ADA Scientific Sessions 2018: Gary’s Top-5 Observations (IDS)

Thought Gary Scheiner’s write-up was interesting. Just passing it along.


Thanks @T1Allison for linking to this. Couple of things I found interesting in the write-up.

By combining Humalog (lispro) insulin with Biochaperone (hyalaronidase), the insulin starts working an average of eight minutes earlier, peaks 10 minutes earlier, and stops working 22 minutes earlier than ordinary lispro. It also shows greater action one hour after injection and a shorter duration of action compared to Fiasp (utra-rapid) insulin.

Although the low carb approach doesn’t seem to do any real harm (and may help in a few areas) for those with type-2 diabetes, the same cannot be said for low-carb diets in children. Data revealed that kids following low-carb diets are more prone to stunted growth, family emotional conflicts, iron deficiency, high cholesterol, eating disorders, hypoglycemia, and a diminished response to hypoglycemia.

I wonder what the threshold for low carb was in the Australian study.


The fact that there was no change in A1c is highly suspicious to me for Type 2 diabetes. I suspect maybe thier “low-carb” cohort was really not that low carb.

And I wonder where the data about the children comes from. I wish he would have included citations.

I looked into this a few years ago. But I was concerned that repeated use might cause tissue damage. Hyaluronidase breaks down hyaluronic acid. I understand using it for treatment can be helpful, and it is used for various things. But I was just not sure about repeated use.

Doing anything once or twice, or maybe even occasionally, it’s no big deal. But when you are talking about doing something 5-10 times per day, that’s where you really need to be careful with stuff like that.

I don’t think anyone has yet used it 5-10 times per day for years!

Ultimately I decided that just doing IM shots would serve the same purpose without the possible side effects.

Maybe at some point they will have tests where people on MDI use it over and over and it is shown to be safe. At that point, I would be all aboard.

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I was looking for the low carb threshold Chris mentioned, and I came across a different list regarding an ADA session (maybe the same one? maybe not?). I thought the paragraph below was interesting. It’s nice to see some positive publicity about Afrezza.

Direct Comparison of Inhaled Insulin Afrezza to NovoLog in People with Type 1

The STAT study did a head-to-head comparison of Afrezza, an inhalable insulin, to NovoLog, an injectable; Afrezza is an ultra-rapid acting insulin, and NovoLog is a rapid-acting insulin. Compared to the participants on NovoLog, Afrezza users saw a 12% increase in time-in-range (70-180 mg/dl), which translates to 1.5 more hours per day in range. Additionally, post-meal blood sugar spikes were 20% (about 24 mg/dl) lower at breakfast and 25% (about 36 mg/dl) lower at lunch. Though the study size was small (60 participants), Dr. Satish Garg spoke highly of Afrezza as filling an unmet need for faster mealtime insulins, attributing the positive results to Afrezza’s very fast onset (about 12 minutes to the first measurable effect) and offset (about 90-180 minutes to return to baseline, depending on dose).