User experiences of Fiasp

The below table shows the details from various users of Fiasp that have shared their experiences of the new insulin to make it easier for those who are about to start using it to understand it in the real world.

Experiences with Fiasp
Entries
26
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# How is your insulin delivered? How long have you been using Faster Insulin Aspart? Are you using CGM while using Fiasp? Please select what your FIasp experience relates to? (You can select multiple responses) Please provide your experience with Fiasp. Provide as much detail as you can so that those coming along later can understand what happened, what you changed and what to watch out for. If you were to start using Fiasp again, what do you wish you'd known before starting?
1
Hybrid Closed Loop
1.5 weeks
Yes
Action time
Insulin Tail
Hypoglycaemia
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Fiasp takes effect for me within 20mins of bolusing.

It seems to have a shorter effective tail.

My hypo symptoms seem to be starting earlier, but this may be temporary.

I've noticed that insulin stacking can create extra sensitivity.

I adjusted my DIA to two hours due to the changes in action, but other settings are the same.

The main thing to watch out for is the speed of action. I've noticed that it is very consistent in taking effect after 20 mins, so given the time it takes for food absorption to start, I rarely bolus more than ten minutes prior to eating .

I wish that I'd known that the effective tail is quite short.

2
Hybrid Closed Loop
1 week
Yes
Action time

Great experience. Starts fast. Do not prebolus under any condition.

Pretty straightforward.

3
Hybrid Closed Loop
8 days
Yes
Action time
Insulin Tail
Hypoglycaemia
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

I've noticed the quicker action (which is expected). I did have one meal where food did not absorb quickly enough and was seriously considering giving glucagon since my blood sugars dropped below 1.1mmol/L. Because I have gastroparesis, I now wait until my blood sugars start to rise a bit after eating and then bolus, and because Fiasp is so quick, I still don't peak at a crazy high blood sugar (which is kind of nice).
I've had to drop back my DIA with the Fiasp compared to Novorapid. Novorapid I had at 4.5hrs and I tried Fiasp at 4, but have just dropped it again to 3.5hrs.

I wish I'd known how aggressively it works up front.

4
Pump
4 days 
Yes
Action time
Other things worth considering

Works faster, works more effectively at high bg levels (less insulin resistance at higher bg levels).

Less insulin resistance at higher levels.

5
Hybrid Closed Loop
8 days
Yes
Action time
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

We use Fiasp with Loop with our 11 year old son. We adjusted our bolus time to 0-8 minutes before a meal (novorapid was 10-20 minutes pre-meal), depending on current BG, trend, and meal. We have also done minor adjustments to ISF. We have found a significant reduction in post meal spikes and also a nice response to Loop's high temp basals (due to the faster action time of Fiasp). We continue to monitor and make adjustments as necessary. We did not have issues with lows because we anticipated the faster action time and adjusted for it. It's certainly a new, very useful tool to have in the diabetes tool box and like any diabetes tool requires careful monitoring and caution while learning how it works for you.

I had researched and done plenty of reading on Fiasp so felt prepared, and had no surprises, so nothing really.

6
Pump
A week
Yes
Action time
Hypoglycaemia
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Have shortened action time to 2 hours but need to do proper ISF test. Think might need to change I/C ratio from roughly 1/4 units to 1/5 or 6. Am using extended bolus's much more. Have had a couple of unrecognised bad lows, symptoms slightly different. My targets = 3.9 to 7.5 of which I usually achieve around 50%, this week's has been 63% which is better, less highs but more lows. Work to be done!

Reduce bolus units by 10% to start, increase basal for dawn phenomenon. Check ISF, I/ C ratios fairly soon after starting. Carry fast acting fudge, juice for those hypos.

7
Pump
3.5 weeks
Yes
Action time
Insulin Tail
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

Action time is brilliant. But does not help in morning after breakfast - well, it did a bit, but I only tried on one occasion. I dealt with it by giving myself a correction bolus on waking and a third of my dose for b/fast, then showering, then doing the rest of the dose just before breakfast. That works.

I have come to the conclusion that if your blood sugar is very high - it does not like it. And does not work particularly effectively.

Moreover, after removing the cannula after 3 days (I always do 3 days as micro-scarring occurs after 24 hours, not visible, but there, so don't take chances, been diabetic for 46 years so have to be careful of sites) the place was sore, a little red lump.

I have had to change every 48 hours - the sites are still red and a little sore and still a lump. The sites are still visible, every single one I have used though the lumps do go down. That worries me.

I am continuing use as it is fabulous for control as long as blood sugars are kept under control.

Not sure what to think, to be honest.

I am still using it.

8
Hybrid Closed Loop
3-4 weeks
Yes
Unexpected results after bolusing

Over the last week of use i have been eating and bolusing as normal for breakfast. It appears that FIAsp doesn't appear to work and my sugar levels spike (typically would be increase from 5.0 to 9.5) - am seeing the insulin having almost no effect and peaking over 15.0 before it appears to work. Significant enough effect to consider changing back to Humalog.

Nothing to add

9
Hybrid Closed Loop
2 weeks
Yes
Action time
Insulin Tail
Hypoglycaemia
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

Action time is ~15mins faster than Humalog, great for bolusing during/end of meal. Really cuts down on post meal spikes.

Using Loop Hybrid closed loop with medtronic pump. Tried setting shorter DIA of 3.5 and 3.75 (from 4hrs with humalog) but kept going Hypoglycemic from insulin stacking.

From what I can tell DIA is similar to humalog at 4hrs but insulin starts working quicker. Will try again once Loop is updated with better/multiple insulin DIA curves which include FIASP.

Expect total DIA to be similar to current fast acting insulin, only with a quicker onset. Expect more Hypo's. Did not use long enough to encounter medium/long term effects.

10
MDI
14 Days
Yes
Action time
Insulin Tail
Hypoglycaemia

Works much better than Lispro. Less Insulin Doses (ca. 3/4). Shorter "Injekt-Eat-Distance" (20 to 45 minutes). Shorter Duration of Action (ca. 4 instad 5 hrs.). Since using Fiasp no numbers obove 11 and under 3 mg/dl. So far no problems or abnormalities.

All fine, nothing 🙂

11
Pump
5 days
Yes
Action time
Insulin Tail

Overall I’m impressed with Fiasp and think it’s a great step forward from Humalog.
Post meal highs are much lower and general BG profile flatter.
Mentally its taking some getting used to - being a 7 an hour after a meal with 6 units of insulin on board screams impending hypo to me. But it just flatlines then returns to around 6 (when I get it right!).
I bolus as I eat and that seems to work quickly enough to avoid any post meal high.
I’ve reduced active insulin time to 2.5 hours and that seems to be working – the tail is noticeably shorter than Humalog.
Breakfast is an issue. It seems much less effective then. I’ve increased my carb/insulin ratio in a morning which has helped and am also taking a super-bolus with breakfast (bolus the following hour’s basal rate with the meal, then run a 0% temp basal for an hour). That is really helping.
I’ve experienced no irritation at the site after 3 days of use, although for the first time ever I can feel a bolus going in- its a very mild itching sensation that stops as soon as the bolus ends.

Reduce active insulin to around 2.5 hours.
You might need to tweak your approach for breakfast - it seems less effective then.

12
Pump
3 weeks
Yes
Action time
Insulin Tail
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

need 20% more insulin. acts fast. less of a tail. still fair enough.

?

13
Pump
1 week
Yes
Action time
Insulin Tail
Hypoglycaemia

We switched from Humalog to Fiasp. After reading the publications about Fiasp I did not expect very much. However our experience has been a very positive one!

It is now much easier to bolus for a carb-rich breakfast. If the starting BG is good, it is enough to bolus parts of the total insulin needed as we lay the table and the rest while we eat. The spikes are much lower, but also the drop later on is much softer. This causes much less temptation to overcorrect and we have had fewer hypos after bolusing for a large meal.

On the negative side, the tail is notably longer than with Humalog. But since the drop is softer, it is very easy to handle. We now turn off basal completely for 2 hours after bolusing for a larger meal. I imagine the longer tail may become a challenge with many smaller meals throughout the day, but we have not tried that yet.

We did not have to make significant changes to basals or carb ratios coming from Humalog.

Nothing, the change was not a problem at all

14
Pump
8 weeks
Yes
Action time
Insulin Tail
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

The action time is noticeably faster than with Novorapid, so there is no room for delays between bolusing and eating.
The tail is similar to that with Novorapid, on AGP or CGM it looks like BMs are stable but I'm still experiencing unexpected lows up to 4 hours after bolusing appropriately. I have increased my basal rates on the pump by 0.05 each hour as I was experiencing higher than normal BMs from 01:00-14:00hrs and have reduced the basal by 0.05 from 15:00-21:00 in view of the lows. My carb ratios have also been adjusted from 1unit:10grams to 1unit:12-15grs depending on time of day.
So far I haven't had any illness to confound results but with menses glycaemic control has been easier to maintain.

I'm still using it and will be for the foreseeable future. It would have been useful if my hospital consultant had known as much about it as I did as I spent much of the appointment discussing potential benefits of FIASP over Novorapid and it wasn't so much a consultation as a teaching session...

15
Pump
6 weeks
Yes
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Stability overnight has deteriorated. Gone from flat lines overnight to unpredictable substantial falls in glucose overnight which persist despite alterations in basal rate. I:C ratio during the day also adjusted to make ratio slightly more aggressive. Onset time is better and offsets pp peaks but not sure this trade off is worth the less stable basal overnight.. .

If on a pump it make take over a month to stabilise insulin settings and it may make basal insulin and glucose overnight less predictable but this is based on n=1.

16
MDI
6 weeks
Sometimes
Action time
Insulin Tail
Hypoglycaemia

Helped reduce number of post prandial spikes. I did find an increased incidence of hypos but i feel the overall better control was worth it. Didn't find i beeded to change carb ratios.

Stock up on your hypo treatments!

17
Pump
4months
Sometimes
Action time
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

I found the first week things were really stable without any changes to pump hand outs then all of a sudden I started to have lots of lows and had to back off my basal rate at night while lowering my carb ratio at meals.
I have been using 3 hours as the insulin action time and it seems pretty good.
I do not eat a lot a sweets but have found that bolusing right before or during the beginning of a meal works really well in regards to post meal BG excursions. but I find if I bolus after eating it doesn't work as well and this was not tested simple carbs rather a well rounded meal.

That setting may change over time and its not quite as fast as the claims are but better than the other insulin out there. Mind you I have only used Humalog
Rates on a pump may have to drop.

Interested in hearing if others have more bubbles in there pump tubing with FIASP?

18
Pump
week
Yes
Action time
Hypoglycaemia
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Changed from animal insulin so trial and plenty of error has been the name of the game.
So far taken 10.2 units off of my basal carb ratio has changed from 1-10 to 1 - 13 and profile much smoother.
Very frustrating to use because as soon a one section fixed another needs adjusting.
May I apply for sainthood?

Nothing really as I had read plenty of blogs/reports from other people before I started.

19
Pump
3 months
Yes
Insulin Tail
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

1.Not as much tail as novo rapid. It does kick in more quickly, bringing a high down faster.
2. Required more fiasp in both basal and bolus, I:C, ISF than when we used Apidra.
3. Over the 3 months, increasing irritation at the site for pump inset. At first just red irritation that was a small spot, then noticed skin where site had been located (only for 3 days) remained red, irritated for a long time after site was changed. Finally quit using Fiasp when started to get a large red, swollen area around the site after 2-3 use in that spot.
4. Over the 3 months, started to get spikes in high BG, which we wondered might be attributable to less absorption when by day 2 of a new site skin was becoming irritated.
5. Was very disappointed as had hoped we could use it.
6. Went back to Apidra, which also lacks the long tail of novorapid.

We will not, due to skin irritation.

20
Hybrid Closed Loop
3 months 
Yes
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Badal rates neeeded to be upped pretty much across the board. Carb ratios increased (less insulin). Much quicker to
Come down from highs- DO NOT STACK THIS INSULIN or you will crash!

Using in a 6 year
Old for what it's worth!

Check check
Check all settings!

21
Hybrid Closed Loop
1 month
Yes
Action time
Hypoglycaemia
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

Prebolus time is best at 0-8 minutes for me. 10-15 is to long, resulting in lows during or right after the meal.
Basal rates have needed slight increase. (Avg 15%)
Must change pump sites more often. Sure-Ts every 1.5-2 days, Mios every 2.5-3 days.
Skin can become irritated quickly if I wait too long to change site, and insulin absorption gets way slower if I don't change promptly.
I have found that I need to change my reservoir out every 3-3.5 days.
I've been experiencing light headedness and feeling faint and dizzy when moving to standing position. So I've been checking my blood pressure at least once a day for a week. I normally have blood pressure in the 100s/60s range, but this week it's been in the 90s/50s range. I even had one reading of 89/56. This is pretty low, and I definitely feel it. I think it could be caused by the Vit.B3 in the Fiasp (since it's related to niacin). Nothing else has changed in my life or health to explain the lower blood pressure. I plan to discuss it with my endo and request a lipid panel as well, since my cholesterol and triglycerides are usually pretty low too, and B3 can lower those as well.

The faster onset sometimes means that you don't have enough insulin left to cover slower digesting meals. This has been more of a challenge than I expected.
Be aware of any blood pressure changes you may experience (esp. for children).

22
MDI
1week
No
Action time
Insulin Tail

Action time appears faster than humalog that I was using. Tails off quicker so adjustments for slow absorption required.

.

23
Pump
4 days
Sometimes
Action time
Insulin Tail

I have previously used APIDRA and couldn't get spikes after eating under control, even if I injected half an hour before meals.
I have found since using FIASP that I can generally get post-prandial CBG's less than 10mmol/L but on occasions have had hypos shortly after eating.
I am now injecting no more than 10 minutes before eating and so far so good.
It's still very early days so I haven't made any adjustments to basal rates, ISF, or carb ratios yet.

Anecdotal evidence is always useful but in true diabetes fashion the experience appears different for everyone.
I had already done a fair bit of research before switching and so I don't think there is anything I wish I'd known before starting

24
Pump
3 months
Yes
Action time
Insulin Tail
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

I use a Vibe + Dexcom and in May switched from Humalog to Fiasp. From the start, I found it very aggressive with a super-quick action (less need to prebolus and much faster response to corrections) but a shorter tail (need for longer extended boluses). I also had to reduce my I:C ratio from 1:8/1:9 to 1:9/1:10. Unfortunately by the third cartridge, I was starteing to experience SEVERE site issues. Big red bumps were appearing within a few hours of site change and there was painful stinging on bolusing. Also, obvious site absorption issues appeared (CGM showing upward trend overnight and not responding to corrections - not attributable to evening meal). I have always had to change on a 2-day rotation, but with Fiasp it was not possible to make sites work even when changing sets daily.

Because site sensitivity issues have been reported previously and supposedly improve with time, I tried desensitising myself by pumping a premixed "home-brew" of Humalog + Fiasp, starting at a 4:1 ratio. This has worked well and I have now managed to get to a 1:1 ratio with only occasional site issues towards the end of day 2. My impression is that the 1:1 mix shows the same aggressive onset and short tail as does 100% Fiasp. I assume that the Niacin (vitamin B3) added as the accelerant has the same effect on the Humalog in the mix.

I have been able to set my I:C ratios back to the same as for 100% Fiasp. I now almost always extend meal boluses even for fairly high GI meals and extend longer for pizza/pasta etc (50% over 3 hours) which seems to deal with the 4-hour rise. Have had to increase my basals by ~10% particularly on the overnight rates. I don't eat low carb and now suspect that I have perhaps been "covering" part of my basal requirements with the "tail" from my boluses.

It would have been nice to have known about the site issues - I might have started out on a mix from the outset.

25
Pump
3 weeks
No
Action time
Insulin Tail
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)

Novorapid and Apidra both took usually about 45-60 minutes to show any drop if bg sitting fairly level. Testing with a steady starting level of 10 one morning a correction and bolus for 30g carbs with Fiasp showed a 3 mmol drop within 15 minutes, continuing to fall after eating cereal before coming back to a level of 6 after an hour. Previously it would have taken a minimum of 45 minutes to see a starting drop. With pasta and rice dishes I have had to reduce the up front amount and extend the rest for a longer period to maintain steady levels - rice now 8 hours instead of 6 and pasta 3.5 instead of 2.5. Basal levels have increased by about 10% which is actually meaning I'm getting closer to the 50/50 ratio the consultant would prefer to see. On novo and Apidra I would often spike into the teens 2 hours after eating, particularly at lunchtime but would be back to normal and still dropping by 4 hours later without correction. Fiasp is showing levels generally back to starting levels at 2 hours and no drop over the next 2 hours. Hypos have reduced as have levels above my 4-8 target. Past 2 weeks showing 80% results in target, 10% above and 10% hypo which is usually 3.6-3.9 so pretty safe, with average at 6.4, standard deviation 1.7. Previously it usually would have been about 2/3 on target, 10% hypo (wider variation) and about 1/4 above target. Average bg around 7.5 standard deviation a bit over 2.

I read others' experiences before starting so increased basal by 10% and dropped breakfast and lunch boluses by 10%. Trial and error showed I needed to switch boluses back to normal.

26
Pump
1 Month
Yes
Action time
Insulin Tail
Unexpected results after bolusing
Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio)
Other things worth considering

Fiasp is fast, but effective time is shorter than novorapid. I need to change set more often. basal + 20%.

There need to be done more changes than was expected. Not just bolusing.



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