Sam,
By the way, Quest Diag. bought Athena Diagnostics in 2011. Athena is the only lab that does full-gene sequencing for common forms of monogenic diabetes in the US, I am fairly sure. It is located in Waltham, MA which is in my area. Costs still run into a few thousand dollars for this type of testing.
If there is any possibility of HNF1-beta one would probably want to know – this has serious kidney complications (independent of hyperglycemia and potential for CKD). It is less common than HNF1-alpha and HNF4-alpha. But there is little that can be done to avoid death typically in middle age, as far as I know. I hope you don’t have any such renal problems.
HNF4-alpha is associated with large birth weight and neonatal hypoglycemia, for example. HNF1-alpha has a large number of distinctive characteristics.
I would recommend reading up on the characteristics of each HNF form of diabetes. Their phenotypes are pretty distinctive, and there are also biomarkers (for HNF1-alpha, at least) that are inexpensive indicators.
My doc says he specifically wants the lab processed at the Mayo Clinic instead of quest… which as near as I can determine is why it will require a trip to a different city because the local lab doesn’t work with mayo (as far as I can piece together) I’m just along for the ride here at this point
@Sam19 - if your doctor faxes the lab request to Mayo, they will send you a collection kit and return box with FedEx overnight label. You can get the draw at any lab, pack it up with the enclosed ice pack, and send it back to Mayo.
I do this on a regular basis with Mayo Rochester.
Costs me $6 at the lab I have the draw at (my doctor’s office)
I don’t know… sounds reasonable enough. My doc practices in the city in private practice and in my small town as a contractor to the hospital, he looked into it and is telling me he can only arrange it from the city. I suppose it could be a matter of shipping speeds to meet the labs requirements being possible from the city and not from where I live too… or maybe his contract with the hospital requires him to go through their lab arrangements… I don’t know the fine print… I pass through several times a year anyway, it’s not a dealbreaker
The problem is people with impaired lung function cannot take afreeza, that’s why you need a lung function test done 1st.
If I do the google on “early insulin initiation” I see a long list of documents. They all pretty much say the same which is early insulin intervention has significant benefits.
If I do the google on “early insulin initiation bad” I am not seeing much so I think its fair to say the consensus is early insulin intervention has benefits and some would argue huge benefits.
Based on the recent label update for afrezza its pretty clear nothing is faster in and out. If we are to believe the 118 trial and some of the analysis done around the 171 and 175 trials afrezza also blocks glucogen release and reduces glycemic variability bringing the liver back in sync with insulin action. If true, this is a game changer.
Now, if I do the google on COPD it says about 7% have this. Lets assume 10% are not good candidates for afrezza but 9 out of 10 are. Thats not bad having 90% of PWDs the chance of using a game changer in diabetes care. In fact I would say that’s awesome and even 80% would be huge.
For that other 10% the medically correct thing to do is use an RAA. While some may be allergic to some of the preservatives there are 3 popular RAAs they can try. If they don’t want MDI then at least use the basal or even the regular insulin.
Now if we look at the AACE document page 8 they say “Insulin is the most potent antihyperglycemic agent.” Yet they recommend delay, delay and further delay until the PWD is in such bad shape you have little choice. At this point the PWD already has huge complications and will never benefit from the early intervention advantages.
Now, I am just saying but unless the AAEC has some undisclosed reason their current guidelines, simply put are at best medically incorrect. https://www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf
Or as Ralph DeFronzo said at the BeyondA1c forum last July “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center)
May not be able to. I know some people with asthma that pass the spirometry and use Afrezza without problems.
Red herring… saying the problem with afrezza is that if you can’t pass a breathing test you can’t use it is like saying the problem with running is that you can’t do it if you have no legs.
Heck. I used Afrezza for 6 months before I ever had a spirometry test. One doctor has been trying to get me to stop using it based on that test almost 2 years ago. I’m not a fan of the test at all.
Well known in afrezza circles that the test is the result of big pharma strong arming the fda to disrupt a small competitor (and create an obstacle to keep from becoming a big one). I did it once, it was dumb, I refuse to do it again
Yep. Here is a good discussion on Afrezza and spirometry.
In fact, lots of good Afrezza discussion here:
Here is a good educational session I saw last year which I thought it was on topic. It discusses several insulin topics including inhaled insulin.
It also talks about a 1999 study showing the relationship between insulin release and hepatic action which I thought Mac might find interesting.
It includes both T1 and T2 discussions and qualifies for continuing ed credits but it will take some time but IMO worth it.
Just an update…no dice with insulin. I’m only on Trulicity and Metformin for T2D. I was unable to persuade my endo or general practitioner to agree to let me start insulin. So…dropped the endo, looking for another. Left general and found another just today. She seems very receptive to insulin use. I just got 3 months worth of Trulicity and it is expensive, so I’ll finish what I have before moving on.
I also had a long bought of trying to get a doctor to listen to me about the joint and muscle pain the orals caused. Finally, my doctor agreed to some testing. I saw a neurologist who did several test and determined I have zero neuropathy. He diagnosed me with Fibromyalgia. Another issue to deal with.
I thank everyone for the words of advice. I guess insulin if is my best option is on hold for now. Thanks folks.
Doctor speak for “I don’t know what is causing the pain.” See a rheumatologist. They are better equipped for joint and muscle pain issues.