO as well as some other press releases you may be familiar with. All I was saying was that, as a former litigation claims examiner, an attorney could whip out a cautionary letter in a few minutes. Perhaps even cc the SEC for their supposed file and, while they're at it, the FDA so THEY can be ABSOLUTELY certain that WE are correcting these bold-faced lies with the utmost care and respect for the precious guidelines and limitations of the benevolent FDA. Lawyers write for a living. A few moments is not asking a lot. IMHO
And, actually, a simple rebuttal gets picked up on Twitter, FB and the likes, so yeah, it IS that easy.
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Post by dreamboatcruise on Mar 10, 2017 16:08:18 GMT -5
After a working lifetime in the news business I can only shake my head at MNKD investors who assume that all the company has to do is put out a PR release and get instant coverage. Even more absurd is the suggestion that the company "should go on 60 Minutes" or "go on Ellen." If only it were that easy. It seems to me they do have a friendly local news station that will get the word out. The one who reported on Hakan becoming CEO as well as some other press releases you may be familiar with. All I was saying was that, as a former litigation claims examiner, an attorney could whip out a cautionary letter in a few minutes. Perhaps even cc the SEC for their supposed file and, while they're at it, the FDA so THEY can be ABSOLUTELY certain that WE are correcting these bold-faced lies with the utmost care and respect for the precious guidelines and limitations of the benevolent FDA. Lawyers write for a living. A few moments is not asking a lot. IMHO
And, actually, a simple rebuttal gets picked up on Twitter, FB and the likes, so yeah, it IS that easy.
Sorry... I may be a bit lost. Who are you suggesting sending a threatening attorney letter to and what are the bold-faced lies? Seems like this was just a less than ideal person to be discussing Afrezza... unclear to me whether he is really pro or anti or whether he really just isn't that familiar with Afrezza. Doesn't seem like a case where legal threats are appropriate.
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Post by radgray68 on Mar 10, 2017 16:29:13 GMT -5
It seems to me they do have a friendly local news station that will get the word out. The one who reported on Hakan becoming CEO as well as some other press releases you may be familiar with. All I was saying was that, as a former litigation claims examiner, an attorney could whip out a cautionary letter in a few minutes. Perhaps even cc the SEC for their supposed file and, while they're at it, the FDA so THEY can be ABSOLUTELY certain that WE are correcting these bold-faced lies with the utmost care and respect for the precious guidelines and limitations of the benevolent FDA. Lawyers write for a living. A few moments is not asking a lot. IMHO
And, actually, a simple rebuttal gets picked up on Twitter, FB and the likes, so yeah, it IS that easy.
Sorry... I may be a bit lost. Who are you suggesting sending a threatening attorney letter to and what are the bold-faced lies? Seems like this was just a less than ideal person to be discussing Afrezza... unclear to me whether he is really pro or anti or whether he really just isn't that familiar with Afrezza. Doesn't seem like a case where legal threats are appropriate. Call them legal threats if you like. I call it an opportunity to clarify the incorrect assumptions that are killing this product. A "Teachable Event" if you will. An actual lawsuit may have to meet a higher threshold to be legitimized in a court of law, but a shot across the bow is warranted.
As for false or misleading info;
I especially like the one that says the insulin will grow additional lung tissue. WHERE IS THE FDA APPROVED STATISTICS ON THIS? He can say whatever he wants, but Mannkind cant even issue a reply?
“There are some preparations you have to do. You have to put a capsule in the bottle, you have to measure it right, not that you don’t have to measure insulin, but it’s a little more involved,” Dr. Evron said "It’s also about double the cost of injectable insulin."
“It’s irritating. Insulin is a growth hormone. So, when you put insulin in the lung, there’s always that fear that you get growth of lung tissue as well,” Dr. Evron said.
It also may not work well in the long run.
“It’s in a foreign place. So, the body attacks it. So, there was some worry about anti-insulin antibodies forming from this. So yes, the question is this could become less effective with time?” Dr. Evron said.
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Post by dreamboatcruise on Mar 10, 2017 16:58:49 GMT -5
Sorry... I may be a bit lost. Who are you suggesting sending a threatening attorney letter to and what are the bold-faced lies? Seems like this was just a less than ideal person to be discussing Afrezza... unclear to me whether he is really pro or anti or whether he really just isn't that familiar with Afrezza. Doesn't seem like a case where legal threats are appropriate. Call them legal threats if you like. I call it an opportunity to clarify the incorrect assumptions that are killing this product. A "Teachable Event" if you will. An actual lawsuit may have to meet a higher threshold to be legitimized in a court of law, but a shot across the bow is warranted.
"“There are some preparations you have to do. You have to put a capsule in the bottle, you have to measure it right, not that you don’t have to measure insulin, but it’s a little more involved,” Dr. Evron said "It’s also about double the cost of injectable insulin."
Seems he isn't that familiar with Afrezza... or very possibly his comments have simply been butchered in editing. Seems like some of his statement may have been talking about the development of inhaled insulin in general, not just Afrezza. I follow a lot of different technical/scientific/medical fields and often coverage in mainstream media is this bad or worse. I've realized that if I really know details about something, I rarely see coverage that is accurate. As closely as I follow Afrezza I couldn't even tell you how our price actually compares with injectable insulin for insurance or for patients... and we don't even know what comparison he is making. If he was talking about the cash price for Afrezza vs the cheapest option for injectable (vial), then Afrezza would be much more than double. There are an unlimited number of things that statement could have been referring to. Would be great if MNKD somehow could make sure the right doctors are the ones going in front of media, but this isn't and shouldn't be a legal issue. Further, there isn't much a company can do about the fact that most media outlets are horrible about covering technical or scientific issues. They often edit things in a way that they think is clarifying for the non-technical audience, but in the process change the meaning, miss the relevant and highlight the irrelevant.
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Post by agedhippie on Mar 10, 2017 17:35:17 GMT -5
Sorry... I may be a bit lost. Who are you suggesting sending a threatening attorney letter to and what are the bold-faced lies? Seems like this was just a less than ideal person to be discussing Afrezza... unclear to me whether he is really pro or anti or whether he really just isn't that familiar with Afrezza. Doesn't seem like a case where legal threats are appropriate. Call them legal threats if you like. I call it an opportunity to clarify the incorrect assumptions that are killing this product. A "Teachable Event" if you will. An actual lawsuit may have to meet a higher threshold to be legitimized in a court of law, but a shot across the bow is warranted.
As for false or misleading info;
I especially like the one that says the insulin will grow additional lung tissue. WHERE IS THE FDA APPROVED STATISTICS ON THIS? He can say whatever he wants, but Mannkind cant even issue a reply?
“There are some preparations you have to do. You have to put a capsule in the bottle, you have to measure it right, not that you don’t have to measure insulin, but it’s a little more involved,” Dr. Evron said "It’s also about double the cost of injectable insulin."
“It’s irritating. Insulin is a growth hormone. So, when you put insulin in the lung, there’s always that fear that you get growth of lung tissue as well,” Dr. Evron said.
It also may not work well in the long run.
“It’s in a foreign place. So, the body attacks it. So, there was some worry about anti-insulin antibodies forming from this. So yes, the question is this could become less effective with time?” Dr. Evron said.
I have worked extensively with a major news agency and I can tell you that they are very good at knowing what letters are really a threat and what can be ignored. It's extremely rare that they will act on a letter simply because the protections are so high and they know it. You stand a better chance sending corrections and relying on an editor to correct things the next time. I would not get into an argument over insulin in lungs. I strongly suspect that insulin can cause lung tissue to grow, after all it's a growth hormone, but I also suspect that it would take far higher doses than you would normally take and hence it is not an issue. Body builders take insulin (illegally) to increase muscle for example. There is no requirement for FDA statistics since the doctor is talking about medicine and not a drug. There is no requirement for doctors to be accurate in what they say (it's opinion) or Dr Oz would have been off the air long ago.
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Post by matt on Mar 10, 2017 17:59:50 GMT -5
“It’s irritating. Insulin is a growth hormone. So, when you put insulin in the lung, there’s always that fear that you get growth of lung tissue as well,” Dr. Evron said. That one is true. Insulin activates RTK Class II receptors, which can dimerize with any factor that activates the RTK Class II receptor which activates the ATK pathway, one of the principal tissue growth pathways in the human body. There are many examples where growth factors acted strangely and the patient wound up with ectopic tissue deposits in the wrong part of the body (ectopic bone in the heart and brain for example). It doesn't happen often, but if a physician worries that delivering growth factors several times a day directly to the lung will stimulate this type of response you can't say that he is crazy. Other growth factor drugs had to be removed from the market due to similar unintended consequences. You can't ignore legitimate scientific questions and hope they go away, because they won't. The proper solution is to run larger post-marketing safety surveillance studies to quantify the risk. A little data goes a long way.
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