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

[tim2000s]

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

I suspect you'll eventually get Fiasp cartridges....

 

[TheBigNewt]

Never had a problem with high fat meals. In the business splitting a bolus is sometimes referred to as "stacking". Question: if split boluses are all that, does that mean that pumpers can alter the speed of their bolus delivery depending on what they eat? Or is a bolus a bolus.

 

[azure]

@TheBigNewt I wouldn't call a split stacking. All you doing is spreading the bolus out to account for a low GI or high fat meal. It can reduce the risk,of hypos.

Pumps have different bolus types eg Extended Bolus, which spreads the bolus over an amount of hours of your choice, or various forms of combination boluses where you can deliver some insulin up front and spread the rest over as long as it's needed.

 

[steve_p6]

@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.

Bit of info here on fiasp and CSII
http://onlinelibrary.wiley.com/stor...c7&s=e87751205b4f7efaab32c62e2acb1c6e87b9c469

 

[TheBigNewt]

@TheBigNewt I wouldn't call a split stacking. All you doing is spreading the bolus out to account for a low GI or high fat meal. It can reduce the risk,of hypos.

Pumps have different bolus types eg Extended Bolus, which spreads the bolus over an amount of hours of your choice, or various forms of combination boluses where you can deliver some insulin up front and spread the rest over as long as it's needed.

OK, I didn't know that. I guess I haven't seen a need to rebolus after a meal. I do eat a pretty regimented diet, which generally contains similar amounts of similar foods. I figure if I bolus right after mealtime (I quit blousing prior to meals many years ago, not a good practice IMO) and I'm at a decent BS prior to the next one I'm good to go. And that's usually the case. Where I have problems is fast food, which I avoid for the most part.

 

[azure]

You bolus after meals? Do you not spike @TheBigNewt ? I'm always careful to time my bolus to reduce any spike.

 

[donnellysdogs]

I too am having to bolus after food now for some foods.... I can be 5.0 before food and if I eat directly before food I can drop and remain that way for 90-100 minutes before glucose will be released from the food.

Thats why I asked Tim2000s my question, but didnt get a response..

 

[TheBigNewt]

You bolus after meals? Do you not spike @TheBigNewt ? I'm always careful to time my bolus to reduce any spike.

Back in the Humulin synthetic days I would bolus before I ate, or after I ordered at a restaurant. Then I'd fail to eat the whole meal and get low. I typically do not check my BS 1-2 hrs after I eat like some here do. I check it before meals and fasting AM and bedtime. I figure that's enough already. Like I said before if it's good before dinner I figure I took the right amount at lunch. And if my A1C stays at 6.5% I'm under good control. Right?

 

[tim2000s]

So,for someone like me who actually has to inject 30 mins AFTER food this would kick in probably just right for the late rises I get.... if I inject with or before food I can go hypo for a good hour before food digests..
or for my 4.30am 1st pre waking jab I could possibly extend my sleeping til 5.30(?) if its that quick??

Sorry @donnellysdogs - missed that one. Taking one unit, I saw that it started working within about 15 mins, and was done after about 75 (although there is a tail, but due to the earlier higher absorption it seems less effective at lower doses). Based on comparing with Novorapid, I think you could probably extend your sleep by 30 mins, I don't know about an hour.

 

[slip]

OK couple of questions, do we know for sure if fiasp is the same price as novorapid? if it's more I assume there will have to be a 'clinical need for it' for it to be prescribed - what are the likely clinical needs? (post prandial spikes and/or preprandial bolusing or something else?)

 

[steve_p6]

OK couple of questions, do we know for sure if fiasp is the same price as novorapid? if it's more I assume there will have to be a 'clinical need for it' for it to be prescribed - what are the likely clinical needs? (post prandial spikes and/or preprandial bolusing or something else?)

Pricing I have seen for UK is exactly the same for both.

 

[tim2000s]

OK couple of questions, do we know for sure if fiasp is the same price as novorapid? if it's more I assume there will have to be a 'clinical need for it' for it to be prescribed - what are the likely clinical needs? (post prandial spikes and/or preprandial bolusing or something else?)

Yes, we know for sure it's the same price. I confirmed that with the pharmacist before ordering it.

I'd say that the clinical need would be "being Type 1 diabetic", but what would I know....

In all fairness, I think this is going to be an interesting one to prescribe. It seems to work well in hybrid closed loop, and also it was okay on a pump, but I'm not convinced of the effects with MDI. If you eat anything with a protein/fat tail, you will have to split bolus. I don't think the intensity of the tail is large enough for those types of meal.

I hope the RCTs that are being done pick this information out, but I wouldn't be at all surprised if they don't.

 

[donnellysdogs]

Sorry @donnellysdogs - missed that one. Taking one unit, I saw that it started working within about 15 mins, and was done after about 75 (although there is a tail, but due to the earlier higher absorption it seems less effective at lower doses). Based on comparing with Novorapid, I think you could probably extend your sleep by 30 mins, I don't know about an hour.

Thanks Tim...

 

[steve_p6]

Yes, we know for sure it's the same price. I confirmed that with the pharmacist before ordering it.

I'd say that the clinical need would be "being Type 1 diabetic", but what would I know....

In all fairness, I think this is going to be an interesting one to prescribe. It seems to work well in hybrid closed loop, and also it was okay on a pump, but I'm not convinced of the effects with MDI. If you eat anything with a protein/fat tail, you will have to split bolus. I don't think the intensity of the tail is large enough for those types of meal.

I hope the RCTs that are being done pick this information out, but I wouldn't be at all surprised if they don't.

I would argue that point for MDI, for a fatty meal I have to split bolus anyway. Question is whether fiasp is fast enough to influence hepatic glucose release/post prandial and as mentioned earlier it will definitely help speed of effect on correction doses.

 

[steve_p6]

I would argue that point for MDI, for a fatty meal I have to split bolus anyway. Question is whether fiasp is fast enough to influence hepatic glucose release/post prandial and as mentioned earlier it will definitely help speed of effect on correction doses.

Or maybe I give up and think about pumping as best option!

 

[Esther444]

OMG you guys know so much , tbh is quite intimidating.... however very happy and grateful your all here. @tim2000s particularly impressed in your apparent total confidence in your basal rates. Mine are rubbish.
I love that u are testing on such naughty things.

 

[tim2000s]

To give the Fiasp more of a challenge, I rolled out the Chicken Katsu Curry challenge.

OpenAPS and Fiasp would need to keep me on the straight and narrow with a 160g bucket load of carbs (if you're going to have them, you might as well enjoy them) combined with fats to make the absorption profile a little painful.

In the interests of safety I Pre-bolused five minutes before eating as I knew it would take the five minutes to deliver the 12u I was giving up front. The rest was over to the system. And it delivered.

Boy did it deliver. Peak at 8. Back to 6.8 3.5 hours after eating. Smooth and low. Very impressive stuff!

 

[TheBigNewt]

That's impressive. What would it look like using Novorapid? Is that graph from a Libre CGM?

 

[pinewood]

To give the Fiasp more of a challenge, I rolled out the Chicken Katsu Curry challenge.

OpenAPS and Fiasp would need to keep me on the straight and narrow with a 160g bucket load of carbs (if you're going to have them, you might as well enjoy them) combined with fats to make the absorption profile a little painful.

In the interests of safety I Pre-bolused five minutes before eating as I knew it would take the five minutes to deliver the 12u I was giving up front. The rest was over to the system. And it delivered.

Boy did it deliver. Peak at 8. Back to 6.8 3.5 hours after eating. Smooth and low. Very impressive stuff!

Awesome! I'd need to bolus at least 30 mins before to then keep under 8. And I'd probably need a split my bolus too (guessing Fiasp won't help with that).

 

[tim2000s]

I'm not showing the Novorapid graph. Even with a 30 min prebolus, it isn't pretty. 30 mins in advance still sees me get up to 12, although it's possible to use a dual wave/combi bolus to manage it. It still has never been as impressive as this.