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Post by joeypotsandpans on Mar 29, 2018 14:29:22 GMT -5
SO put out his trading call on the shares today, what was funny was his stating that the selloff was on higher volume....everything is relative, how is this "selloff" volume compared to the run-up volume on the previous accumulations....again track the OBV (On Balance Volume) ....there remains a HUGE deficit that still has to be reconciled at some point...they continue to wait for significant diluted shares to reconcile, the longer they wait the more shares they need added to the float pool, thus that sense of security Sla will be feeling whilst enjoying the beaches of Punta Cana
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Post by joeypotsandpans on Mar 29, 2018 13:25:53 GMT -5
Agusta, don't get too down as for every 5 obsolete physicians there is 1 new open minded young one entering the field. I met with my endo yesterday and she is young and eager to learn. Her last words as she was leaving the room "I love learning about new stuff". As with my new current primary who is also a year out of residency they are awed by Afrezza and show genuine excitement about it when I am discussing it and explaining the history behind it as well as the proper way to look at it from a dosing per individual perspective. Yes Peppy, it is the unusual case of the patient educating the physician and fortunately in my case my primary and endo are all ears and eyes. It helps tremendously that they can read the Libre live so that is a huge plus, my endo (I will refer to her in the future as endo1) said I am her only patient using Afrezza currently (that is because they are a UHC/OPTUM facility and I am the only one on Express Scripts, this was a follow up visit from when I was on previous insurance so I went with it). I actually have another endo appointment from the more recent referral next week (the insurance system is such a clusterphk that now I'm technically with two primaries and two endos until my current insurance figures things out...I'll wait until they do lol). Also it doesn't hurt to have one as a backup with respect to writing my script. My next set of labs were ordered by endo1 for May so we'll see how they compare with the first 2.9 point drop improvement from the last set. The appointment with endo2 next week should be interesting as he was the one that originally set me up with a set regimen of 8u at meal and 4u follow up dose 1 hr. after, he also wanted me to take the extended release Metformin before bedtime. He might fire me as a patient after I went rogue on his regimen and am taking care of my own dosing/titration to stay in range but hopefully when he sees my most recent lab results he will rethink the "set regimen" and understand that each individual needs what works best for them rather than some type of universal preset dosing (sorry for the run on sentences bad habits are hard to break). Endo1 was very receptive and understanding of the fact that it needs to be a much more individualized approach IMO. In summary, TG for Kendall's arrival to help Mike C with the paradigm shift . All I can say is record short interest and these current prices....the gift that keeps on giving Have a great Easter weekend everyone!! Joey, what doses are you taking to keep your blood glucose where you want it? What are you finding you need for your meals? Generally speaking it is case by case depending on meal and time of day. Remember I am not taking a basal or any Met. so depending on where I am prior to going to sleep and where I am in the am. I may take a correcting dose but mostly depending on meal it may be anywhere from 8-12u at meal and then if needed a correcting dose of 4-8u pro re nata. I take a PPI (Nexium) which greatly reduces my stomach acid so my food takes much longer than normal to break down and digest. If I eat a bagel and depending what I eat it with it can be a marathon lol and thus you can't just use a set dose and time like prescribing a drug "8 units 3X daily at mealtime" etc., this is what I was alluding to when I wrote the post about everyone is different regarding stage of disease, medications they are taking, diet, exercise, activity, etc. Everyone is so different you can't have a "set" dosing especially for T2's, you have to educate them to use as necessary as they track their BG...this is why the CGM's are paramount and revolutionary regarding real time management and compliance and how this is going to progress to the new standard of care as Kendall alludes to
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Post by joeypotsandpans on Mar 29, 2018 12:34:37 GMT -5
Forgot to mention, my new PCP said he had heard that it's hard to figure out correct dosing and that was part of his issue. Agusta, don't get too down as for every 5 obsolete physicians there is 1 new open minded young one entering the field. I met with my endo yesterday and she is young and eager to learn. Her last words as she was leaving the room "I love learning about new stuff". As with my new current primary who is also a year out of residency they are awed by Afrezza and show genuine excitement about it when I am discussing it and explaining the history behind it as well as the proper way to look at it from a dosing per individual perspective. Yes Peppy, it is the unusual case of the patient educating the physician and fortunately in my case my primary and endo are all ears and eyes. It helps tremendously that they can read the Libre live so that is a huge plus, my endo (I will refer to her in the future as endo1) said I am her only patient using Afrezza currently (that is because they are a UHC/OPTUM facility and I am the only one on Express Scripts, this was a follow up visit from when I was on previous insurance so I went with it). I actually have another endo appointment from the more recent referral next week (the insurance system is such a clusterphk that now I'm technically with two primaries and two endos until my current insurance figures things out...I'll wait until they do lol). Also it doesn't hurt to have one as a backup with respect to writing my script. My next set of labs were ordered by endo1 for May so we'll see how they compare with the first 2.9 point drop improvement from the last set. The appointment with endo2 next week should be interesting as he was the one that originally set me up with a set regimen of 8u at meal and 4u follow up dose 1 hr. after, he also wanted me to take the extended release Metformin before bedtime. He might fire me as a patient after I went rogue on his regimen and am taking care of my own dosing/titration to stay in range but hopefully when he sees my most recent lab results he will rethink the "set regimen" and understand that each individual needs what works best for them rather than some type of universal preset dosing (sorry for the run on sentences bad habits are hard to break). Endo1 was very receptive and understanding of the fact that it needs to be a much more individualized approach IMO. In summary, TG for Kendall's arrival to help Mike C with the paradigm shift . All I can say is record short interest and these current prices....the gift that keeps on giving Have a great Easter weekend everyone!!
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Post by joeypotsandpans on Mar 21, 2018 15:32:37 GMT -5
MNKD real time Nasdaq volume, 1,184,269 shares. $2.64 plus .10 (double yesterdays volume) www.nasdaq.com/symbol/mnkd/real-timeMNKD Nasdaq summary volume, 1,646,377. www.nasdaq.com/symbol/mnkdMNKD trading better than the market, as the SPX ended down on the day, -5 points. Some of this buying secondary to the Oppenheimer 28th Annual Healthcare Conference? Did audience members go home and look at continuous glucose monitors? C'mon Pep, you know the deal, would you expect anything else on volume...the short deficit looms large....just ask Nate & MK ....btw,I feel like im in that Corona commercial right now...have to figure out how to send this picture lol
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Post by joeypotsandpans on Mar 21, 2018 11:32:01 GMT -5
The skeptic in me thinks the lost data none of us have seen is similar to the agreement with RLS that was worth up to $100M. Standard mnkd playbook. Sales are down because underperforming sales reps were fired but don't worry because this issue was solved. Everything is wonderful now. Really? History would suggest a short time price spike followed by dilution followed by a price crash. I hope I'm wrong. The skeptic in you should have been asking why does a guy as smart as Al Mann invest $1B of his own money? Did he loose his mind or did he really know what he was doing? It was the 118 trial clinicaltrials.gov/ct2/show/NCT00570687 Per the 3Q2009 Quarterly call Al Mann said - I have long argued that AFRESA does not require complex meal titration. Certainly there is no need for carb counting and so forth. The basis of my view was derived from the dose escalation study with meal challenges in which better glucose control was achieved with ever greater doses of AFRESA, yet without any hypos. Yet based on decades of battling these challenges of conventional insulin therapy, some physicians have questioned my suggestion. Therefore, I proposed a meal escalation study in which patients would take a fixed dose of AFRESA and then a series of meal challenges. Our clinical team designed a protocol to set a standard meal with 50 g of carbohydrates. That was the 100% challenge. This was followed by challenges at 200%, 50% and zero percent. When I heard of zero I was shocked. Surely there would be severe hypo. The remarkable thing was that with the regular prescribed dose of AFRESA regardless of carbohydrate intake between zero and 100 grams the range of excursion is only plus or minus 30-35 mg [reduction] from baseline for all of the Type II patients in the study. At the ASDA meeting I described to Dr. [Jay Skyler] the finding that in Type II diabetes with a fixed dose of AFRESA and even with no food there is excellent control without hypo risk. I asked him how that was possible. "Obvious," he responded. He was basing his comments on our recently reported 118 trial in which we showed rapid and virtually complete sensation of [hepatic] glucose relief with AFRESA and the common inability of the remaining endogenous insulin to maintain control, as is the case for a healthy person without diabetes. Indeed, I mentioned this result to a number of KOL's who agree with Jay. So I say to you that AFRESA is what no other insulin has ever done for Type II diabetes. AFRESA restores more physiologic hepatic function, takes a load off the pancreas and avoids the hyperinsulinemia resulting from resistance of other insulins. It better mimics the normal pancreas response. So what does all this mean? First let me say that we will need to follow these findings with much larger trials. If the results of the larger trials support the earlier findings then I state to you that AFRESA should be used very early, certainly after failure with Metformin and as a first sign therapy for a significant portion of patients who are not candidates for Metformin or who do not do well with Metformin. It should be used well before fasting glucose is out of control and as we have seen, AFRESA even leads to lower fasting levels by eliminating the excessive gluconeogenesis. Of course, we will have to repeat some of these findings with specific trials but we have already seen the possibilities for AFRESA as we evaluate the timing of hypos in our already completed trials to date. From what we have seen in our extensive clinical program, AFRESA should benefit the entire progression spectrum of Type II diabetes with a very simple therapy and the experts tell us that it could even stop the progression of the disease. It's one thing to read this and another to be living it ....currently on vacation in Costa Rica and living it while on the beach, no refrigeration, and carbs a plenty....just catching up on these threads and the oppenheimer presentation...as usual thanks all for the posts and updates. When I return next Wed. have endo appt., rep and her new diabetes educator are supposed to join me at the appt. with endo, looking forward to it. Yes you read correctly, they hired a diabetes educator to work with the sales rep and in liason with the physicians to further help with dosing/titration education between the physicians and patients...IMO this will help tremendously with the retention rates going forward.... One thing I was a bit nervous about was taking the Libre sensor into the ocean, one thing to shower with fresh water another to swim in salt water but came out of ocean and heard the magic beep when the reader caught the signal from sensor...music to my ears .....again living Al's dream, life is good and will be even better after Dr. Kendall presents in June.....as Austin says "yeah baby yeah"!! www.youtube.com/watch?v=JBHKVAs85Kono worries about hypo's keeping me up at night, the only thing keeping me up at night here are those darn howler monkeys that come out in the evening overnight lol...
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Post by joeypotsandpans on Mar 9, 2018 22:59:57 GMT -5
So I had my new labs done last Thurs. and just got my results this am. after 2 1/2 mos. on Afrezza my HbA1c dropped 2.9 pts. and this after having stopped any Metformin and not using any Basal. What's also interesting is that my cholesterol numbers improved as well. My follow up visits with my Primary and Endo should be very interesting, especially because I invited the local rep to come to the follow up with me next Friday, she's been trying to get into this office for awhile and they have made it very difficult....well they can expect a surprise visit, can't stop me from inviting her to my next visit Been wondering all day about how this visit went, especially if the MNKD rep was able to make the visit with jp&p. So to follow up I met with my new primary this afternoon, the rep could not make it due to the national sales meeting being held and conflicting time, however I did connect them over the phone and they will be meeting going forward. My visit could not have gone better, as expected (due to her being pretty young and a year out of residency) my new primary was very receptive and enthused about my orientation of Afrezza to her. The "small world" cliche applies here as we were conversing and it turns out she was pre-med with my son as they were both biochem majors in the same class as undergrads. To top that off, she was so enthused about Afrezza, she excused herself from the room and came back with her mentor who happened to know my wife and was her primary some years ago....the whole thing was crazy in a good way. I am very optimistic going forward with her and her getting her group more exposed to Afrezza as a viable option/alternative, we'll see how things progress and hopefully the follow up meeting with the rep also reinforces her enthusiasm. I'm sure the 2.9 point reduction in my A1c was what impressed her and opened the door as a nice conversation starter, the rest was easy and I did show her that 2 minute video that the T1 endo did from Brentie's thread titled - "What is Inhaled Insulin and Who is it for?" Will continue to update as things progress
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Post by joeypotsandpans on Mar 6, 2018 14:59:48 GMT -5
I'm reading this thread wondering how much due diligence some of these people do when investing, that's IF they are in fact investors I originally thought VDex was interesting (1st location). But then the didn’t do anything they said they were going to do, so I stopped paying attention. After seeing this huge thread, I looked back into it and realized VDex isn’t relevant to really anything. If people are looking for VDex to drive sales of Afrezza, they’re going to wait a long time. The thing that I find confusing is why does VDex get attention from MannKind Investors... I believe the 95% retention rate says it all, investors will understand that validates the effectiveness and pretty much confirms that the dosing/titration issues with lazy/too busy (ok I know they run tight schedules and that is not directed towards all of course as we know full well Liane would disrupt that thesis ) or uninformed physicians are a BIG reason for the falloff of renewed scripts and insurance and cost being the other. So being that they (VDEX) has possibly a higher success rate with both the results for their customers along with the insurance that says quite a bit and most likely why they recently expanded. This is where SO really lost quite a bit of respect and credibility with me when he stated something to the effect that VDEX doesn't make a pimple regarding scripts....he loses sight of the importance of their retention rate and what that means regarding the discrepancy in scripts and/or script renewals. Without getting too redundant (BD can I use too and redundant together? lol) that is why even thought it can't be used formally, the white paper they did speaks volumes as I mentioned not just to investors but more importantly to the potential PWD population as a whole. The statement I made regarding due diligence or lack thereof is half meant (the other half was directed at those that have no investment and troll) in a constructive manner regarding how much or rather how little some investors don't really investigate where they are putting their $$ relative to not just risk/reward but just looking at face value ie., past results as opposed to future potential and the cause/effect nature of why something may be under or overvalued. Reading between the lines like the results of VDEX for example and their observations is paramount and an integral part to successful investing. The lack of any real accumulation in the script numbers is so telling and VDEX IMO helps one understand the fundamental problem with the current providers/writers outside of VDEX not understanding how to best take advantage of the superiority Afrezza has over the other current treatments. Hope that helps clear up some of your confusion.
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Post by joeypotsandpans on Mar 6, 2018 12:47:11 GMT -5
I'm reading this thread wondering how much due diligence some of these people do when investing, that's IF they are in fact investors
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Post by joeypotsandpans on Mar 5, 2018 20:24:43 GMT -5
I will be hitting this up on my phone at my visit to my new primary on Friday with the local MNKD rep with me...it's perfect, he's an Endo and T1 so for this young still wet behind the ears physician (she's about a year out of residency) will be a conversation opener as it is very short, sweet and right to the point! Thanks Brentie!
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Post by joeypotsandpans on Mar 4, 2018 21:54:02 GMT -5
It doesn't exclude those with GERD from what I read quickly....or take into consideration how far along one may be with gastroparesis if they haven't been diagnosed yet. When you think about all the variables it kind of makes you laugh that they try and set any regimen, it has to be individualized and the patient is the only one that can really determine when and how much to take at any given time....thus the added safety factor of Afrezza (lower risk of hypo) along with an instant read type of monitor is the ultimate "custom" treatment for each T2 situation that is eligible.
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Post by joeypotsandpans on Mar 4, 2018 21:44:50 GMT -5
metabolism, amount of digestive enzymes.... Who can name all the variables? the meds, ie., proton pump inhibitors they really slow down the breakdown of the foods...do you think they check for those that use Nexium, Prilosec, Protonix or others in the category in the studies (I am sure they ask what other meds you're on but do they categorize them regarding the differences in reaction times and need for follow up dosings etc.
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Post by joeypotsandpans on Mar 4, 2018 20:04:16 GMT -5
Sunday brunches in Vegas requires a whole separate regimen unto itself and trust me they last a lot longer than 11 minutes (the better brunch buffet's that is)...just sayin, I save the under average inventory of units allotment for Sunday's Joey, ever been to the Sterling brunch? Pretty awesome:-) Absolutely, the Wynn's is also top notch if you get a chance to visit....on me, just let me know ahead of time ....bagels are my kryptonite, add the smoked salmon, cream cheese, tomatoes and sweet red onions and that alone is a unit burner....
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Post by joeypotsandpans on Mar 4, 2018 17:09:46 GMT -5
Sunday brunches in Vegas requires a whole separate regimen unto itself and trust me they last a lot longer than 11 minutes (the better brunch buffet's that is)...just sayin, I save the under average inventory of units allotment for Sunday's
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Post by joeypotsandpans on Mar 4, 2018 15:25:01 GMT -5
Just read this after my post in the VDEX thread, case in point! Thanks for posting MM & Pep
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Post by joeypotsandpans on Mar 4, 2018 15:11:35 GMT -5
Regarding the paper from VDEX, they are spot on regarding the meal and dosing relationship...the Endo I went to suggested I take 8u at mealtime and if still high 1-2hrs after to take a 4u. You can't do a standard regimen like that with everyone especially T2's depending on what else is going on with other meds etc. That is why the real time mgmt. is key with using a sensor unless the T2 is going to stick themselves 20+ times a day. There are days when depending on meals, time of day, and activity I could use anywhere from 16u to 48u (since my prescription avg's out to 48u/day I am conscious of meal selectivity to make sure it balances out). The days I eat closer to a "rabbit diet" I rarely have any spike and use much less. The biggest takeaway is that most individuals that are either pre-diabetic and/or T2's that don't realize it yet or are in denial, given the option would take Afrezza with a much less non-invasive manner of monitoring their BG. Case in point, I recently wrote about the two business associates that claimed they would love to get their dads on it, well one of them I am fairly confident is either going to be a candidate or already is just from the questions he was asking me and answers to some of my questions. He was going to schedule to get his blood work done after our conversation. Another friend of mine recently went back to visit his folks in MN. and his mom is diabetic, she asked him if he has had his blood work checked, he is one that is more in denial I believe but when we were out the night we went to dinner and Spiro joined us you could tell he was very interested in both Afrezza and since has seen my use of the Libre when we've been at lunch. Back on topic with regard to the "non-scientific" white paper, that comment from Mike doesn't surprise me one iota...he is a PharmD and that was the politically correct statement from his training. What he also knows is that physicians are trained and held to work within the realm of what is published professionally and that is why they need the official "studies" to get published. When looking back at the outset of product launch to where we are now, it is blatantly obvious to why the scripts, refills, and salespersons have struggled. With the addition of an extremely credible voice in Kendall, the baby steps of having more/better insurance coverage, the approval of the Libre here in the US, the long elusive pathway to the eventual shift continues to get shorter especially with continued satisfied user experiences being logged and shared. Bottom line, the VDEX paper is worth far more to the patients currently then it is to physicians (as far as their limitations in using it)...having read it, it made me much more confident in my dosing relative to what the Endo had suggested at my first visit and he's been subscribing it pretty much since it's been on the market. I am sure his 8/4 regimen works for some and not so much for others depending on their individual needs...my plan is to wake him up a little bit at my next visit with the stellar results as I'm sure he scratches his head with different results he sees with different patients
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