If you follow social media, you’ll be aware that Novo Nordisk’s Faster Insulin Aspart (brand name Fiasp) became available earlier this year, having passed its European marketing certification. According to the Novo bumph:
Fiasp® is a mealtime insulin with a fast-acting blood sugar lowering effect. Fiasp® is a solution for injection containing insulin aspart and is used to treat diabetes mellitus in adults. Diabetes is a disease where your body does not produce enough insulin to control the level of blood sugar. Treatment with Fiasp® helps to prevent complications from your diabetes.
Fiasp® should be injected up to 2 minutes before the start of the meal, with an option to inject up to 20 minutes after starting the meal.
This medicine has its maximum effect between 1 and 3 hours after the injection and the effect lasts for 3 to 5 hours.
This medicine should normally be used in combination with intermediate-acting or long-acting insulin preparations.
This medicine can also be used for continuous infusion in a pump system.
Taking this in context, what Novo are saying is that it is considerably quicker than Novorapid (also insulin Aspart), which states:
NovoRapid® is a modern insulin (insulin analogue) with a rapid–acting effect. Modern insulin products are improved versions of human insulin.
NovoRapid® is used to reduce the high blood sugar level in adults, adolescents and children aged 1 year and above with diabetes mellitus (diabetes). Diabetes is a disease where your body does not produce enough insulin to control the level of your blood sugar. Treatment with NovoRapid® helps to prevent complications from your diabetes.
NovoRapid® will start to lower your blood sugar 10–20 minutes after you inject it, a maximum effect occurs between 1 and 3 hours after the injection and the effect lasts for 3–5 hours. Due to this short action NovoRapid® should normally be taken in combination with intermediate–acting or long–acting insulin preparations. Moreover NovoRapid® can be used for continuous infusion in a pump system.
Both of these are taken from the Patient Information leaflet provided with the insulins, and suggest that Fiasp should be pretty rapid and alleviate post-prandial spikes.
I managed to get hold of some on Friday, and decided that it was only right to put it to the test.
Given that this is supposed to be effective with a much shorter pre-bolus than Novorapid, the first test to be undertaken was Fiasp v Krispy Kreme. 47g carbs taking on 4.7u of insulin.
And yes, I did get the date wrong. That vial was opened on the 24th, not the 25th. I was perhaps a little overexcited! Anyway, with a ten minute pre-bolus, the rather tasty Lotus Krispy Kreme was consumed and I monitored glucose levels afterwards. Starting at 7.1 mmol/l, it peaked at 9.3 mmol/l for about 15 minutes, before returning to 7.3 mmol/l within three hours:
This seems to be very much in line with the claims, and my previous experience with previous Krispy Kreme was that I needed at least 30 mins of pre-bolus with Novorapid in order to get similar results.
So far, so good. Following this I then ate another one (I know!!), this time with twenty minute pre-bolus. The results were rather different, as my glucose levels barely rose, and I was hypo after about 90 minutes. I suspect that there was interaction between the two doses of Fiasp, but I certainly didn’t expect to go low like that. Further investigation is definitely needed.
Really, I shouldn’t have just jumped in with assumption, and instead should have done the sensible thing, testing ISF and DIA of the insulin, so today, I decided to do this. The results are shown below:
This suggests that the first thing I need to do is recheck my basals as I appeared to be dropping when I gave that 1u. It appears that there is then around 20-30 mins where very little happen, before the downward slope starts, which comes to a fairly abrupt end some 75 mins after the bolus. There is then a flat section, before I see a slight uptick in momentum, suggesting that the insulin is mostly done. I’m slightly dubious about these results, as they seem to indicate a very short life (and it is still apart after all) and a fairly sharp kick in. I could understand the faster start, but the lifespan doesn’t appear reasonable. As a result, I’ll be testing this again.
So how is it living up to the marketing that Novo have provided. Well so far, it seems to be living up to it, in as much as the action I’ve seen does seem to get started fairly fast.
There are one or two questions for me though.
- Does the tail vary by dose size? I get the impression that the larger doses required for dealing with carby food really last longer than the one unit test did. Especially when the cross over into a second bolus for Krispy Kreme seemed to really go low. It was an unexpected stacking effect. One to watch I think.
- It doesn’t always have an instant effect on glucose when taken with food. I’ve tried the unannounced cake test with coincident bolus, and I can safely say that the jump that resulted immediately afterwards was rather higher than anticipated. It started to come down again a bit sooner, but simultaneous eating and dosing where large carbs are eaten doesn’t stop a post-prandial high.
There are still plenty of tests required to determine what this stuff is really like and transpose that into the looping algorithms. I need to undertake further tests on DIA for example, and if possible in larger doses. As more people are explicitly using it we’ll gain a better knowledge base of behaviour, which is a little sparse at the moment.
But the biggest question, by far, is is it truly Faster? Well my initial cautious response to that is, yes. It seems to be.
But how do you get hold of it? Well…..
To get hold of it, I tried speaking to my DSN, Consultant, GP, etc. No-one could prescribe FIAsp as they had to wait for it to arrive on the formulary. My consultant said that if I could get it, then she would be very interested in the results.
However, harking back to blog post I made, the UK listing of these things isn’t by brand name but by insulin name, and this may be branded FIAsp but it is still insulin aspart.
I went to see my friendly pharmacist with whom I’d already been discussing this and we worked our way through the PIP codes to find the one that was in her system. She agreed to put a note on my account saying that when they received a prescription to order insulin aspart, they would order the FIAsp PIP code.
I then spoke to my GP and got them to change from penfills to phials,explaining why I was doing so. They were happy to support it as long as my consultant was, and were happy for me to confirm that.
The prescription for Insulin Aspart vials was issued on Thursday night. It went to my pharmacy on Friday morning. They ordered it and it was in by 3pm. Job Done.
No-one had to do anything they couldn’t, but it took a bit of me linking things together and taking advantage of the way the system works.