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Post by Deleted on Mar 28, 2017 11:13:49 GMT -5
I'm quite interested in what exactly has changed in the two weeks since q4 earnings were announced to bring on this extremely negative sentiment. Were you expecting much better scripts? The PPS decline? Did something else happen? I lost faith during the recent call when the Reverse Split was announced. Sold 75% the next morning at $.64 ($3.20 post split). I sold the rest a few minutes before the recent conf call at about $.41 (2.05 post split). I lauded and praised Matt last Nov 9 or so when he improved the financial position of MNKD by almost $130 million with the Sanofi settlement. A great job. Well done. THAT was 5 months ago. They continue to spend cash at $10 million per month while selling less than 300 scrips per week. THEY WILL SOON BE OUT OF CASH. Apparently with zero prospects of raising any funds. Certainly none they are willing to share with investors with 95% losses. I guess we're "on or own" I am/was an accountant/CPA. It doesn't take Warren Buffet to see that the financial prospects of MNKD are hopeless. I always thought the Mann Foundation or a Bill Gates-like investor would bolster them long enough to get Sales going. I no longer believe that. THREE fricking years now since FDA approval and 250 scrips per week. I am ashamed that I stuck with this investment as long as I did. The settlement if you think about it cost more then it was worth, realistically speaking..... What did they raise when they diluted last spring 40 million and what did they get out of SNY as far as cash is concerned 35 million. So they made zero progress in sales when the diluted and then it cost more then they received back. I dont care about the SNY loan. The only thing that has been consistent is salaries.
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Post by silentknight on Mar 28, 2017 11:26:08 GMT -5
I lost faith during the recent call when the Reverse Split was announced. Sold 75% the next morning at $.64 ($3.20 post split). I sold the rest a few minutes before the recent conf call at about $.41 (2.05 post split). I lauded and praised Matt last Nov 9 or so when he improved the financial position of MNKD by almost $130 million with the Sanofi settlement. A great job. Well done. THAT was 5 months ago. They continue to spend cash at $10 million per month while selling less than 300 scrips per week. THEY WILL SOON BE OUT OF CASH. Apparently with zero prospects of raising any funds. Certainly none they are willing to share with investors with 95% losses. I guess we're "on or own" I am/was an accountant/CPA. It doesn't take Warren Buffet to see that the financial prospects of MNKD are hopeless. I always thought the Mann Foundation or a Bill Gates-like investor would bolster them long enough to get Sales going. I no longer believe that. THREE fricking years now since FDA approval and 250 scrips per week. I am ashamed that I stuck with this investment as long as I did. The settlement if you think about it cost more then it was worth, realistically speaking..... What did they raise when they diluted last spring 40 million and what did they get out of SNY as far as cash is concerned 35 million. So they made zero progress in sales when the diluted and then it cost more then they received back. I dont care about the SNY loan. The only thing that has been consistent is salaries. I wish they'd pay me over a million a year or grant me free stock options to run a company into the ground. That's what dreams are made of.
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Post by zuegirdor on Mar 28, 2017 11:36:31 GMT -5
Afrezza has to be understood as a new insulin tool. You cannot compare it to RAA PD/PK in terms of dosing. The problem is in the comparison of "units" and timing, pricing, prescription. The whole deal. ... .... ....Oh what a mangled clustercluck we have hatched! Oh yes clustercluck well said. Thanks for the great insights. If cost were not an issue would your son tend to use afrezza more for the phase 2 release or continue to use his RAA? Is Vdex doing any monitoring? The TV show MNKD is involved in is pushing a low fat diet. Any experiences with "low fat and high carb" versus "high fat and low carb"? Hows the high fat and high carb pizza work out for him? First off I need to point out that our diabetes mileage varies along with everyone else's. We have to pay out of pocket since we have an off label Rx (or so I understand-have heard otherwise too). So I don't mean to over-harp the price factor. He actually does use only Afrezza for about half of his meals and it works great as long as he wears his CGM and most of the time even when he does not wear the CGM. (I actually called Dexcom about the limitation of its high alert settings for those using Afrezza. Dexcom took my call seriously and said they would refer my suggestion that the high alert be lowered to operate below the current 120 limit. I also asked that it repeat the alarm every 5 minutes instead of every 15. This is one main reason why the CGM is not as useful as we though it would be. By the time you are at 120 the optimum time for follow up has almost passed. A 15 minute wait for a repeat warning and you are playing catch up-not ideal with Afrezza. Look at peakabull and Duckfiabetes' CGM traces. They gets great control because they are very experienced at knowing when they need to dose AND, perhaps most importantly, are mature persons, engaged with their pattern, who remember to look at the CGM for the slightest rise which signals the need for a follow up. They did not tell me the foregoing, but such is what I have gathered from our experience and looking at their BG graphs) High fat diet is how non-diabetics HAVE to eat to make the ketogenic diet work. If you are a T1, keto or not, fat is a little trickier. Bernstien only uses RAA for corrections, I believe. I wonder how much of the correction he needs on his diet is purely related to the effect of fat on gastric emptying and alternate routes of deriving glucose and glycogen from fat...? Fat makes covering carbs tricky. Insulin boluses with a longer tail (or repeated followups of either RAA or Afrezza) will be needed. However, Pizza is easier for us to manage with Afrezza. Start with an 8u cartridge. Then shoot some humalog and forget about it until bedtime. He is at 190? No problem. Take an 8u wait an hour and go to bed in range. We have done it without humalog. But he forgets to follow up over the long course of a pizza meal which I would guess needs about 4 hours worth of your attention. If you start out in range, say 85, and can beat the rises (a big if for us), I imagine you could take a 4u every 40 minutes or so and flat line. But I have never read any other Afrezza users accounts of exactly how they do Pizza- would be instructive if they shared with us. You have to appreciate that my kid does pizza big (like most kids). He frequently ingests more than 100g carbs in addition to all that fat. So any other accounts need to define the "boundary conditions" as well as the dosing method.
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Post by sportsrancho on Mar 28, 2017 11:49:17 GMT -5
Tom's son, 18 now. On Afrezza for two years. Takes a 12 if having pizza. 8 for other meals, and 4 for snacks. No follow ups. He just now got a CGM though so that may change. Their insurance has covered off-label for both kids.
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Post by zuegirdor on Mar 28, 2017 12:01:48 GMT -5
Tom's son, 18 now. On Afrezza for two years. Takes a 12 if having pizza. 8 for other meals, and 4 for snacks. No follow ups. He just now got a CGM though so that may change. Their insurance has covered off-label for both kids. Thanks for sharing. we have noticed the importance of taking a big starting dose, but in truth have not been doing that much out of concern for lows. We are still learning it seems. Our Rx does not include 12s. He will take an 8 and a 4 but have heard its not the same as a 12. I have to admit though, that unless my son is exercising while Afrezza is on board, he ALWAYS needs a follow up.- little skeptical here. But I hope to prove that skepticism misplaced. It would change our whole dosing regimen if a 12 worked the same way for son. Pizza again this Friday?
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Post by sportsrancho on Mar 28, 2017 13:16:33 GMT -5
Tom's son, 18 now. On Afrezza for two years. Takes a 12 if having pizza. 8 for other meals, and 4 for snacks. No follow ups. He just now got a CGM though so that may change. Their insurance has covered off-label for both kids. Thanks for sharing. we have noticed the importance of taking a big starting dose, but in truth have not been doing that much out of concern for lows. We are still learning it seems. Our Rx does not include 12s. He will take an 8 and a 4 but have heard its not the same as a 12. I have to admit though, that unless my son is exercising while Afrezza is on board, he ALWAYS needs a follow up.- little skeptical here. But I hope to prove that skepticism misplaced. It would change our whole dosing regimen if a 12 worked the same way for son. Pizza again this Friday? Right, they aren't afraid of lows, and the whole family are work-out nuts:-) all kinds of sports, skiing, weight training. The son has put on muscle and his well being is top notch now. Daughter has lost fat.
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Post by zuegirdor on Mar 28, 2017 17:57:30 GMT -5
When we are in recreation mode, he seldom needs a follow up. One 8u for a big meal and he stays in range. I think the other trick is staying in range. He often drifts out of range and starts a meal high, like this morning at 169. That uses an 8u right there! When he starts meals at 82, he does not even take a puff for at least 20 minutes, then he usually only needs a 4u follow up an hour later and hes good. But these situations are the reality for a lot of T1Ds-most of whom even worse control on RAA. Perhaps part of the difficulty with adopting Afrezza is that many T1Ds just give up period. They are beyond caring, hoping and help. Did not want to see that happen to my son. But I see it wearing him down...less so, but even with Afrezza.
Wish there was a pill that would make him more interested in exercise. I hardly ever ask him if he wants to go to the gym with me anymore...never wants to go. He acts as if he is not a T1D and does not need to care about the benefits of exercise.
Venting/Ranting now. This is not the place...
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Post by sportsrancho on Mar 28, 2017 18:36:23 GMT -5
When we are in recreation mode, he seldom needs a follow up. One 8u for a big meal and he stays in range. I think the other trick is staying in range. He often drifts out of range and starts a meal high, like this morning at 169. That uses an 8u right there! When he starts meals at 82, he does not even take a puff for at least 20 minutes, then he usually only needs a 4u follow up an hour later and hes good. But these situations are the reality for a lot of T1Ds-most of whom even worse control on RAA. Perhaps part of the difficulty with adopting Afrezza is that many T1Ds just give up period. They are beyond caring, hoping and help. Did not want to see that happen to my son. But I see it wearing him down...less so, but even with Afrezza. Wish there was a pill that would make him more interested in exercise. I hardly ever ask him if he wants to go to the gym with me anymore...never wants to go. He acts as if he is not a T1D and does not need to care about the benefits of exercise. Venting/Ranting now. This is not the place... You are a good example. That pays off. Tom's daughter is your sons age and is like that too. She's going to a gym now that a lot of her friends go to and shes doing better. Out side of all the other benefits it raises your mood level and just makes you feel like taking better care of yourself. As they get older they start to care more IMO:-)
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Post by dreamboatcruise on Mar 28, 2017 18:37:23 GMT -5
When we are in recreation mode, he seldom needs a follow up. One 8u for a big meal and he stays in range. I think the other trick is staying in range. He often drifts out of range and starts a meal high, like this morning at 169. That uses an 8u right there! When he starts meals at 82, he does not even take a puff for at least 20 minutes, then he usually only needs a 4u follow up an hour later and hes good. But these situations are the reality for a lot of T1Ds-most of whom even worse control on RAA. Perhaps part of the difficulty with adopting Afrezza is that many T1Ds just give up period. They are beyond caring, hoping and help. Did not want to see that happen to my son. But I see it wearing him down...less so, but even with Afrezza. Wish there was a pill that would make him more interested in exercise. I hardly ever ask him if he wants to go to the gym with me anymore...never wants to go. He acts as if he is not a T1D and does not need to care about the benefits of exercise. Venting/Ranting now. This is not the place... A welcome break from the venting/ranting about Mannkind from some... and by some, I think I primarily mean me. Your son is the one that really has a reason to vent. Hopefully can do that constructively rather than just burning out with the issue. Good luck.
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Post by peppy on Mar 28, 2017 19:03:49 GMT -5
When we are in recreation mode, he seldom needs a follow up. One 8u for a big meal and he stays in range. I think the other trick is staying in range. He often drifts out of range and starts a meal high, like this morning at 169. That uses an 8u right there! When he starts meals at 82, he does not even take a puff for at least 20 minutes, then he usually only needs a 4u follow up an hour later and hes good. But these situations are the reality for a lot of T1Ds-most of whom even worse control on RAA. Perhaps part of the difficulty with adopting Afrezza is that many T1Ds just give up period. They are beyond caring, hoping and help. Did not want to see that happen to my son. But I see it wearing him down...less so, but even with Afrezza. Wish there was a pill that would make him more interested in exercise. I hardly ever ask him if he wants to go to the gym with me anymore...never wants to go. He acts as if he is not a T1D and does not need to care about the benefits of exercise. Venting/Ranting now. This is not the place... we need the 4,8,12 unit tritation packs. we need the 4,8,12 unit titration packs priced correctly. your son is our target audience. Since MNKD seems to be going out of business, make that insulin into monomeric human insulin start the show, and lower the price on the titration pack. The pack.
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Post by sayhey24 on Mar 28, 2017 20:03:00 GMT -5
When we are in recreation mode, he seldom needs a follow up. One 8u for a big meal and he stays in range. I think the other trick is staying in range. He often drifts out of range and starts a meal high, like this morning at 169. That uses an 8u right there! When he starts meals at 82, he does not even take a puff for at least 20 minutes, then he usually only needs a 4u follow up an hour later and hes good. But these situations are the reality for a lot of T1Ds-most of whom even worse control on RAA. Perhaps part of the difficulty with adopting Afrezza is that many T1Ds just give up period. They are beyond caring, hoping and help. Did not want to see that happen to my son. But I see it wearing him down...less so, but even with Afrezza. Wish there was a pill that would make him more interested in exercise. I hardly ever ask him if he wants to go to the gym with me anymore...never wants to go. He acts as if he is not a T1D and does not need to care about the benefits of exercise. Venting/Ranting now. This is not the place... we need the 4,8,12 unit tritation packs. we need the 4,8,12 unit titration packs priced correctly. your son is our target audience. Since MNKD seems to be going out of business, make that insulin into monomeric human insulin start the show, and lower the price on the titration pack. The pack.
Yes, we keep going round and round on pricing and packaging. In addition to insurance coverage and the need to have help when learning to titrate. Taking a 4 + 8 is exactly the same as a 12 which has 30units(4 has 10 and the 8 has 20). You will only get about 40% of the usable insulin due to loss in device, mouth and throat. It clearly sounds you are under dosing on the initial puff and following Sport's friend outline you probably want to try. With afrezza you are better to take more than less and let the liver do its job but I would get the titrating done with out the RAA which is bringing in a whole set of different variables and will impact the livers ability to correct a low. The reason I asked about fat and carbs is, in theory with afrezza if you take enough on the initial dose with a low fat diet you shouldn't need a second dose. afrezza can handle the carbs spike which an RAA can't. Bernstein's diet is ideal for the RAA because of the slowed digestion and lower glucose spike which mimics the RAA profile but has been obsoleted by afrezza which mimics the pancreas. The slowed digestion may require a second afrezza dose depending on the carbs as you see with the pizza. Best of luck, I wish afrezza was much more affordable for you.
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Post by sellhighdrinklow on Mar 28, 2017 20:32:35 GMT -5
Oh yes clustercluck well said. Thanks for the great insights. If cost were not an issue would your son tend to use afrezza more for the phase 2 release or continue to use his RAA? Is Vdex doing any monitoring? The TV show MNKD is involved in is pushing a low fat diet. Any experiences with "low fat and high carb" versus "high fat and low carb"? Hows the high fat and high carb pizza work out for him? First off I need to point out that our diabetes mileage varies along with everyone else's. We have to pay out of pocket since we have an off label Rx (or so I understand-have heard otherwise too). So I don't mean to over-harp the price factor. He actually does use only Afrezza for about half of his meals and it works great as long as he wears his CGM and most of the time even when he does not wear the CGM. (I actually called Dexcom about the limitation of its high alert settings for those using Afrezza. Dexcom took my call seriously and said they would refer my suggestion that the high alert be lowered to operate below the current 120 limit. I also asked that it repeat the alarm every 5 minutes instead of every 15. This is one main reason why the CGM is not as useful as we though it would be. By the time you are at 120 the optimum time for follow up has almost passed. A 15 minute wait for a repeat warning and you are playing catch up-not ideal with Afrezza. Look at peakabull and Duckfiabetes' CGM traces. They gets great control because they are very experienced at knowing when they need to dose AND, perhaps most importantly, are mature persons, engaged with their pattern, who remember to look at the CGM for the slightest rise which signals the need for a follow up. They did not tell me the foregoing, but such is what I have gathered from our experience and looking at their BG graphs) High fat diet is how non-diabetics HAVE to eat to make the ketogenic diet work. If you are a T1, keto or not, fat is a little trickier. Bernstien only uses RAA for corrections, I believe. I wonder how much of the correction he needs on his diet is purely related to the effect of fat on gastric emptying and alternate routes of deriving glucose and glycogen from fat...? Fat makes covering carbs tricky. Insulin boluses with a longer tail (or repeated followups of either RAA or Afrezza) will be needed. However, Pizza is easier for us to manage with Afrezza. Start with an 8u cartridge. Then shoot some humalog and forget about it until bedtime. He is at 190? No problem. Take an 8u wait an hour and go to bed in range. We have done it without humalog. But he forgets to follow up over the long course of a pizza meal which I would guess needs about 4 hours worth of your attention. If you start out in range, say 85, and can beat the rises (a big if for us), I imagine you could take a 4u every 40 minutes or so and flat line. But I have never read any other Afrezza users accounts of exactly how they do Pizza- would be instructive if they shared with us. You have to appreciate that my kid does pizza big (like most kids). He frequently ingests more than 100g carbs in addition to all that fat. So any other accounts need to define the "boundary conditions" as well as the dosing method.
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Post by sellhighdrinklow on Mar 28, 2017 20:57:23 GMT -5
A few comments.... All pizza is not created equal! Thin crust Vegetarian w chicken and 1/2 the cheese is far different than a combination on thick crust or focaccia! ..As in twice to 3x the calories. Fat content isn't as easily covered via Afrezza unless the type 1 is active! The fat increases the BS 2 or 3 hours down the road when Afrezza efficacy is minimal. A bigger follow up dose is needed. W Humalog a Type 1 has/had more on board to cover inevitable spikes but still in need of more Humalog. Fried foods or high fat foods are a detriment to any Type 1. Afrezza is awesome for me, no doubt! But eating a healthy, lower carb, lower fat diet is key. Period. Yes, I indulge at times and it is SO MUCH EASIER TO CORRECT W AFREZZA, BUT, exercise...Even "only" putting 4 miles on your phone's pedometer tracker w one's movement throughout the day, is key to keeping things in range, feeling great and having an A1C sub 6.
I've used a 4-unit cartridge along w 3 units Humalog w meals when I was rationing Afrezza at the end of a prescription ( 2 boxes for 30 days) and quite frankly, it worked exceptionally well. My BS barely moved. This is in place of 5 Humalog. or 8 Afrezza. I told my Dr. this and and he was perplexed and had me repeat what I said. He then agreed w my rationale. I had to talk my doc into prescribing for me because of my research. I'm now almost 2 years in, Afrezza use. Quite frankly, I'm informing my doc of my success and logic w dosing. I'm basically teaching him although he has other patients on Afrezza as well as me. I don't know how many.
Before, I had 2 boxes per month. Now 3 and I'm accumulating more cartridges so that I never run out. My last co-pay was $15. The second month of 3 boxes. Last month I paid $215. Anthem BC, silver, California.
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Post by seanismorris on Mar 28, 2017 21:50:13 GMT -5
It's sad that many bullish posters are now turning bearish...
I've been bearish for quite some time... Just call me a visionary! : (
Everyone (patients & investors) lost out big time.
The only people that haven't lost is MannKind Executives.
The sad reality is companies don't work for you (the investor). They're going to continue to lie to you until the doors close for the final time.
Investing in individual companies is crazy risky.
I figure we (MannKind) have a 15% chance of surviving 2 years.
If things continue... we're probably looking at 1-2% by the end of the year.
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Post by agedhippie on Mar 29, 2017 9:04:03 GMT -5
There are some misconceptions about the Bernstein diets, fat, and carbs. The reason that Bernstein emphasizes fat is because it is an ultra-low carb diet. He recommends 30g of carbs per day which is not much more than an apple. This means you are getting about 120 calories from carbs and the remaining 1500+ must come from protein or fat. Fat is calorie dense so it helps cover that gap - it would take a couple of pounds of grilled chicken a day otherwise.
Normal numbers are quite common on the diet as is serious weight loss. Bernstein still uses basal (he is Type 1 so he would die if he didn't) but hardly uses any mealtime insulin. I have never used the diet myself, it really doesn't appeal, but I know people who have and it certainly seems to work.
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