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. 




Diabetes supplies or pay the electricity bill?

Yesterday I went to the pharmacy to order diabetes supplies.  After an initial heart attack when the woman suggested that there was no prescription for one item that I needed for my son, all went well.  When I went back to pick up all of our goodies, the woman at the counter knew our name.  As she tallied up our bill, she hid the screen and said “You don’t want to see this.”  She was right–over $600 spent and that did not include pump supplies. $100 of it was mine but the rest was all to manage diabetes. 

The glucagon kits, that we thankfully have never used (looking for wood to knock on), were over $235 for two.  I am so grateful that they have never been used but was terrified for the families who need it but don’t have the insurance to cover the cost.  We are lucky.  My son’s drugs are covered by his father’s plan.  I pray my son will have a good drug plan on his own one day or I don’t know how he will make it.

$500 for insulin, test strips and glucagon.  There was nothing extravagant in that list.  There were no syringes or pump supplies.  I did not order six months worth of insulin and there are only enough strips there to last 15 days (give or take a few).  That is equal to our grocery bill for a month.  That is rent for a small apartment in some places.  That is the amount of our electricity bill to heat our house during the winter. That is also the amount of money required to keep my son alive for approximately two weeks–scary!

My heart breaks for those who do not have health insurance. Anxiety attacks occur when I think of the fact that my son will have to carefully consider his employment future. He knows what he wants to do with his life but at almost 14, I know that he has not looked to see if that career would give him good benefits.  Benefits are not something that kids should have to worry about. Which is why if I could, I would recommend a European health insurance card type system for everyone here, no child should have to limit their career choices over this. Then again, injecting something into their system on a daily basis to stay alive is not something a child should have to worry about either.

Our province does offer a low income and middle income drug plan.  This will cover some but not all of his supplies if he needed. He would be limited in the number of test strips he could purchase.  He would require special permission to have his insulin covered.  His pump supplies are covered until he turns 25.  This all changes if he decides to live elsewhere in the country.  

I know that there are other countries that have it a lot worse.  We don’t live in those other countries though.  We live in a rich country.  We live in a place with socialized health care.  Despite that fact, people with diabetes and other illnesses, must fight to obtain access to devices and supplies. They cannot chose to have the very best in care unless they also have the very best in insurance plans or bank accounts.  

People say that diabetes does not stop you from doing anything but it does limit your career choices.  We have made some inroads.  There are pilots with Type 1 diabetes and people working as police officers who are living with this disease.  In reality, diabetes has a huge impact on career choices.  If you live with diabetes AND you want tight control, you have to be able to afford it.  The easiest way to do that is to have a great job with even better benefits. 

That needs to change. I am not sure how but it needs to change.  For the time being, we can work on having insulin pumps covered for everyone regardless of age.  The next step will be to have an insurance program that covers everyone regardless of income and despite an existing condition. If you make $100,000 a year then perhaps you can afford a $5000 a year deductible but if you make $25,000 a year then lets be able to offer them $750 a year.  Its something to think about. Its something to work towards…