As we saw in a session at the EASD 2019 Conference, there are some interesting advances coming (or already here) in the realm of Ultra-Rapid insulins, and some of these can be used within existing closed loop solutions. Others (such as Afrezza above) can’t be used in a closed loop but can be used alongside it.
This short series of articles looks at these options and how they can, or do, interact with a closed loop?
To start with, I’ve previously used Fiasp, and that has been widely written about, however, I also encountered issues with it. When it works it’s great, but for me I had to give up. As Dana says “I’ve gone two years without having to bolus”, which shows the power of Ultra-Rapids in closed loops. I’ll not cover this one again due to my previous attempts with it.
Instead, I’ll focus on a couple of others. Firstly:
Ultra Rapid Lispro
A formulation of Lispro (Humalog in it’s normal form, from Lilly), that has additional excipients that make it faster absorbing. The Phase III clinical trial data that has been produced looks incredibly promising, so we’ll take a deeper dig into what that looks like, and why it will be even more interesting than Fiasp in a closed loop.
I’ve been gifted a decent amount of Afrezza by a friend and I often see questions on the Looped facebook group that ask how you use this inhaled insulin with one of the existing solutions. The plan is to use the stash that I’ve been given alongside OpenAPS to see what’s the best way for me (and perhaps others) to use it in tandem with the algorithm.
I’ve been titrating the dosage over the last week or so, based on the advice provided in another presentation given at EASD, and will provide feedback on how I use the two in combination, and the outcomes that results in. Let’s just say that, based on the last time I used it, and the titration so far, it’s not always as straightforward as it might seem.
In answer to a member of the audience in one of the presentations relating to Ultra Rapid Lispro (URLi):
“Why would you bother with URLi over an existing rapid insulin of Fiasp, if cost isn’t in play?”
Because it makes life so much easier when you don’t have to plan, and even easier if you don’t have to do anything when you eat…
Hopefully the forthcoming articles will back up this statement and provide a conducive response to this question!