One of the major advantages you could argue for trying Fiasp is that, on the occasions when you get hyperglycemia for unknown reasons (like occlusion of the infusion set), you could inject it and rapidly bring down your BG. It would be a reason to try it and see how it works for you.
I’ve been using Fiasp in my pump, using the RileyLink closed loop for the past 3 months and I love it! I live in California and I ordered from Canada, before it was approved by FDA. It cost me about $40/bottle. Between the loop and Fiasp, my a1c this week was 5.7%. 3 months ago, it was 6.0 … so I credit Fiasp because if it’s fast action.
As I don’t see Medicare covering Fiasp anytime soon, I’ll continue to buy through Canada … feel free to ask me any questions about how.
My endo told me there is a preservative in FIASP that causes him some concern, so I don’t know if he’ll Rx after it’s available in the US. Having said that, he also told me he is going to try it in his pump. I guess he wants to be a bit of a guinea pig.
I read this article with great interest, as I love fiasp and am planning to switch to a pump soon-ish.
I discussed this issue with my endo a week ago, and he was astonished, that there would be something as an approval for pen but not pump use (in Switzerland, as all over Europe, Fiasp is approved for both)
so he does not see a problem with using fiasp in a Pump
Using insulin in a pump presents it’s own issues, not found via other delivery methods.
As an example, back in the 90’s, I used Velosulin, which was a form of Regular Humalin, in my first MM pump. It was just basically a “buffered” R, designed to not clog or crystallize in tubing. I don’t follow your logic that simply because something is approved for pen usage, it follows that it is also approved for pump usage. ie, his astonishment isn’t shared by myself.
I have used Fiasp in an Omnipod pump for about 10 months. It works great for me and I have no issues. I used to pump with Humalog and I find that FIASP has much quicker absorbtion.
In Canada using FIASP in the pump is off label. My understanding is the approval is waiting for more studies to tell doctors how to tell patients how to adjust their DIA and basal times.
Can you share some timings that compare the Humalog and Fiasp? This might be not be the same for everybody but I would be interested in what you have observed. This (Fiasp in a pump instead of the Humalog/Novolog) is something we are considering.
When I bolus, my Humalog works at a good speed for my food intake. You want your insulin even faster than your Humalog? I’m not understanding that. I suppose if someone frequently overboluses and wants the tail to drop off faster so that they don’t have to worry about getting low 4-6 hours later, I see that as a good point, but insulin onset I do not want any quicker than Humalog.
Insulin doesn’t work at the same rate in every person, and not everybody finds their Humalog works at a good speed. For instance, Humalog users who find they have to pre-bolus by 30 or 45 minutes or even longer may appreciate something that kicks in faster. (That said, from my own experience with Fiasp, it was not significantly faster.)
Also this is what I heard. So, I thought it would be interesting to get feedback from @AE13 in this regard.
I used to prebolus with Humalog between 45 minutes and 30 minutes for meals. With Fiasp usually 15 minutes is enough. For slow carbs I just give the bolus with the carbs. For me this improves my quality of life, because I can come home and just eat dinner without having to wait a long time for the Humalog to kick in.
I also see less of a sharp rise in BG after carbs. More of the insulin is active up front so it stops the spike.
I sometimes see after an hour my BGs start to rise. I usually either just hit it with another bolus if I am lazy, or I will set-up an extended bolus with my meal to flatline when I am feeling organized.
I have heard negative comments from T1 people I have met in my community (one commenter was a nurse with T1). Generally the complaints fall into three groups:
- It stings when I bolus
- The bolus gets used up really quickly and then I go high after 1 hour
- It is not really faster than the rapid acting analog that I used to take.
What triggers me to leave positive comments about Fiasp, is some people (like the nurse who is educating folks with diabetes) say - Why would you want to use Fiasp? It is terrible.
This worries me because I don’t want “them” to pull Fiasp from the market because it does work for some people. I want people to take a try and see if it works or not for them.
I know that. I thought I made it clear that I was speaking for myself, no??
I appreciate the feedback.
There are not often magic bullets. But perhaps it might be worth us giving it a try. It certainly sounds like some people find it beneficial and some do not.
My own experience was mixed. Fiasp is new on the market in Canada, and I think because of forums like this, many patients were eager to try it before endos and CDEs were up to speed about how to handle it (guilty!). It isn’t a simple switch from Humalog/Novolog. Users usually find they have to adjust IC ratios, correction factors, and DIA. Some people find they need more basal, whereas others report needing less basal. The later post-meal rise @AE13 describes can be a real nuisance. If you have guidance (which I didn’t), great. If you have the patience to figure all that out on your own, great. After a month I gave up the struggle. I would love to try it again, because of its advantages (but only without the site irritations).
It depends what you’re eating, at least for me. I find bread very difficult as well as fruit. I get spikes unless I pre-bolus (and still often do) which I don’t always have time for or remember to do, so a faster insulin would be helpful for these foods. Unfortunately Fiasp didn’t work well for me long term, so I live with the spikes or pre-bolus far in advance when I can.
It does sound like it would be a lot of work to try out the Fiasp. If it is in the pump then it impacts everything.
We might still try the Fiasp. Or just wait to “age out of Endo” and give Afrezza a try for some of those “fast” meals like @Scott_Eric mentions that cause very large spikes.
The reviews of Afrezza (of those people who use it) really sound very good and it comes with the bonus of not having to completely change the rest of the pumping environment.
But still on the fence…
I most definitely want something that starts working faster than Humalog (and Novolog)! I’m sure everyone has different experiences, but for me Humalog takes quite a long time to show effectiveness and lasts quite a long time after my typical meal is no longer affecting my BG. Also, for corrections, faster is better/more effective. I use Apidra, currently, which works (for me) marginally faster, though still not as fast as I’d like.
On the flip side, I don’t worry much these days about lows; however, I still want an insulin that tails off faster for several reasons: First, there are times in my life, regularly, when “meals” are much closer than 4-6 hours apart. Granted, I only bolus for what I am about to eat, but too much overlap/stacking can still produce unexpected results. Second reason, I find it much better and safer to exercise when I have little-to-no bolus insulin on board – a long tail means that I have a longer wait if I wish to exercise any time after a meal (or almost all of the day!).
Finally, a faster-acting insulin will really be a facilitating factor in true AP technology – Sure, we can (and currently must) tell the pump what we’re about to eat, but it would be best to have it act fully automatically. Injected insulin today is really just too slow for any kind of good control – by the time the sensor recognizes the increase in BG, it’s far too late to “catch it” before it rises fairly high.
Thas, you didn’t say how long Humalog takes for it to start working for you.
When exercising you should try cutting back (based on experimentation–far be it from me to suggest a percentage) on boluses, so that you don’t have any appreciable IOB when exercising. Having IOB just doesn’t work well when exercising unless it’s to combat a lot of carbs. I don’t like having even 1 unit IOB when I’m doing my more active stuff out in the boondocks.
But I see the point of insulin that has less of a tail. (Which I already stated in an earlier post)
Using a pump Humalog took more than an hour before I saw any appreciable action - sometimes quiet a bit more. Novolog usually took 45min to an hour for me. With Apidra, I see some results in as little as 20min these days. All were lower by injection, rather than via pump.
When I spoke with my CDE earlier this week, as I think I mentioned, they suggested I might want to try Fiasp in particular for corrections. I generally eat lower carb, but have some meals that spike me - especially on weekends. She thought that driving it down quicker might be helpful. I guess I’ll see (my endo appointment is coming up in a bit over 2 weeks).
Novolog takes about 45 minutes to an hour for me, and to keep the spikes even remotely under control I need to use a fairly severe carb ratio. Which of course means I have lows afterwords.
My problem is that with my job, I don’t dare (anymore,) prebolus correctly before eating. I cannot truly know when I will actually eat, let alone finish eating. So the ‘potential’ for fiasp to start faster, hit harder, and tail off sooner has a very strong attraction for me.
I use a private endo (can’t say how much I love having an endo that truly cares, she is Type 1 with a type 1 daughter.)
She doesn’t know enough about it, but feels confident that I can work through the details about using it in a pump.
She wrote a prescription, but the VA substituted it back out for Novolog again.
I will see my VA Dr in a couple weeks and will try and get her to specifically prescribe it for me.
Btw, I have found that if I have a very aggressive carb ratio, raise my target BG, and shorten my IOB down around 3 hours, that my spike isn’t as high, and that I don’t often go too low. Not ideal, but I think that this might actually be a close approximation of how I will start with fiasp.
For those that have pumped with it, how did you change you basal? carb ratio, etc?
I have read a bit about fiasp, but I never here how much THEY had to change. I fully understand we are all different, and that it would be a miracle if two people would be even close to the same. I just would like to see a few examples of how people made changes to their pump settings, etc. to cope with the difference with fiasp.