My understanding is that we did not see superiority in previous trials because the doctors were afraid to increase the basal insulin to a point where fasting blood glucose (BG) was less than 120 mg/dl.Due to the prandial rapid acting analogs such as Humalog remaining in the blood long after the meal is digested, it is not possible to safely increase the basal insulin enough to lower fasting BG levels to less than 120 mg/dl, without significant risk of hypoglycemia.This is not the case for Afrezza since it is out of the patients system at about the same time that the meal is digested.

In trial MKC-171 the FDA has authorized Mannkind to retain an independent monitor who sees the e-Diary data, and who is charged with contacting the clinician with any noncompliance.IMO, this should increase compliance more than the fact that there is a long period for titration.

Another important point is that since Afrezze turns off hepatic glucose production, a lower dose of Afrezza should be required to control post prandial glucose levels, further reducing risk of hypos.

Things are looking up here after Sandy; I just bought gasoline without waiting on line for 3 hours.