Fiasp insulin

[SusieGriff]

Has anyone had any problems with Fiasp? It seems to vary so much these days. It seems some days I'm injecting water... no response at all, other days it's fine, reacts as normal. Is it just me???

 

[Eternal422]

Not used it myself but tagging @rebrascora who I know does use it and may be able to offer some advice.

 

[rebrascora]

Hi
I have often described Fiasp as quirky. It is not straightforward like Novo(not so)Rapid and you have to learn how to use it to best effect. Most of it's quirkiness is down to BG in my experience. When your levels are in the 4s and 5s it works quickly and effectively, when your levels are in the 8s it works reasonably well but above 10 and it is as you say, like injecting water and you can be waiting hours and need more than you would expect.

It took me 2x 3 month trials to get the hang of it and both of those 3 months were very frustrating, but 4.5 years down the line I wouldn't go back, but I have to be very proactive about keeping my levels under 10 and I have my high alarm set at 8.2. This works for me as I follow a low carb way of eating so don't generally spike above 8 but when the alarm goes off, I jab 2 units of Fiasp regardless of when I last jabbed some insulin and if I continue to rise 45mins later, I will jab another 1.5-2 units, essentially stacking small corrections until I see levels coming down. I keep a very close eye on my levels if I have to stack corrections and have jelly babies close to hand in case I need them and sometimes I might need 1 just to level things out about 5. I am sure most DSNs would be horrified to learn that I am stacking corrections, but this is what I have found works for me with Fiasp and small corrections at 45mins to an hour between is better than letting it get above 10 and needing much bigger corrections. I am not advocating you do the same as I do, as it can be dangerous to stack corrections and you need to keep a close eye on your levels if you do, but this is what I found works for me to get around Fiasp's "quirkiness" and feeling like you are injecting water when levels are high.

I hope knowing that others experience this problem helps you and that you can find a way to make it work for you, but for me I have to be quite aggressive with it to keep in range and have it work well. If I get above range, it becomes a bit of a battle and I had to learn not to be scared of being heavy handed with it.

 

[SusieGriff]

Hi
I have often described Fiasp as quirky. It is not straightforward like Novo(not so)Rapid and you have to learn how to use it to best effect. Most of it's quirkiness is down to BG in my experience. When your levels are in the 4s and 5s it works quickly and effectively, when your levels are in the 8s it works reasonably well but above 10 and it is as you say, like injecting water and you can be waiting hours and need more than you would expect.

It took me 2x 3 month trials to get the hang of it and both of those 3 months were very frustrating, but 4.5 years down the line I wouldn't go back, but I have to be very proactive about keeping my levels under 10 and I have my high alarm set at 8.2. This works for me as I follow a low carb way of eating so don't generally spike above 8 but when the alarm goes off, I jab 2 units of Fiasp regardless of when I last jabbed some insulin and if I continue to rise 45mins later, I will jab another 1.5-2 units, essentially stacking small corrections until I see levels coming down. I keep a very close eye on my levels if I have to stack corrections and have jelly babies close to hand in case I need them and sometimes I might need 1 just to level things out about 5. I am sure most DSNs would be horrified to learn that I am stacking corrections, but this is what I have found works for me with Fiasp and small corrections at 45mins to an hour between is better than letting it get above 10 and needing much bigger corrections. I am not advocating you do the same as I do, as it can be dangerous to stack corrections and you need to keep a close eye on your levels if you do, but this is what I found works for me to get around Fiasp's "quirkiness" and feeling like you are injecting water when levels are high.

I hope knowing that others experience this problem helps you and that you can find a way to make it work for you, but for me I have to be quite aggressive with it to keep in range and have it work well. If I get above range, it becomes a bit of a battle and I had to learn not to be scared of being heavy handed with it.

Thanks ! I do seem to do as you do i.e. stack corrections as it horrifies me to be so high. I am seeing my consultant in feb so I'll have a word with him, although they just seem to tick your levels and dismiss you as " you're doing fine " I tweak my peramiters too, at 4.1 and 10. Maybe I'll tweak them a little more. My average is always about 80-90% so when this happens I tend to freak a bit. But as you so rightly say, it does tend to prefer the lower range to behave properly. weird stuff. always a learning curve eh?

 

[rebrascora]

Sounds like you are doing really well. How long have you been using Fiasp?

Just to be clear, I don't alter my range which is always set at 3.9-10 because that is what the TIR guidance is set for and I too manage 80-95% most of the time. It is just my alarms which are set different at 4.5 for the low one and 8.2 for the high alarm Many DSNs will discourage you from correcting below 10 and very much discourage stacking corrections, but you have to find what works best for your body and lifestyle with the insulin you have and this consistently works for me over several years so I don't see how anyone can tell me it is wrong or criticise. I am the expert in my own diabetes because I live with it every minute of every day. It sounds like you are working out what works best for you with Fiasp and the next step is becoming confident with doing that regardless of what others might think.... which was one of the hardest things for me to grasp, as I felt I would get into trouble for "breaking the rules" and it concerned me that I had to do so. Once I accepted that this is what works for me and I am doing the right thing, the frustration with Fiasp stopped and I just accepted what I needed to do to make it work and no one had the right to criticise me for doing that, because they don't live in my shoes. I am not sure if that makes sense to you but hopefully it will. Yes, it would be great if Fiasp was uniformly effective for all of us at any BG level, but it isn't and much as NR is dependable it is fairly consistently sluggish for many of us, so Fiasp is an improvement in my eyes, but just needs you to be bold with it sometimes.

 

[nonethewiser]

Has anyone had any problems with Fiasp? It seems to vary so much these days. It seems some days I'm injecting water... no response at all, other days it's fine, reacts as normal. Is it just me???

That could also be injection/infusion site issues, whereas you hit a good spot insulin works fine hit a bad spot then insulin is next to useless.

Been using fiasp for good few years now having previously used novorapid, like it as it works slightly faster than novo but doesn't hang around for as long.

Tbh any insulin will struggle to bring bg back down when in double figures, so it's not unique to fiasp.

 

[SusieGriff]

Sounds like you are doing really well. How long have you been using Fiasp?

Just to be clear, I don't alter my range which is always set at 3.9-10 because that is what the TIR guidance is set for and I too manage 80-95% most of the time. It is just my alarms which are set different at 4.5 for the low one and 8.2 for the high alarm Many DSNs will discourage you from correcting below 10 and very much discourage stacking corrections, but you have to find what works best for your body and lifestyle with the insulin you have and this consistently works for me over several years so I don't see how anyone can tell me it is wrong or criticise. I am the expert in my own diabetes because I live with it every minute of every day. It sounds like you are working out what works best for you with Fiasp and the next step is becoming confident with doing that regardless of what others might think.... which was one of the hardest things for me to grasp, as I felt I would get into trouble for "breaking the rules" and it concerned me that I had to do so. Once I accepted that this is what works for me and I am doing the right thing, the frustration with Fiasp stopped and I just accepted what I needed to do to make it work and no one had the right to criticise me for doing that, because they don't live in my shoes. I am not sure if that makes sense to you but hopefully it will. Yes, it would be great if Fiasp was uniformly effective for all of us at any BG level, but it isn't and much as NR is dependable it is fairly consistently sluggish for many of us, so Fiasp is an improvement in my eyes, but just needs you to be bold with it sometimes.

Been using it coming up for 2 years now, at first it seemed fine, but just lately i've noticed, over the past 6 months or so, the change. I have on several occasions changed the cartridge and immediately seen the improvement, thats what made me a bit curious as to the state of it. I tried keeping it in the fridge for as long as I could too to no avail. anyway, I'll keep on with it as It's better anyway than novorapid was. plod on and keep trying.... as you say, what's good for one always isn't the case for another.

 

[helli]

The "complication" with Fiasp (which I think @rebrascora is doing her stacking to accommodate) is that the speed at which it works for me is very dependent upon my starting BG.
- if my BG is below 5, it works instantly. I need to bolus after eating.
- if my BG is above 10, it takes forever to start working. I need to avoid eating until the correction dose has started working. However, this could take an hour. It is as if I bolused water and then suddenly my BG drops. Therefore, I need to check my BG an hour before my meal starts. This does not mean bolusing for my meal at that time - it means I need to decide whether a correction is needed at that point and then proceed as I would in the third case for the meal.
- if my BG is between about 5 and 10, I can bolus just before I eat without getting too much of a spike.

We are all different so this is likely to vary.
One way in which we are different is how long the insulin remains active. For me, it is not much shorter than NovoRapid - my pump is set for active period of 3 hours for both.

The other thing to consider is whether Fiasp has stopped working as well for you - I think @everydayupsanddowns found that it lost its potency for him after a few months of use (please accept my appology if I remember wrong).

 

[everydayupsanddowns]

The other thing to consider is whether Fiasp has stopped working as well for you - I think @everydayupsanddowns found that it lost its potency for him after a few months of use (please accept my appology if I remember wrong).

No that was me. It started working quickly, but after 2-3 weeks I was having to up my doses. They kept creeping upwards for another month, in the meantime the rapidity of action stopped happening.

By the time I was on my 3rd vial (of my initial 3) the doses were behaving pretty erratically, occasionally ‘disappearing’ altogether, and I was getting pretty angry/inflamed sites, plus a stinging sensation on delivery.

I switched back to NotVeryRapid, and my doses started behaving again. NR is frustratingly sluggish, but it is at least reliable for me. My body just seemed to get quite cross about the added component, and reacted quite dramatically to it.

 

[Ivostas66]

I've been on FIASP for a few years. I found Novorapid took forever to kick in.

I agree it is a bit quirky sometimes. I have found on very rare occasions that it will do absolutely nothing, causing me to doubt whether I have actually injected and then around 4 hours later the dreaded downward arrow appears and I can plummet from a high to quite low in minutes. This is very rare though and the last couple of times it has happened I have also been under the weather either due to illness or in a stressful state.

Can't see if you said you were using a pen or pump. I've not really had any issues with the insulin since I switched to a closed loop system back in November, but I am aware that FIASP is not recommended for some pumps as it is too thin compared to the gloopier Novorapid et al.

 

[PhoebeC]

The "complication" with Fiasp (which I think @rebrascora is doing her stacking to accommodate) is that the speed at which it works for me is very dependent upon my starting BG.
- if my BG is below 5, it works instantly. I need to bolus after eating.
- if my BG is above 10, it takes forever to start working. I need to avoid eating until the correction dose has started working. However, this could take an hour. It is as if I bolused water and then suddenly my BG drops. Therefore, I need to check my BG an hour before my meal starts. This does not mean bolusing for my meal at that time - it means I need to decide whether a correction is needed at that point and then proceed as I would in the third case for the meal.
- if my BG is between about 5 and 10, I can bolus just before I eat without getting too much of a spike.

I find mine similar to this, actually under 6 I am careful as its fast.
6 -10 is fine for me, the 5 minutes works but over 10 then it takes longer.

However now I am on HCL I have been told I must be careful of waiting over the 5 minutes even if higher / out of range as when I have done this the pump then pauses insulin for a period, so it seems to be better if I do the 5 and then eat. But still I am only a few months in.

I much prefer it over NR, and the other one (I can never remember the name of) which I couldn't even be on for a week as it made me feel so green I couldn't eat.

 

[nonethewiser]

However now I am on HCL I have been told I must be careful of waiting over the 5 minutes even if higher / out of range as when I have done this the pump then pauses insulin for a period, so it seems to be better if I do the 5 and then eat. But still I am only a few months in.

Strange you should mention this as find on a morning that breakfast bolus seems to work super fast, whereas before hcl wait time was 15 mins now can it's around 5mins. Other meal times as we're before.