Goodbye Novorapid, it's been emotional...

[AaronH83]

So the past few months I've had real issues with Novorapid. Came to a head last week, but the short of it is I was injecting, the insulin wasn't working for 2-3 hours and then I was crashing. Rang the DSN because I was literally a broken man. I felt like all control had gone from me, I was fighting a losing battle against hypers and hypos. So on Monday past I got to see her face to face, we went through everything, got bloodwork done for the first time in over a year, and she suggests changing me to Fiasp. Took my new prescription to the doctor but called in to my pharmacy on the way to tell them I needed my insulin changed and ordered in, but they had it in stock and gave me it and took the letter to the doctor's for me. Got a follow up today about the bloodwork and my HbA1C is 69 (lol), liver, kidneys and thyroid are all good, no proteins in the urine and cholesterol is a touch high but nothing too serious. I was expecting much worse to be honest. The Fiasp is working really well for me despite it only being a few days and me still working out my new ratios.

She's also referred me to take DAFNE online, and agrees that I'm a perfect candidate for a pump in that I work shifts, have irregular mealtimes and need a lot of flexibility.

I've had some great support from work too. They've been fantastic, especially my colleagues. One turned round to me and said "I don't know how you manage this job and diabetes at the same time."

 

[nonethewiser]

Fiasp is great, switched to it 2 years ago having previously used Novorapid.

Pump will bring flexibility that you can be sure of, good luck.

 

[rebrascora]

I found Fiasp challenging for the first 3 months or so after swapping from Novo(notso)Rapid. In fact I went back to NR after my first trial but then decided to give it another go and promised myself I would stick at it for a year. For the first 3 months I really struggled with it again and would have swapped back if I hadn't made that promise, but the following month I seemed to make a breakthrough and we get along better now, but it can be quirky for me and I seem to need more of it than NR.
Great that you finding it works well from the start for you. I hope that continues.

DAFNE is really worthwhile but I would encourage you to push for an in person DAFNE course if you can. You gain so much from spending a week with other Type 1s as you learn so much from each other.

 

[rebrascora]

If it's not working for you, try something else.

If this comment is aimed at me, I have discussed it with my consultant and we are both of the opinion that I am unlikely to gain anything from other brands of "fast" acting insulin as it may just be that my body is slow to absorb insuiin or resistant and I might well have to endure another 3 months of frustration trying to get along with a different one. I have come to a working compromise with Fiasp but I don't love it like I love my Levemir and it is still nowhere near "fast acting" for me. NR took 75mins prebolus at breakfast time and 30 mins at other times of the day, Fiasp takes 45mins at breakfast and 20 mins at other times unless my levels are borderline hypo and then I can inject and eat straight away. If my levels are above 8 I can wait over an hour with Fiasp and anything above 10 and I might as well be injecting water so I have to work quite hard to keep levels below 8 as much as possible to give it a fighting chance and I often need to stack corrections to get them to work. I'm OK with that now but it took time to figure it all out and be brave enough to get tough with it.

 

[helli]

I have been using Fiasp for a couple of years now
I agree with @rebrascora that it's profile does not appear consistent and takes a bit of learning. The speed at which it works is dependent on my starting blood sugars and I have to time the prebolus according to that as well as the food I am eating. If my levels are in the 4s, I need no prebolus time whereas, of they are above 8, I need to prebolus about 30 minutes before eating. And anything above 10, it appears not to work for an hour but, if I repeat the dose, I will end up stacking. I need to know to wait because after an hour by levels will plummet.
This may sound complex but it motivates me to keep my levels lower.

 

[nonethewiser]

I have been using Fiasp for a couple of years now
I agree with @rebrascora that it's profile does not appear consistent and takes a bit of learning. The speed at which it works is dependent on my starting blood sugars and I have to time the prebolus according to that as well as the food I am eating. If my levels are in the 4s, I need no prebolus time whereas, of they are above 8, I need to prebolus about 30 minutes before eating. And anything above 10, it appears not to work for an hour but, if I repeat the dose, I will end up stacking. I need to know to wait because after an hour by levels will plummet.
This may sound complex but it motivates me to keep my levels lower.

Thus it has always been helli no matter what insulin used, have to be prepared to experiment to get pre bolus timing right.

Pre bolus time has reduced since starting on fiasp, in range before breakfast it would be 25mins with novo now its 15mins, in fact even bolusing just before food has less of a spike than with novo, so win win all round in my book.

 

[helli]

The other thing I forgot to mention is I have found that Fiasp doesn't last as long out of the fridge.
After 2 weeks, it can appear to turn to water.

 

[nonethewiser]

The other thing I forgot to mention is I have found that Fiasp doesn't last as long out of the fridge.
After 2 weeks, it can appear to turn to water.

Interesting, is that in all seasons? Not noticed that tbh but one to look out for.

 

[helli]

Interesting, is that in all seasons? Not noticed that tbh but one to look out for.

It was certainly the case when I first got it. That was in February and I spent a week in Helsinki. So, it is the case in winter.

 

[everydayupsanddowns]

Sorry to hear NR gave you a hard time @AaronH83

Glad to hear Fiasp is working well for you - I tried it but it wasn’t for me.

Why can’t diabetes just leave things alone. The constant need to fix problems when things stop doing what they used to do is such a bind!

 

[Pumper_Sue]

The other thing I forgot to mention is I have found that Fiasp doesn't last as long out of the fridge.
After 2 weeks, it can appear to turn to water.

I believe this is stated in user instructions, keep in fridge unless being used. I've used Fiasp ever since bovine insulin became unavailable had a few ups and downs as we all do anyway.

 

[helli]

I believe this is stated in user instructions, keep in fridge unless being used. I've used Fiasp ever since bovine insulin became unavailable had a few ups and downs as we all do anyway.

I keep it in the fridge until I start a vial (unless I am away from home when I need to take a spare out earlier).
However, a vial lasts more 2 weeks for me - a pen cartridge can last that long.

 

[Pumper_Sue]

I keep it in the fridge until I start a vial (unless I am away from home when I need to take a spare out earlier).
However, a vial lasts more 2 weeks for me - a pen cartridge can last that long.

The vial in use needs to be kept in the fridge as well.

 

[helli]

The vial in use needs to be kept in the fridge as well.

I wish it was that easy but I need to carry a vial with me when I go out in case my pump fails.
I do not carry pens as that would be a waste of insulin cartridges. Carrying avial and a syringe (and a spare pump patch if out for longer) is much less wasteful.

Plus filling a pump from a chilled vial is not recommended because it causes bubbles when the insulin fills the pump cartridge.

I have been using Fiasp for years, understand the limitations and how to manage them with my lifestyle and pump.
I was trying to explain these to the OP and think we have got a bit distracted.

 

[nonethewiser]

The vial in use needs to be kept in the fridge as well.

Didnt know that, thought it was just like novorapid & coild be kept out of fridge for 4 weeks, expect it might see that in patient info but never read it tbh.

 

[helli]

Didnt know that, thought it was just like novorapid & coild be kept out of fridge for 4 weeks, expect it might see that in patient info but never read it tbh.

According to thr Patient Info leaflet, it can be kept out of the fridge for 4 weeks and, as I said, makes no sense to return it to the fridge if you want to ever leave the house.
The patient info says …

After first opening or if carried as a spare

You can carry your vial with you and keep it at room temperature (not above 30°C) or in a refrigerator (2°C-8°C) for up to 4 weeks (including time in a pump reservoir). Always keep the vial in the carton in order to protect from light.

My personal experience is that it does not last this long at room temperature but certainly not carrying a fridge around with me.

 

[nonethewiser]

Wouldnt like to carry fridge about either ha.

Only time had any insulin degrade is in summer obviously due to heat, so try to store in use insulin in cool place away from direct sunlight & such, otherwise it can be like injecting water.

 

[AaronH83]

Sorry to hear NR gave you a hard time @AaronH83

Glad to hear Fiasp is working well for you - I tried it but it wasn’t for me.

Why can’t diabetes just leave things alone. The constant need to fix problems when things stop doing what they used to do is such a bind!

Sorry to hear NR gave you a hard time @AaronH83

Glad to hear Fiasp is working well for you - I tried it but it wasn’t for me.

Why can’t diabetes just leave things alone. The constant need to fix problems when things stop doing what they used to do is such a bind!

I was at the stage where I was willing to try anything. I was off work all last week and I was an absolute broken man. I was sat in the house in tears because of my sugars. They were so unstable I couldn't go to work because it wouldn't be safe at all, for me or my colleagues who rely on me being ready to respond. The Fiasp genuinely seems to be working for me but I'm really looking forward to getting a pump. Sadly here in Northern Ireland it's a bit of a lottery but my team have said I'm an ideal candidate for it given the nature of my work where I really need the flexibility. I'm so so thankful for the diabetic clinic at my hospital, nothing is too much trouble with them. I'd love an in-person DAFNE course but with COVID still making things awkward I'll take whatever I can get.

Also I'm incredibly grateful to everyone on this forum too, sharing their experiences and advice, and the admin and mod team who go out of their way to keep the forum safe for everyone. Thank you all, from someone who's only been T1 for 6 years and is still learning every day.