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Post by me on Apr 12, 2017 8:15:38 GMT -5
seyhay... if you didn't like the scientific reference, perhaps a layman's version will be easier to read... www.dummies.com/food-drink/special-diets/diabetes-diets/insulin-and-zinc-two-peas-in-a-pancreas/The insulin stored in the pancreas that makes up the first phase release is indeed hexamer. The difference between hexamer and monomer isn't relevant when it goes directly into the blood, as the former rapidly disassociates into the latter. Novalin-R and Humulin-R (regular human insulin) create hexamers in the solution just as occurs in the pancreas. They have rapid action when injected IV just as when hexamers are released from the pancreas. The delayed reaction of these when injected subq is because the hexamer is too large to readily transfuse into the capillaries. It must first disassociate and that does not happen quickly in the subcutaneous environment. Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. THIS is the key that should be communicated, if not to potential patients, then certainly to physicians.
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Post by kbrion77 on Apr 12, 2017 8:29:39 GMT -5
Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. THIS is the key that should be communicated, if not to potential patients, then certainly to physicians. Maybe they should work towards an organic label for insulin...... Apparently saying Insulin Human isn't getting the point across.
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Post by ssiegel on Apr 12, 2017 9:07:09 GMT -5
seyhay... if you didn't like the scientific reference, perhaps a layman's version will be easier to read... www.dummies.com/food-drink/special-diets/diabetes-diets/insulin-and-zinc-two-peas-in-a-pancreas/The insulin stored in the pancreas that makes up the first phase release is indeed hexamer. The difference between hexamer and monomer isn't relevant when it goes directly into the blood, as the former rapidly disassociates into the latter. Novalin-R and Humulin-R (regular human insulin) create hexamers in the solution just as occurs in the pancreas. They have rapid action when injected IV just as when hexamers are released from the pancreas. The delayed reaction of these when injected subq is because the hexamer is too large to readily transfuse into the capillaries. It must first disassociate and that does not happen quickly in the subcutaneous environment. Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. No, that's incorrect: "...insulin hexamers must dissociate once released from the beta cells to be biologically active. In the bloodstream, the concentration of zinc is much lower than in the storage vesicles of the beta cell, enabling dissociation by removal of the zinc. The pH of the blood is also higher than in the storage vesicles, probably contributing to the dissociation of the hexamer." Taken from: www.ebi.ac.uk/pdbe/widgets/QuipStories/insulin/insulin.pdf
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Post by me on Apr 12, 2017 10:18:32 GMT -5
Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. No, that's incorrect: "...insulin hexamers must dissociate once released from the beta cells to be biologically active. In the bloodstream, the concentration of zinc is much lower than in the storage vesicles of the beta cell, enabling dissociation by removal of the zinc. The pH of the blood is also higher than in the storage vesicles, probably contributing to the dissociation of the hexamer." Taken from: www.ebi.ac.uk/pdbe/widgets/QuipStories/insulin/insulin.pdf ssiegel, sayhey24 was correct. He said nothing about the insulin being released into the bloodstream as a monomer...he said, "it passes through the cell membrane as a MONOMER."
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Post by dreamboatcruise on Apr 12, 2017 11:51:13 GMT -5
seyhay... if you didn't like the scientific reference, perhaps a layman's version will be easier to read... www.dummies.com/food-drink/special-diets/diabetes-diets/insulin-and-zinc-two-peas-in-a-pancreas/The insulin stored in the pancreas that makes up the first phase release is indeed hexamer. The difference between hexamer and monomer isn't relevant when it goes directly into the blood, as the former rapidly disassociates into the latter. Novalin-R and Humulin-R (regular human insulin) create hexamers in the solution just as occurs in the pancreas. They have rapid action when injected IV just as when hexamers are released from the pancreas. The delayed reaction of these when injected subq is because the hexamer is too large to readily transfuse into the capillaries. It must first disassociate and that does not happen quickly in the subcutaneous environment. Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. It does not disassociate to dimers and then monomers until it is in the blood. Anytime you have high concentrations of insulin, such as in the pancreas and in the portal circulation system, you will get various multimers, the concentrations of which have to do with the concentration of insulin and of Zinc. In general blood circulation, insulin concentration is low enough that monomers are by far the dominant form. Rapid acting insulins are in fact engineered specifically to tilt the equilibrium in favor of the monomeric form, which is what allows it to transfuse faster into the bloodstream. Human insulin (recombinant), which via genetic engineering is produced by bacteria in vats, was not created by Al Mann. He just combined two existing technologies (recombinant human insulin and technosphere) to allow a delivery mechanism much faster than subq. From everything I know (a fair amount learned here from long ago when we had several people that actually knew the science), recombinant human insulin (Humalin-R and Novalin-R) behaves pretty much the same as Afrezza if it is injected IV. Either of these methods if taken as a single bolus provide pd/pk curves which resemble the first phase of release from the pancreas. Afrezza is a great advance for sure, but the insulin in Afrezza is the same insulin in Humalin-R and Novalin-R, all three of which are basically structurally the same as that produced by the pancreas. Neither inhalation nor IV delivery of recombinant human insulin has the very complex dynamic response of the pancreas... i.e. first bolus looks like first phase release of stored insulin from pancreas, follow up doses don't really look like second phase of pancreas secretion. The latter may not have a meaningfully adverse consequence in clinical use, but it is what it is. Mannkind does not claim there are "no severe hypos". The clinical trials had incidence of severe hypos. They showed reduced severe hypos compared to lispro, though apparently not at a level where the FDA was convinced to allow it as an efficacy claim on the label. Hopefully we can get some trials that show a clear and meaningful reduction in hypos... or better yet "time in range".
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Post by sayhey24 on Apr 12, 2017 19:52:55 GMT -5
Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. It does not disassociate to dimers and then monomers until it is in the blood. Anytime you have high concentrations of insulin, such as in the pancreas and in the portal circulation system, you will get various multimers, the concentrations of which have to do with the concentration of insulin and of Zinc. In general blood circulation, insulin concentration is low enough that monomers are by far the dominant form. Rapid acting insulins are in fact engineered specifically to tilt the equilibrium in favor of the monomeric form, which is what allows it to transfuse faster into the bloodstream. Human insulin (recombinant), which via genetic engineering is produced by bacteria in vats, was not created by Al Mann. He just combined two existing technologies (recombinant human insulin and technosphere) to allow a delivery mechanism much faster than subq. From everything I know (a fair amount learned here from long ago when we had several people that actually knew the science), recombinant human insulin (Humalin-R and Novalin-R) behaves pretty much the same as Afrezza if it is injected IV. Either of these methods if taken as a single bolus provide pd/pk curves which resemble the first phase of release from the pancreas. Afrezza is a great advance for sure, but the insulin in Afrezza is the same insulin in Humalin-R and Novalin-R, all three of which are basically structurally the same as that produced by the pancreas. Neither inhalation nor IV delivery of recombinant human insulin has the very complex dynamic response of the pancreas... i.e. first bolus looks like first phase release of stored insulin from pancreas, follow up doses don't really look like second phase of pancreas secretion. The latter may not have a meaningfully adverse consequence in clinical use, but it is what it is. Mannkind does not claim there are "no severe hypos". The clinical trials had incidence of severe hypos. They showed reduced severe hypos compared to lispro, though apparently not at a level where the FDA was convinced to allow it as an efficacy claim on the label. Hopefully we can get some trials that show a clear and meaningful reduction in hypos... or better yet "time in range". I am really not sure what you are trying to say? Look, the only active form of insulin is when its in a monomer state. As it is excreted from the beta cells through the cell membrane of the islet capillaries it is immediately converted to the active monomer state. It not much more complicated than that. Here is a guy who wrote an entire paper on it. As he says "Once the hexamers are secreted from the β-cell and diffuse into the blood down their concentration gradient, a combination of electrostatic repulsion and decreased concentration of insulin favors the dissociation of insulin into its monomeric form [1]. Hence, the monomer is the active form of insulin, while the hexamer is the storage form of insulin." www.ncbi.nlm.nih.gov/pmc/articles/PMC3934755/Bottom line - Insulin needs to be in its monomer state to get the glucose out of the blood. Not hexamer or dimmer but monomer.Now why are you conflating Al Mann and Genetech? What Genetech did was amazing creating GMO Human Insulin. They created an unending supply of insulin and we sure have no shortage of bacteria. Eli Lilly and Genetech made a fortune. Good for them. The problem was to stabilize it they needed to add zinc and put it into a hexamer state. It takes too damn much time to break down from hexamer to monomer. Nova Nordisk then thought through further Genetic Engineering they can make a better version which would get the insulin into a monomer state as fast the pancreas. They called it AspB10 which laid the foundation for ALL other Analog insulin developments. The problem we learned from it is the Analogs may not really be as safe in the long term as everyone has been saying. At least according to some new studies coming out. If in fact these studies are correct it explains at least part of the reason we see high cancer in PWDs on Analogs. Now to say ALL " Al Mann (and Sol Steiner) was just combined two existing technologies" is an insult to all the scientists who tried to do it for 90 years. But yes that is all they did. They took Genetechs GMO bacteria and Sol's FDKP. The result is the Holy Grail in diabetes care. afrezza combined with a CGM obsoletes ALL current T2 treatments. Fact is if treated immediately most T2s will be put into remission. afrezza combined with a CGM and a good basal (i.e. tresiba, toujeo) obsoletes the pump and all other RAAs and Dr. Berstein's diet.
You say "Afrezza is the same insulin in Humalin-R and Novalin-R" - Wrong. Afrezza is a monomer and the other are six-packs. Did you ever try to drink a can of beer while its still in the six pack? It doesn't work so well. Now take that can out of the six pack and pop the top, yes now they are the same. Now, of course you get the same Pk/PD pancreatic and afrezza curve when you take R human insulin directly into the blood through IV but who is doing that unless you are laying on your back in the ER? IMO, afrezza could actually reduce some of the ER craziness and all EMTs should be carrying afrezza correction doses. If the PWD is not passed out afrezza will get the BG down a lot faster than an ambulance ride. You say - Mannkind does not claim there are "no severe hypos". The clinical trials had incidence of severe hypos. My understanding is the guy who had the severe hypos had a liver problem. Regardless, I do not think anyone is saying that if you take enough insulin you won't get a severe hypo. That would be crazy. If I take enough salt or drink 2.5 gallons of water it will probably kill me. All I am saying is you really really have to try to get a severe hypo as long as your liver is healthy. If you are taking metformin - ALL bets off. If you miss dosed on your basal - ALL bets off. If you are a T2 sitting at 125 3 hours after eating I would not think twice about taking a medium afrezza but thats me. Others may want to take a small and then maybe another small. You say - Hopefully we can get some trials that show a clear and meaningful reduction in hypos... or better yet "time in range". From the ADCOM document page 24 - In all 3 active-controlled trials, both T1DM and T2DM subjects on TI experienced less hypoglycemia across severity categories with severe hypoglycemia event rates reduced by a range of 20% to 65% in the trials. I think the hypo question is settled. Now "time in range" - I have no idea what MNKD management is doing. If they are planning to stay an independent company most of their actions and in-actions IMO make NO sense.
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Post by rockstarrick on Apr 12, 2017 22:06:24 GMT -5
It does not disassociate to dimers and then monomers until it is in the blood. Anytime you have high concentrations of insulin, such as in the pancreas and in the portal circulation system, you will get various multimers, the concentrations of which have to do with the concentration of insulin and of Zinc. In general blood circulation, insulin concentration is low enough that monomers are by far the dominant form. Rapid acting insulins are in fact engineered specifically to tilt the equilibrium in favor of the monomeric form, which is what allows it to transfuse faster into the bloodstream. Human insulin (recombinant), which via genetic engineering is produced by bacteria in vats, was not created by Al Mann. He just combined two existing technologies (recombinant human insulin and technosphere) to allow a delivery mechanism much faster than subq. From everything I know (a fair amount learned here from long ago when we had several people that actually knew the science), recombinant human insulin (Humalin-R and Novalin-R) behaves pretty much the same as Afrezza if it is injected IV. Either of these methods if taken as a single bolus provide pd/pk curves which resemble the first phase of release from the pancreas. Afrezza is a great advance for sure, but the insulin in Afrezza is the same insulin in Humalin-R and Novalin-R, all three of which are basically structurally the same as that produced by the pancreas. Neither inhalation nor IV delivery of recombinant human insulin has the very complex dynamic response of the pancreas... i.e. first bolus looks like first phase release of stored insulin from pancreas, follow up doses don't really look like second phase of pancreas secretion. The latter may not have a meaningfully adverse consequence in clinical use, but it is what it is. Mannkind does not claim there are "no severe hypos". The clinical trials had incidence of severe hypos. They showed reduced severe hypos compared to lispro, though apparently not at a level where the FDA was convinced to allow it as an efficacy claim on the label. Hopefully we can get some trials that show a clear and meaningful reduction in hypos... or better yet "time in range". I am really not sure what you are trying to say? Look, the only active form of insulin is when its in a monomer state. As it is excreted from the beta cells through the cell membrane of the islet capillaries it is immediately converted to the active monomer state. It not much more complicated than that. Here is a guy who wrote an entire paper on it. As he says "Once the hexamers are secreted from the β-cell and diffuse into the blood down their concentration gradient, a combination of electrostatic repulsion and decreased concentration of insulin favors the dissociation of insulin into its monomeric form [1]. Hence, the monomer is the active form of insulin, while the hexamer is the storage form of insulin." www.ncbi.nlm.nih.gov/pmc/articles/PMC3934755/Bottom line - Insulin needs to be in its monomer state to get the glucose out of the blood. Not hexamer or dimmer but monomer.Now why are you conflating Al Mann and Genetech? What Genetech did was amazing creating GMO Human Insulin. They created an unending supply of insulin and we sure have no shortage of bacteria. Eli Lilly and Genetech made a fortune. Good for them. The problem was to stabilize it they needed to add zinc and put it into a hexamer state. It takes too damn much time to break down from hexamer to monomer. Nova Nordisk then thought through further Genetic Engineering they can make a better version which would get the insulin into a monomer state as fast the pancreas. They called it AspB10 which laid the foundation for ALL other Analog insulin developments. The problem we learned from it is the Analogs may not really be as safe in the long term as everyone has been saying. At least according to some new studies coming out. If in fact these studies are correct it explains at least part of the reason we see high cancer in PWDs on Analogs. Now to say ALL " Al Mann (and Sol Steiner) was just combined two existing technologies" is an insult to all the scientists who tried to do it for 90 years. But yes that is all they did. They took Genetechs GMO bacteria and Sol's FDKP. The result is the Holy Grail in diabetes care. afrezza combined with a CGM obsoletes ALL current T2 treatments. Fact is if treated immediately most T2s will be put into remission. afrezza combined with a CGM and a good basal (i.e. tresiba, toujeo) obsoletes the pump and all other RAAs and Dr. Berstein's diet.
You say "Afrezza is the same insulin in Humalin-R and Novalin-R" - Wrong. Afrezza is a monomer and the other are six-packs. Did you ever try to drink a can of beer while its still in the six pack? It doesn't work so well. Now take that can out of the six pack and pop the top, yes now they are the same. Now, of course you get the same Pk/PD pancreatic and afrezza curve when you take R human insulin directly into the blood through IV but who is doing that unless you are laying on your back in the ER? IMO, afrezza could actually reduce some of the ER craziness and all EMTs should be carrying afrezza correction doses. If the PWD is not passed out afrezza will get the BG down a lot faster than an ambulance ride. You say - Mannkind does not claim there are "no severe hypos". The clinical trials had incidence of severe hypos. My understanding is the guy who had the severe hypos had a liver problem. Regardless, I do not think anyone is saying that if you take enough insulin you won't get a severe hypo. That would be crazy. If I take enough salt or drink 2.5 gallons of water it will probably kill me. All I am saying is you really really have to try to get a severe hypo as long as your liver is healthy. If you are taking metformin - ALL bets off. If you miss dosed on your basal - ALL bets off. If you are a T2 sitting at 125 3 hours after eating I would not think twice about taking a medium afrezza but thats me. Others may want to take a small and then maybe another small. You say - Hopefully we can get some trials that show a clear and meaningful reduction in hypos... or better yet "time in range". From the ADCOM document page 24 - In all 3 active-controlled trials, both T1DM and T2DM subjects on TI experienced less hypoglycemia across severity categories with severe hypoglycemia event rates reduced by a range of 20% to 65% in the trials. I think the hypo question is settled. Now "time in range" - I have no idea what MNKD management is doing. If they are planning to stay an independent company most of their actions and in-actions IMO make NO sense. Sayhey, your responses are fascinating to read, it's obvious to me that you were fairly close to Al and are basically a book of knowledge on this Company we call Mannkind. I sure hope a few of your hypotheses come to fruition, and it wouldn't surprise me one bit if they did. GO MANNKIND !!! 🇺🇸
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Post by mango on Apr 12, 2017 23:20:01 GMT -5
Great - no one is talking about what is STORED. We are talking about what is USED. When it is excreted into the blood it passes through the cell membrane as a MONOMER. No one is taking insulin IV unless they are in the emergency room. I will read BOTH your papers later. Regular human insulin is stabilized with zinc which makes the 6 molecules get all balled up. They are not usable in that form. Analogs are a whole other story - first they have different GMO molecules much different than human insulin. They are not what is natural to the body and in the solution you have a mix of hexamers, dimmers and monomers. That is why Al Mann created the holy grail of insulin. He figured out with Sol Steiners help how to create the exact same insulin used NATURALLY by the body. Thats the greatness behind afrezza and all we hear about is its inhaled. This is also why the afrezza users are seeing two important things; no severe hypos - because it works in harmony with the liver; its very predictable because its natural to body function. He just combined two existing technologies (recombinant human insulin and technosphere) to allow a delivery mechanism much faster than subq.To be accurate—Al combined three technologies. 1) monomer (rDNA) insulin human 2) FDKP 3) The inhaler MannKind was approved a drug-delivery combo
MannKind also created and patented their awesome sexy superiorly engineered inhalers. They didn't borrow them. MannKind was granted approval for FDKP and the inhaler. MannKind also did not borrow the monomer insulin. They, themselves, figured out a way to stabilize the monomer molecules onto the FDKP particles. The end result is the dissolving of the particles within the distal airways and immediately entering into systemic circulation. MannKind then created the BluHale which uses an electro-static sensor that measures sound that is emitted in response from the high-resistant airflows. They assessed the pressure-time profiles (PIP and AUC) and correlating sound and cutting to the chase— engineered an inhaler that can effectively de-agglomerate the powder into small micrometer sized individual particles that are able to slowly travel, while avoiding agglomeration/clumping and disposition into the upper airways, and reach the small distal airways where the technosphere-drug loaded particles immediately dissolve and enter systemtic cirulation. Technosphere loaded insulin exits the cartridge housed in the inhaler as a monomer, and is immediately absorbed into systemic circulation as a monomer where it will then mimic the endogenous secretion of mealtime insulin.
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Post by sayhey24 on Apr 13, 2017 6:00:46 GMT -5
Bingo - thats 100% correct and what raises the issue what was the FDA thinking. All the discussion was about monomer human insulin not being as good as a faux insulin. It had to explode Al's head. What was approved was the Technosphere Insulin Inhalation system.
Nothing reduces high Blood sugar but insulin and there is no better insulin than the monomer human insulin the pancreas secretes and afrezza is the exact same when entering the blood.
Afrezza with the CGM obsoletes all T2 treatment. What are T2s going to do when they plug the CGM in and see medformin do nothing to control mealtime spikes? Well there is an entire session on this at ADA 77 and what I think is MNKD should put a petition together to have afrezza and CGMs become front line treatment and present it at the ADA session. Graphs showing metformin dealing with mealtime spikes would be a beauty.
Just like Dexcom did for their CGM approval with the FDA, gets 1000's to sign it.
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Post by derek2 on Apr 13, 2017 6:57:07 GMT -5
Bingo - thats 100% correct and what raises the issue what was the FDA thinking. All the discussion was about monomer human insulin not being as good as a faux insulin. It had to explode Al's head. What was approved was the Technosphere Insulin Inhalation system. Nothing reduces high Blood sugar but insulin and there is no better insulin than the monomer human insulin the pancreas secretes and afrezza is the exact same when entering the blood. Afrezza with the CGM obsoletes all T2 treatment. What are T2s going to do when they plug the CGM in and see medformin do nothing to control mealtime spikes? Well there is an entire session on this at ADA 77 and what I think is MNKD should put a petition together to have afrezza and CGMs become front line treatment and present it at the ADA session. Graphs showing metformin dealing with mealtime spikes would be a beauty. Just like Dexcom did for their CGM approval with the FDA, gets 1000's to sign it. Hi Sayhey I agree with your view on CGMs. Real time = best info. T2s don't tend to have insurance coverage for them, however. In fact, many insurance plans will only cocer 1 or 2 strips _per day_ for T2s. I think that's short sighted, but until that changes it will be a barrier to T2s getting the best data. I would add that nothing lowers blood glucose _better than_ insulin. Activity, excretion through urine and sweat, movement from blood to the gut and conversion in the gut by bacteria all play a lesser role as well. Re: Metformin - Metformin is an insulin sensitizer, also it just helps your body's or exogenous insulin work better. It doesn't work directly on blood glucose, although it may block some glucose from getting to the blood from the gut (thus the flatulence side effect). Well, your body works better at binding the insulin on cell receptors in order to receive the signal to absorb glucose. Give a T2 on Metformin a Dexcom - Holy cow there's a rise after meals!. Take the metformin away for a week. Holy cow the rise after meals is much worse! Put them back on metformin - okay, that's better. The rise is smaller. One side comment: I find it really interesting to see how many people can have the same data available yet come to varying conclusions. The difference between data, knowledge and wisdom.
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Post by mango on Apr 13, 2017 9:27:53 GMT -5
Bingo - thats 100% correct and what raises the issue what was the FDA thinking. All the discussion was about monomer human insulin not being as good as a faux insulin. It had to explode Al's head. What was approved was the Technosphere Insulin Inhalation system. Nothing reduces high Blood sugar but insulin and there is no better insulin than the monomer human insulin the pancreas secretes and afrezza is the exact same when entering the blood. Afrezza with the CGM obsoletes all T2 treatment. What are T2s going to do when they plug the CGM in and see medformin do nothing to control mealtime spikes? Well there is an entire session on this at ADA 77 and what I think is MNKD should put a petition together to have afrezza and CGMs become front line treatment and present it at the ADA session. Graphs showing metformin dealing with mealtime spikes would be a beauty. Just like Dexcom did for their CGM approval with the FDA, gets 1000's to sign it. Hi Sayhey I agree with your view on CGMs. Real time = best info. T2s don't tend to have insurance coverage for them, however. In fact, many insurance plans will only cocer 1 or 2 strips _per day_ for T2s. I think that's short sighted, but until that changes it will be a barrier to T2s getting the best data. I would add that nothing lowers blood glucose _better than_ insulin. Activity, excretion through urine and sweat, movement from blood to the gut and conversion in the gut by bacteria all play a lesser role as well. Re: Metformin - Metformin is an insulin sensitizer, also it just helps your body's or exogenous insulin work better. It doesn't work directly on blood glucose, although it may block some glucose from getting to the blood from the gut (thus the flatulence side effect). Well, your body works better at binding the insulin on cell receptors in order to receive the signal to absorb glucose. Give a T2 on Metformin a Dexcom - Holy cow there's a rise after meals!. Take the metformin away for a week. Holy cow the rise after meals is much worse! Put them back on metformin - okay, that's better. The rise is smaller. One side comment: I find it really interesting to see how many people can have the same data available yet come to varying conclusions. The difference between data, knowledge and wisdom. Again, Metformin does not do anything beneficial long-term. It disrupts signalling processes, causes oxidative stress (which just is essentially addin to the already occuring oxidative stress that diabetes causes by itself causes), causes mitochondrial dysfunction, increases amyloid precursor proteins and presenilin which causes aggregation of beta-amyloid and so on. Why not treat the actual underlying process? Cannabidiol augments IL-4 and IL-10 through a Th1 > Th2 cytokine shift. Since the endocannabinoid system is directly responsible in the regulation of all the processes that can cause diabetes, then maybe utilizing that knowledge will result in real outcomes instead of just making more junk like Metformin.
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