Changing from Novorapid to Fiasp insulin.

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Ian Knight

Ian Knight

New Member
Relationship to Diabetes
Type 1
After approximately 20 years using Novorapid my diabetes consultant has switched me to Fiasp as I have too high peaks after meals. I use a Freestyle Libre sensor to monitor results. I'm about a week in and my early experience has been that for like for like insulin doses my results have worsened. Does anyone have any tips based on your own experience of making the switch?
 
Hi Ian welcome to the forum.🙂

I don`t know if this will help because you have a specific question.
My senior Podiatrist is T1D and takes Fiasp instead of NR, Fiasp is fast acting
and is good for meals but it does take trial and error, I`m hoping to switch soon
from NR to Fiasp. I see TW has asked my next question Pump or MDI.
Thankyou for joining our forum we appreciate it.
 
I am MDI . I don't really want to use a pump as I swim a lot and don't like the idea of a catheter in open water.
 
I also seem to take a LOT more insulin than anyone else I know -30 units of Lantus at night and 24 Novorapid or Fiasp at mealtimes.
 
Hi @Ian Knight , I have used Fiasp in the past and when I first started on it I found that my doses needed some adjustment. It may take a little time to get used to using a new insulin as they all work slightly differently. It definitely helped with my post meal spikes though, and I didn't need to pre-bolus as much as I did on Novo Rapid.

Might be worth doing some basal testing to start with to see if your basal dose is correct?
 
Welcome to the forum @Ian Knight

I agree with @Type1London - checking your basal is more or less currently doing its job right would be a good first step before chasing in circles with meal doses.

I tried Fiasp for about 2 months.

Initially it worked rapidly and I needed to split doses I would usually be able to do ‘all up front’ with NR. Corrections were nicely speedy though.

I did notice is was a bit sting-y, and seemed to leave pea-sized lumps at infusion sites (I’m on a pump).

After a couple of weeks I found I needed to hike up my doses, and then again... and again. Some for whom it works well have suggested a 2-day cannula change might have helped. However weirdly as well as the increasing doses I found my (pre)bolus timings gradually needed to revert back to NR standards, and the corrections no longer worked any more rapidly. Plus the stinging was getting more noticeable.

I used up the last of the 3 vials I had started with, and switched back, as Fiasp doses and behaviour getting more and more erratic towards the end (I was wearing CGM throughout). Pretty much immediately my Time In Range went back to ‘normal’ (for me).

I’m glad I gave it a go, but there must have been something about it that my body didnt like at all.

There are several on the forum that love it though!
 
I use Fiasp in a pump and do very well with it. It took a long time to gradually sort out new basal settings and bolus as well. The secrete to using it though is to get your basal spot on. You also need to consider the action of Fiasp, so if for instance you have a high fibre or a fatty meal or even just protein based then you need to split your bolus. I tend to find 80/20 split over two hours works wonders for me. Obviously as you haven't a pump this doesn't help you.

Ian Knight said:
I am MDI . I don't really want to use a pump as I swim a lot and don't like the idea of a catheter in open water.
Click to expand...
If you take the pump off there's a small clip you plug into the cannula which solves any worries. Pumps are also waterproof so nothing to stop you wearing the pump whilst swimming.
 
I have to say I had a very similar experience to @everydayupsanddowns... I was on Fiasp for around 1 year, but I had noticed my sugars creeping up and needing more and more insulin to bring them down. Eventually a fellow Type 1 mentioned they had had a very similar experience with Fiasp and recommended I try switching insulins, which seemed to do the trick.

But I'm sure some people get on with it very well! Might just be something to watch out for.
 
Just wondering if you’d experimented much with prebolusing @Ian Knight (leaving a gap between delivering the dose and beginning to eat)?

Getting dose timings right helped me squash my post meal spikes far more effectively than changing insulins I think.

My timings have changed over the years and are currently quite modest at 15-20 minutes for breakfast/lunch, but they have been as long as 45-60 minutes in the past!
 
Hi

Regarding Ian Night's comment "I also seem to take a LOT more insulin than anyone else I know -30 units of Lantus at night and 24 Novorapid or Fiasp at mealtimes.".... I also seem to need a lot of basal and mealtimes insuline.

I am 60k and 1.55 m and I am using 22 units of Toujeo and sometimes also 16-20 units of Fiasp for mealtime. I even need to inject for a coffee with some milk 2.5 to 3 units!!!!

I changed from Lantus to Toujeo and the hypos at night were better, I had a dose of 20 with Lantus and currently on 22 with Toujeo and still not sure is the corret dose because I constantly keep raising after meal insuline runs out...

But the problem got worse when then they changed me from Novorapid to Fiasp too. It seems to be that helps the peak but after a while start raising again.

At this point I don't know if I should keep raising Tourjeo o inject again Fiasp after 2 hours to help the "second" peak?
 
Hi @PatriciaGS and welcome

Have you done a basal test? It sounds like your basal insulin is not holding you steady and until you get the correct basal dose and/or a basal insulin which suits your body's needs, then nothing makes sense and you will be what we call "fire fighting" with your Quick acting insulin to try to keep your levels in range. Once you get your basal insulin dose correct, I can tell you that it is bliss and everything makes sense and life is so much easier and surprisingly, just 1 or 2 units of basal insulin wrong can need an awful lot more Quick Acting (QA) insulin trying to fix it, particularly once your levels go too high. I find I need a disproportionately higher amount of Fiasp to bring me down when I get into the teens with my BG and it is much slower to respond in those situations and then I rsik getting frustrated and injecting too much (rage bolus) and then going hypo.
I am on Levemir rather than Toujeo as I need to adjust my basal insulin quite frequently to balance it and I need much more basal insulin during the day than at night, which I achieve by splitting my Levemir dose (currently taking 22 units in the morning and just 7 at night). You can't adjust Toujeo like this because it is a very long acting insulin, so if you increase your basal dose and find you are going low sometimes and high others, then ask for a change to Levemir because it will give you the ability to get a better balance. I really can't tell you how much better you feel physically and mentally when you get the right basal insulin/dose and there are a variety of options. I found I gained a lot of confidence in adjusting my basal insulin from doing the DAFNE course (Dose Adjustment For Normal Eating) It is so much more than the title suggests. If you haven't done the course or a local equivalent, do ask about it because the courses here are starting up again now. Just spending a week with other diabetics is an amazing experience, as it gives you a whole different perspective, but the course educators can really help you to understand how your body and the insulin you use works. I was reluctant to attend because of the title because I follow a low carb way of eating and I wasn't sure it would be helpful, but I am so pleased I did and I feel so much more confident and happier managing my diabetes since then.
 
Hi Rebrascora,
thank you so much for your message!!!

Honestly I had been fighting this battle alone since the beginning, I was diagnosed 10 years ago and I moved to 3 different countries since...so it's been difficult.

1. I had no idea what a basal testing is... I googled it and found this instructions --> https://www.diabeteshub.com.au/info...-general-practice/type-1/basal-testing?living -- I think I will do this, it will give me lots of information.

2. I see that the DAFNE course is in the UK only... I am in Spain at the moment, but i guess I can travel if necessary to do the course.

3. Living in Spain and trying a low carb diet is difficult, but not impossible. During some time a couple of years ago I went to minimum amounts of cards with a KETO diet. My sugar levels were absolutely amazing during that period, but I stopped because I was told that diet is extremely dangerous for diabetics type 1... because your body is constantly in a high level of ketosis and the danger that this could bring if your sugar level rises while having such a high amount of ketosis in blood.
When you say you are in a low carb diet, what exactly do you mean? What is low carb diet for you?

I have so many questions for you... I hope i am not a pain.
thanks anyways for your message.
Regards,
Patricia
 
@PatriciaGS Not a pain at all. Happy to share experiences. I don't do keto, mostly because I am not organized enough and I think it is too restrictive. I basically avoid high carb foods, so I don't eat bread or pasta or potatoes or rice or pastry and I usually steer clear of pulses and legumes as my body seems to be particularly effective at breaking those down into glucose. The only time I have a higher carb product is at breakfast when I have a sprinkle of low carb granola (45% carbs) on my yoghurt, berries and seeds. I eat lots of cheese and meat and eggs and nuts and veggies and salad and coleslaw and once in a while if I am eating out I will have a very small portion of rice or a little bread just to be sociable and I might have 2-3 new potatoes once a fortnight during the season at home. It generally works out I eat about 70g carbs a day, but I don't specifically count them, it's just the way it works. I usually end up injecting Fiasp 2 hours after a meal to cover protein break down and sometimes it might take 3 or 4 units to deal with that, usually in 2 injections an hour or so apart. It took me quite a while to work out that strategy and it is something the DSNs would frown upon because effectively I am stacking correction but I monitor it closely and it works consistently. I usually inject those "corrections when my levels are 8 or above and rising and I can usually keep it below 10 doing that. I would not be able to do that safely without Libre.

Thankfully my consultant is very happy for me to continue with my low carb, higher fat way of eating because he can see that it is working for me and my cholesterol levels are decreasing, despite the large amount of cheese I eat. With Libre I can keep a close eye on my levels and having done DAFNE and learned an awful lot on this forum, so I am confident to adjust my insulin to deal with difficulties. I am only 2.5 years in but this is working for me and my consultant is very happy.

I started on Fiasp because NR was taking over an hour to kick in on a morning (sometimes an hour and a half) and if I didn't wait, I would spike up to 15 and then come crashing back down later which I didn't find pleasant. I still need 40-45mins pre-bolus at breakfast with Fiasp and 15-20mins later in the day, but I have found a system that works for me.
 
PatriciaGS said:
2. I see that the DAFNE course is in the UK only... I am in Spain at the moment, but i guess I can travel if necessary to do the course.
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Travelling to the UK for DAFNE may not be as easy as it should be as you need to be registered on the course with your UK diabetes team.
If you are interested, there is an online version called Bertie Online. This was developed by Bournemouth CCG but I think it is open to all. Google should help you find it.
 
Well the Dose Adjustment For Normal Eating course (ISTR) originated initially in Germany - but anyway we also have this which is an equally informative course, though obviously no interaction with HCPs and other T1s

Welcome - BERTIE Online

www.bertieonline.org.uk www.bertieonline.org.uk

So nowt to prevent an English speaker doing that anyway far as I know?

Have no idea though why you couldn't low carb in Spain - I certainly could if I moved there as the vast majority of a British diet is available there. Same meat fruit and veg, better fish and shellfish usually, same rice, same pasta, not sure about cauliflower so just do without mashed spuds entirely or just boil up less potato to begin with. Wholemeal bread has been available there for donkey's ages and has the same carb count in Spain as it does in England. We're not normally trying to adopt a keto diet - only cut down on daily carbohydrate intake. Hamburgesa sin pan rules, OK. Most things con ensalada. Churros once a year treat during Feria. (Cos just not the same unless extruded into a vat of boiling oil, dredged with vanilla sugar and handed to you in a conical paper bag) No prob.
 
Hi @PatriciaGS Reading about your insulin doses, it seems there are two possible main suspects - your basal being wrong as suggested or you’re possibly suffering a degree of insulin resistance. Maybe a mix of both.

So doing a basal test will help a lot and give you useful information. The BERTIE course is here:

https://www.bertieonline.org.uk/

If it turns out you do have a degree of insulin resistance, that can sometimes be improved with a very low fat diet. One proponent of that eats 600-700g carbs per day and only takes 26 units of insulin in total! Obviously he’s super-dedicated, but watching fat intake can potentially help improve things. Avoiding the keto diet can help too because that causes insulin resistance. I too think it’s dangerous - especially when we get ill. I eat a reasonable amount of carbs including bread, cereal, pasta, rice, potatoes, etc, take 7-9 units of basal via my pump and have an excellent HbA1C. Retaining good insulin sensitivity is a big part of that.
 
helli said:
Travelling to the UK for DAFNE may not be as easy as it should be as you need to be registered on the course with your UK diabetes team.
If you are interested, there is an online version called Bertie Online. This was developed by Bournemouth CCG but I think it is open to all. Google should help you find it.
Click to expand...
Thank you!!!
 
Inka said:
Hi @PatriciaGS Reading about your insulin doses, it seems there are two possible main suspects - your basal being wrong as suggested or you’re possibly suffering a degree of insulin resistance. Maybe a mix of both.

So doing a basal test will help a lot and give you useful information. The BERTIE course is here:

https://www.bertieonline.org.uk/

If it turns out you do have a degree of insulin resistance, that can sometimes be improved with a very low fat diet. One proponent of that eats 600-700g carbs per day and only takes 26 units of insulin in total! Obviously he’s super-dedicated, but watching fat intake can potentially help improve things. Avoiding the keto diet can help too because that causes insulin resistance. I too think it’s dangerous - especially when we get ill. I eat a reasonable amount of carbs including bread, cereal, pasta, rice, potatoes, etc, take 7-9 units of basal via my pump and have an excellent HbA1C. Retaining good insulin sensitivity is a big part of that.
Click to expand...
Hello there,
thanks for your comment. I will check the basal and then take it from there one option at the time.
 
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