Mannkind

If you want a doctors opinion on Afrezza, pick one who's familiar with the trial results, and an axpert on diabetes.

Here's one: Dr. Jay Skyler.

Dr. Skyler's career in diabetes spans over four decades, where his research interests have concentrated in clinical aspects of diabetes, particularly improving the care of Type 1 diabetes.
Dr. Skyler is a Professor of Medicine, Pediatrics and Psychology at the University of Miami Miller School of Medicine and Deputy Director for Clinical Research and Academic Programs at the Diabetes Research Institute. He also is an Adjunct Professor of Pediatrics at the Barbara Davis Center for Childhood Diabetes, University of Colorado at Denver.
He is a past President of the American Diabetes Association, the International Diabetes Immunotherapy Group, and the Southern Society for Clinical Investigation, and was a Vice-President of the International Diabetes Federation. He served as a member of the Endocrinology, Diabetes, and Metabolism Subspecialty Examining Board of the American Board of Internal Medicine, as Chairman of the Council of Subspecialty Societies of the American College of Physicians (ACP) and a member of the ACP Board of Regents. A frequent national and international lecturer, Dr. Skyler has been an author, editor and co-editor of numerous books, monographs, chapters and articles. Dr. Skyler was founding Editor-in-Chief of Diabetes Care.

Here is a portion of an interview he gave several years ago:

Prof. Home: Interesting, interesting, just following on the insulin theme there, at this meeting also, there have been a number of interesting abstracts bringing us back to pulmonary insulin notably from the MannKind Corporation. I think you're quite familiar with that data. What's your take on, first of all, the pharmacokinetics of that particular preparation?

Dr. Skyler: You called it a pulmonary insulin, and it is true that it's delivered by the pulmonary route, but I think that you also hit upon its distinguishing feature: that it is a super-rapid-acting or ultra-rapid-acting insulin, as opposed to even the rapid-acting insulin analogs -- insulin aspart, insulin lispro, and insulin glulisine -- that we currently have. That makes it very different. In contrast, the previous pulmonary insulin and the way people generally perceive a pulmonary insulin had a profile similar to those others. It differed from the other insulins mainly on its method of delivery, whereas the method of delivery here is incidental and the real issue is the super-rapid or ultrarapid action.

Prof. Home: That's going to be an advantage?

Dr. Skyler: I think so. Let's for a moment assume that you and I are the same height and weight, same age, and the same degree of physical fitness, so we put those parameters to rest. Let's assume that you don't have type 2 diabetes and that I do, and that I'm keeping my fasting glucose under control by taking a bedtime dose of insulin glargine. Today we come in, here in New Orleans, to have breakfast together and we measure our fasting glucoses. They're both perhaps 100 mg/dL, 5.5 mmol/L -- if I use your lingo. We come in; we're starting out exactly the same. We have all those other features: same height and weight, physical fitness, and so forth. We consume the same big New Orleans breakfast. Your glucose level may rise to perhaps 10 mmol/L, 180 mg/dL, and be back down to 5.5 mg/dL. It will rise quickly, and it will be back down within 2 hours. Mine, on the other hand, with type 2 diabetes and only on basal insulin, will rise to perhaps 240-270 mg/dL, 15 mmol/L, and will take 4 of 5 hours to come down. The reason for that is that my pancreas lacks that rapid burst of insulin that is important in restraining the liver from producing glucose. Because our meal consumption was identical, the reason my glucose rises more is that I didn't turn my liver off and tell it to shut the darn thing down and stop pumping out glucose.

Prof. Home: You see these ultra-rapid-acting mealtime insulins as being a complement then to the basal insulins. You see the once-a-day injectable plus a series of inhaled; is that what you see?

Dr. Skyler: I think that would be a really great way to be using insulin in diabetes, because we would get the basal profile right with a flat-acting basal insulin, such as insulin glargine, and we would get the prandial insulin right with a super-rapid-acting insulin. That's the advantage of the new insulin -- not the fact that it's pulmonary delivery; that's incidental.