Fiasp

[MichelleF78]

Morning guys

Started Fiasp this morning from NR and it’s been rapid..a bit too rapid. Here’s my issue. Every meal time I have 1:5 ratio. I have dropped down to low 4’s on Fiasp and I have felt very shaky. Anyway I have emailed my nurse. Should I try the normal 1 ratio for 10g carbs on this? Prefer to be in the 6 range as this is where I am comfortable. Thoughts please? I knew where I was with NR as 1 unit only dropped me by 1. Also got very little spike with breakfast! Thanks

 

[helli]

If your levels end up as you want them after 3 or 4 hours, the trick is with the timing rather than the dose.
If they fall too low after eating, try taking the Fiasp after you have finished rather than before.

 

[Vamppir8]

Watch your basil as well, I found it boosts that as well, had to knock my night one down to 1 as up to 4am it boosted it down as well, also knocked day down as well, could be what you are experiencing.

 

[rebrascora]

Hi Michelle. How are you doing? Been a few days since you posted.... Hope you are managing OK and the change to Fiasp isn't proving too frustrating.

 

[MichelleF78]

Hi Michelle. How are you doing? Been a few days since you posted.... Hope you are managing OK and the change to Fiasp isn't proving too frustrating.

Oh Barbara thanks for messaging. I don’t like it. A bit all over the place to be honest. I still don’t know how much one unit is dropping me by and I have had low episodes quite a lot. I have dropped my morning Levemir down by 1 to see if that helps. I am a little blotchy and it does sting a little. It is quicker at reducing my spikes but like you I am needing about 30 minutes in morning before I eat. Going to persevere as I feel I can eat quicker with this compared to NR. How you doing? NR dropped me by 1 but this is at least 2-3.

 

[rebrascora]

Sorry to hear you are having a bumpy ride with it but I half expected that might be the case because it wasn't a simple and straightforward swap for me and I had a lot more experience than you even when I tried it the first time. I think perhaps it is less difficult if you are started on it when you are first diagnosed and know nothing else, but I found the transition from NR to Fiasp really challenging and as I have said before, I gave up the first time after 3 months of tearing my hair out with it. I think I just wasn't confident enough with my diabetes management to make it work for me then and even the second attempt a year later took another 3 months of frustration before I cracked it. I think being in the honeymoon period doesn't help either as it is much more difficult to see patterns and get consistent results. Don't be frightened to ask to go back to NR if you find it gets too much for you, because it really is tough enough in the first year without adding extra challenges. I think for me, it was a relief to go back to NR and whilst it is horrendously slow, I appreciated it's consistency more when I reverted to it so it eased the frustration until I was ready to try again. What do they say.... "Rather the devil you know than the devil you don't!" 🙄

All good with me thanks and my levels have settled down nicely after my dietary/mental wobble last week. 🙄 I accept that they will happen occasionally (it's the nature of the beast) and thankfully they are pretty rare now, but very happy to be back on an even keel with my diabetes. I think sometimes when it all going horribly wrong, it sort of resets your expectation and you are so relieved for a bit of stability that you worry less about the actual numbers. Not sure if that makes sense, but you can get so wrapped up in trying to keep everything really tight and want better and better "control" that falling off the rails every once in a while means that the slate is wiped clean and anything is better than the bad bit that you hit, so you appreciate how good "averageishly good" is, rather than striving for perfection which is of course impossible. I don't mind having the odd day or two when I "crash" because it is kind of a way of resetting my expectation and taking the pressure off myself.
The psychology of diabetes management is extremely complicated in itself, let alone the complexity of diabetes management and you really have to be quite self aware to keep yourself mentally balanced as well as balance your BG levels. It's a lot to deal with which is why it is important to manage your expectation and be kind to yourself.

 

[MichelleF78]

Sorry to hear you are having a bumpy ride with it but I half expected that might be the case because it wasn't a simple and straightforward swap for me and I had a lot more experience than you even when I tried it the first time. I think perhaps it is less difficult if you are started on it when you are first diagnosed and know nothing else, but I found the transition from NR to Fiasp really challenging and as I have said before, I gave up the first time after 3 months of tearing my hair out with it. I think I just wasn't confident enough with my diabetes management to make it work for me then and even the second attempt a year later took another 3 months of frustration before I cracked it. I think being in the honeymoon period doesn't help either as it is much more difficult to see patterns and get consistent results. Don't be frightened to ask to go back to NR if you find it gets too much for you, because it really is tough enough in the first year without adding extra challenges. I think for me, it was a relief to go back to NR and whilst it is horrendously slow, I appreciated it's consistency more when I reverted to it so it eased the frustration until I was ready to try again. What do they say.... "Rather the devil you know than the devil you don't!" 🙄

All good with me thanks and my levels have settled down nicely after my dietary/mental wobble last week. 🙄 I accept that they will happen occasionally (it's the nature of the beast) and thankfully they are pretty rare now, but very happy to be back on an even keel with my diabetes. I think sometimes when it all going horribly wrong, it sort of resets your expectation and you are so relieved for a bit of stability that you worry less about the actual numbers. Not sure if that makes sense, but you can get so wrapped up in trying to keep everything really tight and want better and better "control" that falling off the rails every once in a while means that the slate is wiped clean and anything is better than the bad bit that you hit, so you appreciate how good "averageishly good" is, rather than striving for perfection which is of course impossible. I don't mind having the odd day or two when I "crash" because it is kind of a way of resetting my expectation and taking the pressure off myself.
The psychology of diabetes management is extremely complicated in itself, let alone the complexity of diabetes management and you really have to be quite self aware to keep yourself mentally balanced as well as balance your BG levels. It's a lot to deal with which is why it is important to manage your expectation and be kind to yourself.

It’s a tough road Barbara for sure. The weight gain is bothering me more to be honest. I eat much less than I did previously and the not eating what you want when you want kills me. I am suffering but I’m going to see consultant tomorrow and I have to be brutally honest with him. These people may know all about diabetes but they don’t live with it. There is no support. I love to eat out but it really is a guess and when you ask for carb information they just look at you.

Glad to hear you are doing alright. It is a constant battle and sometimes I find it all so overwhelming.

 

[rebrascora]

Hope you get the support you need at your appointment tomorrow, but can understand your concerns and frustrations. As you will be aware, we are all very different, so I imagine it is quite tough for clinicians to give very specific guidance and we have to find what works for us personally by experimenting.
I am putting on a bit of weight at the moment too, but the answer for me is to do more exercise.... and lay off the peanut butter. 🙄 I have to be quite strict with my diet to keep everything balanced. Doesn't mean I don't enjoy my food, but just make the right choices most of the time. For me cutting my carbs and eating more fat stopped the hunger and cravings and I lost weight initially, but I'm eating too much at the moment and not burning it off, plain and simple.

 

[MichelleF78]

Thanks Barbara. Can I ask you about split doses on Fiasp. How do you work over 100 carbs if going out for a meal? Had it down to a tee with NR but concerned about this.

 

[rebrascora]

Thanks Barbara. Can I ask you about split doses on Fiasp. How do you work over 100 carbs if going out for a meal? Had it down to a tee with NR but concerned about this.

Sorry Michelle but I can't help you on that as I don't eat that many carbs. @helli might be able to advise as she uses Fiasp although being on pump it is a lot easier to manage split doses. It does tend to be very individual though. I would probably take less Fiasp up front that you did with NR but it will depend on the meal. If it is fatty or high protein it will need less up front or even all of it just after you eat or maybe between courses (but will also depend on your premeal level). If you are above 6 before the meal then some before and some after, if you are 6 or under and a fatty meal then maybe inject all of it after the first main course. If split over 3 courses, then some after the first course and some later..... There really are too many configurations and variables to give any definitive advice.
The one and only time I had anything like that was a Chinese banquet. I was about 9 before I set off in the car, so I jabbed 2 units correction before I drove there knowing it was just 20 mins and there would be prawn crackers to munch on when I got there. Then jabbed some about 4 or 5 more units when I got there and the meal was ordered. Then I just kept an eye on my Libre and jabbed a bit more as my levels approached 10. I logged every injection on my Libre so that I could keep track but I probably had 5 or 6 injections including the one before I left home and at least one more when I got home. I have to be honest, I didn't even attempt to count carbs as that would be far too complicated but I avoided lots of rice and noodles and just ate the tasty stuff with a tiny bit of stodge to soak up the juice. You really just have to play it by ear. I love having Libre for enabling me to do this in stages and see how I am getting on and I can whip my pen out and jab myself a few extra units in seconds.... Of course it helps that I reuse my needles so no faffing about having to change after each dose and keep the sharps somewhere safe. I do have a spare in case something happens to the "in use" needle but so far I haven't needed it except to enable Elaine (@eggyg) to jab for a fruit scone when when we met up one lovely afternoon and she hadn't brought her insulin. 🙄 Fancy going anywhere without your insulin!! Anyway, we are now "diabetes sisters" instead of "blood brothers" because we have shared insulin. Naughty aren't we😉

 

[helli]

Thanks for the tag @rebrascora
As you mentioned, we are all different, we eat differently. For example. 100g of pizza is different to 100g biscuits (don't judge me 🙄 ). And my experience of Fiasp is only with a pump so I have more options available to me.

Maybe what is most useful is how I find Fiasp to be different to NovoRapid. I find it incredibly sensitive to my starting BG.
This need to be considered when splitting doses but more in terms of timing than splitting the dose.
In fact, when I eat out, I do not dose until the food is in front of me (or even after eating the course if my levels were in the 4s) and then bolus separately for each course. Yes, I may go high because I bolus too late but I would rather that than dose for what I expect and then be served a smaller portion or not like it.

For fatty foods such as pizza or curry, I split my dose. I rarely have 100g carbs with a curry but usually do with a pizza. With a pizza, I dose about 30% at the start (as mentioned before timing depends on my levels) and then the rest about 60 to 90 minutes later.
Unlike rebrascora, I do not watch my CGM to know when to dose as there are too many other things to distract me. I have to set a timer to remind myself to have the second part of my bolus 60 to 90 minutes later.

 

[eggyg]

Sorry Michelle but I can't help you on that as I don't eat that many carbs. @helli might be able to advise as she uses Fiasp although being on pump it is a lot easier to manage split doses. It does tend to be very individual though. I would probably take less Fiasp up front that you did with NR but it will depend on the meal. If it is fatty or high protein it will need less up front or even all of it just after you eat or maybe between courses (but will also depend on your premeal level). If you are above 6 before the meal then some before and some after, if you are 6 or under and a fatty meal then maybe inject all of it after the first main course. If split over 3 courses, then some after the first course and some later..... There really are too many configurations and variables to give any definitive advice.
The one and only time I had anything like that was a Chinese banquet. I was about 9 before I set off in the car, so I jabbed 2 units correction before I drove there knowing it was just 20 mins and there would be prawn crackers to munch on when I got there. Then jabbed some about 4 or 5 more units when I got there and the meal was ordered. Then I just kept an eye on my Libre and jabbed a bit more as my levels approached 10. I logged every injection on my Libre so that I could keep track but I probably had 5 or 6 injections including the one before I left home and at least one more when I got home. I have to be honest, I didn't even attempt to count carbs as that would be far too complicated but I avoided lots of rice and noodles and just ate the tasty stuff with a tiny bit of stodge to soak up the juice. You really just have to play it by ear. I love having Libre for enabling me to do this in stages and see how I am getting on and I can whip my pen out and jab myself a few extra units in seconds.... Of course it helps that I reuse my needles so no faffing about having to change after each dose and keep the sharps somewhere safe. I do have a spare in case something happens to the "in use" needle but so far I haven't needed it except to enable Elaine (@eggyg) to jab for a fruit scone when when we met up one lovely afternoon and she hadn't brought her insulin. 🙄 Fancy going anywhere without your insulin!! Anyway, we are now "diabetes sisters" instead of "blood brothers" because we have shared insulin. Naughty aren't we😉

I owe you one Barbara!
I went for lunch with a friend today, a muggle, and I had almost finished my panini and half portion of chips when I realised I hadn’t taken any insulin! So it doesn’t make much difference whether I have it with me or not, I’m still a numpty! Then to put the icing on the cake, I realised after my last mouthful I hadn’t taken my Creon! Oops! Double numpty! So high BGs and a possible mad dash to the loo! Luckily I’m home now.

 

[rebrascora]

I owe you one Barbara!
I went for lunch with a friend today, a muggle, and I had almost finished my panini and half portion of chips when I realised I hadn’t taken any insulin! So it doesn’t make much difference whether I have it with me or not, I’m still a numpty! Then to put the icing on the cake, I realised after my last mouthful I hadn’t taken my Creon! Oops! Double numpty! So high BGs and a possible mad dash to the loo! Luckily I’m home now.

Yes, but just the loveliest "Numpty" in the world!! 😉
Hope you don't pay too high a price for those omissions.

 

[eggyg]

Yes, but just the loveliest "Numpty" in the world!! 😉
Hope you don't pay too high a price for those omissions.

Slight bump in the BG but tummy been ok. Phew!