4 ms·

I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of treating diabetes i

by llccbb 9y ago

I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of __treating__ diabetes is technology that helps maintain excellent blood glucose control. Diabetes Mellitus (T1) is not a curable disease right now except through pancreas transplants. Diabetes is therefore a disease that has to be treated. The treatment for diabetes is personal, non-uniform, active, and adaptive. Every ingestion of food or liquid affects your body and needs to be considered. Diabetes is a disease that needs its symptoms to be monitored and managed at a high granularity. Both monitoring and managing blood glucose can be really invasive though, with needles and finger-sticks causing extensive scar tissue development. Minimally invasive glucose monitoring technology that generates high-resolution time series data (such as Dexcom systems) literally transforms the way that people can manage their disease. Going from glucose reading every 6 hours (test strips) to every 5 minutes (CGM) is life changing. Monitoring that is non-invasive is the next technological step. The holy grail for treating diabetes should actually be stabilized monomeric human insulin. Afrezza[0] is exactly that, and inhalable no less. The company that makes it just can't break through the insulin cartels and insurance-pharma exclusivity, so they are having a hard time. They did what was unachievable for 100 years though, and they are amazing chemists. [0] https://www.afrezza.com/hcp/afrezza-action-profile/ https://www.afrezza.com/hcp/afrezza-action-profile/

zaroth 9y ago
I'm not sure inhalable is a feature. Insulin pumps/pods micro-dose fast acting insulin throughout the day to cover your basal dose, you can't do that with fast-acting insulin via inhaler. You can't close loop your inhaler with a CGM to adjust your basal based on your current BG and automatically control for overnight highs/lows. You can't dose your kid from across the room from your smartphone. Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...
- llccbb 9y ago
  I think alternative delivery mechanisms to injection are a feature. Ask any diabetic if they would like less needles in their bodies. There is work and patents on adjustable dose inhaler systems, but its never going to be a basal insulin that is being delivered. It's prandial. The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers. I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.
deleted 9y ago
[deleted]
oasisbob 9y ago
I can really relate with your read on the treatment of type 1 diabetes. My father was involved in some of the early long-term diabetes control trials which began at the University of Washington in the '80s. One group was randomly selected and told to keep doing what they were doing. The other group was to keep as tight of control over their blood sugar and insulin administration as humanly possible, and was continually given state of the art tools to do so. He was in the later group. Despite having excellent leading-edge advice, and being one of the most disciplined people I've ever known - marathon runner / Mormon* / literal boy scout (master) - it was a constant battle to keep things under control. It's a myth that diabetics can't have sugar; rather, it's easier avoid it because it ends up being such a pain in the ass. I wasn't really paying attention, but still knew what a basal rate was as a kid. * I never realized how much more difficult Diabetes could be until college, when a roommate was relieved to hear I knew what a glucagon shot was, and how to administer it. Alcohol & everything else was something my dad never had to deal with.
- sp332 9y ago
  Drugs really did improve since then. My grandmother had trouble managing her diabetes until she was put on metformin, which was only introduced in the US in 1995. https://en.m.wikipedia.org/wiki/Metformin https://en.m.wikipedia.org/wiki/Metformin
perfmode 9y ago
What do you mean by "insurance-pharma exclusivity"?
- foota 9y ago
  Potentially this: http://www.hopkinsmedicine.org/news/media/releases/why_people_with_diabetes_cant_buy_generic_insulin http://www.hopkinsmedicine.org/news/media/releases/why_peopl...
- llccbb 9y ago
  I don't have a link available, but I will try to describe it. Insurance company A needs to help with a wide variety of prescription needs -- cholesterol management, heart disease, kidney disease, cancers, MS, diabetes. Insurance company A negotiates with pharmaceutical companies B, C, and D for how much A will pay for any drug and what copay A will charge to the insured patient. Pharma B makes a deal to ensure that their diabetes drugs are on tier 1 or preferred status (most likely to be approved/used/paid) in exchange for a very good deal to the insurance companies on the price for each prescription and a lower tier for their cholesterol drug. The agreement also states that all other diabetes drugs (insulin, let's say) will be tier 3 or need prior authorization. This is a contract that might last a year or 5 and is not public. Company C makes a deal to get their MS drug as the only reasonably priced option in exchange for basically giving away their foot fungus drug. The insurance company is happy because every foot fungus prescription is pure profit. Company C is happy because they are they only game in town for MS treatments on that insurance provider. Pharma D wants to get their insulin at a higher tier so that patients can afford it and not buy out of pocket. But Pharma B already has an agreement that all other insulins will be tier 3 or lower, so Pharma D is locked out of that insurance company. The current health insurance and prescription system in the US __heavily__ favors large pharma companies that can negotiate on multiple grounds and leverage competing health interests. Small pharmas that offer a singular stellar product have a tremendous fight to even get past prior authorization.
coldpie 9y ago
> Every ingestion of food or liquid affects your body and needs to be considered. You know, it's funny. I've had Type 1 Diabetes since I was 13, more than 15 years ago. I just can't imagine what it's like to not think about everything you eat. I have to do several math equations every time I eat just to survive. At this point it's just a part of eating, there is no alternative. The idea of eating a donut and not worrying about feeling like shit for the next two hours is totally foreign to me. I always say, if you want to monitor your food intake, just become a Type 1 Diabetic. You will consider everything you eat :)
- richie5um 9y ago
  Completely. As a T1 I could complain that it is draining, but, hey, it's just the way things are. ¯\_(ツ)_/¯

I am certainly not defending the article, but here is my take from living and being very close with a type-1 diabetic. The holy grail of __treating__ diabetes i

by llccbb 9y ago

zaroth 9y ago

I'm not sure inhalable is a feature. Insulin pumps/pods micro-dose fast acting insulin throughout the day to cover your basal dose, you can't do that with fast-acting insulin via inhaler. You can't close loop your inhaler with a CGM to adjust your basal based on your current BG and automatically control for overnight highs/lows. You can't dose your kid from across the room from your smartphone. Also there seems to be a a notable incidence of lung cancer which raises a bit of a yellow flag there...

llccbb 9y ago
I think alternative delivery mechanisms to injection are a feature. Ask any diabetic if they would like less needles in their bodies. There is work and patents on adjustable dose inhaler systems, but its never going to be a basal insulin that is being delivered. It's prandial. The lung cancer concerns come from the only previous inhaled insulin Exhubra, which was literally vaporized insulin solution and offered no pharmacological benefit over injected insulin. The two instances of lung cancer in the 12(?) years of Afrezza testing occurred with patients who were smokers. I'm not saying that Afrezza is the greatest invention ever, but it is a substantial step up from other mealtime insulins in my opinion.

deleted 9y ago

[deleted]

oasisbob 9y ago

I can really relate with your read on the treatment of type 1 diabetes. My father was involved in some of the early long-term diabetes control trials which began at the University of Washington in the '80s. One group was randomly selected and told to keep doing what they were doing. The other group was to keep as tight of control over their blood sugar and insulin administration as humanly possible, and was continually given state of the art tools to do so. He was in the later group. Despite having excellent leading-edge advice, and being one of the most disciplined people I've ever known - marathon runner / Mormon* / literal boy scout (master) - it was a constant battle to keep things under control. It's a myth that diabetics can't have sugar; rather, it's easier avoid it because it ends up being such a pain in the ass. I wasn't really paying attention, but still knew what a basal rate was as a kid. * I never realized how much more difficult Diabetes could be until college, when a roommate was relieved to hear I knew what a glucagon shot was, and how to administer it. Alcohol & everything else was something my dad never had to deal with.

sp332 9y ago
Drugs really did improve since then. My grandmother had trouble managing her diabetes until she was put on metformin, which was only introduced in the US in 1995. https://en.m.wikipedia.org/wiki/Metformin https://en.m.wikipedia.org/wiki/Metformin

perfmode 9y ago

What do you mean by "insurance-pharma exclusivity"?

foota 9y ago
Potentially this: http://www.hopkinsmedicine.org/news/media/releases/why_people_with_diabetes_cant_buy_generic_insulin http://www.hopkinsmedicine.org/news/media/releases/why_peopl...
llccbb 9y ago
I don't have a link available, but I will try to describe it. Insurance company A needs to help with a wide variety of prescription needs -- cholesterol management, heart disease, kidney disease, cancers, MS, diabetes. Insurance company A negotiates with pharmaceutical companies B, C, and D for how much A will pay for any drug and what copay A will charge to the insured patient. Pharma B makes a deal to ensure that their diabetes drugs are on tier 1 or preferred status (most likely to be approved/used/paid) in exchange for a very good deal to the insurance companies on the price for each prescription and a lower tier for their cholesterol drug. The agreement also states that all other diabetes drugs (insulin, let's say) will be tier 3 or need prior authorization. This is a contract that might last a year or 5 and is not public. Company C makes a deal to get their MS drug as the only reasonably priced option in exchange for basically giving away their foot fungus drug. The insurance company is happy because every foot fungus prescription is pure profit. Company C is happy because they are they only game in town for MS treatments on that insurance provider. Pharma D wants to get their insulin at a higher tier so that patients can afford it and not buy out of pocket. But Pharma B already has an agreement that all other insulins will be tier 3 or lower, so Pharma D is locked out of that insurance company. The current health insurance and prescription system in the US __heavily__ favors large pharma companies that can negotiate on multiple grounds and leverage competing health interests. Small pharmas that offer a singular stellar product have a tremendous fight to even get past prior authorization.

coldpie 9y ago

> Every ingestion of food or liquid affects your body and needs to be considered. You know, it's funny. I've had Type 1 Diabetes since I was 13, more than 15 years ago. I just can't imagine what it's like to not think about everything you eat. I have to do several math equations every time I eat just to survive. At this point it's just a part of eating, there is no alternative. The idea of eating a donut and not worrying about feeling like shit for the next two hours is totally foreign to me. I always say, if you want to monitor your food intake, just become a Type 1 Diabetic. You will consider everything you eat :)

richie5um 9y ago
Completely. As a T1 I could complain that it is draining, but, hey, it's just the way things are. ¯\_(ツ)_/¯