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Post by babaoriley on Mar 26, 2018 16:50:15 GMT -5
haha. I’m looking forward to it and as soon as our share price hits 7 in the next month or so. 😁 OMG, brotherm1, you're actually Mike K!!!!  |
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Post by sportsrancho on Mar 26, 2018 17:16:27 GMT -5
haha. I’m looking forward to it and as soon as our share price hits 7 in the next month or so. 😁 OMG, brotherm1, you're actually Mike K!!!! If we hit seven in the next month and 1/2, my May $3 calls will be screaming and I’ll buy you both dinner! |
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Post by buyitonsale on Mar 26, 2018 19:01:10 GMT -5
haha. I’m looking forward to it and as soon as our share price hits 7 in the next month or so. 😁 OMG, brotherm1, you're actually Mike K!!!! He did not say "double digits", so definitely not Mike K  |
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Post by uvula on Mar 26, 2018 19:15:34 GMT -5
Prescribing insulin for non-insulin dependent T2’s is going to be a tougher sell than prescribing Afrezza to adults with T1. I’ve been T2 for 15 years or so. As great as Afrezza is and as much as it may help, the medical community is not going to embrace this regardless of what the trials indicate. We can’t even get endos to prescribe Afrezza to T1’s. Bingo. You nailed it. Especially when it is so ridiculously high priced. The Brain Trust at MNKD can't seem to figure out that they could triple or quadruple sales or more by significantly UNDER-pricing Novalog and Humalog. If they did that, it would amount to medical malpractice for a doctor to NOT put Type 1s on Afrezza. Sales would skyrocket. The goal is not to increase sales. The goal is to increase sales without bankrupting the company. |
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Post by agedhippie on Mar 27, 2018 8:43:16 GMT -5
The medical world will say that It would need to be for much longer than 1 week, probably at least 3 months. You would also need to select the participants randomly rather than have them self-select, also to randomly assign them between the Afrezza and RAA groups (again rather than self-select). What they are looking for is whether Afrezza out-performs RAA in a random group of users over a period of time. Basically a superiority trial  @agedhipped - I wonder about whether you'd really want randomness in an Afrezza superiority trial. Is the goal to show that Afrezza is superior, or perhaps that PWDs using Afrezza and CGMs can get superior results compared to alternatives. I think the latter is more relevant and may be easier to prove. A PWD doesn't really care whether their individual medication, delivery mechanism, monitoring device, and dosing is, or is not superior. What they care about is that their results using some combination of these products and dosing are superior. Essentially, let everyone bring their best game to the trial and let the CGM videos dictate the winners. The problem is that what the medical world want to know is how the average person is going to perform on a treatment. For that you need a statistically solid result which means a large sample set and randomized participants.If what you want to do is show what people can achieve then that is happening today with the CGM postings both for Afrezza and for RAA. The posts lack impact though because they are not seen as typical by either the doctors or the PWD. I am not sure that it is true that PWD don't care about the delivery mechanism provided the results are good. I would give myself as an example - I get significantly better results on a pump than I do injecting, and yet I almost never use a pump because I don't like the idea. Rationally I absolutely should use a pump (my endo keeps trying to get me back onto it) but it is not going to happen because psychologically it is far more important to me to be comfortable with my treatment than it is to have the optimal treatment. The complication that normally gets ignored is diabetes burn out and yet I know more people who have died of that than hypos. |
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Post by zuegirdor on Mar 27, 2018 17:37:08 GMT -5
Bingo. You nailed it. Especially when it is so ridiculously high priced. The Brain Trust at MNKD can't seem to figure out that they could triple or quadruple sales or more by significantly UNDER-pricing Novalog and Humalog. If they did that, it would amount to medical malpractice for a doctor to NOT put Type 1s on Afrezza. Sales would skyrocket.If that were what doctors believe they would now be prescribing Afrezza to all their patients that are with insurers that cover it, which the script numbers clearly indicate is not the case. Whether price is or isn't a major issue, few doctors currently believe that Afrezza is a superior prandial insulin. I have recently become aware or understood something my son's endo recently tipped me off to. She was worrried about potassium levels. it is in the black box though I pooh poohed it. and may be it is just pooh pooh but, for cases in which a T1D self treats with a fast and effective insulin like afrezza (and lets face it- all diabetes is treated outside the clinical setting except for DKA and complications) there is a temptation to let ones glucose control go out the window, pre-emtively speaking, becuase you know that if you are at 400 you can just take 3 or 4 eights and get back into range. Problem is, if you spend any length of time in DKA, for which a reading of 400 for 6 hours or so would probably qualify, you now have a K+ ion imbalance. Ion potential is how your body maintains the voltage for keeping your heart beating (or something like that). Extended DKA masks a K defeiciency becasue the blood ph drives all K into circulation on one side of the potential barrier. Taking Afrezza quickly moves insulin out of blood into the cells which is good, but the switch raises te risk for fibrillation. The risk for this on injectable is somewhat less, so not sure how fair it is to make a comparison. but this may be one reason for hesitation onpart of some endos to prescribe afrezza. You might also ask how many physicians are even aware of this. You might prefer not to know the answer, for a variety or reasons....(?) Try asking your MD... |
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Post by zuegirdor on Mar 27, 2018 17:38:10 GMT -5
Bingo. You nailed it. Especially when it is so ridiculously high priced. The Brain Trust at MNKD can't seem to figure out that they could triple or quadruple sales or more by significantly UNDER-pricing Novalog and Humalog. If they did that, it would amount to medical malpractice for a doctor to NOT put Type 1s on Afrezza. Sales would skyrocket. The goal is not to increase sales. The goal is to increase sales without bankrupting the company.  ? |
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Post by peppy on Mar 27, 2018 17:55:43 GMT -5
If that were what doctors believe they would now be prescribing Afrezza to all their patients that are with insurers that cover it, which the script numbers clearly indicate is not the case. Whether price is or isn't a major issue, few doctors currently believe that Afrezza is a superior prandial insulin. I have recently become aware or understood something my son's endo recently tipped me off to. She was worrried about potassium levels. it is in the black box though I pooh poohed it. and may be it is just pooh pooh but, for cases in which a T1D self treats with a fast and effective insulin like afrezza (and lets face it- all diabetes is treated outside the clinical setting except for DKA and complications) there is a temptation to let ones glucose control go out the window, pre-emtively speaking, becuase you know that if you are at 400 you can just take 3 or 4 eights and get back into range. Problem is, if you spend any length of time in DKA, for which a reading of 400 for 6 hours or so would probably qualify, you now have a K+ ion imbalance. Ion potential is how your body maintains the voltage for keeping your heart beating (or something like that). Extended DKA masks a K defeiciency becasue the blood ph drives all K into circulation on one side of the potential barrier. Taking Afrezza quickly moves insulin out of blood into the cells which is good, but the switch raises te risk for fibrillation. The risk for this on injectable is somewhat less, so not sure how fair it is to make a comparison. but this may be one reason for hesitation onpart of some endos to prescribe afrezza. You might also ask how many physicians are even aware of this. You might prefer not to know the answer, for a variety or reasons....(?) Try asking your MD... the same potassium warning on RAA package inserts. • Hypokalemia: All insulins, including HUMALOG can cause hypokalemia, which if untreated, may result in respiratory paralysis, ventricular arrhythmia, and death. (5.4) www.accessdata.fda.gov/drugsatfda_docs/label/2013/020563s115lbl.pdf• Insulin, particularly when given intravenously or in settings of poor glycemic control, can cause hypokalemia. Use caution in patients predisposed to hypokalemia (5.3). • Like all insulins, NovoLog requirements www.accessdata.fda.gov/drugsatfda_docs/label/2012/020986s057lbl.pdf Every beat of your heart involves K+. every move you make, (muscle) every step you take. Just to ask was she worried about K+ potassium levels when on RAA? hmmm, she pulling a wisenheimer?  |
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Post by peppy on Mar 27, 2018 18:14:58 GMT -5
All people on insulin should have their potassium levels checked periodically. When I think things through, which person would I think be more likely to have a normal potassium level?  She is rearing up. |
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Post by brotherm1 on Mar 27, 2018 18:38:34 GMT -5
Potassium is extremely imprortant to the body in many ways. Bllod pressure and heart functioning are just a couple. Most people I’ve read are probably deficient. RDA for K is 4,700 mg. per day. That’s the equivalent of like a dozen bananas, or five baked potatos, or a boat load of spinache. Yet good supplements are hard to find. Suplemental tablets are only 3% of the RDA, probably because too much can kill. Try No Salt salt substitute. Just don’t do more than the RDA. No Salt is potassium chloride.
I read an article not long ago where a state banned lethal injections for a while because they gave a death row inmate potassium chloride and it took him - I believe it said - like hours to die. They gave him this because at fhe time they could not obtain the correct potassium iodide. After reading the article I’ve been more careful each morning when I pour it into my protein shakes
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Post by agedhippie on Mar 27, 2018 20:06:55 GMT -5
If that were what doctors believe they would now be prescribing Afrezza to all their patients that are with insurers that cover it, which the script numbers clearly indicate is not the case. Whether price is or isn't a major issue, few doctors currently believe that Afrezza is a superior prandial insulin. I have recently become aware or understood something my son's endo recently tipped me off to. She was worrried about potassium levels. it is in the black box though I pooh poohed it. and may be it is just pooh pooh but, for cases in which a T1D self treats with a fast and effective insulin like afrezza (and lets face it- all diabetes is treated outside the clinical setting except for DKA and complications) there is a temptation to let ones glucose control go out the window, pre-emtively speaking, becuase you know that if you are at 400 you can just take 3 or 4 eights and get back into range. Problem is, if you spend any length of time in DKA, for which a reading of 400 for 6 hours or so would probably qualify, you now have a K+ ion imbalance. Ion potential is how your body maintains the voltage for keeping your heart beating (or something like that). Extended DKA masks a K defeiciency becasue the blood ph drives all K into circulation on one side of the potential barrier. Taking Afrezza quickly moves insulin out of blood into the cells which is good, but the switch raises te risk for fibrillation. The risk for this on injectable is somewhat less, so not sure how fair it is to make a comparison. but this may be one reason for hesitation onpart of some endos to prescribe afrezza. You might also ask how many physicians are even aware of this. You might prefer not to know the answer, for a variety or reasons....(?) Try asking your MD... That's a known problem. In ketoacidosis as insulin is introduced the potassium level drops sharply. Blood potassium levels may be high but that is because it has been pulling from the body cells and so there is a hidden deficiency. The insulin causes the potassium to be sucked up from the blood by the body cells to replace the missing potassium making the blood potassium levels sharply drop. The faster you drop the glucose level the worse it is. In hospital there are protocols for treating DKA and they start pushing potassium along with fluids before they introduce insulin because they know when the insulin hits you plasma glucose is going to dive so they are trying to match the potassium loss. If you do this at home then you drop your glucose levels slowly so the potassium levels have time to even out. I can see doctors being concerned that if people don't know to do that they would regard a rapid return to normal levels as good and that might end badly. Yes this is also an issue with RAA, but there is more margin for error because it is slower. |
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Post by agedhippie on Mar 27, 2018 20:11:39 GMT -5
All people on insulin should have their potassium levels checked periodically. When I think things through, which person would I think be more likely to have a normal potassium level? [RAA user in the 200s, Afrezza user around 100] They would both have a normal potassium level. The cause of DKA (and the attendant potassium issues) in diabetics is absence of insulin, not glucose level. |
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Post by peppy on Mar 27, 2018 20:20:33 GMT -5
All people on insulin should have their potassium levels checked periodically. When I think things through, which person would I think be more likely to have a normal potassium level? [RAA user in the 200s, Afrezza user around 100] They would both have a normal potassium level. The cause of DKA (and the attendant potassium issues) in diabetics is absence of insulin, not glucose level. ok. So this physician was concerned about the absence of insulin with afrezza? Help me aged.  |
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Post by digger on Mar 27, 2018 21:06:17 GMT -5
They would both have a normal potassium level. The cause of DKA (and the attendant potassium issues) in diabetics is absence of insulin, not glucose level. ok. So this physician was concerned about the absence of insulin with afrezza? Help me aged. A rapid decrease in glucose from a severe hyperglycemic state will also cause a rapid transfer of potassium from the blood into cells. A diabetic can get a transient hypokalemia from a rapid correction which can produce cardiac arrhythmias -- see "Hypokalemia and sudden cardiac death" at www.ncbi.nlm.nih.gov/pmc/articles/PMC3016067/ and look for "Hypokalemia due to shift of potassium to stores." Perhaps that was what worried the doctor. |
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Post by agedhippie on Mar 27, 2018 21:07:34 GMT -5
They would both have a normal potassium level. The cause of DKA (and the attendant potassium issues) in diabetics is absence of insulin, not glucose level. ok. So this physician was concerned about the absence of insulin with afrezza? Help me aged. [Love the picture ] She was concerned about people getting sloppy because Afrezza was so effective Her scenario is this I think. Suppose you cannot be bothered with the hassle of dosing (why bother, you will end up in the 400s but you can clean up the resulting high later, Afrezza is fast). Depending on where you are with your basal, and how long ago you last took Afrezza, you might not have enough insulin in your system to suppress ketosis and could slide into DKA. At that point taking Afrezza to drop back to normal quickly could be potentially lethal. It's less of a problem with RAA because it is much more work to get back to normal so you avoid that sort of behavior and that slower drop reduces (but does not eliminate ) the risk. Afrezza gives you more freedom, but that freedom can give you the illusion of more control than you have. |
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