I am now 8 days into pumping with Fiasp and so far so amazing. Looking at my first week Diasend reports, I can see a modest increase in % Time in Range (at the moment set at 4-9) achieved by a rather larger decrease in % Time above Range but a doubling (from 45 to 8%) in Time below Range. My average Sensor Glucose has fallen by about 0.4, but probably more significant is that I haven’t seen a single sensor reading over 13 and I have only been above 10 a couple of times (goodbye after breakfast spikes). Interestingly my TDD has reduced from ~45 to ~36 U per day with no change in my diet (and I am NOT a low carber) - this is all attributable to lower boluses. I haven’t yet done any tweaking to my basal rates but have had to increase (or should that be reduce) my I:C ratios.
My impressions are that it starts to act much MUCH quickly than Humalog and has a shorter tail so it acts a lot more aggressively. I think the major reason for the increase in hypo frequencies has been moderate hypos occurring 30-60 mins after a meal bolus. This stuff kicks in QUICKLY so no need to prebolus and a lot more boluses extensions. This is pretty straightforward with a pump, but I wonder how people on MDI will find it?
I haven’t yet started to play with my basals, although these will need some modest adjustment. I tend to use quite aggressive temporary basal reductions to fend off impending hypos. With Humalog I would typically use -90% for one hour. If I do this with Fiasp, I see a big rise in sensor readings - I assume because on-board basal insulin is leaving my system much more quickly. I have my DIA set at 4 hours but that is largely guesswork.
Next - the acid test. How well did Fiasp deal with a decent sized chocolate-covered brownie from Costa Coffee (usually worth a big spike). With Fiasp not only did my levels not rise, they were lower at 60 mins.
Finally - I normally have a “6 month call off” prescription for 8 vials. I asked my Health Centre for a prescription for 2 vials as a trial. When I arrived at the pharmacy to collect it, there had apparently been a clerical error by the Doctor and a bag of 24 vials waswaiting for me. That’s about a year and a half supply (probably nearer 2 years if I maintain my reduced TDD). They wanted me to take all of them - the pharmacist was complaining that they were taking up too much room in his fridge. I said if the insulin worked out I would take my 6 month supply of 8 vials next time I was there,
I’ve been pumping with Fiasp for three weeks now, I was previously using Novorapid and I’ve not changed basal rates, set my DIA at 3.5.
It certainly acts more quickly, standard deviation has improved markedly and I’ve not had a high above 12 regardless of the number of carbs I’ve eaten.
Only negative so far is that pump sites do not last over 48 hours, a lot more itching and redness with this insulin over novorapid.
I’m finding this as well. Even sets that I change at one day have a lump underneath the skin. I aim to have sets last two days and notice that that’s become more challenging since switching to Fiasp and I’m usually changing sites at one day or less. I already had site problems with Humalog and Apidra, so struggling to have sets last two days isn’t new to me, but chnaging at one to two days didn’t leave a lump with other insulins, so that part is concerning.
Yes, I have to admit I’d often break the cardinal site change rule and leave a teflon set in for 3-4 days without issue with novorapid but it just isn’t possible with the fiasp, welts starting to appear around the 48 hour mark.
I’ve read that it’s because of the additional Vit B3 added to help speed up absorption, I’ve also read that this additional additives that help with rapid absorption make the insulin less stable!
There is a good guy in the online diabetes community called Tim who has looked into it all quite closely.
I had significant site issues with Apidra - they wouldn’t even last 2 days. Humalog was better and I could get 2 days out of a site (although I suspect that absorption was beginning to be affected overnight on day-2. I have not noticed any problems with Fiasp. So far it seems similar to Humalog. I haven’t tried to keep the set in for a 3rd day.
Fiasp is basically a reformulation of Novorapid, so you might expect it to behave similarly,
Yes I was on Novorapid before Fiasp, aware it’s an empirical sample of 1 but Fiasp seems a bit less stable to me and I think the additional additives (nicotinamide) that aid absorption cause greater site irritation.
After 3 days in the vial I see unexplained highs occasionally so I am also half filling cartridges and swapping out insulin earlier.
I am using Fiasp in the Omnipod and change the pods every 3 days. I do not see a huge difference between Humalog and Fiasp in terms site irritation or insulin effectiveness.
I will say perhaps with Fiasp I am getting a bit more redness at the site but it is very minor and goes away fairly quickly after I change site. For me, the benefits of Fiasp still greatly outweigh the minor irritation.
I thought I was starting to have the same problem, but tried a Silhouette on my lower backside on Monday. I didn’t change my reservoir which I had last refilled last Thursday, and used tubing I changed on Sunday. It worked perfectly up to today and I only changed it because my reservoir was empty. I didn’t see any redness at the site either, but had when I was inserting on my abdomen. Not sure what any of this all means, but I’ll keep trying sites other than my abdomen which is horribly overused and abused. ADP doesn’t pay enough to change sites more than once every 3 days (and still doesn’t pay enough for reservoirs on top of that), so hoping I don’t have to change sites more often or that would be a huge disadvantage of Fiasp over Novorapid.
So to update my Fiasp site redness issue. After I posted this comment, I started on a new order of pods that have a much stronger adhesive that the previous order. I have gone through 4 site changes and do not get any site redness at all.
I think the last pod order (which happened to be my first ever pod order) had much weaker adhesive and the pods were moving a bit causing the redness at the site. I think this was a cannula movement problem and not a Fisap problem. Much happier with the new order of pods!
I pumped using Novolog for several years, many years ago. I had to switch insulin when I started experiencing raised circular red welts about two inches in diameter. They would heal after removing the infusion cannula but would take a week or two.
I’m very interested in Fiasp but these reports of red swelling suggest I may run into the same allergy issue I had with Novolog. When available in the US, I will get a sample and try it. Maybe I’ll be pleasantly surprised.
My site issues are with infusion sets in general, not Fiasp specifically. I did notice more problems after starting Fiasp, but I think it was just a coincidence since I had similar increased issues last allergy season.
I recently saw a dermatologist about eczema, and asked her about my site issues. She looked and confirmed that I seem to be allergic to the infusion cannula/needle itself (Teflon/nickel) rather than it being primarily a tape issue. Since I’ve been trying everything and nothing has helped (inclufing steroid sprays), she prescribed an immunosuppressant cream for my eczema and said I could also try the cream on sites. This cream is a topical version of what people use after getting an organ transplant to prevent rejection, so it’s pretty powerful stuff (the pharmacist commented on it).
Since using the cream, every site has lasted two days except for one. I can’t say that there’s no irritation whatsoever (and I do worry more about site infections, though I’ve never experienced any in the past), but there’s no unbearable itching or sites simply dying and not working. The only issue I have with it is that the cream seems to render adhesive useless, so keeping sets stuck down is challenging.
Unfortunately I am also having some site problems with Fiasp. With Humalog, I could make sites last reliably for 2 days but not 3. With Fiasp, some sites have developed red bumps that take a few days to go away (this is a cannula, not an adhesive/skin issue). Also, basal rates that result in a slowly falling CGM reading overnight day 1, will give me a slowly rising overnight sensor reading on day 2.
I can deal with the basal issues (TB) and the occasional red bumps, but I am also experiencing significant stinging at the site when I bolus. Animas pumps are notorious for their fast bolus delivery and consequent stinging, but I hardly ever experienced a problem with Humalog (or previously Apidra). I have tried to change the bolus delivery speed from Normal to Slow, but this doesn’t really deal with the problem (it just means that for a 5 unit bolus, instead of 5 seconds of stinging, I feel 5 sequential one second bursts of stinging punctuated by a couple of seconds gap between each unit).
I really like Fiasp, but pain when blousing is a major problem. The stinging gets worse over the second day, so I suppose that I could go to a 1-day rotation. Putting in a new set every day wouldn’t really bother me but I am not sure how the NHS would react to the substantially increased costs.
Thanks for that report @Terry4 … I started using FIASP (I’m in Canada) - just via MDI for the first week … for meals / corrections … and found it worked great. Finding FIASP in the pump will be a labour of love while I sort through how it is a faster insulin, etc. All these observations from everyone using it is very helpful.
What infusion set are you using? I had problems using the teflon cannulas … so switched to using the stainless steel (not sure what pump you use - but if Animas it’s Sure-T / Medtronic it’s Sure-T) - and no issues with irritation, etc. Like you, I had thought it was the tape, but it was the teflon. The other nice thing though about stainless steel infusion sets, if you’re in a pickle . and say by accident you rip out infusion set … you can easily place it back into a new spot if you have abit of tape to hold it in place.
Jim - okay - so I noticed once in awhile - when bolusing that a slight stinging occurred with the FIASP too. Very rare though. I’m on Animas too, and the slow speed is what I have Big Blue set up to. Is it perhaps because you are bolusing a large amount of insulin all in one go? How I get around that, say I have to give 5 units of insulin via the pump … I split it up 50/50 over 1/2 hour … and no stinging - and blood sugar levels stay level.
Here where I live in Canada, the province of Ontario pays for pumps for T1D’s with with $2,500 Cdn a year for supplies. So, every 3 days for infusion changes is my route I go … though if I had to pay out of pocket over and above what province gives to us … then I’d have to go that route.
BTW, I’m an expat, and when I was in Wales / UK in April - was very tempted to come back home … but sadly … my Canadian pension and savings won’t go far with conversion (get better bang for our buck in Euro) … so Spain is still a dream on mine to maybe retire one day.
II’m using the 6 mm Contact Detach sets with my Ping. They are much better than the Teflon sets, which used to cause itching and hives that would last for weeks (I also have problems with Teflon coated pans), but unfortunately I’m allergic to nickel, and stainless steel does contain about 10% nickel. So, I do at times still react to the sets, and at times my body somehow manages to “take them out” and they stop working early. It seems in part connected to how bad my allergies are in general; I have a lot of allergy issues and lately my allergies have been horrible despite taking seven or eight daily allergy medications.
I’ve discovered that eating low-carb seems to be what has helped the most with preventing irritation and allowing me to wear a set for a full two days. At times I’ve also been using the cream I mentioned above, but that cream makes tape not stick at all, so I try to avoid it… It seems that the less insulin I infuse, the less my immune system notices that the set is there. Eating low-carb also makes me feel better in general, leads to better blood sugars, and helps my Dexcom sensors last longer (since roller coaster blood sugars seems to make sensors fail faster). So, it’s a win-win-win situation.
