|
|
Post by rockstarrick on Oct 25, 2017 15:57:44 GMT -5
Closed loops are absolute nightmares if not calibrated frequently and accurately. It’s nearly impossible to get a pump to change directions without overshooting the desired set point resulting in higher and lower doses of whatever it is you are feeding, until the pump stabilizes. I can imagine when dosing something like Insulin, these fluctuations would happen after every meal !! I can’t see them getting it done without paying special attention to fluctuating mealtime glucose levels, which in my opinion, takes a lot of the automation out of it. I agree 100%, they will get better glucose levels easier with Tresiba and Afrezza. This will only be an issue until more PWD learn of the Tresiba/Afrezza combination. 👀 Add to what you said about calibrating and fluctuating glucose, the fact that foreign body rejection, infusion line occlusion and infusion site irritation are not just uncomfortable but can lead to serious under and over dosing and infections. It happens. I don't have frequency data handy but I have read accounts of pump caused hypo and hyper glycemia. Also have read (sorry no link to studies) that average A1c are not that impressive, something just on the verge of the more recent target recommendations of 7 or less. I want to say the average I remember for pumps being around 7.3...? My kid's latest on A1c Afrezza was 6.0. We go in on the 9th of Nov for another test. He has been nailing it lately with Afrezza. I won't be surprised if he pulls a 5.8. but I am getting ahead of myself... Calculating and administering an exact dose will always be better than a closed loop APS. They’ll never be able to even attempt to target the #’s your kid is experiencing, not with a closed loop APS. Congratulations to him/her on the Great #’s, 5.8 would be incredible. Good Luck ! |
|
|
|
Post by rockstarrick on Oct 25, 2017 16:01:02 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. I know in the Samsung APS trials, Afrezza was used to tackle the mealtime glucose challenges. agree again, this is a non issue. |
|
|
|
Post by rockstarrick on Oct 25, 2017 16:05:39 GMT -5
So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza  What did Al say about pumps? He said Afrezza would destroy their market, I believe this was @ John Hopkins when he said maybe someday Mannkind would buyout Medtronic. 😎 |
|
|
|
Post by rockstarrick on Oct 25, 2017 16:08:52 GMT -5
Just to add,,,
Didn’t J&J just ditch the Pump ??
😎
|
|
|
|
Post by agedhippie on Oct 25, 2017 16:10:27 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. I will take the AP in a heartbeat if it works, and so would most of the Type 1s I know. I never need to bother about diabetes again apart from refilling the insulin pump every few days and changing a sensor every couple of weeks? Where do I sign, and this from someone who doesn't like devices attached to him. On the practical side I would reserve judgement until I see a live production version and it's trial data. I would also expect insurance to be a real struggle, at least initially. To Baba's point the AP is not going to touch the Type 2 market, and that's where the numbers are. |
|
|
|
Post by esstan2001 on Oct 25, 2017 16:10:56 GMT -5
So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza What did Al say about pumps? I'm paraphrasing: that the pump is complicated and way more expensive, and Afrezza works so much better / costs way less, it would obviate the need for the pump (or just go with what DBC said) or best, just read Brentie's AM quote . |
|
|
|
Post by zuegirdor on Oct 25, 2017 17:44:16 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. I will take the AP in a heartbeat if it works, and so would most of the Type 1s I know. I never need to bother about diabetes again apart from refilling the insulin pump every few days and changing a sensor every couple of weeks? Where do I sign, and this from someone who doesn't like devices attached to him. On the practical side I would reserve judgement until I see a live production version and it's trial data. I would also expect insurance to be a real struggle, at least initially. To Baba's point the AP is not going to touch the Type 2 market, and that's where the numbers are. Depending on how well you tolerate the intrusion, you also might be changing infusion sets every three or four days, no? |
|
|
|
Post by mnholdem on Oct 25, 2017 18:29:17 GMT -5
What did Al say about pumps? He said Afrezza would destroy their market, I believe this was @ John Hopkins when he said maybe someday Mannkind would buyout Medtronic. 😎 He said that about Merck. I remember because I thought at the time that Al may have made that statement after negotiations with Merck went south...Al Mann was pretty candid about wanting a ton of money for Technosphere. |
|
|
|
Post by sayhey24 on Oct 25, 2017 18:47:47 GMT -5
Here you go Al in his own words 26:50m "pumps are going to be obsolete" www.youtube.com/watch?v=muBuxTqxmQoBut concerning the AP, it works best with afrezza www.youtube.com/watch?v=GGgGjtM5ipg 3minute mark This will also be the conclusion at Yale. Concerning Fiasp there are huge reports of injection site issues and its not currently approved for pump use by the FDA. However some have tried and have reported numerous issues. |
|
|
|
Post by agedhippie on Oct 25, 2017 19:30:08 GMT -5
I will take the AP in a heartbeat if it works, and so would most of the Type 1s I know. I never need to bother about diabetes again apart from refilling the insulin pump every few days and changing a sensor every couple of weeks? Where do I sign, and this from someone who doesn't like devices attached to him. On the practical side I would reserve judgement until I see a live production version and it's trial data. I would also expect insurance to be a real struggle, at least initially. To Baba's point the AP is not going to touch the Type 2 market, and that's where the numbers are. Depending on how well you tolerate the intrusion, you also might be changing infusion sets every three or four days, no? Yes, you would still have the site changes. I wouldn't be happy about that but the gain would outweigh the annoyance. An ordinary pump or a hybrid AP does not give enough benefit and I am with your son on that one. |
|
|
|
Post by sellhighdrinklow on Oct 25, 2017 20:05:13 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. I will take the AP in a heartbeat if it works, and so would most of the Type 1s I know. I never need to bother about diabetes again apart from refilling the insulin pump every few days and changing a sensor every couple of weeks? Where do I sign, and this from someone who doesn't like devices attached to him. On the practical side I would reserve judgement until I see a live production version and it's trial data. I would also expect insurance to be a real struggle, at least initially. To Baba's point the AP is not going to touch the Type 2 market, and that's where the numbers are. Disagree , 100%. Pump/artificial pancreas attached to you with a computer controlling your ...life? You're out of your mind. |
|
|
|
Post by sellhighdrinklow on Oct 25, 2017 20:07:40 GMT -5
I will take the AP in a heartbeat if it works, and so would most of the Type 1s I know. I never need to bother about diabetes again apart from refilling the insulin pump every few days and changing a sensor every couple of weeks? Where do I sign, and this from someone who doesn't like devices attached to him. On the practical side I would reserve judgement until I see a live production version and it's trial data. I would also expect insurance to be a real struggle, at least initially. To Baba's point the AP is not going to touch the Type 2 market, and that's where the numbers are. Disagree , 100%. Pump/artificial pancreas attached to you with a computer controlling your ...life? You're out of your mind. I will also add, that I doubt you are a type 1 using Afrezza if you have this opinion. If you are are Type 1 and still hold this opinion while using Afrezza, you're here for FUD. |
|
|
|
Post by sayhey24 on Oct 25, 2017 20:29:06 GMT -5
Disagree , 100%. Pump/artificial pancreas attached to you with a computer controlling your ...life? You're out of your mind. I will also add, that I doubt you are a type 1 using Afrezza if you have this opinion. If you are are Type 1 and still hold this opinion while using Afrezza, you're here for FUD. Aged has said many times he has never used afrezza. First it was his huge NYC endo group thought it was too new. Then his endos thought it would make your lungs explode. Then he was going to ask his PCP. Then his endo prescribed their first afrezza user but it was not him. And then? To be honest I may have some of the facts wrong so Aged, please straighten me out so we have the correct history. |
|
|
|
Post by dreamboatcruise on Oct 26, 2017 13:39:23 GMT -5
rockstarrick ... there is variability in absorption dynamics (such as caused by hydration level), so it really isn't even possible to just have a calibrated electro-mechanical pump system. An AP really has to adjust for end to end dynamics using the CGM. Dual hormone helps with the issue of overshooting. I haven't really tracked the research in APs to see what level of time in range they are achieving, as my basic thesis on Afrezza is that even if an AP can match the results, the cost and inconvenience of AP will prevent it from becoming mainstream. So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza No, my view of pumps has not changed. I think my posts on them has been pretty consistent. |
|
|
|
Post by esstan2001 on Oct 26, 2017 13:52:55 GMT -5
So DBC... you are finally coming around to Al Mann's conclusion regarding pumps (his last major paradigm in Diabetes treatment) and Afrezza No, my view of pumps has not changed. I think my posts on them has been pretty consistent. Yes I know, I was being facetious and I thought you would sense that (hence the smiley with the shades). It's not humorous if one has to explain it, or if it is not even the least bit funny in the first place. Hmmm... |
|
