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Fiasp First Try

We finally got our new Endo to prescribe us Fiasp!

For those who don’t know, Fiasp (fee-asp) is the latest and fastest mealtime insulin manufactured by Novo Nordisk available in a FlexTouch Pen or vial. It is advised that you take the same safety precautions before using Fiasp as you would any other fast-acting insulin such as Novolog or Humalog. Fiasp is considered a rapid insulin because it contains the addition of niacinamide (vitamin B3) and a formulation-stabilizing amino acid (L-Arginine). B3 increases speed of initial absorption while amino acid aids in the stabilization of the formulation.

Our First Try

She was over 300 before dinner - ideal for testing this out. No thanks to "low" binge eating in the car while I was driving after leaving the Spring Festival with a cup full of treats. I didn’t wanna give her a full pre-bolus for the snacks since she ran around so much at the playground, but I stacked her insulin as needed. We were soon on our way to pick up her Fisasp pens at Walgreens. Daddy took her for a ride on her scooter once we got home and I read through the Pamphlet before dosing her. The pen doesn’t come in half units so I’m glad we still have plenty of half-unit syringes in-stock. Poke or fingerstick value was 251mg/dL. I let the Fiasp reach room temperature as usual and calculated 1.75U of insulin on her Animas Pump remote for 18g carbs, disconnected the tube, and wasted that amount (aka "air bolused"). Dinner was Trader Joe’s chicken chow mein and orange chicken.

I filled the syringe eye-balling 1.75U (see pic) and placed it in the AutoJect (buy on Amazon), and shot her in the thigh. PACK! I massaged her real quick and sat her at the table. Within 5min, she started dropping, 237, 183. Then within 15min, she was 136⏬(see Dexcom screenshots below). Granted we had no trend arrows since this sensor has been pretty whack all week, I obviously knew she was gonna be trending down quickly. Timing and amount of insulin were on point since she didn’t go low. We waited about 15min post-prandial until Dexcom showed a ➡️ at 117mg/dL indicating that she should be stable before taking a bath. Warm water increases insulin sensitivity along with physical activity. 

I watched her Dexcom almost every 15min until she fell asleep near 10pm and almost every hour overnight up until the next morning. Yes, this mama was nervous. Despite giving her a protein shake before bed, she still continued to “Tight Rope” that low line on Dexcom so I kept her basal completely off on the pump. BOOM! She shot up past 200⬆️ around 3am, but I wasn’t trusting this sensor. I stacked her insulin little by little until she came safely back down and cruised between 80-120 before breakfast. PHEW!

FlexTouch-pen-autoject2





Visit Fiasppro.com for more info and to see if you qualify for a savings card or to request FREE samples. At this point, my Hubs and I have not found any online medical journals published on research of the new drug since it is just that. Most endocrinologists or "endo's" have just about as much access to research about Fiasp as we do. Sadly, Coral's new endo hadn't even heard of it before I requested the prescription and insisted she do her own research before writing us the script. I followed up with the endo's office with three phone calls before they finally sent the script to CVS (unavailable - on back order 'til who knows when) then, to Walgreens. Where we finally picked it up yesterday.




Will you be adding this to her pump?
We will NOT be adding this into her pump cartridge until we feel fully confident in it's effectiveness and are watchful of any short-term and/or long-term side effects. Naturally, we still want to get down the right timing of this insulin pending what her pre-meal BG is at each occasion. For now, this will strictly be for mealtimes only and I will be administering it via syringe. Furthermore, adding this to any pump would mean having to adjust ALL our basal settings. No thanks! We have quite a few.

How quick does it act?
Fiasppro.com states you can use it at the start of a meal up to within 20 minutes of eating. We saw it take affect within 10 minutes for Coral on this particular occasion. Also, depends on how active she is before administering it. Results will vary per individual and lifestyle. I would prefer NOT to bolus her with it if she's under 90 until she's had a couple bites of food that I'm certain she'll eat such as yogurt, pasta, bread, or ice cream. Basically, I told Coral, "This is the price you pay to eat what you want." It's sad, but true.

Why would you use Fiasp and not just Humalog (or any other fast-acting insulin)?
Parents of Type 1 diabetic toddlers will likely already know the answer to this question. Toddlers are picky eaters in general and want what they want exactly when and how they want it. This makes pre-bolusing for a Type 1 diabetic toddler all the more challenging because although you may want to prevent the spike in BG, you never know if they're going to eat all the carbs you bolused them for. Since Fiasp acts much quicker than any other fast-acting insulin (or at least its supposed to with said ingredients earlier), this should prevent those sharp spikes once eating or drinking anything with carbs. Learn more about the short and long-term effects and diabetes complications of constant spikes ("glucoasters") or a consistently high BG (over 200) with books like Think Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh and Ruth Roberts.

We can now allow her to eat special treats in moderation and will have plenty of practice before our vacation coming up. Timing is everything. This T1dLife requires constant planning and suppresses my once, free-willed surfer girl spirit. Please continue to do your own research beyond this blog to extend your knowledge and explore the best options for your individual needs regarding all things in managing Type 1 diabetes. Subscribe to Typeonediabtic-life.com for more T1dawarness and tips. Don’t forget to follow @type1diabetic_life on Instagram and/or @typeonediabeticlife on Facebook. Mahalo for your support. Malama pono (live well in Hawaiian).

*Note: Coral needed some Fairlife Milk with Premier Protein aka "Chocolate Protein Shake" before bed last night and I still had to keep messing with temp baslas on her pump just to keep her from dropping low (under 70mg/dL). This was most likely due to all the activity she had earlier that day - not particularly due to the Fiasp. We will know more pending how tonight and the next few days go with Fiasp. I will post an update within the next couple of weeks.

March 26, 2018 - UPDATE:

We've used Fiasp via syringe and injection to thigh as she starts to eat her meal at dinnertime and have had continued success. Meaning, no spike in BG even after eating carby foods such as bread or pasta and strawberries or yogurt (her usual favs). We also have not experienced episodes of hypoglycemia even after her bath following dinner.

May 15, 2018 - UPDATE:

We started using Fiasp in Coral's Animas One Touch Ping insulin pump a week prior to our Oahu Trip with much continued success. We will be keeping our remaining Humalog pens for backup just in case we need it for whatever reason. I only had to make a few minor adjustments to her basal time settings, but definitely changed the I:C, ISF, and BG Target setttings a by a couple digits.

Here’s what you need to ask yourself at your next Endo appt if interested in trying Fiasp so you don’t jump right into it and end up with multiple severe hypoglycemia episodes:

Fiasp Questionnaire

1. Are you still honeymooning or producing your own insulin? IF YES, STOP READING. SKIP FIASP.
2. Are you on MDI or Pumping?
3. Do you know how to time the bolus precisely (BG is between 80-180 post prandial and majority of the time)?
4. Do you know how to accurately count carbs (Total vs Net)?
5. Are you aware of the many types of sugar alcohols and how they may or may not affect BGs?
6. Do you know how to make your own basal adjustments on the pump safely?
7. Have you actually researched and absorbed the information found on Pumping Insulin (the book and generally speaking)?
8. Do you fully understand how certain carbs (simple vs complex) can have varied affects on blood sugars?
9. How fatty or fried foods can delay the body’s absorption of insulin resulting in a spike than drop in BG?
10. Are you aware of the onset and duration of various types of insulin?
11. Do you use a CGM? Watch it closely when eating new foods? Or trying new insulin?
12. Do you log all of your BGs, meals and bolus amounts, etc with an app or on paper?
13. Do you rely on your Endo to help make decisions in managing T1d or are you fully capable of self-management safely?

Other helpful links:
About Humalog and Novolog - commonly used fast-acting insulins
Read more about the different types of insulin from the Joslin Diabetes Center
Onset and duration of various insulin types available in the U.S. here.

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Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. All photos, unless specified otherwise, are the sole property of Typeonediabetic-life and may not be used or duplicated in any fashion without written consent.

Comments

  1. Great information thank you! Lots to think about when considering such a big change.

    ReplyDelete

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It is understood that each individual manages their diabetes differently. I am in no way suggesting you do as we do nor am I a doctor. Always ask your endocrinologist or diabetes educator any questions and use educated judgement for your treatment decisions.

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