Advocate for Afrezza

Response to Seeking Alpha article re: Dosing

This is my response to Psycho Analyst and his article “MannKind Investors: Don’t Screw Up The Afrezza Launch

After reading your article, I agree with many of your points. However, I must disagree on your inferring that because of my particular size (6’ 3” 230 lbs) or amount of Lantus dose that I take that I am somehow the “magical” patient it works on because no one else has come forward as publicly as I have.

I had the occasion to be with a few other trial patients a few weeks ago (they had the same success (or better) than I had). You will be surprised to learn that your oversimplified argument that because Afrezza doesn’t come in small dosing units as the insulin currently on the market that it won’t work for everyone (ie. except people just like me). Take another Afrezza trial patient Ana Ortiz (yes, she gave me permission to mention her name)—she is a 5’ 4” woman who is half my weight and her Lantus dose was the same or higher than mine. We both noticed that after using Afrezza for a few weeks that we both didn’t need to take as much Lantus during our treatment and we were both reduced to achieve an improved A1C. (*side note—she takes 35U Lantus, and is not back on Afrezza yet and still has to wait another 2 weeks before she could get an appointment with her doctor, but she is very excited about being on Afrezza again soon.) On the trials Ana took dosing that was similar to my prescription and got her A1C down from the high 8’s to 7. Why was Afrezza successful for her with almost the same dosing options as me even though she is half my size? Answer: Afrezza is a new and unique drug that works differently than injected insulins on the market. You are not comparing apples to apples in your article and this is misleading to many Seeking Alpha readers.

While I’m no physician and can’t explain the exact scientific mechanism and process of how Afrezza works, I can tell it it does work and everything in this video of Al Mann speaking at John Hopkins from 2010 is true. (listen from 34:00 min to 38:00 of the broadcast regarding carb counting and titration with Afrezza). Yes, it’s unbelievable—but almost any endocrinologist would say the exact same thing about my daily CGM printouts or my 6-day results before and after Afrezza for a Type 1 diabetic! They would tell you it’s impossible with current medications. Those results are unbelievable, and other people will be having the similar results (ie. just wait until @peakabull, Eric Fenar gets more practice and comfortable using Afrezza—it takes time whenever you begin a new medication).

The important counterintuitive idea I wish to express is that this is a brand new drug with its own unique properties and characteristics – not a different packaging and delivery of the same insulin that has a corresponding dosing match to Afrezza. Every patient with the help of their doctor will need to figure out their “drop rate” and “duration” of how their body reacts to Afrezza—which is exactly what I did and kept very careful notebooks of when I was on the drug trials (I did this all by hand because CGM’s were not allowed). The 4 and 8 unit cartridges were not too much or too little for all of the drug trial patients that I have met and been in contact with, and we are all different ages, sizes, and weights. Hence, I believe Afrezza is the ultimate solution, but it also comes with the challenge of explaining to physicians that this will be like nothing they have ever seen or prescribed before (unless they were a drug trial doctor, in which case, they know this!).

It has only been 11 days back on Afrezza, and my body is behaving like it did in the trials—it feels like the interaction between my liver and pancreas is working again because my sugars don’t behave the same as when I was on injected insulin. I’m not living “the roller coaster” ride and babysitting my diabetes all day—proven day after day by my CGM printouts that I have posted on twitter. I am certainly not the only success in spite of a poor FDA trial design that did not really showcase how amazing Afrezza can be (more on this later on my website sometimes) because we were limited due to protocols. If ever they design a future trial of experienced Afrezza users against experienced Novolog users it will be like Sugar Ray Leonard (who incidentally has a foundation towards awareness and a cure for Juvenile Diabetes) fighting against an amateur – a KO win for Afrezza every time in my opinion.

In spite of the many positive comments I do receive every day, there are a number of others that I’m sure other people would rather never deal with nor take the time and energy to have to defend themselves against online. I took the time to reply to your article because I believe you needed to know more about Afrezza and why the dosing doesn’t have to match up with units of rapid-acting insulin that take too long to start working and stay too long in the body. The best benefit of Afrezza is living like a normal person (ie. quality of life), and it takes me only seconds to correct a spike or knock down a “high” sugar level, and it’s completely painless. On my website in the near future, I will write out what I actually did to “dial Afrezza in”, and I hope it will answer a lot more of questions you have posed—stay tuned.

Thank you Psycho Analyst for your call to non-diabetics to refrain from besieging message boards. That is good constructive advice and I have found most of my interactions over the last 3 years with numerous online posters to be with very decent, caring individuals looking to help another human being on their difficult journey. I wish all diabetics an easier and longer life and to have the same freedom that I now experience. The big thank you is not to us diabetic bloggers—it is to the Sanofi sales force for the extremely difficult job of educating longtime doctors to learn a whole new process to treat diabetes with a brand new drug, which will help their patients “stay in zone” longer, avoid extreme “highs and lows” and providing them a painless way to do it. It won’t be easy because the results truly are “unbelievable”.

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