Yes they are accurate for the most part... many people benefit tremendously from CGM and its not my intention whatsoever to discount those benefits. However, if you are focusing on timing, instead of level, which is in my opinion the key component to managing with afrezza, they leave a lot to be desired. Let's look more closely at the other Sam's notes you referred to--
1) his meter showed he had bottomed out at 12:41. The CGM took until 12:59 to show the same critical data point-- 18 minutes later
2) his meter showed that a rebound began at 12:51. The CGM took until 1:02 to start to show the same rebound-- 11 minutes later.
Those lags are consistent with my own personal observations. Keep in mind this was a designed experiment with only one variable, insulin. In the real world we are generally pairing 2 variables; digestion and insulin... which will absolutely lead to more variations in real time between the CGM and the meter.
This is a relatively insiginificant concept in the world of insulins whose peaks and overall duration were measured in hours. Afrezza changes this dynamic substantially though, with a faster onset than the CGMs lag time....
Again not discounting the benefits of a CGM I just think its important to understand both its benefits and its limitations.... limitations that are much more profound when using afrezza, in my opinion, than other insulins.
Pure nonsense. That's an interesting graph, and I don't entirely understand the assumptions they used to plot those curves.... but I can tell you with absolute certainty, as an afrezza user, that afrezza lowers glucose levels far, far, faster than anything else on the market. No comparison, period. And if you think this entire thread is a farce I'd invite you to have the lunch of your choice with me live via skype, you use your lispro and I'll use afrezza and we'll compare results.
Forgive an ignorant question: What happens if you take your lispro and then don't eat? Doesn't it force you to eat whether you change your mind or circumstances or not? And correct me if I'm wrong, but isn't 150 minutes 2.5 hours? What's going on in your system if you had a snack and 2.5, 3 hours later there is still activity in your system? Don't you have to worry about those hypos?
I'm not a doctor or a pharmacist or a PhD. But I've lived with diabetes for 31 years and know a damn sight more than these fancy credentials know about living with diabetes. And I've paid attention. Draw all the scientific graphs you want. I've now used Afrezza for 20 days. I use a CGM and watch my blood glucose levels closely. Afrezza works faster than any insulin I've ever used, by far.
Maybe you should ask your doctor what effect this quick blood concentration of Afrezza has on the liver. Does it suppress post-meal liver glucose release in a way that no rapid acting analog insulin can?
Thinking about the attitude that this doc has taken bugs me. Does he have any idea what it feels like to live with this disease? I think we diabetics are just clinical subjects and liability risks in his eyes! We are human beings and deserve to be treated with respect and empathy!
Appreciate you chiming in bbraxton, but unfortunately, much of your post doesn't seem to make much sense to me. I think I know what you're trying to say, regarding the time of dosing, but I'm not sure how that would relate to the "onset of activity" question, and you're language is quite unclear.
Mark,Thanks for the feedback. I was trying to figure out how to delete the post. Because I realize I did not convey my thoughts to well after reading the post.:-)I just figured out how to delete it. Notice it is gone :-)
Terry, I am 100% with you. Certainly we want our docs to have our best interests in mind and warn us of the risk associated with taking new drugs to treat our diabetes, but to simply shut Mark down and not listen to what he is saying is not good. It's narcissistic and self serving.
Others have already said it, but so will I. Afrezza without a doubt is the quickest acting insulin I've ever used and is by far the most effective at controlling postprandial spikes while essentially eliminating hypos as it relates specifically to me. I want to be careful to not make a blanket statement for all diabetics.
A few facts about the G4 in support of Sam's excellent analysis above:
The G4 records a sample every 5 minutes. As such, when viewing the current value, it can be up to 5 minutes old.
Interstitial subcutaneous fluids (as opposed to direct arterial or venous flow) takes 5-15 minutes to equalize with blood glucose. This time is highly variable, depending on sensor location, situation (is the location under compression like lying on it, or is the location active and moving), overall bloodflow/heartrate, etc.
The FDA wanted to prevent Mannkind from labeling and marketing Afrezza as "Ultra" or "Super" rapid acting, vs. simply rapid acting as in the case of Humalog and Novalog. The FDA writes its own rules, so if they don't think having insulin begin dropping BG immediately is as important as what BG gets to after an hour or two they can force Mannkind's compliance. The broncial spasms was another example. This was seen in some earlier trials on COPD patients, but Afrezza is contraindicated for diabetics with Lung Disease. This was not seen in any patients in the larger trials, so the inclusion on the label is their to scare doctors from Rx off label, but has the effect of scaring patients with healthy lungs. The Pulmonologist on the Advisory Committee didn't see why asthma sufferers shouldn't use Afrezza when they were not having an attack. That was telling. The only issue that the Advisory Committtee had was that the product needs to be monitored over time to make sure it is not causing any development of problems or cancer in the lungs, but that is to be expected with a new technology and a new route of entry for insulin. We spoke to a Pulmonologist at CHOP that was excited about the drug and if they want to give it to kids that was telling as well.
I cannot help thinking that when two companies share 90% of a 7 billion dollar market that they will do as much as they can to keep that oligopoly as long as they can. If you are a hot shot doctor or clinitian aligning yourself with a 50 billion dollar company makes more sense than with one who can barely keep the light on.
No... what happens is the carbs in the snack just go into the bloodstream, your BG value goes up, and then slowly comes down over those 4 hours as the insulin seeps in to you blood.
Yes, "onset of activity" is similar. This is the time from administration to when insulin levels begin to rise in the blood and glucose clearance starts.
Big whoop... who cares about that metric, when the the time to peak, and serum concentration levels at peak are so much faster and greater? That's the graph on the right.
The fact that your doc can't look at the graph on the right and see the huge difference says something really bad about his expertise and analytical skills.
The graph on the left is, ironically, further supportive of the superiority of Afrezza. What it shows is what we also already know -- most of the drug diffuses into the blood quickly (hence the higher early peak, and rapid dropoff), while lispro diffuses into the blood more slowly and steadily over several hours.
Of course, interpretation of graphs like these must also be informed by actual clinical results, which is what we are are doing here on TuD. And we're not even doctors.
In short, while I'm no doctor, when I look at those graphs they support what we're seeing with Afrezza by actual users. How your doc can look at those two graphs, with starkly different results for Afrezza and Lispro, and claim the two will behave the same is ridiculous.
Ran across this article. It speaks for itself. Think maybe you should help our your NY doctor and his group there come into the current century and pass it on to him.
Signed my daughter up for the pediatric trials once these become available. For me Afrezza will be a bigger change for children. My daughter is a great eater but on a couple of times has sat down to eat and lost her appetite after we had given her the insulin for her meal. Then there is the concern of ordering something when out and she does not like it and she has already gotten her insulin and so forth. From my perspective it may make it easier for children to manage their diabetes...but I could be wrong.
Well I was just thinking a while ago choice is part of life and change is part of choice. That's the whole point. Don't you think? What if you had a sudden urge to go the bathroom or received an important phone call or somebody held up the restaurant or they messed up the order and had to do it up again, or you had to Heimlich somebody or chase after someone? Suppose you're eating a burger in a car and the trip is interrupted. Suppose you decide not to eat the entire meal. Or are part of a travelling group and the order doesn't show up for a while. Suppose the cook got backed up or got a call that his wife needed a ride. Suppose your carb count is off.
