New to forum - eye related concerns

[DAVEFALVEY]

Just joined. Diabetic specialist nurse has asked me to switch to Fiasp from Novorapid. Was just about to shoot up and read on package leaflet info "Eye disorder-Fast improvements in BS control may lead to a temporary worsening of diabetic eye disorder such as diabetic retinopathy." Do I have to worry or is it ok to continue with Fiasco.? I have diabetic retinopathy and have had 4 detached retinas/repairs and on waiting list for oil to be drained. 62 and type one diabetic since 24. Also changing today from Levemir to Tresiba

 

[rebrascora]

Just joined. Diabetic specialist nurse has asked me to switch to Fiasp from Novorapid. Was just about to shoot up and read on package leaflet info "Eye disorder-Fast improvements in BS control may lead to a temporary worsening of diabetic eye disorder such as diabetic retinopathy." Do I have to worry or is it ok to continue with Fiasco.? I have diabetic retinopathy and have had 4 detached retinas/repairs and on waiting list for oil to be drained. 62 and type one diabetic since 24. Also changing today from Levemir to Tresiba

Hi and welcome to the forum.
Sorry to hear you have had problems with retinopathy. I have to be honest and say that I didn't read the Patient Information Leaflet before I started any of my insulins (naughty I know! 😱 ) so wasn't aware of that warning. I personally don't find Fiasp that fast acting so it hasn't made my levels more volatile and in fact they are now more stable, BUT Fiasp did take A LOT of getting used to and it is quite different to NovoRapid for me. I would describe it as being a bit quirky and others have experienced similar issues to me with it. It took me 2 x 3month frustrating trials with Fiasp before I found ways to make it work for me and I was quite relieved to go back to NR in between, but the second time I eventually cracked it and what I found was that in order for it to work well, I had to very proactively keep my levels below 10mmols because once they got into double figures, Fiasp just seemed to turn to water and I have to stack corrections which is risky and frowned upon, to bring me back down, but if I can keep between 4 and 8 most of the time, it works really well for me and I don't regret the change but it was not easy or straightforward for me.

I would very strongly advise against changing both insulins at the same time or even within 3 months of each other. Levemir and Tresiba are very different in their activity profile and NR and Fiasp are also quite different in how they work. I would not want to try to make sense of things if they were both changed.

Why are they suggesting you change both insulins? What issues are you experiencing?
Personally I absolutely love Levemir but you have to understand how to adjust it to your body's needs. Do you take it once a day or twice a day, usually morning and evening and if so, are your doses split evenly between the two or according to what your body needs.
I should also say that there are some people who absolutely love Tresiba and the important thing is knowing how to use each one to get the best from it and how well it suits your body and lifestyle.

Who is supporting you with your diabetes management? Is it a nurse at your GP surgery or a DSN (very highly trained Diabetes Specialist Nurse) or consultant at a hospital clinic?

I wonder if a ember of Admin could move your post and any replies to it's own thread as it may not get enough specific attention here tagged onto a thread about pumps.

 

[Anna DUK]

Just joined. Diabetic specialist nurse has asked me to switch to Fiasp from Novorapid. Was just about to shoot up and read on package leaflet info "Eye disorder-Fast improvements in BS control may lead to a temporary worsening of diabetic eye disorder such as diabetic retinopathy." Do I have to worry or is it ok to continue with Fiasco.? I have diabetic retinopathy and have had 4 detached retinas/repairs and on waiting list for oil to be drained. 62 and type one diabetic since 24. Also changing today from Levemir to Tresiba

Hi @DAVEFALVEY, these are understandable concerns. It is known that if blood sugar results (from a HbA1c) drop rapidly (i.e., a drastic reduction in a short period of time) can cause retinopathy. It might be worth calling our helpline, who although are not medically trained, can offer more information and support on this. See top of the forum for the number.

 

[nonethewiser]

Just joined. Diabetic specialist nurse has asked me to switch to Fiasp from Novorapid. Was just about to shoot up and read on package leaflet info "Eye disorder-Fast improvements in BS control may lead to a temporary worsening of diabetic eye disorder such as diabetic retinopathy." Do I have to worry or is it ok to continue with Fiasco.? I have diabetic retinopathy and have had 4 detached retinas/repairs and on waiting list for oil to be drained. 62 and type one diabetic since 24. Also changing today from Levemir to Tresiba

That just a general warning about sudden tightening of bg control making diabetic complications worse in the short term, nothing to do with fiasp itself, as any tightening of control no matter what insulin is used could result in same.

Switched to fiasp from novorapid about 4 years back, like it as it works slightly faster than novo but doesn't hang around as long from own experience. Prior to pump was using lantus insulin as basal, once tried levemir but just didn't get on with it at all.

Would recommend you speak with your diabetes team regards to your concerns.

 

[Proud to be erratic]

Hello @DAVEFALVEY, welcome to the Forum.

Personally I would absolutely NOT change both bolus and basal insulins at the same time. I wonder if your DSN really meant change to Fiasp from NR in due course (or is just barking mad?). Since your basal change to Tresiba is happening now - and I am a huge fan of this particular insulin - I fully agree with @rebrascora in suggesting wait until you are settled and happy with Tresiba before changing your bolus.

I note you have been T1 for nearly 40 years and have so much more experience than I do. Did your DSN give you much guidance about Tresiba? It is very different to Levermir in that it's profile is c. 40 hrs duration, so yesterday's dose is being topped up by today's dose. This makes it very inflexible (in many people's minds) and you certainly can't just tweak your Tresiba and hope or expect to get a consequence in a few hours time. But, in my mind/opinion that is the strength and beauty of Tresiba.

You will already understand that our basal needs vary across a 24 hr period. So you set your Tresiba up to give you stability through the long fasting period only and use your normal techniques of exercise/activity in conjunction with meals and bolus to manage whatever each day needs. It doesn't matter what your Tresiba is bringing to the day, it is whatever it is and you just manage each day accordingly.

If my nights are not a succession of late and riotous parties, with hugely varied activity, [those dream days have long gone!] I can get extremely level overnight graphs from my CGM and can depend on that night after night. I do need to adjust my doses between 7.5u in summer and up to 9 in winter. Incidentally I was on 14u of Levermir before I moved to Tresiba and was told to start at 12u - which quickly needed bringing down to 10u and I tweaked it further down once I'd recognised that necessity. I have half unit pens (NovoEcho 6).

 

[everydayupsanddowns]

Welcome to the forum @DAVEFALVEY

There’s a research paper which goes into some detail about the phenomenon

Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review - PMC

Worsening of diabetic retinopathy (DR) is associated with the initiation of effective treatment of glycaemia in some patients with diabetes. It has been associated with risk factors such as poor blood‐glucose control and hypertension, and it ...

www.ncbi.nlm.nih.gov

As I understand it, it seems to be associated with a rapid and significant improvement in glucose management, after long-term elevated BG levels.