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Post by cedafuntennis on Mar 14, 2017 16:33:22 GMT -5
However Matt also spoke of a new device from Abbot (if I am not mistaking) which would be ideal for Type 2's and far cheaper than G5. So I would not rush to judgement of impeding partnership with any one company, at least not just yet.
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Post by agedhippie on Mar 14, 2017 16:40:54 GMT -5
I don't think it is difficult to sort out the dosing, but it is different and it requires application. I see something similar in my work - people are confident they can do something and attempt it unaided but they almost inevitably hit a problem. They fall back to their comfort zone which is their existing practice and postpone the change. They still intend to go forwards but they never do. The only way to fix this is to hand hold them through the change although 90% will tell you it's unnecessary at first. My suspicion is that is what you are seeing with Afrezza - "it's insulin, I've used it for decades, I can do this". Then it doesn't behave the same, they stop dead and revert to their current insulin. They never make the jump although they still intend to one day, but that day never comes. How to fix that is harder - one option which I would use is to set up monthly face to face workshops in big locations for new users. You may only get a few, but that is an improvement because they will make the jump. Use the nurses for this.Things like the video are interesting academically, but not material. If you think you know how insulin works you are not going to be scouring the network for advice. It is held to be axiomatic that diabetes is different for everyone so what works for one person will not necessarily work for another. This means another persons experience, unless you personally know them which is different, has low applicability. There are whole careers built on this levels of trust stuff ! I was thinking exactly this same thing recently. I was even wondering if MNKD could host these as dinners for some period of time. Would that be some form of unallowed bribery/kickback in the FDA's eyes? I would expect the idea to pass the FDA because it is training rather than sales - they are already prescribed it. You are teaching how to use the drug safely and effectively, the FDA may even give you a pat on the back for the work. Making these meetings dinners would be ideal because it provides more of an incentive as well as building an ad-hoc support group within each cohort. The FDA may say a meal is over the limit and restrict you to snacks but that would be ok. You could model on the existing diabetes education courses they put new diabetics on.
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Post by dreamboatcruise on Mar 14, 2017 16:48:49 GMT -5
I was thinking exactly this same thing recently. I was even wondering if MNKD could host these as dinners for some period of time. Would that be some form of unallowed bribery/kickback in the FDA's eyes? I would expect the idea to pass the FDA because it is training rather than sales - they are already prescribed it. You are teaching how to use the drug safely and effectively, the FDA may even give you a pat on the back for the work. Making these meetings dinners would be ideal because it provides more of an incentive as well as building an ad-hoc support group within each cohort. The FDA may say a meal is over the limit and restrict you to snacks but that would be ok. You could model on the existing diabetes education courses they put new diabetics on. I'd argue that the dinners would be an integral part of the education. Think of it more like an educational prop to discuss fats vs carbs, digestion speed, etc. If people happen to eat their props, you can't blame them for not letting it go to waste
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Post by brotherm1 on Mar 14, 2017 16:59:58 GMT -5
So Mr Hippie- why do you spend so much time on this board ? Not implying anything, but just really want to know. Please tell Because I find the discussion interesting and I have the time. My work involves sitting around for months and then a few days of blind panic for which I am paid fairly well. My aim, actually, is more to raise the level of understanding as to what it means to be a Type 1 diabetic and how diabetics think because you hear some really odd things from non-diabetics. If you are investing in Mannkind for Afrezza this is your target market so if you want to make an informed decision you really need to understand it. I believe some time ago you said you had a couple of friends that were using Aftezza. Are any type one? Are they still using it?
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Post by agedhippie on Mar 14, 2017 17:04:13 GMT -5
Because I find the discussion interesting and I have the time. My work involves sitting around for months and then a few days of blind panic for which I am paid fairly well. My aim, actually, is more to raise the level of understanding as to what it means to be a Type 1 diabetic and how diabetics think because you hear some really odd things from non-diabetics. If you are investing in Mannkind for Afrezza this is your target market so if you want to make an informed decision you really need to understand it. I believe some time ago you said you had a couple of friends that were using Aftezza. Are any type one? Are they still using it? I did? I know a couple that I think could really benefit from it but I could not persuade them to switch. They are both Type 1 and have absorption issues which I thought were sufficient to run any lung risk - the absorption is a present danger, the lungs are a theoretical danger.
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Post by sayhey24 on Mar 14, 2017 17:07:15 GMT -5
So Mr Hippie- why do you spend so much time on this board ? Not implying anything, but just really want to know. Please tell Because I find the discussion interesting and I have the time. My work involves sitting around for months and then a few days of blind panic for which I am paid fairly well. My aim, actually, is more to raise the level of understanding as to what it means to be a Type 1 diabetic and how diabetics think because you hear some really odd things from non-diabetics. If you are investing in Mannkind for Afrezza this is your target market so if you want to make an informed decision you really need to understand it. Aged since you want to give advice so people can make an informed decision why don't you try it yourself. From what Sam Finta and the rest of the T1s have said, pretty much throw out everything you have learned to date.
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Post by sayhey24 on Mar 14, 2017 17:10:35 GMT -5
I believe some time ago you said you had a couple of friends that were using Aftezza. Are any type one? Are they still using it? I did? I know a couple that I think could really benefit from it but I could not persuade them to switch. They are both Type 1 and have absorption issues which I thought were sufficient to run any lung risk - the absorption is a present danger, the lungs are a theoretical danger. What is the issue you think there is with the lungs and their half a tennis court surface?
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Post by agedhippie on Mar 14, 2017 17:26:58 GMT -5
I did? I know a couple that I think could really benefit from it but I could not persuade them to switch. They are both Type 1 and have absorption issues which I thought were sufficient to run any lung risk - the absorption is a present danger, the lungs are a theoretical danger. What is the issue you think there is with the lungs and their half a tennis court surface? Same replay as always. My endo thinks that there is a possible pulmonary fibrosis risk so they are not switching anyone until after lung trials. I believe my endo (all those years at medical school...) so I am not about to try and persuade someone to change unless their current condition warrants it.
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Post by seanismorris on Mar 14, 2017 17:28:02 GMT -5
I'm very high on CGMs. I was thinking of investing in Dexcom over MNKD years ago... boy did I blow that one. Anyway, from the data I found (today), CGM's have a 20% market penetration for T1. I wasn't able to find the # for T2 (quickly)... anyone know? I assume it's much less. < 5%? I did find something else interesting. Check out CGM's on page7. www.ncbi.nlm.nih.gov/pmc/articles/PMC4717493/Sounds like what we could be experiencing with Afrezza. New treatments for diabetes require lot more participation from patients, and doctors time, creating resistance from doctors. Basically, if the treatment isn't clear, quick, and easy to prescribe, getting it into patients hands is going to be difficult. If something takes more time, docs aren't getting compensation for that additional time. Sounds like a big problem... and an inefficiency in the system. Best patient outcome may be a lower priority than we'd hope. ---- It may also mean that we should be focusing on Pediatric patients, both because of more CGMs, and possibly docs willing to spend more time (money) on younger people. Docs specializing in Pediatrics may have higher priorities than money...
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Post by agedhippie on Mar 14, 2017 17:45:21 GMT -5
Because I find the discussion interesting and I have the time. My work involves sitting around for months and then a few days of blind panic for which I am paid fairly well. My aim, actually, is more to raise the level of understanding as to what it means to be a Type 1 diabetic and how diabetics think because you hear some really odd things from non-diabetics. If you are investing in Mannkind for Afrezza this is your target market so if you want to make an informed decision you really need to understand it. Aged since you want to give advice so people can make an informed decision why don't you try it yourself. From what Sam Finta and the rest of the T1s have said, pretty much throw out everything you have learned to date. I have made an informed decision and there are a series of points: - I have read the trial data and talked to my endo. At best Afrezza is non-inferior and it has a lung risk. That's the head line decider. - There is no way I am taking two doses for a meal - simply not happening. - Injections do not bother me at all and I have no problem injecting in public - if people don't like it they can look away but mostly they never even know I did it. - I would love to use it for corrections but my insurance is enough of a pain without trying to get them let me have two prandial insulins (I had an hour long argument with an idiot tech who didn't understand how MDI works when I last renewed my prescription. They are trying really hard to restrict prescriptions). - I do ok with the exisiting insulin. If I was like Sweedee's dad then I would change in a heartbeat. Diabetics are not interchangeable despite what people and doctors think. I applaud Sam and the rest but for me the risk/reward is not there yet. Nor are they for all those T1s you see reflected in the script numbers who are failing to renew presumably a lot of whom because it has not worked for them.
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Post by agedhippie on Mar 14, 2017 17:48:08 GMT -5
I'm very high on CGMs. I was thinking of investing in Dexcom over MNKD years ago... boy did I blow that one. Anyway, from the data I found (today), CGM's have a 20% market penetration for T1. I wasn't able to find the # for T2 (quickly)... anyone know? I assume it's much less. < 5%? I did find something else interesting. Check out CGM's on page7. www.ncbi.nlm.nih.gov/pmc/articles/PMC4717493/Sounds like what we could be experiencing with Afrezza. New treatments for diabetes require lot more participation from patients, and doctors time, creating resistance from doctors. Basically, if the treatment isn't clear, quick, and easy to prescribe, getting it into patients hands is going to be difficult. If something takes more time, docs aren't getting compensation for that additional time. Sounds like a big problem... and an inefficiency in the system. Best patient outcome may be a lower priority than we'd hope. ---- It may also mean that we should be focusing on Pediatric patients, both because of more CGMs, and possibly docs willing to spend more time (money) on younger people. Docs specializing in Pediatrics may have higher priorities than money... Look at the number of T2 pump users, CGM users will be a subset of under 65 year old pump users. It's extremely difficult to get a CGM for a Type 2 because you usually need to be hypo-unaware and that's very rare in Type 2.
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Post by dreamboatcruise on Mar 14, 2017 18:02:13 GMT -5
Aged since you want to give advice so people can make an informed decision why don't you try it yourself. From what Sam Finta and the rest of the T1s have said, pretty much throw out everything you have learned to date. I have made an informed decision and there are a series of points: - I have read the trial data and talked to my endo. At best Afrezza is non-inferior and it has a lung risk. That's the head line decider. - There is no way I am taking two doses for a meal - simply not happening. - Injections do not bother me at all and I have no problem injecting in public - if people don't like it they can look away but mostly they never even know I did it. - I would love to use it for corrections but my insurance is enough of a pain without trying to get them let me have two prandial insulins (I had an hour long argument with an idiot tech who didn't understand how MDI works when I last renewed my prescription. They are trying really hard to restrict prescriptions). - I do ok with the exisiting insulin. If I was like Sweedee's dad then I would change in a heartbeat. Diabetics are not interchangeable despite what people and doctors think. I applaud Sam and the rest but for me the risk/reward is not there yet. Nor are they for all those T1s you see reflected in the script numbers who are failing to renew presumably a lot of whom because it has not worked for them. A risk adverse approach, but makes sense. Though I'm surprised by the strong aversion to two doses for a meal. Seems you are putting a second meal dose into a very different category than a "correction"? Maybe I don't understand the distinction.
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Post by agedhippie on Mar 14, 2017 19:03:22 GMT -5
I have made an informed decision and there are a series of points: - I have read the trial data and talked to my endo. At best Afrezza is non-inferior and it has a lung risk. That's the head line decider. - There is no way I am taking two doses for a meal - simply not happening. - Injections do not bother me at all and I have no problem injecting in public - if people don't like it they can look away but mostly they never even know I did it. - I would love to use it for corrections but my insurance is enough of a pain without trying to get them let me have two prandial insulins (I had an hour long argument with an idiot tech who didn't understand how MDI works when I last renewed my prescription. They are trying really hard to restrict prescriptions). - I do ok with the exisiting insulin. If I was like Sweedee's dad then I would change in a heartbeat. Diabetics are not interchangeable despite what people and doctors think. I applaud Sam and the rest but for me the risk/reward is not there yet. Nor are they for all those T1s you see reflected in the script numbers who are failing to renew presumably a lot of whom because it has not worked for them. A risk adverse approach, but makes sense. Though I'm surprised by the strong aversion to two doses for a meal. Seems you are putting a second meal dose into a very different category than a "correction"? Maybe I don't understand the distinction. It's a fair comment. Doctors tell you to bolus and then test and correct after two hours but nobody I know does that, it's just to disruptive. What you do is bolus for the food and only retest when you feel something is wrong then correct if necessary. Otherwise you test before the meal and roll any correction up into the meal time bolus. Testing and taking insulin is disruptive and not something I want to do, assuming I remember. It's easier with a CGM but those are still very much in the minority among diabetics and there still is the disruption of taking the insulin. Basically I, and every Type 1 I know, want to ignore diabetes and have as little to do with it as possible. If you start managing it to closely the burnout risk rises sharply and that is very dangerous.
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Post by dreamboatcruise on Mar 14, 2017 19:27:45 GMT -5
A risk adverse approach, but makes sense. Though I'm surprised by the strong aversion to two doses for a meal. Seems you are putting a second meal dose into a very different category than a "correction"? Maybe I don't understand the distinction. It's a fair comment. Doctors tell you to bolus and then test and correct after two hours but nobody I know does that, it's just to disruptive. What you do is bolus for the food and only retest when you feel something is wrong then correct if necessary. Otherwise you test before the meal and roll any correction up into the meal time bolus. Testing and taking insulin is disruptive and not something I want to do, assuming I remember. It's easier with a CGM but those are still very much in the minority among diabetics and there still is the disruption of taking the insulin. Basically I, and every Type 1 I know, want to ignore diabetes and have as little to do with it as possible. If you start managing it to closely the burnout risk rises sharply and that is very dangerous. Just curious... do you think "time in range" is something that would resonate with T1s if MNKD were to do the clinical trials to show superiority in that regard? I'm sure it would matter more to anyone with a CGM stuck to them, but if MNKD could develop a relatively simply protocol (even if involving a follow up test and dose) that had real clinical evidence of meaningful improvement of "time in range" would that be something that would convince you to try it (access issues notwithstanding).
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Post by peppy on Mar 14, 2017 21:12:01 GMT -5
aged knows more about insulin and diabetes than I ever will. Thank the universe! I believe we are focusing on the wrong thing here.
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