Category Archives: insulin usage

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

 

That’s a lot of insulin!

“Twenty-nine units! Wow! That’s a lot of insulin.”

“Its what your body needs for what you ate.  If you are worried that its too much, you will find out when you test in a few hours.”

This was our conversation after breakfast the other morning. My son had had his usual stack of pancakes. His carb to insulin ratio in the early morning hours is something like one unit of insulin for every 5 grams of carbohydrates, so 100 grams of pancakes equals a LOT of insulin.

I never heard any complaints when he came home later that day suggesting that there was an error or he was low.  I think he just realized that he uses way more insulin than he once did. He also eats WAY more food than he once did!

He is a teen. He began this journey when he was a toddler.  Way back in time, he would not use 29 units of insulin in a day.  When we first began pumping, I would fill his pump to about 150 units and still throw out insulin after a week. 

I remember when his basal rates moved from .1 unit per hour to .5 and then 1.0 units.  I was terrified. I had to keep reminding myself that this is what his body needs. If he had an internal pancreas, it would be pumping out gallons of insulin as well, its just that I would not have the visual to go with it.

As he grew, his carb to insulin ratios were no longer 1:40 or even 1:20.  He now sees ratios of 1:5 to 1:15.  Insulin sensitivity is not even a consideration any more but thankfully insulin resistance has not become as much of a problem as it could have been either.

When my son first began to see major changes in his insulin needs, I spoke up to friends and said I was concerned.  A wonderful woman who lives with diabetes laughed at me and reminded me that my son was no longer two.  He was becoming a man and that journey would be filled with many more empty insulin vials before we were through!