Fiasp Help!?

[z.steadman]

Hey everyone, I am new here but have been diabetic for nearly 20 years. I was diganosed when I was nealry 11 years old.

I had been on Novorapid and Lantus for around 8/9 years before switching to Triceba and Fiasp on the 1st March 2023. I am really struggling getting to grips with how Fiasp works and is responding with my body. I was advised to switch because I was spilt dosing my Lantus and NR was taking anything up to 6 hours to work some days! This all came to light when i went for a carb counting refresher course and my total daily dose was near to 80 units a day due to the amount of Lantus i was taking, so my carb ratio was all out of whack meaning I was injecting too much NR and being constantly low and however much adjusting it wasnt working for me.

I admit Im not the healthiest eater (although i do watch what i eat to an extent) and eat way too many carbs then I should but I always have done.

Just wondering if anyone has any tips with how to manage with Fiasp, I love how quickly it works (when I get it right) as I am not spiking as much with meals and it can reduce high sugar levels quickly. Although it just feels at the moment its doing what it wants when it wants, no 2 days are the same! All my averages on my libre 2 seem to be creeping higher and higher and I'm starting to think maybe I should just go back to NR as i seemed much more in control, or that switching both insulins at the same time was the wrong idea.

For a bit of background, this past weekend has been a busy one for me exercise wise as we were on holiday in Devon and doing alot of walking, so I was constantly going low which is fine, yesterday was a good day untill the evenings where it was creeping up more and more. I had to have insulin in the middle of the night to bring it down and when i woke it was 10.6, fine. Have had breakfast and my normal insulin i would have, hasnt touched me. Had a correction at 10:30, hasnt touched it. Have had lunch and more insulin and still hasnt touched me. From previous experiance when this has happened at some point I will then come crashing down when it decides it wants too . I switch up my injection sites, im not poorly in any way. Just feel liek Fiasp is so unrealiable!

 

[helli]

HI @z.steadman
I have been using Fiaps for a couple of years an understand how you feel. I was experienceing something similar for a few months before I got the hang of it.
There are two things i realised (at least for me)

1. It does not last as long out of the fridge as NovoRapid. If you took some spare Fiasp with you to Devon, this may be an issue. I found it was fine for about 2 weeks and then seemed like water.
2. The speed at which is works is very dependent upon my level. If I am between 5 and 9, it works really well. I can inject and eat. If I am in the 4s, it works immediately. I mean I will hypo within 5 minutes of injecting. If my levels are above 10, it will be like injecting water for about an hour and then, suddenly, the Fiasp will start working and my levels will plummet (because I am not very patient and may possible rage bolus stack).

The only way I have found to manage this is to keep a closer eye on my levels as they are creeping up and do a small correction. This is definitely easier on a pump.

 

[z.steadman]

HI @z.steadman
I have been using Fiaps for a couple of years an understand how you feel. I was experienceing something similar for a few months before I got the hang of it.
There are two things i realised (at least for me)

1. It does not last as long out of the fridge as NovoRapid. If you took some spare Fiasp with you to Devon, this may be an issue. I found it was fine for about 2 weeks and then seemed like water.
2. The speed at which is works is very dependent upon my level. If I am between 5 and 9, it works really well. I can inject and eat. If I am in the 4s, it works immediately. I mean I will hypo within 5 minutes of injecting. If my levels are above 10, it will be like injecting water for about an hour and then, suddenly, the Fiasp will start working and my levels will plummet (because I am not very patient and may possible rage bolus stack).

The only way I have found to manage this is to keep a closer eye on my levels as they are creeping up and do a small correction. This is definitely easier on a pump.

Hi Helli

Thank you for your response, once I get home from work I may get a new insulin out the fridge and see if that helps in any way! I wasn't aware that Fiasp doesnt last as long as NR but this could definitley be a contributor to my issue.

I think I may also keep a closer log and see how i respond to the insulin depending on my sugar levels, as it does feel that when my levels are high it takes a hell of alot of insulin to get them back down sometimes. Just feel very frustrated with it all at the moment and not sure what to do to help!

Are you on a pump? If so which one? Is it a closed loop system? Again Id love to go on a pump as i think i could get better control and I have even thought about self funding but not sure where to even begin. My diabeties nurse at the GP had no idea about carb counting when I last spoke to her and said I should give her a lesson 🙄 so I dont have the confidence in that she would help steer me in the right direction of getting a pump. It had been discussed with my consultant when I was pregnant but since having my little one I havent seen him again and dont seem to have been referred to anyone else.

 

[rebrascora]

Hi.

Sorry to hear you are struggling to get to grips with Fiasp but it is certainly not a straight swap with NR for many of us and it took me 2 trials of 3 months a year apart for me to get to grips with it and those 3 months were incredibly frustrating and to be honest, I would have given up the second time if I hadn't promised myself I would stick at it for a whole year the second time.
Interestingly, I seemed to make the break through about 3-4 weeks later and it works well for me now, but it has a few quirks in it's behaviour that take some getting used to. I think the most important one for me was that I need to keep my levels below 10 and ideally below 8 in order for it to work well. Above 10 and it almost seems to turn to water and I need much ore of it than I would expect and I have to be very heavy handed. Keeping levels below 10 means proactively jabbing corrections below 10 in between meals for me and often stacking small corrections when my levels start wandering up beyond 8. Fiasp in my experience and that of some others is that Fiasp works well and quickly when levels are in the 4-6 range but above that it gets less impressive. If my levels hit 10, I keep injecting corrections until it comes down into range and I don't eat carbs until it gets to the 5-6 range.... I might have a chunk of cheese if I am hungry but eating carbs when levels are above 8 just makes it nigh on impossible to get levels down and needs lots of extra insulin trying to do so.

The great advantage of Fiasp is that it is gone in 3 hours for me and it works well if I can keep my levels in range. The main reason I wanted it was to bring my levels down quickly when I need a correction and I find it doesn't do that unless I inject my corrections at a lower level... ie 8 or 9 This works well for me on a low carb diet as my levels tend to drift upwards rather than spike sharply, but may be more tricky for anyone eating normally. I definitely feel that I use more Fiasp as compared to NR but now that I have found a way to make it work for me, I would not go back to NR. I don't love Fiasp though and I would be reluctant to recommend it to anyone else because it is "tricky".

I think it is likely that your swap to Tresiba at the same time is adding an extra layer of complication because Tresiba has a very different profile to Lantus, so I would consider going back a step and just change one at a time.

 

[z.steadman]

Hi.

Sorry to hear you are struggling to get to grips with Fiasp but it is certainly not a straight swap with NR for many of us and it took me 2 trials of 3 months a year apart for me to get to grips with it and those 3 months were incredibly frustrating and to be honest, I would have given up the second time if I hadn't promised myself I would stick at it for a whole year the second time.
Interestingly, I seemed to make the break through about 3-4 weeks later and it works well for me now, but it has a few quirks in it's behaviour that take some getting used to. I think the most important one for me was that I need to keep my levels below 10 and ideally below 8 in order for it to work well. Above 10 and it almost seems to turn to water and I need much ore of it than I would expect and I have to be very heavy handed. Keeping levels below 10 means proactively jabbing corrections below 10 in between meals for me and often stacking small corrections when my levels start wandering up beyond 8. Fiasp in my experience and that of some others is that Fiasp works well and quickly when levels are in the 4-6 range but above that it gets less impressive. If my levels hit 10, I keep injecting corrections until it comes down into range and I don't eat carbs until it gets to the 5-6 range.... I might have a chunk of cheese if I am hungry but eating carbs when levels are above 8 just makes it nigh on impossible to get levels down and needs lots of extra insulin trying to do so.

The great advantage of Fiasp is that it is gone in 3 hours for me and it works well if I can keep my levels in range. The main reason I wanted it was to bring my levels down quickly when I need a correction and I find it doesn't do that unless I inject my corrections at a lower level... ie 8 or 9 This works well for me on a low carb diet as my levels tend to drift upwards rather than spike sharply, but may be more tricky for anyone eating normally. I definitely feel that I use more Fiasp as compared to NR but now that I have found a way to make it work for me, I would not go back to NR. I don't love Fiasp though and I would be reluctant to recommend it to anyone else because it is "tricky".

I think it is likely that your swap to Tresiba at the same time is adding an extra layer of complication because Tresiba has a very different profile to Lantus, so I would consider going back a step and just change one at a time.

Hi Barbara

Thank you for your response its been really helpful!

Personally i havent felt comfortable enough on Fiasp to keep injecting corrections as I just dont know what outcome I am going to get, but I think its something im going to have to do it keep my levels in the right place for it to work its best. As having lower sugars and eating / injecting / exercising does seem to be better (especially from what i could tell this past weekend) as I havent had levels like that since being on Fiasp.

From being on NR and Lantus for so long its a whole different mental shift that needs to happen as they work in such different ways. Struggling.

 

[rebrascora]

I personally don't find it loses potency over time but then I use enough of it that it is used up in 10-12 days and if you are eating quite a lot of carbs and going through a cartridge/pen quite quickly, like me, I imagine this will be less of an issue than it might be for @helli who is quite sensitive to insulin I believe and therefore probably uses less.
My biggest gripe with it is that it is a "wimp" once my levels get above 10 and needs reinforcements ie. several stacked corrections to bring me down once it gets to that level. I always keep JBs (Jelly Babies) to hand and a sharp eye on Libre if I am stacking corrections and the way I see it, I would rather jab too much insulin to bring it down more quickly and then level it up with a JB or two if it gets into range and is still dropping too fast, than leave my levels in double figures for hours on end until I can inject another correction once that first one is spent. I think this was the key breakthrough for me.... ignoring the guidance on stacking corrections and just keep adding another couple of units if it doesn't start to show signs of coming down in 30-45mins after the first correction.

This is what works for me. Your body may well respond differently of course!

 

[rebrascora]

It was sheer frustration in the end which pushed me to stack corrections. I would not and could not do it without having Libre to monitor the outcome and very occasionally I get distracted and have a slight hypo, but I find that recovery from an occasional minor hypo is much quicker and easier than the constant battle and frustration with high levels. I think if you are very sensitive to insulin then this may not be the right approach and I certainly find that if I am able to inject a correction and then do exercise, it can negate the need to stack corrections because Fiasp and exercise seem to be a powerful combo, but it isn't always practical.

I find it really quite amazing that there are so many small nuances in performance and usage between what are two relatively similar medications.

 

[z.steadman]

I personally don't find it loses potency over time but then I use enough of it that it is used up in 10-12 days and if you are eating quite a lot of carbs and going through a cartridge/pen quite quickly, like me, I imagine this will be less of an issue than it might be for @helli who is quite sensitive to insulin I believe and therefore probably uses less.
My biggest gripe with it is that it is a "wimp" once my levels get above 10 and needs reinforcements ie. several stacked corrections to bring me down once it gets to that level. I always keep JBs (Jelly Babies) to hand and a sharp eye on Libre if I am stacking corrections and the way I see it, I would rather jab too much insulin to bring it down more quickly and then level it up with a JB or two if it gets into range and is still dropping too fast, than leave my levels in double figures for hours on end until I can inject another correction once that first one is spent. I think this was the key breakthrough for me.... ignoring the guidance on stacking corrections and just keep adding another couple of units if it doesn't start to show signs of coming down in 30-45mins after the first correction.

This is what works for me. Your body may well respond differently of course!

It sound's like it's just alot of trial and error, I do feel like you though and would rather have snacks on hand incase of being low then constantly being high. Ive been high since 10am now and feeling the affects its bloody horrible!

it does baffle me when there is only an added ingredient that helps with absortion compared to NR, you would think it would work in similar ways. Diabeties is frustrating at the best of times lol!

 

[Pumper_Sue]

Thank you for your response, once I get home from work I may get a new insulin out the fridge and see if that helps in any way! I wasn't aware that Fiasp doesnt last as long as NR but this could definitley be a contributor to my issue.

It does last as long, it's just the way it works is different.
Have you thought of or tried splitting your fiasp when eating a lot of carbs?
Start from the beginning though and do a basal test first so you can see exactly what is going on with your basal.

 

[z.steadman]

It does last as long, it's just the way it works is different.
Have you thought of or tried splitting your fiasp when eating a lot of carbs?
Start from the beginning though and do a basal test first so you can see exactly what is going on with your basal.

I do try to split dose if im eating something which is particulary carb heavy, such as pasta or pizza. Ive been trying not to eat as much of these types of carbs though because of the affect there having. I can inject and eat at 6, then inject again at 9 but its still creeping up overnight and often I will wake at 2/3am and have even more insulin.

Maybe your right and a basal test first and start right from the beginning, thank you