Tuesday, February 23, 2010

Feedbacks from Real Afrezza users

By SharpTail (diabetesforums.com)

02-09-2008, 09:09 PM

The removal of Exubera from the market is old news for sure. They had problems marketing the product and the inhaler was not a convenient advice.

Beyond being a different method of delivering insulin this may be a valuable tool for both MDI and pumpers to manage their diabetes. As some of you know I have been participating in the trial for about 1 1/2 years now for Technosphere insulin. This period of treatment has been my best for control for over 25 years. Part of the reason is the fast action of this insulin and the short period of action. For me in less than 2 hours this insulin is out of my system and there is not an unexpected drop in my blood sugar level due to left over insulin action. The other great thing about the very fast action is for a correction dose. For example I have forgotten to bolus for a meal and discovered a high blood sugar of 18+ two hours after the meal. In less than an hour I have consistently been able to bring my BS level to a normal reading of 5-7 with the Technoshpere insulin. There are definitely some positive features to this medication.
Pat

02-10-2008, 05:24 PM

When the inhaled Technosphere insulin will be available is unknown to me(you can Google this to find our more information). I believe I am in the final phase of the trials. This is a two year trial ending in July 2008 with the objective of assessing whether there is an impact on pulmonary function. Also this trial is being conducted in the US, Canada and in Europe so I assume the Mannkind company will try to get approval for this insulin in all of these countries. I would think they will submit the results of all their trials as soon as possible.

I would certainly not describe the TI insulin as a "wonder" insulin. Inhaled insulin has receive a lot of bad press for sure. However, the way I look at it even individuals with no fear of injecting insulin may occasionally have a use for such a fast acting insulin regardless of how it is delivered. I could definitely see it being used to give a "kick" to a usual bolus of injected fast acting prandial insulin if a meal includes very quickly metabolized carbohydrates. Also, it will work wonders for very fast corrections of high blood sugars as in the example I gave in the last post. Personally for me the absence of that "left over" and somewhat unpredictable insulin 3-4 hours after a meal has just about eliminated any bad hypos. I should say that the other important part of the equation is my injected Lantus for my basal requirements.

There are also some downsides with the TI insulin. For very insulin sensitive individuals the available dosages may be difficult to work with. Exact conversions to the injected insulins may be a challenge. Also, as may be expected, an aerobic activity that increases blood flow to the lungs within an hour or so of an inhaled bolus greatly accelerates and increases the action of the TI insulin. I have found that in this situation the action just about doubles. I suppose this feature could be used to advantage, but with caution as well. Of course all of what I am saying is anecdotal and we will have to see what the final analysis of the data tells the researchers.

I was in the clinical trial for Technosphere Insulin for 2 years. If you liked the Exubera you would definitely like the TI insulin. If you Google "Exubera Technosphere status" you will find information about some patients who were on Exubera and are now using the Technosphere Insulin as a replacment.
Pat

__________________

10-23-2008, 08:56 PM
Type 1 Diagnosed November 1981 at 29 years old
Clinical Trial with Technosphere Insulin until July 2008
October 5, 2009 began pumping with Animas Ping, great technology!

06-23-2008, 09:41 AM

Technoshpere Insulin Trial Finished


I just completed my 2 years participating in the inhaled Technosphere Insulin (TI) Clinical Trial. I believe this was Phase Three, the final phase before the results will be submitted for approval for distribution in North America (Canada and USA) and some countries in Europe.

The TI insulin worked well for me. I started the trial in the summer of 2006 with an A1c of 6.8 and the last tests taken on May 28, 2008 it was 5.9. This is the lowest A1c I have ever recorded. A notable fact was my ability to tighten my control and yet in that 2 year period only have one incidence of a significant hypoglycaemic episode. Part of this is due I am sure to more frequent monitoring of my BS and also to more accurately adjusting my doses of my basal Lantus. I found I needed to split my Lantus, since I was only getting about 18-20 hours of coverage. My basal Lantus is working very well for me right now.

I think a lot of the refinement of my control came from the rapid onset of action and also the short period of action (2 hours or less) of the TI insulin. I found the second hour of action of the TI insulin to be very gentle. Generally I bolused with the inhaled insulin immediately before a meal and sometimes during and after a meal after I determined precisely what I was eating. The lack of lingering action with the TI insulin in the 3-4 hour period like I expect from Humalog helped to minimize an unexpected drop in my blood sugar with a resulting hypo.

The Technosphere Insulin Inhaler did not suffer the problems of the Exubera Inhaler. Since it is hardly bigger than a cell phone, I usually carried it in my shirt pocket when I was eating in a restaurant.

A limitation for some especially insulin sensitive individuals may be the dosing for the TI insulin. Basically there are two doses to work with in various combinations. For me I found them quite easy to figure out and work with in most meal situations. I found if I overestimated the dose and my blood sugar dropped too low the fall of blood sugar in the second hour after bolusing was very gentle and never "crashed" like I became accustomed to with injected Humalog. Therefore no bad hypos.

For the Trial I was required to keep the TI insulin cool like in refrigeration when I travelled which was a burden at times. However, I think this was largely for control during the trial. I have read that the TI insulin can be kept at room temperature for up to two months which is better than injected insulin.

Now that I have been on Humalog for about 3 weeks I am surprised at how slow this insulin is. It is like I was driving a Ferrrari for two years and now I have to settle for a pickup truck. The truck gets the job done, but in its own time. I discussed in Eddy's post about intramuscular injection of the prandial insulin. I have found using this method of injection with the Humalog I have quite closely matched the action of the inhaled Technosphere Insulin.

Needless to say I am disappointed I will not be able to continue to use the TI insulin in the near future. I am not sure I can maintain the A1c of 5.9 with the Humalog, but I will be giving it my best effort. There is some information that there may be a continuing long term trial with the Technosphere Insulin in the future. For me the inhaled feature of the TI insulin was only a different method of delivery. I think the rapid action and short duration of action was more significant in my success with this medication.

Pat

02-27-2008, 08:04 AM

This device, called the Medtone Inhaler, has been shown on their website at Mannkind Corp | Mannkindcorp.com for a long time, so I'm not revealing any "secret". I would think they would like some positive press if they can get it, considering the stain left by Exubera on the "inhaled insulin" concept.

Actually there are two dosages that can be used in different combinations to give the "correct" dose. The smallest dose for me is about equivalent to 2U of Humalog. Personally I would like to see the option for a smaller dose and that would give individuals with high insulin sensitivity almost all the options they would require.

If you disregard the fact that the delivery system is through the lungs, the TI insulin has some properties that could be valuable as an additional tool to control blood sugars. In 10 minutes or less it is working at full "power", but is completely out of your system in less than 2 hours. I think that this short period of action is one reason I have had no serious hypos since beginning this trial in the summer of 2006. Yet I have been able to tighten my range of BS levels and lower my A1C from the high 6's to 6.2 for my most recent test this month. It is quite amazing how this works for rapid corrections of high blood sugars. I can expect to bring my BS levels from 15+ to a good range of 5-7 in less than an hour and you can cut that time by 1/2 if you associate that with an aneorobic activity that will increase blood flow to the lungs.

Certainly the control of the dosing for this insulin may present problems for some individuals if it is used exclusively as a prandial insulin. However, even for those who "micromanage" their dosages, there could be uses for the TI insulin in exceptional circumstances such as for corrections and quickly metabolized carbohydrates.

I have wondered if after this insulin gets approval after the trials, whether it will be priced competitively with other insulins and also covered by insurance. We'll have to wait and see. In July when my 2 year trial is complete I will have to make the adjustment back to Humalog and I know I will miss having the TI insulin.
Pat

Posted by anehamkin Thu Jan 04, 2007 9:42 pm ; from dlife.com

(This is the only other Afrezza user)

The insulin that I'm on in not Exubera. It's the one that's still in clinical trials by Mannkind Corp. This one is about the size and shape of a small throwaway camera.It's actually very convenient and just carry it in a little pouch. Have to carry the insulin powder in something cool though. It's just a small vial that snaps into the inhaler for each dose. It took getting used to and have a slight cough periodically. I've had 3 pulmonary function studies so far in the past 6 months that are required for the study. This is so simple and after 33 years of diabetes and injections, a welcome break. I still take Lantus once a day which is not a big deal in comparison. It beats the 3 add'l injections of Novolog each day. I don't understand why some diabetics are so adamant about not trying new products. Everything is new when it first comes out and someone had to be a study for it. I was actually part of a study for the insulin pump back in 1972, when it was nothing more than an insulin IV. And look when it is today. Anyway, is anyone else on the Mannkind study? I've been in it 6 months now and I feel almost like a new person. And yes, the powder down lower your blood sugars. You just have to find the right dose to calculate. Gets a little tochy sometimes, but worth the effort.