|
Post by careful2invest on Mar 14, 2017 21:43:36 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. That he may Peppy, but that does not mean that he is not "soft-bashing"! My main point that initiated this thread was that we finally heard from MNKD directly, about AFREZZA's role in conjunction with the use of a CGM (either made by Dexcom or Abbot) as well as the mention of GOOGLE'S involvement in Diabetes.
|
|
|
Post by agedhippie on Mar 14, 2017 22:21:50 GMT -5
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). It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit.
|
|
|
Post by peppy on Mar 14, 2017 22:31:58 GMT -5
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). It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit. Aged, what the heck are you typing about? Jeeze, check your glucose level. Molly had two babies before she died and she never had an HgA1c they were not used back then. hgA1c started to be used in? 2009? Heh Molly's dad was a type 1, and molly was born 1960. never had an HgA1c and I know neither of them was ever controlled.
|
|
|
Post by brotherm1 on Mar 14, 2017 22:51:29 GMT -5
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). It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit. possibly 9.2% of pregnant women develop gestational diabetes. 4 million births per year in the USA. Time to start another thread? www.medscape.com/viewarticle/827315
|
|
|
Post by peppy on Mar 14, 2017 23:05:23 GMT -5
It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit. possibly 9.2% of pregnant women develop gestational diabetes. 4 million births per year in the USA. Time to start another thread? www.medscape.com/viewarticle/827315Much better use of afrezza in a hospital situation, is all the people that become, "diabetic" from the medications they are put on in the hospital. corticosteroids. iatrogenic diabetes.
|
|
|
Post by dreamboatcruise on Mar 15, 2017 12:58:25 GMT -5
It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit. Interesting. Sounds like a job for Afrezza + CGM. Too bad they didn't manage to do a trial for this indication back when they had money. Granted, nothing would stop a doctor from seeing this potential on their own and trying it... but when they look at their malpractice insurance bill it might make them forget the potential. Is the OB/GYN normally the one that would make diabetes treatment decisions during pregnancy or would that typically still be an Endo?
|
|
|
Post by agedhippie on Mar 15, 2017 13:21:35 GMT -5
It would help. But I am probably not typical in that I spend a lot of time obsessing over this stuff. Mostly people just go with their endos. That said, any OB/GYN handling diabetics would love Afrezza if it provided solid time in range because it would solve a huge problem, having babies. If you want a kid you need to have an A1c as close to 6 as possible (certainly under 7) for three months before conception and do that by holding a range between 80 and 155 at all times - that is very hard to do as you are usually much higher at the 1 hour post meal mark. Once you are pregnant they want you to stay between 85 and 130 at all times. Personally I don't know how anyone does it. Gestational diabetes is almost as bad for the range. Thing is if you stray outside those limits bad things happen to the baby and mother. That's where I would go, not DTC. I don't know if I have ever seen an advert targeting Type 1, lots going after Type 2 but no Type 1. The reason is probably because it's not a persuadable market. If you are a Type 1 you are unlikely to change your insulin because of an advert in my view because its so fundamental to your life. And in my experience (and a few others on the board) if you bring it up the doctor is going to knock it down and people tend to leave it at that point. Take the DTC money and spend it on cracking the OB/GYN market where time in range is a golden benefit. Interesting. Sounds like a job for Afrezza + CGM. Too bad they didn't manage to do a trial for this indication back when they had money. Granted, nothing would stop a doctor from seeing this potential on their own and trying it... but when they look at their malpractice insurance bill it might make them forget the potential. Is the OB/GYN normally the one that would make diabetes treatment decisions during pregnancy or would that typically still be an Endo? Around here it's the OB/GYN as the person is their patient. They may take input from the endo but ultimately it's their patient. My pitch would be that it's just insulin, however it is particularly effective at keep you in range and it doesn't need injections. They are comfortable with insulin so they wouldn't see it as a big deal. I would spend a lot of time with the first one assisting with titration then let word of mouth do the rest. Also the risk is limited because they would not be on Afrezza long term. Although women who get this tend to get Type 2 later in life at which point they will want what they had before - Afrezza. Meanwhile it gets endos used to the idea of what Afrezza can do.
|
|
|
Post by brotherm1 on Mar 15, 2017 13:39:59 GMT -5
Sports, get on the horn to headquarters 😎
|
|
|
Post by dreamboatcruise on Mar 15, 2017 13:40:21 GMT -5
Around here it's the OB/GYN as the person is their patient. They may take input from the endo but ultimately it's their patient. My pitch would be that it's just insulin, however it is particularly effective at keep you in range and it doesn't need injections. They are comfortable with insulin so they wouldn't see it as a big deal. I would spend a lot of time with the first one assisting with titration then let word of mouth do the rest. Also the risk is limited because they would not be on Afrezza long term. Although women who get this tend to get Type 2 later in life at which point they will want what they had before - Afrezza. Meanwhile it gets endos used to the idea of what Afrezza can do. Seems like Mannkind should be attending OB/GYN medical conferences, especially if they have sessions related to diabetes during pregnancy... which it would seem they would.
|
|
|
Post by agedhippie on Mar 15, 2017 13:46:23 GMT -5
Aged, what the heck are you typing about? Jeeze, check your glucose level. Molly had two babies before she died and she never had an HgA1c they were not used back then. hgA1c started to be used in? 2009? Heh Molly's dad was a type 1, and molly was born 1960. never had an HgA1c and I know neither of them was ever controlled.
Whoops, I will check You are right and these numbers are not absolutely necessary, it's just that the complication rate is a lot lower. A friend who works in social services deals with Type 1 addicts who get pregnant and they definitely are not controlled! There are issues around preeclampsia, malformed organs, premature and still births, and to miscarry. These all risks all rise sharply in uncontrolled diabetics, but that doesn't mean everyone gets them by any means. It does mean if you have an OB/GYN they will probably be hammering the point because they would rather not have the risk. An great-aunt of mine was one of the first Type 1 diabetics on insulin and lived to be 84 without any diabetic complications which was, frankly, amazing. My mother said as children they liked her because she always had biscuits.
|
|
|
Post by dreamboatcruise on Mar 15, 2017 14:06:47 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. That he may Peppy, but that does not mean that he is not "soft-bashing"! My main point that initiated this thread was that we finally heard from MNKD directly, about AFREZZA's role in conjunction with the use of a CGM (either made by Dexcom or Abbot) as well as the mention of GOOGLE'S involvement in Diabetes. No exact definition of "soft-bashing"... but let's take yours that what he is posting is "bashing". Unless you are accusing him of giving factually incorrect information, it would seem that you are saying that insight into why Afrezza has so far not taken off in the market is "bashing". That's a problem for Afrezza that the truth is a "bash". Simply coercing people into not talking about these truthful "bashes" of doctor and patient views of Afrezza isn't going to better the prospects for Afrezza. In fact quite the opposite. Mannkind would have been way better off to have listened to these voices long ago. Google's involvement in diabetes was/is very widely known. I'd be surprised if a total of two people found that as new information coming from Matt. No indication that their involvement would benefit MNKD in any way. In fact, if anything we see that they are partnered with the company that tried to kill Afrezza. Though, whatever they are doing is likely to not have much of an effect on clinical prescribing practices for many years to come.
|
|