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Post by compound26 on Sept 20, 2015 10:53:41 GMT -5
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Post by compound26 on Sept 19, 2015 17:26:00 GMT -5
I think the diabetic associations will be careful on what they say this time. See what happened with Exubera. Convincing Diabetics They Need Exubera (below is content quoted from that blog). FRIDAY, MAY 11, 2007 "At the end of March, we learned that Dr. John Buse, president-elect of the American Diabetes Association had caught hell for his comments about Exubera. His now-infamous quote was:
"I think Pfizer will wish they had never gotten into this. I doubt they'll regain their investment. There is no advantage to Exubera and there may be a safety risk. I see it as my job to talk people out of (using) it."
The Wall Street Journal Health Blog spoke with Buse, and he told them that last part of his quote was taken out of context. He said he was talking about risks for patients who contract diabetes early in life and spend decades on insulin. (Clinical tests showed Exubera can hurt lung function a bit.) Also, it can be hard for Type 1 diabetics, who tend to be younger and whose bodies don't make insulin, to use Exubera, because they may need a more precise dose than the inhaled system can deliver, Buse said. For younger patients, Buse said, "I'm going to make it sound pretty bad: A., You may have to take it for a long time and we only have 3-year safety data. B. You're going to carry this crazy thing that's the size of a can of Coke. You're going to be mixing packets before meals. People are going to think you're doing drugs. Why would you do that?" However, Buse did say that for some older patients with Type 2 diabetes, in which the body doesn't make sufficient insulin and/or becomes insensitive to it, they may be good candidates for Exubera." |
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Post by compound26 on Sept 19, 2015 16:41:35 GMT -5
Compound26 Great post. Now, how do you get Doctors who only read medical journals as this Doctor revealed; as he disregards most anything else. Maybe I'll print this out and just hand him your post on the next visit. It's a fine line to walk when treading on another's professional turf without alienating him. He's a sharp guy; he'll get it eventually. I wouldn't be surprised if he googled Bode and Afrezza only to find the article in his office. thekindaguyiyam, totally agree, it's a fine line to walk when treading on another's professional turf without alienating him. FWIW, you can go to my blog: afrezzajustbreathe.com to see if there is anything you feel you can bring to your doctor. It also has links to Afrezzauser.com, Afrezzadownunder.com and other helpful websites. So you can check out those sites as well. I think the article in the front page of blog ( Afrezza Review: Diabetics Confirm Its Advantages), this post Journal and Magazine Articles on Afrezza, this post Videos of Medical Professionals Discussing/Reviewing Afrezza, and this article Afrezza: Less Hypos may be helpful. There was an excellent presentation (in very appealing formating) regarding less hypos of Afrezza that was posted on ESAD website a few days ago. But the link does not work anymore. The following tweet captures a part of that presentation. |
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Post by compound26 on Sept 19, 2015 16:13:19 GMT -5
I guess Spiro is the lucky one. Thanks for providing your story. Sounds like the 4 unit cartridges are your norm. I wonder what percentage of the population this would work fine for. I'm in a similar situation with cardio hypothyroidism, etc. I crossed over to 6.5 and I'm wanting to be on this drug rather than take metformin which is a liver eater. I addressed these issues with the doc and he confirmed my choice regarding the consequences of taking it. So. I'm good. Still boarderline and losing weight. The question is about the process your doctor went through. Was there any talk as to your configuration... if your 4's it's probably easier. I didn't confront the guy as I know he's helping me and wants to. His willingness to open up and tell me what was bugging him about the process (the amount of time it takes someone to find the matching package challenging) getting in the way of marketing. This was news to me and something I think MNKD is aware of. My speculation is that this is where google comes in to make it easier to decipher and shorten time required to prescribe. I got from the appointment that he respected Dr. Bode. That he has issued prescriptions and he has given out 4 unit cartridges. His intent about the time it takes was letting down his walls with a patient and being honest about his experience. Meanwhile out in his waiting room is the issue of WebMD with Dr. Bode on Afrezza. I think & hope S anofi may be addressing this issue for busy doctors who are flustered and resent the 5 minutes vs 5 seconds to run a script. And yeah; in the long run I think it's short sighted to recognize that 5 minutes could make a significant difference in that persons lifetime. I have a picture of myself in the office with the WebMD advertisement. I can't wait for that inenivatable lable change and a new found attitude by doctors who slowly approach prescribing. I walked away with: 1) change is slow 2) scripting is more difficult 3) you have to have conviction in the product to prescribe. That would come with education and time. Hey John. Tell Spiro to increase your salary for being so attentive when you'd probably rather be at the game with him. GB thekindaguyiyam, would the samples solves the dosage issue? I mean if the doctor gives you one or two boxes of 4Us, you can test it by yourself. You start with one 4U and watch your BG after the meal. If your BG is rising, you take another 4U. So you test your BG more frequently in the first few days until you find out how your body respond to Afrezza. I think Brian in this board has written about his experience when he first started on Afrezza. Then you can tell your doctor how many units of Afrezza you will need daily. I read it somewhere some doctors say that the doctor just needs to prescribe how many units of Afrezza a patient needs, the pharmacist will configure how how many 4Us, 8Us or 12Us to be included in the prescription. In that sense, I agree that your doctor is kindly over thinking on this. If you can take the initiative to test out your needed dosage, maybe it will help your doctor in prescribing Afrezza to you. thekindaguyiyam, here is the post I was referring to above on prescription: The post was by someone with the ID "doctor.stockpicker", supposedly, he is a physician in Oklahoma who has been treating diabetics for 26 years. Feb 11, 2015: The Sanofi rep made it to my office today. Some highlights. 1. The coupons allow the patient to obtain the first month of Afrezza free of charge and then $30/month for a year if they have insurance. Surprisingly, it is already on all of the major insurance companies in my area. Of course, Part D plans have not yet included it on their formulary. They are always nortoriously slow in adopting new medications. The other surprise is that there is no limit in the amount of insulin supplied in a month. He told me to write the script as how I want to prescribe each dose and just dispense a 30 day supply. They pharmacist will the dispense the correct number of the 4 unit and 8 unit cartridges to last the month. |
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Post by compound26 on Sept 19, 2015 15:49:37 GMT -5
thekindaguyiyam, below is the post I was referring to: Afrezza Process Takes Time!!!
Below are just a few posts in that thread. You can see that Brian was experimenting with Afrezza and taking time to find out the ideal dosage and timing of Afrezza for him. Afrezza Process Takes Time!!! Post by nccapitalist on May 27, 2015 at 6:55am Yes, I am asking the endocrinologist for one script. I requested a 60-4U and 30-8U combo pack. My idea is to cover a high carb breakfast of All Bran, nuts, seeds, fruit, whole milk and coffee with milk. That averages about 90 carbs. I may change up on the breakfast soon, as the carbs are awfully high though the nutrition value is great. The sample boxes are all 4U. I took one oral pill and called the doctor about getting on Afrezza. The side effects were too intimidating for my liking. Afrezza is the only medicine I have been on for diabetes and this is about day 10 or so. Post by nccapitalist on May 28, 2015 at 8:07am I'm on Afrezza Day 15 and I wanted to share some interesting data. Keeping a log book for your endocrinologist opened my eyes after initially thinking the data was an anomaly. I am a type II diabetic with a previous A1C of 7.6 (171 BG). Date 2 hr BG Carbs 5/19 86 100 5/20 98 50 5/21 95 25 5/22 111 40 5/23 107 30 5/24 100 60 5/26 121 40 5/27 118 121 First 5 days on Afrezza Date 2 hr BG Carbs 5/14 156 ? (didn't make note, must have been distracted by Stanley Cup playoffs) 5/15 164 40 5/16 123 30 5/17 169 80 5/18 134 100 All doses were ONLY one 4U cartridge no matter how many carbohydrates were consumed. They were all post dinner readings. For me personally, the data shows that Afrezza kicked in on Day 6. Brian also documented his testing out of Afrezza in his tweets. Here are just a few of his tweets. You can check it out: It appears it will take some time to dial in Afrezza. So please be patient. |
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Post by compound26 on Sept 19, 2015 15:23:55 GMT -5
thekindaguyiyam, It's really tough for me to answer all the concerns and comments made by your Endo. I was just an early stage type 2 diabetic with an A1c of 7.1. My doctor and I decided to start treatment with drugs. Afrezza was my choice because of liver and cardiac issues. She agreed to let me try Afrezza. She initially prescribed 4 units at meals for the 1st three months and then added correction doses of 4 units should I eat a big snack ( Cruise ). My A1c dropped to 6.2 after 3 month's. I just had my 6 month blood work taken yesterday. IMO, some doctor's might be overthinking the dosing, particularly for type 2's. I talk with Blindhog quite often, he is going to have an amazing story to share with the board one day. As for the insurance issues, it's a new drug and hopefully Sanofi and MNKD will have this problem resolved soon. John here, Spiro's watching football on TV I guess Spiro is the lucky one. Thanks for providing your story. Sounds like the 4 unit cartridges are your norm. I wonder what percentage of the population this would work fine for. I'm in a similar situation with cardio hypothyroidism, etc. I crossed over to 6.5 and I'm wanting to be on this drug rather than take metformin which is a liver eater. I addressed these issues with the doc and he confirmed my choice regarding the consequences of taking it. So. I'm good. Still boarderline and losing weight. The question is about the process your doctor went through. Was there any talk as to your configuration... if your 4's it's probably easier. I didn't confront the guy as I know he's helping me and wants to. His willingness to open up and tell me what was bugging him about the process (the amount of time it takes someone to find the matching package challenging) getting in the way of marketing. This was news to me and something I think MNKD is aware of. My speculation is that this is where google comes in to make it easier to decipher and shorten time required to prescribe. I got from the appointment that he respected Dr. Bode. That he has issued prescriptions and he has given out 4 unit cartridges. His intent about the time it takes was letting down his walls with a patient and being honest about his experience. Meanwhile out in his waiting room is the issue of WebMD with Dr. Bode on Afrezza. I think & hope S anofi may be addressing this issue for busy doctors who are flustered and resent the 5 minutes vs 5 seconds to run a script. And yeah; in the long run I think it's short sighted to recognize that 5 minutes could make a significant difference in that persons lifetime. I have a picture of myself in the office with the WebMD advertisement. I can't wait for that inenivatable lable change and a new found attitude by doctors who slowly approach prescribing. I walked away with: 1) change is slow 2) scripting is more difficult 3) you have to have conviction in the product to prescribe. That would come with education and time. Hey John. Tell Spiro to increase your salary for being so attentive when you'd probably rather be at the game with him. GB thekindaguyiyam, would the samples solves the dosage issue? I mean if the doctor gives you one or two boxes of 4Us, you can test it by yourself. You start with one 4U and watch your BG after the meal. If your BG is rising, you take another 4U. So you test your BG more frequently in the first few days until you find out how your body respond to Afrezza. I think Brian in this board has written about his experience when he first started on Afrezza. Then you can tell your doctor how many units of Afrezza you will need daily. I read it somewhere some doctors say that the doctor just needs to prescribe how many units of Afrezza a patient needs, the pharmacist will configure how how many 4Us, 8Us or 12Us to be included in the prescription. In that sense, I agree that your doctor is kindly over thinking on this. If you can take the initiative to test out your needed dosage, maybe it will help your doctor in prescribing Afrezza to you. |
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Post by compound26 on Sept 18, 2015 19:16:10 GMT -5
I have been on Affrezza three months. When I started my A1c was 9.2 and I fully expect it to be under 6.0 when I have my follow up this week. I was taking 30 units of Lantus nightly when I started and granted I wasn't behaving as I should. But now when I do splurge (example; pizza and homemade ice cream) my peak isn't as high and doesn't last as long. Many days at bedtime my blood sugar is under 100 so I don't take Lantus and my fasting blood sugar is still under 100 come morning. Other days because my count is under 130 I take a lesser amount of Lantus (15-25 units). Sooo.as a result I'm using less then a third of the Lantus I was taking to start with. It's like my pancreas has decided to jump in and help. It didn't happen immediately or even with consistent improvement Are my results after three months typical? I don't have the answer to that. If they are typical it may be part of why SNY isn't as enthusiastic as we would like them to be in promoting Affrezza. pmikeks, I am neither a doctor nor a diabetic but my understanding from reading posts from people who are both, suggests your results are very much in line with the vast majority of other diabetics on Afrezza. Namely they see the reversal of insulin resistance requiring lower basal doses and the elimination/disappearance of the "dawn effect." In effect Afrezza restores the normal communication between the pancreas and the liver and your body acts as if it were normal (non-diabetic). Take a read of Compounds article that he drafted of SA under the thread for Articles and Media. You will find many other benefits from Afrezza that users are experiencing. Continued good health to you... I think we got carried away on this thread at some point. Back to the original message posted by pmikeks, I think by this point, it appears there is now ample evidence that Afrezza will reduce the usage of basal, at least to a large group of users. See: www.afrezzajustbreathe.com/afrezza-reduced-basal-insulin-need/Aslo, as I posted in this thread previously, ML (Granger, who has been on Afrezza for over five year)'s case also illustrate this regenerative effect of Afrezza. Here is what she says (under the user name: bob_marylou_granger) on tudiabetes.org: “I have been a Type 1 diabetic for 58 years. After 52 years of thousands of injections, I became needle-phobic. The OUCH you think is minor to you is not minor to millions of others. ….Spent 5 1/2 years in a research study trial using AFREZZA inhaled insulin. I have not had to take an insulin injection during those 5 1/2 years. Believe me, I know that is not a cure. But for now it is the best out there for those of us struggling physically and emotionally with injections.” www.tudiabetes.org/forum/t/insulin-independence-revolutionary-phase-3-trial-giving-type-1-diabetics-the-promise-of-a-needle-free-life/46721/15Here is what she says in this forum: "When I first joined the MannKind trial, I was injecting Lantus in the morning at breakfast and inhaling Exubera with each meal. Before Exubera had been taken off the market, I had stockpiled quite a large supply. It could be stored on a shelf at room temperature, no refrigeration was needed. In the beginning, I still took my Lantus at breakfast and then began using the Technosphere {Afrezza as it is now called} with each meal. My BG levels began to drop. My doctor kept lowering the Lantus until he suggested I drop the injections completely. It took me a couple of days to work up my courage, but the idea of not taking ANY shots was worth it. It worked for a few weeks, and then my BG levels started to rise. Terribly disappointed, I went back on the morning Lantus shots and inhaling at each meal. Shortly, my BG levels dropped again, and my doctor took me off injections again. From then on, NO SHOTS!!! No one can explain it --- it just is!ML" mnkd.proboards.com/thread/2135/recent-tudiabetes-diabetics-poll#ixzz3hDZioOeeI am not a doctor, so I am not sure how significant this is from a doctor's point of view. doctor.stockpicker seems to be very exercised in his post below. mnholdem • Jun 22, 2015 10:03 PM Everyone should repost this. Flood the board with it. From doctor.stockpicker @yahoo message boards: What I saw today was almost unbelieveable!!!! I have several patients on Afrezza and have seen some very good results, but nothing like the patient I saw today. Previously, I thought I would not post patient data here, but this astonished me. This patient has been a diabetic for over 30 years and has profound insulin resistance. His regimen was Lantus 60 units every 12 hours and at least 30 units of prandial insulin with each meal. His finger stick blood sugars were terrible, so we decided to try 16 units of Afrezza in place of his injectable prandial insulin. Today, he was in for an acute care visit concerning another issue, but he brought in his glucose log and it was truly amazing..The vast majority of his readings were well less then 200 except his readings prior to the evening meal. But the most astounding revelation was that he had stopped taking his morning Lantus. He was ecstatic and so was I. I told him to split his Lantus 30 units every 12 hours to bring his evening sugar down. (Lantus is a lousy once a day basal insulin). Once again, it was astounding. I know you shorts are going to blast this note, but to prove how much this event has made me believe in Afrezza, I will self bump this daily on the message board until I sell my MNKD years from now. It will be there every day for every one to see and if I'm wrong the detractors will have ample opportunity to tell me so I am absolutely convinced that this will be one of the best selling drugs of all time and I believe every diabetic without contraindications will be using Afrezza. _______________________________________________________________________________________ So what doctor.stockpicker (has claimed in his YMB post quoted above to) have observed has now been confirmed by other users. What is the significance of this phenomenon?
Please share your thoughts. |
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Post by compound26 on Sept 18, 2015 17:02:48 GMT -5
It took me 6 weeks to see my endocrinologist for the initial 45 minute first appointment allotment slot.
Less than one week to have IOS Spirometry test scheduled and one more week to see endocrinologist to evaluate test results.
Two sample kits of Afrezza obtained that carry me another 20 days.
From what I'm hearing, this is a typical timeline, if not slower than mine since my schedule fit the endocrinologist's or visa versa. I will not have my first script written until I see him again with my logbook on June 1st. The whole process from the initial endo phone call to Afrezza written script takes roughly 3-4 months. Now you can see why it's taking so long to build up script numbers (Nrx) and refills (Rrx)!!
It hasn't even been 4 months since official launch date.
BTW, I am a T2 Afrezza user like my friend Spiro. The timeline described above appears to be consistent with what this tweet says: "#Afrezza My Wife recv'd 90 day supply of Afrezza today. It took 4 months to get Dr. appts,spirometer,samples,prescription,Ins prior auth." And here is what regenmedprovider says about this on a post of August 21. 2015 (see whythefutureisbrightformannkind.blogspot.com/?view=classic) regenmedprovider Additionally, as we approach another release of NRX and TRx numbers today. Last night I was able to bend the ears of the drug reps and a couple of pharmacists attending the presentation about NRx and TRx numbers. Samples do not show up in any of those numbers and most Afrezza patients are being given a 1-2 month supply of samples to get started and stabilized on dosage. Further, the TRx is only impacted when a refill is sought. Since, the typical roll out to each patient has been (1) couple of month of samples; (2) initial Rx which is the NRx, but is being written as a 90 days supply, then with 2-3 refills, the TRx numbers aren't affected until a patient has exhausted their 90 day supply. This is a 5 month lag from starting on Afrezza and a 3 month lag from the initial NRx. The Endo also confirmed that is how he is encouraging other providers to roll this out to patients and he is getting numerous calls from other Endo's and Primary Care Providers about Afrezza. Again, inhaled meds is a huge game changer but is quickly becoming of interest and adopted by prescribers. GLTA. Is that fair to say that the NRx/Refills we are seeing reflect prescriptions of patients who started the process of getting Afrezza prescribed in April/May/June (i.e., before DTC (Times) and to a great extent before ADA meeting) ? Please share your thoughts and observations. |
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Post by compound26 on Sept 17, 2015 18:37:56 GMT -5
For your information, the link does not work anymore. Such a good presentation!
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Post by compound26 on Sept 17, 2015 16:06:28 GMT -5
For that matter, I do not think Al has ever done any high profile interview (like ABC, 60 minutes, that level). We can see a few interviews from LA times, etc. on him and there are a few youtube videos on him. See the links below. But even if Al does a few of them, in the grand scheme of things, that won't change things much. Of course, if Al does it like Elon Musk does it, everyday, 24/7, that's another matter.  www.afrezzajustbreathe.com/interviews-of-al-mann/www.afrezzajustbreathe.com/videos-of-al-mann/ |
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Post by compound26 on Sept 16, 2015 17:44:54 GMT -5
Fyi, the number in the main article has been corrected.
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Post by compound26 on Sept 16, 2015 16:02:24 GMT -5
"Not every afrezza user is on twitter and is in contact with Sam. in a way .. we do not know how complete is that list
".
I agree with the above observation. This indicator will be very imprecise. This is like to look at the weekly increase in the people following Sam's Twitter to predict the weekly TRx or NRx. You would think in each week's TRx or NRx, a certain percentage of the new users will start to follow Sam's Twitter and therefore there is a close correlation between the two sets of numbers. But that does not appear to be the case.
However, this indicator may be helpful once we got a large number (say above 200 doctors on the list) and if we look the numbers over a long period of time, say every three or six months.
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Post by compound26 on Sept 16, 2015 12:51:21 GMT -5
Rob sent a PM to me. It was a typo. He has requested for correction to the editor.
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Post by compound26 on Sept 16, 2015 12:17:04 GMT -5
Additionally, even though there are only 75 physicians in Sam's list according to Rob. I would estimate the actual number of Afrezza prescribing physicians is more than that. I would guess somewhere between 100-200 in total.
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Post by compound26 on Sept 16, 2015 10:47:00 GMT -5
Dr. Alan Marcus, a diabetes doctor in Laguna Hills, said he has followed the drug's development for more than a decade. In three months, he's already prescribed the drug to about 30 patients. "They love it," he said. "It allows them to control their glucose ... in a manner that doesn't stigmatize. If you're out at a restaurant, the last thing you want to do is go to the bathroom for an injection or stick a needle through your clothing." But unless something is done to make it easier to get the drug into patients' hands, doctors will probably be reluctant to prescribe it, Marcus said. "It's not an easy prescription," he said. "They have to go through testing. Then you have to take a moment to demonstrate it. Then you have to deal with the insurance companies. Then you have to deal with the pharmacists, because most of the pharmacies don't have it in stock. This is a process that takes a lot of time, it takes a lot of effort." Quoted from MannKind's inhaled insulin drug proves hard for diabetics to get (Published on 3 June 2015 on latimes.com). __________________________________________________________________________________________ My endocrinologist writes Afrezza scripts for over 30 patients. He is an Afrezza believer. Why would he be the exception and not the rule? _____________________________________________________________________________________________ " Dr. XXX has prescribed Afrezza to many patients and seen tremendous results.........He wouldn't mind me sending you his info to include with a list of prescribing doctors......" (Quoted from one of the emails I have received from readers of the blog (afrezzajustbreathe.com). For privacy concern, I have taken out all personal information.) _______________________________________________________________________________________________ Quincy Medical Group Dr. Korhan Raif says this is the first widely available inhaled insulin, which he says makes insulin use much easier. Raif says insulin helps people control their diabetes, but he also says painful injections with needles can cause patients to not take their insulin. Raif says the inhaler can limit the needle injections to one a day. Raif says these insulin inhalers have only been out for the last two months. Quincy 18 year old Sydney Wellman was diagnosed with type 1 diabetes when she was 12 years old. For the past six years, she's had to inject herself with up to five painful needles a day just to get her insulin, which she desperately needs. "You can just break your insulin and there's no shots or meters," Wellman said. "You don't have to stick something on you for a continuous amount of time." Wellman says she's been on the new insulin inhaler for the past week. She says before the inhaler she would skip insulin doses because the needle would hurt. "If I skip my insulin, then I go into DKA and end up in the hospital and I'm really sick and that's not good," Wellman said. Raif says this is the first widely available insulin inhaler. " I think it's really going to help with compliance," Raif said. "I think the other thing is you're going to probably going to have a less weight gain. You're probably going to have a little bit less hypoglycemic. People are probably going to be in the ER a little bit less." Raif says the cost of the inhalers are about the same as the injections. He says most insurance providers will cover the costs. " Inhaled insulin is very rapid," Raif said. "You inhale it and eat your meal, and by the time you're done with your meal, the insulin is out of your system. So, it's less likely you're going to have a low blood sugar episode." Raif says the insulin inhaler is only available for people over the age of 18. Quoted from Tri-State area doctor spreads awareness about new insulin inhaler for diabetic (Published on 3 April 2015 on wgem.com). ________________________________________________________________________________________ Deciphering the Data on Inhaled Insulin: Implications for Practice, presentation given by Janet McGill, MD; Bruce Bode, MD; Daniel Lorber, MD, CDE (follow the embedded link to the video in the following tweet) |
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