Recently, my endocrinologist wondered if I would be willing to try manually injected Fiasp in addition to the Novolog that I have in my Tandem pump. I guess the idea is to use Fiasp to manage meals that have a lot of carbs while the pump takes care of the basal rate and minor corrections. Feels like a lot of work but does anyone have any experience with this? Any advice?
Why not just try Fiasp in your pump? Lots of people here do that.
Ask @Tim35
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Agree with @Eric2
Give it a try simply using Fiasp in the X2 pump. The X2 pump is not FDA approved for such, but there is no issue with your Doc writing an off-label script. Our insurance did not blink an eye even though Fiasp is not even FDA approved for Pediatrics. Fiasp is from Novo Nordisk so if your PBM covers Novolog than almost certainly it would cover Fiasp as well.
We have been using Fiasp in the X2 for almost a year now.
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Thanks for the suggestions. I noticed the post on using the Tandem pump with Fiasp and have been watching that. Just wondered if anyone had any experience with what my endocrinologist was recommending. Putting Fiasp in the pump seems the common sense approach.
I thought this was going to be for a slightly different reason. Some have talked about using the pump for basal and then using injections or afrezza for boluses, mostly due to issues with pump sites. I have wondered about doing such, as I simply can’t get away from pump site issues. It is perhaps the biggest thing keeping me from getting my blood sugar steady in range and lowering my A1C.
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I’ve used Afrezza for bolus when I have a really high-carb meal (pizza or example) or for very high blood sugar that’s not responding well to my pump boluses. It works extremely well for me in these circumstances.
Can you say a bit more about what site issues you’re experiencing?
Well beyond the issues that don’t affect blood sugar (or I don’t think they usually do for me) like skin irritation and stuff like that, main issues are randomly poor absorption and leaking. Often I have sites prematurely fail as well, so it will be working well for say, a day, then out of nowhere just stop working almost completely. I will notice it as I keep trying to correct a high and it won’t come down. There will be no leaking, but when i take the site off to replace it and then press on the area a little insulin will come pouring out. When they have the leaking problem it may be immediately after replacing, or it may start some time later. I have tried using new areas as I thought it may be due to scar tissue, but even in the new areas I have issues, though maybe not as many. I have also tried different kinds of infusion sets.
My endo says that the amount of insulin I use and the size of the boluses shouldn’t matter unless they are really really big (like 50 units or something), but I have to imagine that it is related. I have made efforts to reduce insulin usage and requirements, but I don’t think I will ever reduce it that much. I have close to 1 unit per hour (it varies) for basal, and my bolus ratio is between 1:3 and 1:4 depending on the time of day.
I do this, but not with Fiasp. I use an OmniPod and have had a lot of trouble with absorption. I moved my pod off my belly and started rotating between my arms and legs and found I had much better absorption, but at the same time I had also stopped bolusing from the pod because of tunneling. I only use the pod for basal insulin and I bolus for meals and corrections. It does add a level of effort, but it has paid off. I have several basal rates set for the day, between 0.5 and 0.9. My boluses are typically two to five units. If I go over five units, I’ll use two sites - so for a six unit bolus I’ll put three units in each leg. It’s been working well for the past several months, but now my arms and legs are building up some scar tissue, but that’s another story.
Do a search on “tunneling” and you’ll find some conversations about this.
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Out of curiosity, what is your combined daily Basal+Bolus (TDD)? Are you using more than 50units per day?
My pump history shows TDDs ranging from 28 to 35 units per day for the last week. Some of these days have been amongst my best days so far with maintaining a stable BG, but weekends are usually a challenge due to eating out, not commuting by bike, less predictable schedules, etc.
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Finding virgin tissue for infusion sites can be a real challenge, especially if you’ve been pumping for several years.
In my case I used my abdomen for 3+ years but have moved to my upper legs (both sides of the thigh). This has even required getting infusion sets with longer tubing.
I’m not a large person or overweight, but my sites generally won’t take any more than 100units before they give up the ghost.
My TDD is 20-25 units, and I intentionally change sites after 72 hrs so as not to cause undo saturation scarring (hypertrophy)
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Looking back through my history, it looks like I usually use around 50-75 TDD.
Any issues with clogged pump line or sites failing? My endo will not write a script for Fiasp via my Tandem 2 pump. If I had stayed on pods, he would have! I am now trying Afrezza plus Humulog via pump for basals. Crazy. We need faster insulins that work in our pumps.
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Never a clogged pump line.
I had heard Apidra may have issues with that.
Fiasp is Novolog only with two extra ingredients: Vitamin B3 (niacinamide) for speed and an Amino Acid (L-Arginine) for stability.
Failed sites - sure. Those happen on occasion. But doesn’t seem any more frequent than with Humalog or Novolog. Maybe a site failure once every three months? Just a guess - don’t really track it. And if the site is older then 3 days (like we forgot to change it) then I don’t consider that a “failed site” rather I consider that a “failed memory”.
My suggestion if you want the Fiasp is to argue with the Endo and ask for it as a trial. See how it works. It works for some and doesn’t work for others. If it causes you any issues then you tried it and it didn’t work. But then you know. If you try it and it works then you can fight again with the Endo but this time you would have more ammo.
But the Afrezza sounds like potentially an even better approach? How is that working for you so far?
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Never had a clogged pump line or infusion site go bad pumping FiASP (Animas Vibe). Been on it for 6-8 weeks now (don’t require scripts for insulin in Canada, besides I’m uninsured)
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I have been using Fiasp in my Medtronic 670 for about five months. No issues to date and my average BG seems to have been lowered.
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@Patricia5 - that is a thought. Get a handful of Fiasp vials from Canada to give them a try and see how they work?
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I had one confirmed clogged line using Fiasp in my X2. I think it was because I let the pump fast charge too long and it got pretty hot.
Not sure that wouldn’t have happened with other insulin.
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Thanks, Tim. My logic too but, Dr. pretty stubborn - thinks Fiasp is not that fast and since not on my formulary, blah, blah, blah… he said wait - there will be better options. So now I am day 2 of Afrezza and it is working pretty damn good! Had to figure out the dose/gCHO, etc. but, today dosed at a pre-meal BG of 113 (like that all afternoon!), ate and now I am 117 
It drops high blood sugars super fast and holds me at my pre-meal number (if good enough) - no bump at all. If I am high, it takes longer but I can eat right away. I have not experienced my BGs going up with food and I eat immediately. Need a little more time on it to say more than that. It is weird inhaling something. Once I coughed it all out! Watched BGs and they stay the same (at 1 hr) so I dosed again and I dropped as predicted. Also not sure what our immune systems will do w/ insulin in our lungs. I am willing to do this until a good closed loop is available. Tandem should have something ready by end of the year - maybe earlier.
That is a great idea!