Faster Insulin Aspart: Finally in the wild and in my hands!

tim2000s

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This is ISF/DIA testing from earlier today. I think it probably needs a further attempt but it looks as though at smallish doses, it's hanging around for about 2.5 hours.
105d12c3343ad1494f7548adcdc07a81.jpg
 
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pinewood

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Wow, this sounds like incredible stuff! I can imagine it's especially useful for corrections; the worst part of NovoRapid for me is when I am high and need to correct and have to wait an hour for the correction to kick in. It would probably help reduce cases of over correcting and "rage blousing".

Do you think this will slowly replace NovoRapid? I worry the NHS will try to keep people on NovoRapid because they are more familiar with it. I assume new diagnosis are still getting prescribed NovoRapid at the moment?

I need to find time to speak to my DSN to see if I can ask her to help me change my prescription. Pretty sure going directly to my GP would be a waste of time.
 

tim2000s

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Wow, this sounds like incredible stuff! I can imagine it's especially useful for corrections; the worst part of NovoRapid for me is when I am high and need to correct and have to wait an hour for the correction to kick in. It would probably help reduce cases of over correcting and "rage blousing".

Do you think this will slowly replace NovoRapid? I worry the NHS will try to keep people on NovoRapid because they are more familiar with it. I assume new diagnosis are still getting prescribed NovoRapid at the moment?

I need to find time to speak to my DSN to see if I can ask her to help me change my prescription. Pretty sure going directly to my GP would be a waste of time.
It definitely seems to work more quickly. Breakfast with a healthy portion of beans this morning and a five minute pre-bolus? Glucose went up from 4.7 to 7.2 and is on the way back down again now.

To be clear on Novo Nordisk's strategy, NovoRapid comes to end of patent very soon (later this year I believe), so will be liable for BioSimilars and I believe that Fiasp is part of the evergreening process. It's damned annoying though, because it shows that the medical patent process doesn't speed up the need for rapid improvement in treatments.

Humalog is also nearing the end of its patent, which is one of the reasons why Lilly has been looking at Biochaperoning and now the Diasome HDV product.

Just to be clear. If you are on Novorapid already, you are probably getting a prescription for Insulin Aspart, rather than Novorapid, so technically, if you can convince your pharmacist to change what they order for Insulin Aspart to Fiasp, then there is no need for a prescription change.
 
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pinewood

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So even though Fiasp is currently the same price as NovoRapid, when Novo's patent expires and generics enter the market Fiasp will be seen as more expensive option? And therefore it may be more difficult to get it prescribed?
 

tim2000s

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So even though Fiasp is currently the same price as NovoRapid, when Novo's patent expires and generics enter the market Fiasp will be seen as more expensive option? And therefore it may be more difficult to get it prescribed?
If generics enter the market place. I've not seen anything about a generic novorapid in my diggings, and we knew about Basaglar well before the Glargine patent was up. And to be honest, I think Fiasp you'd get away with the better management argument. As far as I'm aware, Novorapid is going to continue to be produced for some time.
 

Sideburnt

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So to crank things up, I had a second Krispy Kreme waiting (with similar CHO properties). This one was given a n 18 minute lead time and so far my BG has remained flat. I ate it an hour ago!
I feel like we're forcing you to feed. But could you do the same with Humalog?. 18 minute pre-bolus, another donut? It would be interesting to see the effect especially since you're hooked up to to the Nightscout trend graph.
 

tim2000s

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I feel like we're forcing you to feed. But could you do the same with Humalog?. 18 minute pre-bolus, another donut? It would be interesting to see the effect especially since you're hooked up to to the Nightscout trend graph.
Humalog was no faster for me than Novorapid. And for me that needs a 30-40 min pre-bolus for Krispy Kreme to avoid a big spike.
 

GrantGam

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To be clear on Novo Nordisk's strategy, NovoRapid comes to end of patent very soon (later this year I believe), so will be liable for BioSimilars and I believe that Fiasp is part of the evergreening process. It's damned annoying though, because it shows that the medical patent process doesn't speed up the need for rapid improvement in treatments.

I agree, if anything a patent slows down the drive for change and improvement.

Why would a pharma giant bring out a better, more efficient product when they're already getting plenty revenue from their current product - which is untouchable by other market leaders?

The same can be said for insulin pumps, it's dated tech. I can 100% guarantee that if big pharma invested as much money in pumps as the likes of Samsung and Apple have into smartphones, then we could all be bolusing from watches with matchbox sized pumps without a second thought...

The same can be said for insulin, we could actually carb count and bolus JUST before starting a meal. Oh what a thought;)
 

TheBigNewt

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In the US when a brand name drug goes generic (ie Lantus this year) only one company gets to make it for about the first year (Basaglar in this case), so the price doesn't come down much if at all. In fact I'm paying MORE for Basaglar ($450 copay for 90 day supply) than I did for Lantus ($360 for 90 days). The second year after patent expires our FDA lets more companies produce it if they care to and can prove bioequivalency.
 

BeccyB

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I'm very interested in this, not just because of the shorter pre-bolus time, but because it might only be active for a couple of hours as I regularly end up 'stacking' my Novorapid.

I have a friendly pharmacist so I think I'll be having a little chat to him next time my prescription is due.... :)

As ever, massive thanks and kudos to @tim2000s
 

tim2000s

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because it might only be active for a couple of hours as I regularly end up 'stacking' my Novorapid.
I'd be really wary of this. My tests have shown that at small doses, it seems to only last a couple of hours, but when I did a larger dose, there was very much a tail effect. Novo says that it lasts as long as NovoRapid, and I can quite believe that. I'd like to see a graph that shows absorption time in a clamp vs dose size.

Obviously, I don't want to do a massive great bolus to see if I can determine tail length if I can avoid it. I'd have to be fairly high for that....
 

BeccyB

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I'd be really wary of this. My tests have shown that at small doses, it seems to only last a couple of hours, but when I did a larger dose, there was very much a tail effect. Novo says that it lasts as long as NovoRapid, and I can quite believe that. I'd like to see a graph that shows absorption time in a clamp vs dose size.

Obviously, I don't want to do a massive great bolus to see if I can determine tail length if I can avoid it. I'd have to be fairly high for that....

That's a shame, but it'll still be good. I imagine I'll be high at some point so I'll do a big basal test for you :D
 

tim2000s

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@BeccyB Giving it some thought, I suspect that what I'm seeing is that although the overall length of duration of this insulin is similar to NovoRapid, due to the earlier availability of more of the insulin, the tail contains less so to the user feels shorter. This is why variation of dose would feel like it is having a bigger impact on the "size" of the tail.
 

steve_p6

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Wow, this sounds like incredible stuff! I can imagine it's especially useful for corrections; the worst part of NovoRapid for me is when I am high and need to correct and have to wait an hour for the correction to kick in. It would probably help reduce cases of over correcting and "rage blousing".

Do you think this will slowly replace NovoRapid? I worry the NHS will try to keep people on NovoRapid because they are more familiar with it. I assume new diagnosis are still getting prescribed NovoRapid at the moment?

I need to find time to speak to my DSN to see if I can ask her to help me change my prescription. Pretty sure going directly to my GP would be a waste of time.

Spoke to my DSN last Monday on this, I was a little ahead of the game as the consultants had not yet discussed how they wanted to use it. The main concern from what the DSN told me is around potentially needing to split your bolus in the event that you have a slow absorbing meal. This is hardly an issue for those that already pre-bolus and split bolus but it certainly could be more of an educational issue where people have had a more simplistic approach to bolus/meal timings.
 

TheBigNewt

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Why would anyone split a bolus? That sounds like an easy way to get low to me.
 

pinewood

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Why would anyone split a bolus? That sounds like an easy way to get low to me.
The only way I can enjoy high fat / high carb meals (e.g. pizza) without spikes is by splitting out my bolus over multiple shots.
 

tim2000s

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@steve_p6 based on what I've seen, I think I'd agree. I think it's going to require reeducation if using this with MDI. It's not wildly fast but the profile is different to what users are used to.

On the other hand I think it will work well in CSII. The quicker action will make square waves more effective I think.

@TheBigNewt - sounds like you need to attend Diabetes Jedi training. When eating higher fat meals, many people can't manage to keep a decent blood glucose profile without split bolusing. Definitely not an easy way to get a low.
 

Gaz-M

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hmm wonder what will happen to those of us on the Insight that get the Novorapid Cartridges