Sunshine Act and Effect of Big Pharma on Diabetes Treatment. September 28, 2017

I can give you my clinical opinion, which is that, yes, increased use of the newer insulins is a good thing. Administration is via a pen, which is easier to use; they only need to be administered once a day; and hypoglycemia is less of a concern.
Matthew Mintz, MD, an internist and clinical associate professor, also at the George Washington University School of Medicine. Dr Mintz writes frequently about the drug industry and trends in prescribing.
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Sorry, my patient opinion is that MD has no one idea what he is talking about. He has no one idea what is insulin, old or new, what is diabetes in past and in present, and nothing about cost and effect of medicine. Prove? Read it in the hes own writings.
      Yes, to use pen is easy. I can use my insulin pen in any place, in my car, even in Met Opera house. Very convenient.This is why I prefer to use Lantus Solo Star rather then Lantus. But the statement, insulin in pen need to be administered only once daily is perfect medical barbarism. Insulin used in dose, in units, and dose depend on the the stage of medical condition. To say that way of administration has high effect on the medical condition show up that MD is Con Man, one who write and has no one understanding about subject. Personally I take up to 4 shots daily. I take insulin in pen, Lantus Solo Star. I need to inject 300 units daily dose. It is not possible for me to take this dose in one shot.
      Hypoglycemia in condition when insulin dose is too high, or there is nothing to digest due to very low diet. This condition not effected by the way of insulin administration, but be the dose of insulin, timing, activity of diabetic, and many other inner conditions. This is why one can feel low sugar with 100 mg/dl in blood, and another time it is 60 mg/dl in blood but diabetic is not in condition of low sugar.
      Back to MD. He better to know that short acting or rapid acting insulin lead to low sugar regardless if it is administered in pen or in any other ways. Even more then that, SU which are administered orally, it is tablets, not injections, lead to the same low sugar as it is insulin, but more difficult to be controlled.
     Really very interesting, what they teach in Medical Schools?

Now, the downside is that these newer insulins cost more money. So, is the increased spending on better insulins worth it?   

As usual, what really is important, the cost of medicine or diabetic's life? It was time when insulin was not available, so the treatment of diabetes was based on Art of Medicine, Starvation, drops of Opi or  Arsenic, and organic milk. 100 years ago the talks about organic food was the same effective as it is today. Why in all discussions about diabetes treatment it is cost of medicine put on the front line? No one count the cost of treatment cancer or addiction, flu or dental costs. Every one count the cost of treatment for diabetics. What are those costs? Amputations. Home care. Medical equipment such as scooters, treatment for Asthma and Sleep Aphenea, disability, weight loss surgeries, funerals, and so so on. This costs are not in account  when doctor make his mind what to Rx to victim, insulin in pen, very expensive, or Metformin and Invocana, less expensive medicine which lead to amputation, disability, and funeral costs. Really, is newer insulin really better and worth to spend more money then Invocana? It depend, who get what.

 There are some exceptions when treating diabetes. Metformin is a great drug that is very safe and very effective, and every guideline suggests that it be used first line.      

Sorry, what is this really about? That's right, first line is what? The first line is that victim come to this particular clinic first time. So, if one with diagnosed diabetes over 10 years come to clinic, the first line would be Metformin. Metformin did not work to prevent diabetes in first place. It did not work 10 years to bring blood sugar under control, and this is why diabetic come to a new office, in attempt to find what can be helpful to treat high numbers. But victim is first time in clinic, so the first line of treatment is .... .
      I suggest another way. Every one diabetic take Metformin. Now look at, how Metformin improved blood sugar control? It did not in no one way. As MD said, more and more drugs are needed. In contrary with Metformin I take less and less dose of insulin injections. Highest dose in this year was 434 units. Now it is less then 300 units daily dose. No any other types of medicine to address to treat high blood sugar numbers, just Lantus Solo Star. It is insulin pen. Now I can tale all 300 units in just two shots, 160 in the morning, and the rest of the pen in the eve.There are 307 units in each pen.

However, metformin does not work 100% of the time in all patients with diabetes. In fact, most of these patients will need more than one drug.

Simple, most effective, medicine does not work at all. But what I suggest to ask those of us who used to take Metformin year after year, till blood started clotting and stroke of heart attack stopped our hearts. what side effect we do have after using so effective medicine? Pain in muscles. Pain is so severe that there is no spot in our bodies without pain.  This side effect never was published. We all do have it. It takes time to get rid of Metformin from body system and be able to ease muscles pain.

So let's talk about that drug. Invokana, which is also marketed as a combination drug with metformin (Invokamet®), reduces glycated hemoglobin very effectively. It causes patients to lose weight, which is often helpful for patients with diabetes. It also lowers blood pressure, and many patients with type 2 diabetes have high blood pressure. And more recently it has been shown to have cardiovascular benefit. Metformin, despite numerous studies, has never really been shown to decrease heart attacks or strokes.

Almost myrcle drug. Read comments to this publication. 

Recent reports of canvas and canvas R and FDA bblack box warnings on incresed incidence of Amputations in patients taking Invoana debunks the so called benefits.

Well, Invocana is highly effective diuretic. Water retention is one of the symptoms of diabetes type 2.
water does not go away in the healthy way. It is stay between cells. Diabetics type 2 gain weight. This is why diuretics are the really first line in all treatments, diabetes, high blood pressure, heart stroke, and so so on. Regardless of how effective diuretic is, water does not go away. It starts to melt skin, flesh. Infection. Amputation. But amputation of legs does not effect the water retention. The problem was not solved.
 Other parts of body get effected. More amputations are needed.What doctors Rx for this condition? That's right , work out. They Rx physio Therapy, but ..... . The picture taken in Summer. Not it is September last days. The legs and hand much better. The arm is not. It started to effect arm, from hand to elbow. I do take insulin since 2011. If I did not dropped all SU and Mdetformin and all other types of Junk Medicine I would not post today. But I am do. Even more then that. I still use two my legs. I still use two my hands.
Now there is the question, the amputations and disabilities which were resulted by treatment with first line medicine, did the cost of this condition added to the cost of Metformin and SU? I do not think so. The cost our society count is, metformin is $4 month supply, and one box of Lantus Solo Star is about $400. I need 6 boxes a month. $2400 monthly insulin supply. Really very expensive. No one of us, diabetics type 2 can afford to buy insulin. Insulin Resistant type of diabetes, Insulin Independent type 2, it the type of diabetes when dose of insulin to control blood sugar is higher then 200 units daily.
The article published by e-journal

If you want to save money, you can use the cheaper drugs, but cheaper drugs don't necessarily work as well and have more side effects. So what do you want to do? If you're the doctor, you want to do the best thing for your patient. If you're a patient, you want to get the best medication.

So pathetic conclusion! I suggest to say it in better words. If you are healthy but need to show to somewhere you are diabetic, use cheaper drugs. They do have the same effect on society but cost less and usually free with health plan. No co-pay. 
If you are doctor then think about what cost it to you to Rx effective medicine or get higher check from Big Pharma. So, Rx a new drug, and get payment, but do not Rx medicine which will heal patient and you will lost health plan payment.
If you are diabetic, patient, then think twice or even more before trust in any doctor. Be smart. Get educated. And do not take it for granted that MD or any title really provide good health care options. Run your log book, for yourself and for your family. And keep you medical box under your control, regardless it is cheap or expensive.

via Ravenvoron