Category Archives: blood glucose testing

Fiasp Insulin. The New Kid on the Block

Fiasp Insulin the new kid on the blockIt has been a long  time since the diabetes world has seen a new rapid acting insulin brought to market.  The last one that I can remember was  Apidra released back in 2004.  It is  not surprising  then that the release of Fiasp by NovoNordisk is creating a lot of buzz.  Not to be let out, my son recently began using this insulin. Since Fiasp insulin is the new kid on the block, I thought I would give everyone a brief rundown on the highs and lows associated with it.

What is it?

Fiasp insulin was released by NovoNordisk onto the Canadian market in March of 2017.  Many of us scrambled to get a prescription because it promised better blood glucose levels without pre-bolusing for meals! According to the press release, you can dose up to two minutes before a meal and up to 20 minutes after starting a meal without compromising overall glycemic control or safety!*

How is it different?

A Medscape article states that  Fiasp is  absorbed twice as fast as its counterparts.

It does this with the help of  two excipients–Vitamin B3 is responsible for the increase in the speed of absorption and Amino Acid (L-Arginine)  has been added for extra stability.**

What do users think?

All of this science is great but most people are wondering how well it works in real life settings.  From what I have seen, the bulk of users really like it.  I could only find one person out of about a dozen users who had returned to their old insulin aspart.

When I asked my son for his review I was told “I still have highs. I still have lows BUT if I have a heavy carb  loaded meal, Fiasp kicks butt and I don’t have the same crazy swings that I always did before.” For a 19 year old who can definitely binge on carbs, this is huge.

Other users seem to have  had similar results.

Some people with diabetes found that the insulin peaks were no longer as pronounced.  They had some difficulty battling highs with Fiasp however while others found it perfect for corrections. In fact some people are purchasing Fiasp just for corrections.

Other users explained that the faster insulin action allowed them to more quickly respond to rising blood glucose levels.  This in turn meant resulted in much  tighter control.  The quick action has  also left one user to caution about the timing of any  prebolus.

Most seemed to agree that Fiasp insulin resulted in fewer food spikes and more stable blood glucose levels but as I said not everyone loves it.  For some users, their traditional rapid acting insulin seemed to work better.

Final thoughts…

All in all, most people with diabetes who are  trying the new kid on the block seem to be happy with it.  It offers another insulin choice  for those who struggled with post-meal spikes or don’t pre-bolus meals.

It must also be noted however that while Fiasp is not currently approved for use in insulin pumps in Canada, both those on insulin pumps and MDI are using this insulin aspart.

Finally, I was also happy to see that the price of Fiasp insulin was par with NovoRapid.  This meant that there was no need to worry about an increased cost for out of pocket insulin expenses.  My understanding is that Fiasp insulin is not yet on many (or any) provincial formularies.  This most likely will mean that if you decide to use the insulin and are currently using a publicly funded program, you may have to either pay for this insulin out of pocket or speak to your doctor about having special authorization added to your benefits to ensure full coverage.

Please remember to check with your diabetes team before starting any new insulin regimen. 

*http://www.novonordisk.ca/content/dam/Canada/AFFILIATE/www-novonordisk-ca/News/Fiasp_Launch_PR_English.pdf

**http://www.medscape.com/viewarticle/877892

 

Sleep? Sleep? Where are you???

Friday morning I woke to my phone ringing a half an hour before I had to get up.  That is just plain cruel, unless of course the recorded voice is telling you that there is no school and you get to continue to sleep.  In that case, its a welcome distraction! I turned off my alarm, rolled over and planned to enjoy an early long weekend.

I got my sleep Friday but it had to last me for the rest of the weekend because diabetes was not going to play nice.  My son had been running a little high at around 2-3am.  I was considering making a change but was going to give it one more night to be sure.  

Friday night he was his usual teen self and up until 1 or 2am.  He tests before he goes to bed so I continued to doze until something woke me at 4:00am.  I stumbled to his room, found his meter and checked.  He was 5.0 (90).  Such a perfect number–NOT.  I hate 5. I never know if he will stay there or drop.  It gives me panic attacks.  It is not clear cut. Its a fuzzy number that requires me to stay awake and find an answer. At 4:30 I had my answer…he was dropping.  I grabbed a bottle of Liquiblast, had him drink it and waited.  All was fine except for the fact that I had now been awake for an hour and sleep was not going to return to me any time soon.

Luckily it was Saturday so again, I was able to laze in bed a little longer between blood glucose tests.  Saturday was a beautiful day so my son took advantage of it and went for a bike ride with friends.  To counteract the effect of all of that activity, I had a Dairy Queen craving that had to be satisfied!  We headed out for some late night ice-cream.  I then dropped his basal rates for that time period. He was bound to be higher after all of that.

Wrong!  I again found myself awake after 4am.  My son had tested at 2am and was fine but at 4am he was dropping once again.  I grabbed the Liquiblast, he drank, I went to bed to read.  I retested.  He was lower still. Repeat previous performance…more Liquiblast, more reading, no sleep.  After two bottles of fast acting glucose, a temporary basal reduction, and a basal rate change, by 6am I was finally able to go back to bed and try to sleep .  Once again, I was grateful to be able to sleep in the next morning.

Unfortunately my mind and body did not agree on when to get up on Sunday morning.  By 8:30 I gave in and got up.  My son’s readings continued to be lovely all day.  At 9pm he once decided to begin working out.  I have asked him to do this earlier but he doesn’t listen. I asked if he tested? No, but he did proceed to test in front of me before continuing to exercise.  I asked if he had put on a temporary basal to account for the increased activity.  Again, the answer was no but he set one as we talked. 

Sunday night he was high.  Back to the drawing board! One clue may be the container of chocolate milk that he forgot to bolus for after reducing his basal rate.  We will see what tonight brings but in the meantime we both continue to learn…and catch sleep when I can! 

  

Bloodletting is a Good Thing?

Its strange the things that go through your head at three in the morning. Perhaps its because my brain is still asleep. Maybe it thinks that I am still dreaming. I am really not sure but either way, I have had some of the strangest thoughts as I search for a finger and blood.

Last night came a reoccurring thought…how sick is this process?? I mean really! Each night, I crawl into my son’s room to slice his finger and make him bleed. I actually take pleasure in injuring my son’s pale skin.  I am upset when I do not see that red glow of blood flowing from him. This is what diabetes has reduced me to.  A callous parent who is pleased to see blood spill from her child!  

Its true. Blood gives me so much information. From his blood I know if his pump is delivering insulin properly.  I learn if he bolused is meal in the correct manner. I know if we miscalculated for exercise.  I know if we need more insulin, an early morning meal, or if I can sleep feeling relatively confident that he will wake up in the morning.  

I began to wonder how many other diseases are this invasive?  How many other parents take pleasure in seeing their child bleed multiple times over a 24 hour period.  How many others breathe a sigh of relief when a needle pierces the skin of their child multiple times during a day because they know that it means that they will be alive for another day. 

Diabetes is a sick disease.  I am sure that there are other diseases that require our loved ones to be abused simply to stay alive but I thankfully have not experienced them.  I have experienced filling a tiny finger with blood upwards of twelve times per day just to keep him healthy.  I have also experienced seeing a tiny body laying lifeless in Intensive Care with tubes and wires running everywhere. I have seen my strong, young son grey and weak as ketones threaten to ravage his body.  The bloodletting sadly seems justifiable but I pray that one day there will be a better way–a better way to keep him alive and healthy.