Afrezza: dealing with the 4U minimum

I posted a link regarding autonomic testing.

Thanks

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When I started with Afrezza I thought exactly the same. What? 4U minimum? I am going to die. Before Afrezza I was on a pump. I switched to a pump to make it easier to deal with post-exercise hyper-sensitivity (I am a triathlete). The picture shows one of my first experiments with Afrezza. I couldn’t believe it. But there are the numbers.
2 years later the current doses make total sense to me. It has NOTHING to do with injected. Accurate titration and micro dosing doesn’t make sense anymore, because Afrezza is fast-in and out. Its still insulin so you can go low. But at least for me, its a lot harder to get a low, and I know that it wont kill me for sure (that was a REAL risk with injected, especially with exercise).

I have pics of more experiments I did if anyone is interested. And I posted most of them @guasaman in Twitter. Cheers!

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Welcome Gus! I’ve followed some of your stories with afrezza in the past. Happy to have you join here. Please introduce yourself here: Welcome, introduce yourself here!

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Gus, welcome! I am extremely interested in your experiments. I am looking at your 4U curve right now. What would you normally have taken when you had a 154 BG for injectable insulin, as a comparison?

My son, T1D, is an athlete (swimming/soccer/volleyball) also, but he is only 12. He is not taking Afrezza but he and I have been very interested in it.

The whole mental block is that it’s not “4 units” in the same sense that 4 units of injected is…

4 cats are not comparable to 4 dogs… I honestly don’t even think in terms of units when using it whatsoever…

I personally would have taken 1 or 2 units of injected if my bg was 154 depending on the variables (food on board, previous bolus on board, anticipated activity, temperature, phase of the moon, fortune cookies, astrology, the LHA of Aries, state of the tide, all that…) then I would have waited over an hour to have any sense if it was going to work, work too much, or not enough

With afrezza I’d just puff one and be on my merry way without thinking about virtually anything…

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Welcome @Gus this is such great information. Anyone I speak with initially about Afrezza dosing (including the voice inside my head) has trouble understanding it. Completely understandable, but as you mentioned, once you get comfortable and more importantly trust the dosing, it all makes sense!!!

It’s too bad that MannKind is so short on cash and doesn’t have the distribution partners.

I doubt they’ll do the trials or gain the numbers needed to show what you’re saying – which is a tremendous benefit. If you virtually eliminate the risk of a deadly hypo, that’s a HUGE! factor in glycemic control. But you’d probably need to have a huge study to show that the risk of serious hypos requiring hospitalization or outside assistance go down dramatically, even if all this anecdotal evidence makes it seem blindingly obvious.

I mean, can you imagine an insulin that did not have a huge indication for hypoglycemia?

I wish more people would take it or that someone would help partner with them for distribution and marketing for real. Because there are a lot of potential benefits that are, at this point, just word of mouth. And to have it really take off I suspect it would need a stamp of approval from someone.

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I think you are right. I am rooting for them. I want them to succeed. This is a product diabetics NEED.

It is raging to see how the medical community does not embrace it. It truly shows the large gap between doctors (endocrinologists) and their patients.

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The rep I talked to at TCOYD last month said the Mannkind is working on increasing its sales force–there is finally a rep for my region, yay!–and increasing providers’ awareness of Afrezza. They will also help PWDs whose insurance won’t cover Afrezza by working with the insurers (and provide samples to patients during this period). Insurers are a big obstacle, IMO–mine requires me not to do well with covered insulins before they will cover it. The lower risk of hypoglycemia overall is not a primary consideration nor is being able to eat a more typical diet. Ha! I’d like to see them count out 10 taco chips at their favorite Mexican joint and skip that margarita!! :scream_cat:

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I read a Yahoo Finance article that seemed to indicate currently there are fewer than 300 prescriptions written per month for Afrezza? Is this due to the Afrezza trolls?

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I think it’s mostly due to the fact that a) it’s not preferred or even an option on most insurance formularies. b) they have fewer “reps” to go out and market the drug so doctors don’t even know to prescribe it c) endo skepticism because the drug trials to initially approve it were not designed in a way to highlight its benefits, while it comes with a black box warning because of its potential for lung issues. They didn’t really figure out the optimal way to take the drug, and so people in the trials did not have lower A1Cs. d) you need a $600 spirometer thingamajigger in the office to test lung function, something most endos don’t have, so there’s an upfront level of cost and bureaucracy to get around before writing even one script.

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Could also be that most endo’s are fighting the fight to get the majority of their patients to do the minimum correctly, and Affrezza isn’t on their radar as helping those people. At our last diabetes appointment they actually told us to stretch out the appointment time because we obviously knew what we were doing, it was working, and we didn’t need their help…

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Will you post the link for that article? Thanks!

MannKind: Afrezza Sales Still Low As Company Tries To Increase Outreach

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And this. i’m not a fan of Seeking Alpha but they consistently cover all the MannKind weekly scripts. https://seekingalpha.com/article/4066772-mannkind-afrezza-scripts-dip-investor-frustration-rises

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I think this is an important factor – why are people not continuing with it? Is it because no one is bothering to explain how to use it, they get frustrated and quit?
I suspect there are some people out there for whom it’s not a good fit too – maybe they actually digest food pretty slowly and the “fast-acting” insulin action curve works better for them – my son is like this. Or maybe it’s the fact that it might be a great fit for some foods but not a great fit for others, and people don’t want to have two different insulins they use?
But still, just getting more sales reps to fill scripts will only work if people continue to use them.

I would like to make a recommendation to all adult T1D’s (as long as you do not have any pulmonary concerns). No matter what your current insulin regimen is, no matter if you are using a pump or MDI, no matter what insulin you are using…

If you have a glucagon kit at home for emergency lows, why not have a box of Afrezza cartridges for emergency highs? Even if you don’t want to use it daily, you can use it for those times when you are spiking wildly and want to bring your BG down quickly.

I currently do this a different way (it involves the letters I and V), which for me gives me the quick drop. But I know most people don’t want to do this. So get yourself some Af, and give it a try. You don’t need to wait hours for a BG to come down.

I’ve tried Af a few times. It’s quick!

I am going to experiment with a few other methods of using it also, for people concerned with their lungs.

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People tend to have reservations about anything “new”…I’m pretty sure Afrezza falls into this same category. It’s new…it’s radical…it’s different…therefore it must be bad (or maybe not bad, but I’m gonna wait until I see more people using it…type of mentality).

Maybe?

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People don’t know about it, that’s the problem. People love new things, they flock to it. That’s why they buy new iPhones as soon as they come out. It’s the Doctors who do not like new things that are so different. It requires them to learn and spend a lot more effort with their patients in such a different way of treatment. That’s why I had to change Dr’s as he literally said it wouldn’t help me and wouldn’t prescribe it. After 15 years of same Dr I went to new one and I can’t be happier. And guess what? This drug that wouldn’t help my 8.xx A1C which was mainly caused by spikes right after eating brought it down to 6.5 in a few months! This is after YEARS of high A1C.

Every time I meet someone who is diabetic or family member, wife, etc is I ask tell them about it and they are shocked that there is inhaled insulin. My CVS pharmacist never heard of it! They have no clue. It’s up to the Dr’s to educate their patients on the proper medication that can help them and most Dr’s are simply refusing.

Most people are not like us and do not keep up with the latest research and treatment options.

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