Category Archives: insulin pumps

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

 

Active not sitting all day!

My youngest son had the opportunity to head out on the trails and enjoy a ride on his quad the other evening. He was with a responsible adult but “momma panic” still danced around the edges of my mind.  The person he was with knows that my son has diabetes but knows nothing about the testing, etc that we go through.  My son is old enough and responsible enough to handle these things. I had reminded him to have glucose and his meter with him. I know that he would bring them…not necessarily use them, but he would have them with him.

I had to have faith. He had been fine for a week when I had to go away unexpectedly. He survives each time he goes away on his own. He had been on a quad trip the previous weekend without his mother hovering and asking him if he had everything and he had done fine.  He would be okay.

Just in case, I texted him a few reminders…
“Don’t forget your meter and glucose”
“R u ok?”
“Set a reduced temporary basal”

It was the last text that created an entirely new level of stress for me.  After him being gone for a few hours, my son called me. They were taking a break and the person he was with was making a call so he decided to check in with me (brownie point for the kid!).  I asked him if he had set the temporary basal. He said yes, he had put on his travel basal.

WHAT!?!?  That means MORE insulin.  That is for the times when he is sitting in a car or on a plane for hours on end. It is not meant for days when he will be active, throwing his body around and pulling a machine out of mud. I could feel panic rising in my throat.  

I tried to breathe as I told him to go in and stop it. He couldn’t figure out how to do it!  I continued to try to breathe as I tried to offer options over the phone. I finally headed to find his old pump.  Perhaps the settings would still be the same and I could work it out while he was on the phone. In desperation I told him to shut down the pump and power it back up. It might then give us the option of stopping the temporary basal. It turns out that when you ask it to “stop delivery”, the pump asks if you mean the entire pump or just the temporary basal. Victory! He hit turned off the higher basal and reset it with the lower rate. He was now good to go. Thank heavens!!

I worked on breathing again not daring to allow my mind to think about the “what ifs”.  My son continued to enjoy his day of mud and fun.  Just another day in the life of a teen with diabetes! 

Another one bites the dust

My son came racing up the stair yesterday with a “get out of the way, I need to use the washroom” look.  I asked what was going on.

“My pump is sirening!”

Crap. The pump is new.  This is not a good thing. “What exactly do you mean by sirening?” I asked as the pump promptly screamed.

“Sirening.” He stated. 

Well that was just not good.  I took a look at the pump and the battery life was on zero. I assumed that was the problem and put in a new battery.  All was good to go.  Catastrophe averted…or so I thought!

This morning my son was heading out the door as he bolused his breakfast.  Suddenly he came running back up the stairs.

“Its sirening again!”  Now that was bad timing! We quickly grabbed his old ice blue Cozmo, switched cartridges and sent him out the door.  The upside to this happening so close to the last Cozmo death was that the old pump still had close to accurate basal rates.

A few hours later I called Cozmo customer support.  A gentleman answered my call and suggested that the battery cap could have an issue. I reminded him that this pump was pretty new but he still said it could happen and that it had occurred in his own pump.  He said to put a new battery cap on, put in an empty cartridge and let the pump run for 24 hours on its own. If it didn’t siren, then we could hook my son back up.  That worked for me.  I hung up and did as he suggested.  The pump asked to resume the breakfast bolus and I said yes.  It began to siren again.  Well, that was not going to do. I called the helpline right away.

This time I spoke with a woman. She asked me if I had spoken with D on a previous call. I said I didn’t remember his name but I guessed that their staff was pretty limited and it probably was him.  She said, that the staff was the two of them. Since I had just called and the solution wasn’t working, she was ordering us a new pump. She remembered the problem I had getting Sirius Black  (she was the woman who took my complaint about the slow service) and expressed her own dismay.  She said she would do everything she could to make sure that this pump was replaced promptly.  I was once again impressed by their customer service and began mourning the inevitable loss of this great pump company.

At the moment my son is back to using his trusty ice blue pump. He has Sirius Black up and running on air. He has bolused it a few times with no problems and began to worry.  “Mom, if we send this pump back and its not sirening any more, will they just think we are a bunch of whack jobs?” I assured him that based on past experience, the pump will siren again at one point and that they will not think ill of us for sending it back. 

For now we wait for the lastest replacement, wonder what color this one will be and say an extra thank you that the pump still under waranty. The thought that next year we will have to replace him with a completely new pump company still makes me sad but I will cross that bridge when it arrives…sniff, sniff.  

Lessons from Death of a Cozmo

Things I have learned when our Lean Green Pumping Machine cracked for the final time and had to be replaced…
1. A break at the top where the cartridge goes in is a very bad thing.

2.  The emergency number for those of us still clutching to our Cozmos here in Canada is the US toll free number.

3.  When you call the toll free number they will tell you to call your doctor for a back up plan.  Call our doctor? We used our first Cozmo.  She was relieved…so was my son because “my” back up plan is inject the basal amount via injection every four hours until we got our new pump (ideally within 24 hours).
4.  When you switch from the beloved green Cozmo back to the reliable ice blue, it would be a lot easier if the software still worked on newer computers.
5.  Switching from the newer Cozmo back to the older version requires the brains of at least two people. Mom programmed the first 75% and child user figured out the other 25% rather than get out a calculator and do math.

6.  “I think we are too late to get you this pump tomorrow” means be soooooo terribly glad that you have that back up ice blue Cozmo because it could be over seven tomorrows and three phone calls before the new pump arrives.

7.  When you are dealing with a pump that the manufacturer no longer makes, the Lean Green Pumping Machine can and will be replaced by the first pump that they can still find on their shelves.  On our case this means that we now are pumping with “Sirius Black”  (Thanks Rhon!). 

8.  Remember to keep cartridges for your old pump.  The number of tomorrows it can take a pump to arrive may not be as few as you remembered. Having your old Cozmo to rely on makes waiting for the new one so much better!

Our back up, Our dead Green Machine and the new Sirius Black all hooked up!

Blackberry? iPhone? Vibe or Veo?

Its that time again…the time when I look for a new cell phone and a new insulin pump. I never really thought of the process as similar until a few months ago. We were at our diabetes clinic when our CDE asked us if we needed approval for a new pump? Already? I am not ready for a new pump.  She just smiled and said for us to think about it.  “It was just like picking out a new phone” she noted, “You want something that you can be comfortable with for the next four years.”

Ah!!! Deciding on a cell phone is something that I have been thinking of for a year now.  An iPhone, another Blackberry, or one of the other new smart phones? So much choice, so little knowledge, such a huge decision!

Deciding on an insulin pump is no less difficult but with a lot less choice.  When my son began pumping eight years ago (has it really been that long?), there were so many changes on the horizon.  Smart pumps were just on the market.  The choices of pumps were amazing. Every company seemed to be competing for our pump dollars and the decision making process was painful. Each year a new feature was added.  Each year’s pump was leaps and bounds ahead of the previous one’s.  You hated to have to commit to one pump for four or five years!  

Fastforward to 2011 and the choice is now harder for a totally different reason…there is no choice.  Unlike my phone choices, my son’s insulin pump choice is down to only two. Actually there are currently three choices that we could look at but my son will not even consider an OmniPod.  Sorry folks, but he does not like the pods and is happy with tubing.  Its his choice and I am okay with his reasoning. That leaves us with the “big two”… Medtronic and Animas. 

Medtronic has the Veo.  It has CGM integrated technology and other “stuff” that I will have to look into.  Animas will be introducing the Vibe in a few years which will also have this technology but we will have to wait for its Canadian approval.  How much do I care about CGM? Not a lot because I can’t afford the sensors.  So that leaves me back to researching the pumps themselves and looking at their features.

Honestly, I haven’t really done that yet. I just don’t want to think about leaving our Cozmo behind.  My son wants to keep his “Lean Green Pumping Machine” for as long as it is alive. I can understand his loyalty but I still have to look for its backup while the pump is being covered. 

I am heading to Toronto at the end of the month for the CWD conference and hope to have the chance to look at pumps then.  I need to see them, touch them, and play with them before making a decision.  My son will have to have some say this time around as well.

I think for now, looking at a cell phone that I will be commited to for the next two or three years sounds a lot more fun and less stressful.  Blackberry or iPhone? Android or the new HP? Touch screen or key pad? Those are decisions that I can make…well maybe not but it hurts less than thinking of pumps, pump technology and serious change!

Dear Minister of Health, Why won’t you cover my insulin pump?

Over the past few weeks I have received a number of emails from frustrated parents.  Their children are moving onto post-secondary school and have reached the magic age of 18.  Their pump coverage, if there ever was any, is ending and the parents are at their wits end. They fear the high costs associated with pumping will mean that their children will have to use a less effective method of managing their diabetes.

Why does coverage end at 18? Yes, diagnosis usually happens before 18 but why end coverage at that point? The disease didn’t stop.  They still need a pump, insulin and supplies.  Why is this happening? Why aren’t more provinces covering pumps? What is going on?

Those are just some of the questions and frustrations that I hear. I truly feel for all of these parents.  When my son received his first pump, it was given out of love.  We were at a family reunion and my son was on multiple daily injections.  He ate at specific times–which did not mesh with the times that the rest of the family was eating.  He often sat alone. It was heartbreaking. They had heard me talk about an insulin pump and decided to pool their money so that he could have one. I cried a lot that day.  The memory still makes my eyes fill with tears.

His pump supplies came in a no less emotional way.  I wondered how we would pay for them. An extra $200+ per month in a single income family would not be an easy burden but my son’s health was at stake.  A friend knew of our plight.  She had extra supplies and made sure to share with us.  She found others who were switching pumps and no longer needed their supplies.  They were sent to us as well. It was a true blessing that we were later able to share with someone else.

A few months before my son’s pump warranty was to expire, our advocacy efforts paid off once more and the province that we live in stated that they would cover insulin pumps for children up to age 18.  This was a victory.  We now had the first bite out of the cookie but the rest of it was still out there.  With a lot more hard work, letter writing and educating, we were able to add young adults up to the age of 25. The final piece will be to get all adults covered and that must still be done.

Back to the original question though–why 18? I think its completely political.  A small child with a pump looks good on the government who provides it.  Can you imagine depriving a three year old of a piece of medical equipment? Now look at the image of an adult with a pump.  The adult can get a job.  They can pay for their own pump. Why should everyone else pay for them? They can live without a pump.  Injections keep them alive and if they would go out and get a real job they would have their own insurance that would cover luxuries like a pump.

Okay that was pretty crass but sadly some people will view it that way.  As a person who has advocated from pumps for all ages, I tend to try to spin things in a different way.  Many adults will have jobs that provide them with the insurance to cover their pumps. Even more adults with Type 1 diabetes would have the opportunity to be in the workforce if they had a better method of insulin delivery through access to an insulin pump.  The number of adults who require pumps and do not have insurance is relatively small but their choice of occupation or employer should not dictate if they can use an insulin pump or not. 

When my son talks of a career, my mind quickly turns to “what sort of benefits will that job come with? How will you afford to cover your supplies?”  I hate that. Why should my son be limited by a disease that costs so much to take care of?

So to answer the question, why does coverage end at age 18? Because we still have to educate the public and those in government who control the purse strings why continuing pump coverage makes financial sense.  We have to teach them that the small outlay of cash to maintain the program throughout the life of the person with diabetes will mean that these same people can be productive members of the workforce for longer and have a lower chance of being a burden on the health care system because of complications.

To the question, when will our province provide any coverage? The answer has some of the same components as the last one…when we educate them.  When we make them understand that the benefits far outweigh the costs.  Only then will we see improved coverage. 

People are working on this and have been for years.  We need more people working together.  We need our voice to be stronger…and it will!

The Follow Up….

The good news is that after the insulin/ketone disaster of Thursday, both mother and son are still alive.  It took close to twelve hours for my son to come back to himself.  He spent the whole afternoon on the couch and slept for close to five hours.  During the entire time I was testing, checking for ketones and administering more insulin.  As he blood glucose levels began to drop but ketones stubbornly hung on, I was beginning to get a little nervous when I was giving him more insulin but thankfully Mom got it right.


By the time the evening arrived, my son was adamant that he did not want this to happen to him again.  He swore that he would listen to alarms. He would never allow his cartridge volume to go down to zero again. I knew that those were all of the words that I wanted to hear but also knew that he was a young man with swiss cheese for a mind at the moment.  I prayed that this time what had happened would truly break through and hit his grey matter.  This time he really would learn from what had been a life-threatening situation. 


Saturday he headed over to his father’s once again.  I had him check his cartridge before he went out the door. He had more than enough insulin to last him the weekend. I told him that when he came home he was to change it right away…or as soon as it alarmed. 


Sunday came.  He came home and after a few hours the low cartridge alarm sounded.  I waited to see what he would do.  Sadly I was not disappointed…he simply turned it off. I asked what the alarm was.  He said it was a low cartridge but he was going to shower in a few minutes. He would then change his site and his cartridge at the same time.  Again I waited.  He showered.  He headed off to do his homework.  I reminded him of what had happened on Thursday.  I was adamant. He was sitting down and dealing with this now before it was forgotten. He sat down and got the site changed and cartridge put in.  I could breathe again for a few days. 


Today I asked to see his pump. I wanted to know exactly how long he had been without insulin. How quickly did my child’s condition escalate to DKA? I scrolled through the history and was surprised to find out that he had a low battery that day as well. He ignored the battery and the insulin cartridge alarms.  By midnight Wednesday his pump shutdown and the household slept through the sirening of the pump. I was in shock.  As the numbness set in, I realized that I should not be surprised.  Both father and son can sleep through a fire alarm. Nothing wakes them up…not even a pump that is shutting off.  This left me terrified. 


He went eight hours with no insulin. No one noticed that the pump was completely shut off. No battery was changed. Nothing was done until he walked through the door at my house on Thursday morning….and was terribly sick. 


My son looked at me and swore that he had learned his lesson. He repeated that he did not want to go through Thursday ever again. He said that he would pay attention to his alarms.  I reminded him that on Sunday he had done just the opposite.  He had turned off the alarm and quickly been sidetracked.  He said that he was going to change.  For his sake I am praying that he does. Mom is going to stay very, very on top of this for awhile yet though.