First time I’ve read someone using Fiasp with IM correction. Getting back in range within an hour is very good. That’s in a similar performance range for my Afrezza corrections.
I have not tried Fiasp. It is not approved in the U.S. Its great to hear you are getting great results. As I said its a risk/reward which is a personal choice. The potential unknowns of its ingredients and their long term effects are something which need to be weighed. We are just starting to see some studies from the early analogs.
I was diagnosed early as a T2. My PCP wanted to put me on metformin. I had the advantage/disadvantage of growing up in a home of diabetics and seeing what they went through and also knowing an expert in the field. I asked his advice and he told me afrezza had just gone on the market and the results they were seeing from internal studies were remarkable. He gave me additional background on early insulin intervention studies. He also pointed me in the the direction of the Abbott Libre which I could get from England on ebay.
For me at least, he was right. After less than 3 months I had non-diabetic numbers. I am currently maintaining near non-diabetic without any meds but lower carbs and walking. Post meal BG usually <130 and back under 100 usually less than 3 hrs. Its an on going experiment for me. I don’t know how long it will last but if the numbers start to rise I will get some new Libre sensors and a 3 month script for afrezza and give it another go.
What you have to remember about afrezza is it is not an analog and it does not require subcutaneous absorption. As a result it is very predictable unlike the analogs. The body has been tuned over thousand of years to use this molecule so it sees it as natural and it works just like first phase pancreatic release and does things like liver signalling which none of the analogs can do. When people say it does work for them what they are saying is the insulin which the body sees as natural is not working. In reality its usually either a titration issue or they are following some version of Berstein’s diet and if so would require follow-up doses.
Don’t you think inhaling a foreign substance over time is risk/reward too though? Not saying it is harmful, or that I wouldn’t try it if it were available, just saying there are probably risks to inhaling insulin as much as there are risks to injecting analogs.
Scott - great question about afrezza being inhaled. The short answer is no concerns. I have more issues going outside on a spring day with a lot of pollen in the air.
afrezza unlike all the injectables and Exubera does not contain any toxins. It is composed of a monomer human insulin molecule stabilized with an inert coating. As soon as it hits the lung lining the insulin goes directly into the blood and the inert material gets excreted in the urine just like other waste products. Since its inert it does not metabolize.
All afrezza users are currently doing lung function testing. I suspect over time this requirement will be dropped but its been interesting. The first users got compassionate use approval in 2008. So its been around awhile. Most users when first tested show a slight decrease in the test which is attributable to a slight change in the larynz with the powder. However, users are not showing any additional decrease and some are actually showing improved function which is being attributed to better overall BG control and their health improving.
As a correction tool for T1s which is only going to be used occasionally there should be zero concern. For others its a risk/reward personal decision. If other T2s can get the results which I got then the reward versus the risk is huge.
Medscape put out an article on metformin in May Long-term Metformin Use 'Has No Cognitive Impact'
I have a great deal of research on brain plaque and metformin use. When I start seeing studies being funded to contradict other studies its always time for concern.
Two take aways from the article are no brain scans were done and the study was done on pre-diabetics of which 69% of the metformin users went on to develop diabetes while only 32% using intensive lifestyle intervention did. The obvious question is the long term risk versus reward when other studies show 50% of metformin users later in life develop dementia.
What is clear is early insulin intervention with T2s is the way to go and only afrezza mimics first phase release which is so important for proper liver function and to blunt the after meal sugar spike. Is Fiasp an alternative? If I had to decide between metformin and a 69% chance of having progression of diabetes and Fiasp potentially halting the progress in 3 to 6 months I am going with the Fiasp.
However, choosing between Fiasp and afrezza for early insulin intervention, at least for me afrezza is a no-brainer. Its easy to use, its natural to the body and it mimic pancreas insulin release.
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I found it to be faster for sure, but often when I’m correcting it’s because of those stubborn protein/high fat meal highs I didn’t extend my bolus enough for, and have to take multiple corrections/temp basals to bring down. I didn’t find Fiasp was any quicker at helping with these than NovoRapid and in fact caused more of them. I’ve never tried an IM injection before, but I will give it a shot (literally) with Fiasp if I ever have a big high and see how it works.
I’m glad you’re getting good results and I would definitely try it if it were available up here. I’m really not scared of analogs though, I’m sure most of the chemicals/preservatives in the foods I eat (including my favourite - aspartame) are way more harmful. Plus as a type 1 I need a basal insulin, so there is no way to avoid analogs unless I were to use NPH, which I’ve never tried and it sounds dreadful.
If you wanted to avoid analog insulin and use a pump, Regular insulin may be used. I used Regular (bio-engineered Humulin and Velosulin) in a pump for almost a decade until the first rapid acting analog insulin, Humalog, arrived in 1996. It’s longer onset, peak, and duration made it more difficult to live with but it provided a reasonable quality of life. Stacking insulin doses was a bigger issue back then. My first few pumps did not provide an insulin-on-board calculation or bolus wizard. I definitely would revert to Regular insulin in a pump before using NPH again. Some people did well on NPH but I wasn’t one of them.
This surprises me. I thought Afrezza would be faster. People have been talking about it dropping them into range in 10-15 minutes.
Of course, check with your doctor first, as nothing on this site should be taken as medical advice. I used an IM injection of Fiasp this morning and went from 15.5 mmol/L to 4.3 mmol/L in just over an hour. Freakin’ amazing. I was also running a +100% basal on my pump for an hour, as that seems to make corrections work better. (I’m currently using Apidra in my pump for basal because I need to use it up, and I agree that there is definitely less site irritation with Apidra than with Fiasp.) The Apidra in my pump has been sitting out for several months and so doesn’t seem to be working all that well… I’ve never understood the people who claim that insulin can sit out for months on end and still be potent. My experience has always been that insulin sitting out for months on end results in ridiculous highs!
I understand that researchers measure two things with respect to insulin speed. The first is the profile of insulin level in the the blood and that is followed by actual effects of pulling blood glucose levels down. The 12-15 minute number often quoted regarding Afrezza is the “insulin peak” not the maximum BG lowering peak.
Of course, my experience with using Afrezza for corrections will range by time of day, recent or concurrent exercise, and meal timing and compostion. Afrezza performance will also range from person to person.
I will often see a higher BG start to drop by 30 minutes following an Afrezza correction and back in range by 60-75 minutes. I was pleased to read of your experience with IM Fiasp for correcting and if that held true for me, I would consider its correction speed comparable.
With my relatively new habit of not eating after dinner (inspired by Adam Brown’s Bright Spots and Landmines, my blood sugar control has improved markedly. I used to correct 2-3 times per day with Afrezza and now I use it about 2-3 times per week.
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I’ve been using NovoRapid in my pump lately, but last Friday wanted to eat an apple and thought I would try just taking a small amount of Fiasp in a syringe to avoid having to prebolus or superbolus for it. Not only did it work very fast, but it seemed to make me extremely insulin sensitive even using NovoRapid following that. I went to the Jays game that night and ate pizza, tons of popcorn, and an ice cream cone. Using the same NovoRapid in my pump, I could barely keep my blood sugars above 5. The effect lasted about 24 hours and wore off around dinner time the next day. I wonder if this was just a coincidence or if it was the additive in Fiasp.
Interesting! I tried using Apidra in my pump for basal while bolusing with Fiasp for two weeks. My control deteriorated significantly. Even with Fiasp, I was spiking high after eating and generally going high a lot. I switched back to Fiasp and things immediately calmed down. Clearly, whether it’s the different brand (I’ve never used NovoRapid before, only Humalog and Apidra) or the faster action, Fiasp performs far better for me for both basal and bolus.
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I tried an IM injection of about 1 unit of Fiasp when I was 13 and it brought me down to 7 in under an hour - pretty, pretty, pretty good!!
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That’s an amazingly quick correction! For those of us that think in mg/dL, @Scott_Eric’s one unit of Fiasp dropped him from 234 mg/dL to 126 mg/dL. Is your insulin sensitivity really 1:100 (1:5.6) or were you just being reasonably cautious trying an intramuscular injection?
Just being cautious and it worked out well! My ratio is about 1 unit per 3.5 mmol so I doubt I could repeat that again but it worked very well!
Update:
Now using Fiasp:Humalog home-brew at 1:1 - no site issues or absorption problems. Pump settings are same as for 100% Fiasp.
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Hi,
I hope no one minds me bringing this topic back to life but thought others might find my experience with Fiasp of some use.
I started Fiasp 5 weeks ago, so still work in progress to iron out a few hiccups.
Basals I have reduced by about 7 units, I’ve had to redo my basal pattern, carb ratio is the same as it correction factor.
Bolus is work in progress depending on what I eat. My normal strategy is to do a 80/20 combi just as I eat, if a high GI snack/meal then it a straight bolus a couple of mins before I eat.
Temp basal I notice the difference within 15 mins of starting the temp basal.
Corrections 30 mins and there’s a drop and by 3 hours back to normal.
Duration is about 4.5 hours for me as a slight tail.
I’ve found better results/sensitivity by changing my cannula every two days and cartridge no later than 3 days. Hot weather both need to be changed every 2 days as Fiasp does not like heat.
Hope this helps others making the change to Fiasp. 
How intriguing! This just goes to show how different we all are. After two weeks, my basal rates, basal profiles and carb ratios remain unchanged, and my correction factor has significantly dropped.
So you’re saying you do an extended bolus for every meal? Is this because you found you were susceptible to a later rise after eating, after an initial levelling off and drop?
Just out of interest, what insulin were you using before? And apart from being able to eat sooner after bolusing, what do you see as the advantage of Fiasp?
Hi,
yes I do the extended over a two hour period, I found with some meals I would drop to quickly if I did a straight bolus then have to treat the low which obviously then caused a yoyo effect.
Obviously we are all different and other have found a 60/40 split over 3 hours works for them.
I was using Bovine neutral before so obviously quite a change for me.
Advantages are flatter profile and more even results. My average A1c for the last 10 years has been 6.4 and according to my test results it will be in the 5% club next time. Oh and so far fewer hypos.
It’s been a lot of trial and plenty of error whilst adjusting everything but def worth persevering with.
Only down sound for me is I seem to have gained about 5 pounds in weight yet eating exactly the same.
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This is obviously very relevant. I would expect the activity curves of Bovine neutral to be most similar to “Regular” human insulin (e.g. Actrapid, Humulin R). Fiasp is basically an analog insulin which has been turbo-charged by adding Niacin.
At the moment I am (possibly the only person on the planet) to be pumping with a 1:1 mix of Humalog and Fiasp. I suspect that the accelerative effect of the Niacin is effective on both insulins. I now find that with almost any substantial meal, even with relatively high GI carbs such as mashed potatoes, I have to use a combo bolus.
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I too have noticed less than good control with FIASP. This is my second vial. Although I have not had sore sites, I am getting post meal spikes and poor control at night. I am under the impression that it degrades quicker therefore I have not put as much insulin in the cartridge. I still don’t have good control. This last time I went from 5.7 A1C to 6.1. I am very disappointed in FIASP. Is it the niacin in it that is causing weird, non food related spikes?