FIASP for Insulin Pumps

My endo refused to write Rx for FIASP for off label use in insulin pump. She cited absence of FDA approval and lack of data from the manufacturer. The response to European approval and use in insulin pumps was “we’re not in Europe”. First two points are valid, but not in Europe doesn’t set well with me. I’m thinking of looking for a different endo, but will have to wait until after transition to the 670G (pump to ship in Jan and sensors in either Jan or Mar).

Does anybody have any idea how long it is likely to take for FDA approval to use FIASP in insulin pumps?

I don’t know the answer to your FDA approval question. I have followed several online discussions about using Fiasp in a pump. One source who I find credible is Tim Street at Diabettech. After much hope and effort that he could use Fiasp in his pump, he finally gave up. Pump site irritation and unexplained hyperglycemia are two reasons he cites for returning to his former insulin, Novorapid.

There’s no harm in your trying Fiasp in your pump. You may find that it works well for you. I also find your endo’s uncooperative stance annoying. Good luck with your Fiasp pump trial. Please report back whatever you discover.

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That stuff usually takes a while. It was just recently approved in the U.S., well after everyone else.

You could just get a prescription for use for when you are not using your pump. You know, for the occasional days when you are on MDI instead of the pump.

And then hopefully you won’t accidentally put Fiasp into your pump by mistake. :wink:

BTW, I tried it. Not great.

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I fully understand your endo’s refusal to issue you an Rx for something not approved for pumping. Why shouldn’t they adhere to legal standards of care??

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It’s my understanding in the US, that any medical doctor can prescribe any FDA-approved (US) medication for any condition. Doctors prescribe medications for off-label use all the time. They’re given latitude to use their best clinical judgment. They are still responsible for their actions but they can professionally and legally follow their considered judgment.

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Did you try any Fiasp blended with another rapid acting analog insulin in your pump?

No, just straight Fiasp.

As folks have said, it will probably be a while before FIASP is approved for use in pumps. But you could always just buy a few bottles from Canada and try it out before you get all excited about how it might work for you. I tried it this summer when I went to Vancouver for a cruise. I put it in my Omnipod and to be honest it was not significantly different from the Novolog I have been using for years. There is no prescription required in Canada and there are some reputable Canadian pharmacies that ship to the US via a forwarding company. I have not looked into the details but do have a couple of friends who get their FIASP this way.

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Agreed.

I used Mark’s Marine Pharmacy - https://rxcanada4less.com/

They required a script, but once they got it, they shipped it to me in a refrigerated pack. They are very reliable.

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My endo is more than willing to write off-label scripts for approved medications when appropriate. He claims that he tends to be an “early adopter” of new ideas/meds/devices and does a lot of research - so going off-label is often his only option.

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:scream::scream:

Surely this must cause mass insulin abuse and serious hazards to everyone everywhere!!!

(that was sarcasm if it wasn’t obvious)

I had thought it was approved for pump use in the US, but I suppose I was wrong. I am wondering if my endo will let me try it as I have been having horrible results with Humalog lately and I am hoping to find an insulin that works better for me.

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how about Novolog? works the same as Humalog for me, but others report different results between the 2 insulins.

My doc used to provide me with Novolog for my pump but after a while he got weird about it and has only wanted me to use (and gives me) Humalog. Maybe the reps bring more of the Humalog to his office? :slight_smile:

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Depends on what the “horrible” is. If it is a problem with your infusion site going bad or not lasting 3 days, I don’t think Fiasp is the answer.

I have used Fiasp, Apidra, NovoLog, and Humalog in a pump. For me, NovoLog has been the most consistent from day 1 to day 3. I’ve had less problems with NovoLog than the others.

Don’t know if it’s the same for others, just my experience.

Like I mentioned above, you may want to consider saying that you want to use it for MDI.

Endos have to consider malpractice issues, but I don’t have to worry about that. I am not going to sue myself.

I tried it, it didn’t work well, so I stopped. No big deal.

It is because my sites stop absorbing within about 1.5 days, and so far insulin is the only thing I haven’t changed. I figure why no try fiasp since my body is weird about things, maybe it will be the complete opposite of other’s experiences lol.

Mainly I was wanting to try Novolog and Apidra since they have far fewer complaints that i have heard, but I figure I could through fiasp in there too since the supposed faster action is appealing. I’m not sure if he will be very open to it, he is kind of of the mindset of all rapid acting insulin is the same.

Definitely try NovoLog if the problem is after a few days. That’s why I switched and I’m very happy with it!

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Do your sites leak at all, or all the insulin goes in but isn’t as effective?

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I’ve been using Fiasp in my pump for about six months. I’ve had some issues with site irritation, but I’ve found those are minimized as long as I keep boluses small (eating low-carb). I have issues allergies to infusion sets, so I do change my sets every one to two days (almost never leave them longer than two days). I’ve found it to be a great. I used to have to bolus for meals by 45-60 minutes ahead of time, but with Fiasp need minimal pre-bolus time. Highs also come down much faster. (Note: I’ve also had some irritation from Fiasp after injection it, as I’m currently using it while trialling MDI; so I’m not sure the irritation issues are due to pumps alone.)

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Good to know! Thanks.

They rarely ever leak, mostly just stop absorbing (when I remove the site any recent insulin will pour out if I press on the injection point). Sometimes there doesn’t appear to be any built up insulin, but it just doesn’t work well. Usually it happens rapidly as well, like it will seem to be fine in the morning of the second day, and then around lunch time there is an almost immediate change to not absorbing/working effectively.

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Thanks for all the replies and especially Jen’s. I dose insulin 30-40 minutes before meals, snacks depending on BG and carbs. I dose to keep post prandial BG down, but then tend to have hypo episodes in the tail period. I use Novolog and don’t have any problems with irritation and no problems that are clearly absorption. I change infusion sets every 3 to 3 1/2 days, but have gone 4 upon occasion.

No chance of getting an Rx from either my Primary Care doc or endo. Had hoped to try FIASP before starting on the 670G, but that won’t happen. A short side-trip when driving through Buffalo in April looks the best option. The if results from a trial vial are good, I’ll be looking for a new endo.

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