Switched Bolus and Having Issues

[Michele01]

Hi there - I'm wondering if you can help me please?

History: I'm type 1.5 and have been on insulin for about 10 years now. My HBAIc has always been ok but at the expense of large peaks and troughs. So based on that, my endo suggested using a Libre2. I've had that for over a month and it was clear that my basal probably wasn't correct and my bolus wasn't controlling the spikes well enough. So I managed to get my basal right and then my Endo changed my bolus from Novorapid to Fiasp to try to reduce the time of the peak. She warned me that it works really quickly and I should see the peak in an hour and it will be out of my system in 4 hours.

This is where I need your help please. I haven't changed my basal BUT this new Fiasp seems to be creating huge peaks and troughs. For example I ate a low carb meal last night of 40g. Normally I would take 8 units (I'm on a 2 x 10g). Over the past few days I've realised that my normal amount per 10g isn't working with the Fiasp so I took 11 units. My readings went from 6.4 to 18.4 in an hour, 3 hours later were 9.7 but then shot up to 13.1 (without eating anything) at 4 hours later. Overnight my levels plummeted to 3.7. This morning the levels have shot up again (without eating) but taking basal to 17.9! It looks like the introduction of this new bolus is upsetting my basal now.

I am so confused and upset. I don't know how to control this and I'm about to throw the towel in with this new insulin. Is it the insulin just not suiting me or is it me? Should I expect such huge differences with a different insulin until I get used to it? Thank you for any help you can give.

 

[Robin]

I haven’t used Fiasp myself, but reading stuff on the forum over the last year, I have noticed that for some people, Fiasp doesn’t seem to suit them. I think our Admin, @everydayupsanddowns is one for whom it didn’t suit, and after a few weeks of it working well, and faster, he saw insulin resistance creeping on and needed higher doses. (he'll correct me if I'm wrong!) Others have said it works fine for them, though, so it may be an individual thing.
Have a read of this thread, especially posts #16 onwards.

https://forum.diabetes.org.uk/boards/threads/hello.94318/#post-1084541

 

[Pumper_Sue]

How and when are you injecting the fiasp?

I must admit to being confused by your post as you posted in 2017 and according to your post you have been on insulin for 4 years

• May 17, 2017

In March 2015 I was diagnosed as Type 2 and in July was prescribed Dapagliflozin (Forxiga). Within 3 weeks I was in intensive care with life threatening DKA. The only symptom I had was extreme tiredness. Other than that, I had no other symptoms. My BG levels were under 8. In November 2015 I when medication didn't work for my diabetes, I was told I was now Type 1 and had to inject. 6 months after this, I was diagnosed with a rare form of breast cancer (triple negative). My medical team are now looking to see if there's a link. I have to be honest and say that whilst I know this drug can work well for some people, there isn't enough known about it at the moment. In clinical trials there was evidence of raised breast and bladder cancers and it was high enough for the FDA to suspend the use of the drug until it had been investigated further. A later report said that the high incidence probably related to poor screening and breast cancer being undetected. I remain sceptical.

 

[helli]

I switched to Fiasp a couple of years ago.
I notice that the speed at which it works seems to vary according to my blood sugar level. If my levels are under 6, Fiasp starts working immediately whereas when they reach above 8, there seems to be a significant delay (could be as much as an hour when my levels reach double figures).
I use an insulin pump and need to use the extended bolus on the pump more with Fiasp than with NovoRapid. I also need to be careful not to rage bolus when my levels are high.

I read on another forum that someone felt that Fiasp had a double peak. This is definitely not my experience.

I just need to be more reactive to my starting level when timing my dose, especially when eating high carb meals.

 

[Inka]

@Michele01 Some people simply don’t get on with FiAsp. If it’s not working for you and/or is causing you stress, don’t be afraid to insist you go back to Novorapid.

You don’t necessarily need FiAsp to stop the post-meal spikes anyway. I use Humalog and found correct timing of my bolus injection stops spikes.

 

[Michele01]

Thank you for your replies. This is my graph today. I haven't eaten at all and you can see that I'm getting peaks and then a second peak. I think I may be one of those for whom Fiasp might not work as I'm having to use huge amounts to get control.

I'm going to try to eat a tiny amount to get me back out of this hypo and then not having anything until dinner when I'll go back to Novorapid.

 

[Michele01]

How and when are you injecting the fiasp?

I must admit to being confused by your post as you posted in 2017 and according to your post you have been on insulin for 4 years

• May 17, 2017

In March 2015 I was diagnosed as Type 2 and in July was prescribed Dapagliflozin (Forxiga). Within 3 weeks I was in intensive care with life threatening DKA. The only symptom I had was extreme tiredness. Other than that, I had no other symptoms. My BG levels were under 8. In November 2015 I when medication didn't work for my diabetes, I was told I was now Type 1 and had to inject. 6 months after this, I was diagnosed with a rare form of breast cancer (triple negative). My medical team are now looking to see if there's a link. I have to be honest and say that whilst I know this drug can work well for some people, there isn't enough known about it at the moment. In clinical trials there was evidence of raised breast and bladder cancers and it was high enough for the FDA to suspend the use of the drug until it had been investigated further. A later report said that the high incidence probably related to poor screening and breast cancer being undetected. I remain sceptical.

What exactly is confusing you? The fact that I said I was Type 1.5 (which I am but my body reacts as a Type 1 and I have to medicate as such). Apologies if I got the amount of years wrong! So it should be 7 instead of 10 years - does this really make such a difference to my current problem?

I am injecting the Fiasp directly before eating as instructed by my Endo.

 

[Michele01]

I haven’t used Fiasp myself, but reading stuff on the forum over the last year, I have noticed that for some people, Fiasp doesn’t seem to suit them. I think our Admin, @everydayupsanddowns is one for whom it didn’t suit, and after a few weeks of it working well, and faster, he saw insulin resistance creeping on and needed higher doses. (he'll correct me if I'm wrong!) Others have said it works fine for them, though, so it may be an individual thing.
Have a read of this thread, especially posts #16 onwards.

https://forum.diabetes.org.uk/boards/threads/hello.94318/#post-1084541

Thank you this is incredibly helpful.

 

[Ljc]

Hi . I have no experience with FASP but have read on here that it does not always work as quickly as expected in some folks.

I suggest you contact your Endo or DSN asap for advise as your peaks are too high

 

[everydayupsanddowns]

Welcome back @Michele01

Sorry to hear you are having such a tough time with your BGs at the moment.

Yes unfortunately I didn’t get on with Fiasp. It started OK, and I saw a slight uptick in doses after a couple of weeks (which I knew had been the experience of some others, so wasn’t unduly difficult), but after 3-4 weeks it became quite erratic for me, and infusion sites were increasingly uncomfortable. The speed of action also tailed off, and ended up the same as NR, but just more of a ‘dose lottery’. I was glad to switch back to NovoTurgid, which is still frustratingly slow at times, but at least seems to act more reliably in my body.

First thing I would do is another set of fasting basal checks spread over the next week or so, so that you can reset your basal (just in case your needs have changed). Then hopefully you’ll be able to switch back to NR without any bother, and can start experimenting with prebolus timings (leaving a gap between injecting the dose, and starting to eat, so that the insulin has a bit of a head start).

Those BG fluctuations must be making you feel pretty grim and fed up

 

[Pumper_Sue]

Thank you for your replies. This is my graph today. I haven't eaten at all and you can see that I'm getting peaks and then a second peak. I think I may be one of those for whom Fiasp might not work as I'm having to use huge amounts to get control.

I'm going to try to eat a tiny amount to get me back out of this hypo and then not having anything until dinner when I'll go back to Novorapid.

If you haven't eaten then it stands to reason you wouldn't be injecting Fiasp unless for a correction dose, so if that graph is without food then there's something wrong with your basal.

 

[Michele01]

Welcome back @Michele01

Sorry to hear you are having such a tough time with your BGs at the moment.

Yes unfortunately I didn’t get on with Fiasp. It started OK, and I saw a slight uptick in doses after a couple of weeks (which I knew had been the experience of some others, so wasn’t unduly difficult), but after 3-4 weeks it became quite erratic for me, and infusion sites were increasingly uncomfortable. The speed of action also tailed off, and ended up the same as NR, but just more of a ‘dose lottery’. I was glad to switch back to NovoTurgid, which is still frustratingly slow at times, but at least seems to act more reliably in my body.

First thing I would do is another set of fasting basal checks spread over the next week or so, so that you can reset your basal (just in case your needs have changed). Then hopefully you’ll be able to switch back to NR without any bother, and can start experimenting with prebolus timings (leaving a gap between injecting the dose, and starting to eat, so that the insulin has a bit of a head start).

Those BG fluctuations must be making you feel pretty grim and fed up

Thank you SO much. Yes I am feeling grim and fed up - I couldn't have used better words. I'm going to go back to Novorapid this evening because I can't cope with the stress of this. I think you're right that another fasting basal needs to be done. It definitely was correct with NR but I'm all over the place with Fiasp.

 

[Michele01]

If you haven't eaten then it stands to reason you wouldn't be injecting Fiasp unless for a correction dose, so if that graph is without food then there's something wrong with your basal.

Yes it looks like my basal has gone bananas but it was SO good with NR. I have no idea why this may be the case but I'm going to go back to NR tonight and also look at the basal now.

 

[Pumper_Sue]

Yes it looks like my basal has gone bananas but it was SO good with NR. I have no idea why this may be the case but I'm going to go back to NR tonight and also look at the basal now.

Fiasp wouldn't have caused your basal to go bananas, I would suspect your problem is the basal rather than the fiasp.
If you are not sure how to do a proper basal test check the sticky in the pump forum. As NR is slightly longer than Fiasp and it's profile is different I would just hazard a guess the NR was doing a good job at hiding things.

Using Fiasp I found that my basal has to be spot on to reap the full benefit from it and I also think it's far better off being used in a pump.

 

[Michele01]

Fiasp wouldn't have caused your basal to go bananas, I would suspect your problem is the basal rather than the fiasp.
If you are not sure how to do a proper basal test check the sticky in the pump forum. As NR is slightly longer than Fiasp and it's profile is different I would just hazard a guess the NR was doing a good job at hiding things.

Using Fiasp I found that my basal has to be spot on to reap the full benefit from it and I also think it's far better off being used in a pump.

Thank you - I'm not using a pump but I'm going to check the sticky because I want to go back to basics and back to NR - once I've got that sorted then maybe it'll be time to try Fiasp again but I've gone from being a happy diabetic to feeling totally out of control.

 

[Michele01]

Update:

I'm not so sure my Basal is that far off (contrary to what I said earlier). This is what has happened today and tends to suggest that Basal may be almost right so it does point to Fiasp as being the culprit.

TIME
06.00 - 3.7 and going down so ate a snack
06.18 - 7.4 with arrow showing now stable
09.42 - 16.4 with arrow rising (no food has been eaten)
10.06 - 17.9 with arrow rising - Took 12u of Fiasp and 19u of Levemir (normal dose of Levemir)
10.30 - 13.2 with arrow going down
11.15 - 16.2 with arrow rising - Took 10u of FIasp to counter 2nd rise
12.22 - 8.2 with arrow falling
13.35 - 4.2 with arrow falling
14.11 - 3.0 with arrow falling - (caused by second dose of Fiasp - possibly 8u or less needed)
ATE PRAWN SALAD 50G CARBS - NO INSULIN
14.43 - 6.1 with arrow rising
15.54 - 11.6 with arrow rising
16.18 - 8.1 with arrow stable
17.16 - 8.6 with arrow stable
17.45 - 8.4 with arrow stable

This suggests (I think) that my basal needs are probably not too bad but might need adjusting by one or two units up. However it's clear that I'm having to take far more Fiasp to reduce highs than I had to with NR. Just on this day I would have had to take about 20u of Fiasp to reduce the morning high without eating whereas with NR 12u would have been ideal.

 

[helli]

This is a small snap shot and I am not medically trained but, to me, something looks wrong with your basal.
If your basal was ok, I would not expect
- a hypo at 6am. if your level is going down overnight, your basal is too high.
- to be able to eat 50g carbs in the evening with no bolus. Again, this suggests your basal is too high.

It is difficult to draw any conclusions from the rest. If your basal is wrong it would affect everything else and not possible to tell whether your Fiasp ratios are correct or whether you are over treating hypos.

Have you done a basal test recently to check your basal dose without any food or bolus?

Another thing which you may benefit from is a half unit pen.

 

[Michele01]

This is a small snap shot and I am not medically trained but, to me, something looks wrong with your basal.
If your basal was ok, I would not expect
- a hypo at 6am. if your level is going down overnight, your basal is too high.
- to be blue to eat 50g carbs in the evening with no bolus. Again, this suggests your basal is too high.

It is difficult to draw any conclusions from the rest. If your basal is wrong it would affect everything else and not possible to tell whether your Fiasp ratios are correct or whether you are over treating hypos.

Have you done a basal test recently to check your basal dose without any food or bolus?

Sorry this snapshot is with me struggling for 3 days with the new bolus that is giving me double spikes and which I think has been responsible for the hypos.

I don't suppose you have a link to an easy to understand way to check the basal dose? I've read the one linked to above and don't understand it. I've never been taught how to do this and have always felt my way through things. Interestingly, I've been keeping a spreadsheet of doses (basal/bolus), foods etc in the last month and I've just looked back and the basal rate (prior to using this bolus change) does seem to be holding so I'm just seriously confused now. I don't know which way to turn!

 

[Lucyr]

Your comment below, I am not sure I agree with (sorry not sure how to quote just a bit):

However it's clear that I'm having to take far more Fiasp to reduce highs than I had to with NR. Just on this day I would have had to take about 20u of Fiasp to reduce the morning high without eating whereas with NR 12u would have been ideal.

Yes you did take 22u of fiasp but I don’t think that was ideal, as it not only reduced your blood sugar but it sent you hypo, and it covered 50g carb in the salad, plus whatever hypo treatment you used (I’m assuming you didn’t eat salad for a hypo but had fast acting carbs first). So a much lower dose of fiasp would theoretically have dropped your bg to a normal level. Stacking boluses an hour after each other is not advised as the correction will take up to four hours to finish working.

 

[helli]

I don't suppose you have a link to an easy to understand way to check the basal dose?

This looks easy to understand https://www.diabeteshub.com.au/info...-general-practice/type-1/basal-testing?living