Fiasp experiences

@dancer I've read about that happening others too so I'm just waiting on the same starting to happen with me also, I hope not but it does seem to be the standard reaction for whatever reason. I think @tim2000s has blogged about it. I've to basal test at the minute with the view of decreasing my basal but I'm sure once I've everything set that's when the resistance will kick in

@Kateyo how has it been?

And the same question to everyone else?

I have started to feel so much more free with the correction time, I tend to give it a little top up if the arrow is up, even during a meal, if I eat too quick or misjudge I feel ok having a mini stack to pre-emptively stop it going past my ideal food threshold of 8.0 (tight I know but I havent breached 8 all week!).

I wouldn't suggest it to everyone, as it is stacking and can definitely lead to a serious low later on, but with a cgm I can watch it and it has worked a fair amount with no lows past 4.0.

I suppose for me, its kinda of acting like Tims artificial pancreas but manually, see it going up quickly, give it a little bit more.

Secret to eating is all timing, and I now eat slow so it doesn't spike all at once, also means I taste the food a lot more.

paulliljeros said:

This is interesting. I asked a consultant at Kingston Hospital (a different one to my normal consultant) and both he, and my DSN stated that FIASP is still undergoing trials, and is not available on their formulary. I have now had the discussion with my DSN 3 or 4 times, but with no success. It is frustrating, as they have been hugely pro-pump and great in all other ways

Click to expand...

I too had a similar conversation a fortnight ago. My consultant who I have lots of faith in mentioned FIASP. However he felt that the jury was still out at the moment and that testing had not been done on a wide enough spectrum of people. It's interesting reading people's experiences here.

It's not yet approved here, it is in Canada. The blurb I read on it makes it sound like it's a "little better" than Novolog. BS an hour after meal was about 10mg/dl lower than Novolog, which isn't a whole lot. It'll probably cost an arm and a leg here. We get the shaft when it comes to new drug prices. The president of my heath insurance company's name is Ben Dover.

TheBigNewt said:

The blurb I read on it makes it sound like it's a "little better" than Novolog. BS an hour after meal was about 10mg/dl lower than Novolog, which isn't a whole lot.

Click to expand...

It's certainly an interesting one. Blurb versus usage make for rather different bedfellows, and most of us wh've tried it have found the shorter time to start acting and peak means far less pre-bolusing. Of course, some people get that effect with Humalog, but they seem to be few and far between.

Just loaded my Vibe with a Fiasp sample bottle i got from my doctor last month. Its been 1 day, and so far its not worse then Novorapid.
Post meal spikes are a bit lower, corrections seem to happen a bit faster. So ill give it a couple days and cycle off and maybe run a couple minor tests.

ElkBond said:

@Kateyo how has it been?

And the same question to everyone else?

I have started to feel so much more free with the correction time, I tend to give it a little top up if the arrow is up, even during a meal, if I eat too quick or misjudge I feel ok having a mini stack to pre-emptively stop it going past my ideal food threshold of 8.0 (tight I know but I havent breached 8 all week!).

I wouldn't suggest it to everyone, as it is stacking and can definitely lead to a serious low later on, but with a cgm I can watch it and it has worked a fair amount with no lows past 4.0.

I suppose for me, its kinda of acting like Tims artificial pancreas but manually, see it going up quickly, give it a little bit more.

Secret to eating is all timing, and I now eat slow so it doesn't spike all at once, also means I taste the food a lot more.

Click to expand...

Ah sorry @ElkBond i haven't been on here as much lately! It's been going well all in all. Definitely helped with spikes and corrections and overall I have found my control to be improved compared to novo(not so)rapid. I do still have to pre bolus for breakfast by maybe 10-15 minutes then possibly a small snack later to preempt any lows but I used to have to pre bolus 40 mins for breakfast and still fight off spikes so it's a big improvement. It's not so bad at lunch and dinner, I can pretty much bolus just before eating and be ok. All in all I'm happy with it! Hope it's still working well for you? I now just need to get Dexcom back up and running, it's just so expensive with transmitter and sensors, wish they would extend the transmitter life for G5

Diamattic said:

Just loaded my Vibe with a Fiasp sample bottle i got from my doctor last month. Its been 1 day, and so far its not worse then Novorapid.
Post meal spikes are a bit lower, corrections seem to happen a bit faster. So ill give it a couple days and cycle off and maybe run a couple minor tests.

Click to expand...

Hope all goes well with Fiasp for you! Keep the thread updated and let us know

Fiasp fail.

Everything was working well the first 3/4 days, day 5 and 6 six were nightmares. Everything I would eat would send me so high as if I hadn't even taken insulin. Correction doses would work, but not nearly as well as I would have expected. It got to the point where i woke up this morning at 18.5, and had to skip work for half a day getting myself sorted.
The first thing I did this morning was put Novorapid back in my pump, and its been working as expected.

I don't know what happened with Fiasp, i feel like it gave up and went home around day 5 - I think maybe I will switch back to Novorapid.

Is this common?

Diamattic said:

Fiasp fail.

Everything was working well the first 3/4 days, day 5 and 6 six were nightmares. Everything I would eat would send me so high as if I hadn't even taken insulin. Correction doses would work, but not nearly as well as I would have expected. It got to the point where i woke up this morning at 18.5, and had to skip work for half a day getting myself sorted.
The first thing I did this morning was put Novorapid back in my pump, and its been working as expected.

I don't know what happened with Fiasp, i feel like it gave up and went home around day 5 - I think maybe I will switch back to Novorapid.

Is this common?

Click to expand...

How had you been using it? Is there a set change between days 3 and 4 or 4 and 5? Had you changed the insulin in the reservoir between days 3 and 4 as recommended? There's a bunch of possibilities that could be the cause, not just the insulin.

My doctor had told me to use Fiasp exactly like i had been using Novorapid - she said not to touch a thing.

I used a new cartridge and infusion set on day one, and changed it out on day 4 (3 days of use). On Day 4 i used a new cartridge and infusion again (no recycling of cartridges).
Everything was great on the start of day 4, but then i went out to dinner and everything just starting wrong that night. The next day 5 was a bit better but whenever i ate anything i would go high and have to correct to bring it back down, and then over night went up over 18, and i changed it out and back to NR the next morning and everything was back to normal.

I was only given 1 sample 10ml vial as a trial because if i change my prescription officially then my travel insurance is impacted for the next 3 months, and if i have to change back its 6 months - So i only have this 1 vial to be convinced.

My A1Cs have been pretty good with NR so I am not super eager to switch unless the results are really compelling.

I will certainly try again next month with a dexcom in place to catch this before it goes crazy again.

7 weeks in

A few tweaks still needed overnight on the whole though very pleased with Fiasp.

No1. rule is don't throw toys out of the pram if you don't get instant results or things go pear shaped after the first week.

So far I have had to reset my basal,
carb ratio has changed from 1/11 at lunch time to 1/12 Evening has changed from 1/12 to 1/13.
Breakfast I have no idea as don't eat any.
Corrections have changed from 1/5.5 to 1/6
Combi bolus is the only way to deal with meals, the length and amount of insulin up front depends on the carb load.

Very few spikes after meals a spike would mean a reading of 7 for me. If carb count or bolus length is wrong then higher numbers can be seen at the 3 - 4 hour mark so a temp basal soon sorts that out.
Very few lows and the ones I've had I know what caused them (Error on my part)

My conclusion is Fiasp needs to be treated with respect and is a steep learning curb but well worth sticking with if you have the patience.

I agree @CarbsRok . I seem to have entered a new phase with it where my basal rates all run smoothly, but my I:C ratio for food has dramatically changed. Apart from driving me up the wall as I try and establish what's happening, it's all a little odd.

I'm currently having to reconfirm timing of effect and pretty much everything else after being stable for four months.

@tim2000s I wish I could be stable for 4 months! I saw my consultant in May and told him I was having to do basal checks a lot more often than when I first started on the pump. I started keeping a diary of basal and ratio changes, to make sure it wasn't the same ones going up and down (it wasn't). I changed to Fiasp after that appointment and expected lots of changes to continue, but there weren't as many as I thought.

One week I noticed that I felt good. I couldn't believe how good I felt. I went onto Carelink, as I thought it was more than a fortnight since I checked my patterns properly. I was shocked to find it was 6 weeks! After checking Carelink, I felt less good, and I realised that all the checking and re-checking for highs and lows had been getting me down.

I've been checking basals this week and found my breakfast bolus needed lowered. This morning was the first morning with the new ratio and, wouldn't you know it, I got out of bed at 12.9 (it could've been worse, my cgm said 15!) So much for checking the new ratio!

Even Fiasp took its time lowering my highs today, so it looks like I'll have to look at my insulin sensitivity (again!)

I used to have to make occasional changes to basals and ratios and rarely had to change sensitivity but, since the end of last year, I've had to make some changes every month. I don't even know if recent changes are due to Fiasp or just me!

Oh for a little bit of stability!

dancer said:

Even Fiasp took its time lowering my highs today, so it looks like I'll have to look at my insulin sensitivity (again!)

Click to expand...

Perhaps keep your ratio the same for normal! highs and just have extra insulin for the higher highs. Some people do become very resistant once over 10.
Personally I found sticking a temp basal on worked wonders with a correction when I first started with Fiasp and learning the ropes.

CarbsRok said:

Perhaps keep your ratio the same for normal! highs and just have extra insulin for the higher highs. Some people do become very resistant once over 10.
Personally I found sticking a temp basal on worked wonders with a correction when I first started with Fiasp and learning the ropes.

Click to expand...

I must remember that thanks!

DOing a look back over my data, it appears that anything that causes my liver to produce glucose is now not getting mopped up as effectively by Fiasp. It's almost as though my liver has stopped responding to the (very low level of) signalling it receives when it finally gets it's tiny proportion of insulin. Things I've noticed causing raises much more heavily recently:

• Coffee
• Feet to the floor effect
• Food

And all look related to glucagon release and hepatic glucose production.

As an experiment, and because I was fed up with the massive highs I was experiencing, I flipped over to Novorapid yesterday. Astonishing difference. Immediate return to normal IC ratio (had been languishing at 1u:4.5g carbs. Instant return to 1u:9g. I'm going to be taking the rest of the batch of insulin back to the pharmacist and asking for replacement vials, just to absolutely confirm it wasn't the insulin batch that was the issue, but it has raised some serious concerns for me about Fiasp.

What's interesting is there seems to be a lot less strong correlation between carb content and bolus amounts over the last six weeks than expected. When I took a further dig, I found that for most of the last six weeks, the correlation between carb count and bolus was roughly 80% (varying between 78% and 91%) but for the last week it dropped to 63%.

When I apply a trendline to this data, I get some interesting results too. Namely, the R-squared value for the data-set is terrible, suggesting that over a period of time, it's pretty hard to determine the amount you'll need to bolus based on the carb counted content of the food.

Taking that a step further, and breaking the periods out on a week by week basis, I can see that some weeks there is a pretty strong link between amount entered and bolus amount administered and on other occasions, although there doesn't seem to be a pattern of worsening R-squared.

I really need a week of NovoRapid data to make a comparison of the difference between the two.

I have been on Fiasp for about 3 months and it is significantly quicker than all the others. I was on Humalog since it was introduced, tried Novorapid but it didn't suit me at all and have been on Apidra for the last few years.

I use a pump.

On Apidra I would take my bolus as soon as I got up in the morning and about 45 minutes before my porridge, shower, exercise, get dressed, then breakfast. I always got highs after eating, even on the pump, even eating porridge for breakfast. On Fiasp, I have my bolus 5 minutes before my porridge, any sooner and I will go low before my meal raises my blood sugar. My highs are not usually so high after eating too.

I have found that my basal bolus ratio has changed, I need more basal, less bolus.
My hba1c is as low as it has ever been: 52.

I think Fiasp is a big step forward. The problem is getting it.
Luckily I recently ordered my prescription a little early, I get 2 vials and have only been able to obtain 1 from my pharmacy 18 days later. The pharmacist is going to ring the manufacturer directly today to find out what is going on. I only have 3 weeks of Fiasp left, if they can't get it soon, it's back to Apidra.