[Steve_]

All the posts in this section seem a little old but anyway if you haven't heard there is a new type of insulin that has come out called: "Fiasp" which is short for: "Fast-acting Insulin Aspart".

It's made by Novo Nordisk. It's marketed as a faster acting version of Novolog/Novorapid. It acts roughly twice as fast. It's approved in Canada and the UK and will likely be approved by the FDA in the US in November.

In Canada it costs CAD $45 for a 10ml vial and CAD $65 for the pen.

What I've found so far in using it is that it definitely does work twice as fast as Novorapid, however there is a catch - the dosage to get the same effect is double.

So what I've been doing is continuing to use Novorapid at meal times and I only use Fiasp to bring down hypers. But it does make life a heck of a lot easier I have to say. I'm not too sure about using it at meal times, because it works too quickly, it outpaces my digestion.

It's really handy though if you're eating something you don't normally eat, because you can guess the dosage on the low side with Novorapid and if the reading starts to creep up you can bring it down really fast with Fiasp.

 

[Bounty]

In Canada it costs CAD $45 for a 10ml vial and CAD $65 for the pen.

You mean a box of 5 pens, right?

 

[Steve_]

According to the blurb, yes.

I was the first person to buy it at my local pharmacy, and my GP knew nothing about it so he wouldn't write me a prescription for it either. Not that it matters because insurance doesn't cover it anyway because it's too new.

So the pharmacist looked it up on her computer and said it was vial or pen, so I went with vials, I can't stand pens. Unfortunately Toujeo is only available in pens so now I have to put up with the damn things.

Bear in mind the marketing blurb is very misleading - I got one of my friends to buy some as well so we could compare notes and we've both noticed the dosage needs to be exactly double to get the same effect.

I'm sure that wasn't by design, cough.

God knows how much it will be in the US, my guess is $300 for a 10ml vial. And as you need twice the dosage, that puts it in the hands of only the very wealthy.

But my advice is to only use it to bring down hypers anyway. It's really useful say if you go hyper while you're asleep and wake up, or if it goes high because you had a bigger meal or something.

I do suffer from quite strong insulin resistance, but for example to bring down a hyper of 300 mg/DL I usually take around 25-30 units of it which is a ton of insulin when you haven't eaten anything.

If you use it this way you won't get through as much of it, so a vacation to Canada to buy half a dozen vials becomes realistic.

I've noticed other people on the web talking about "stacking", this happens because they haven't taken enough of it. The key piece of information is to double the dose you would take compared to Novolog.

 

[Bunjee]

Not available in the US yet, it seems. It was resubmitted to FDA at end of April. I don't see any approvals though.

 

[mbuster]

Does it also double (or worse) the risks of hypos in the event of miscalculating dosing requirement or the instance of even a slight testing error? I guess if you are following Dr. Richard Berstein's Rule of Small Numbers, the odds are more in your favor of not having as frequent or severe hypo events.

 

[Daytona]

The author of "Think Like a Pancreas" just posted a review of fiasp insulin

Review*of FiASP insulin | Integrated Diabetes Services

Most reviews I have seen have not said that the dose is double, or half as effective. I wonder if perhaps something else is going on? One person (another forum) noted that at first it worked really well, but over the period of 1-2 months found that it wasn't as effective and that they needed larger doses. I'm wondering if there's something about this insulin that some people's bodies are reacting to?

 

[MtlKnight]

Hi guys & gals, I signed up here to discuss Fiasp and other meds (and other meds) for type 1. So, Hi.

I just switched from Humalog to Fiasp today, and don't find a big difference yet.

I'm hoping to be able to use it and get my sugars lower faster, and consequently avoid the impulse to take more shots to bring it down faster. So less excursions.

My goal is mostly to lower my insulin TDD from 60 to 40. I'm 40-ish, on LCHF but not strictly, and A1C 6.2 which I think is OK. I do have high BP for which I take verapamil (not sure if it helps me in other ways, like the research says), but I also had some high cholersterol so I got a new Rx for that. I'm bordering on obese but going to work on it now. My goal for reducing TDD is to lower weight and hypo frequency, while keeping an OK-ish A1C but not being skittish about it or overzealous which usually implies more insulin but of course that's a double-edged sword. I think I may even have some IR now since my old humalog dose has been slowly increasing since I work from home now and not getting out of the house as much.

Anyway, just wanted to share my preliminary thoughts. I'm Canadian if that matters, I guess for once we're lucky that the government approved Fiasp so soon! I remember Victoza came out like a year later in Canada than it did in the States.

I plan on chiming in a few other threads about various drugs and strategies for control (mostly focusing on LCHF but other stuff too like cyclical fasting, wonderfoods, supplements, etc).

So far what I've seen from posts here are very informed so this seems like a good place to bounce some ideas around and maybe boost my numbers a bit.

 

[mbuster]

Hi MtlKnight, welcome to the forum. Hope you don't mind, but I took the liberty of copying this post and placing it in our introductory forum. You can get to it HERE. It should get you more of a chance to get your other interests addressed. I am leaving your post here also.

 

[MtlKnight]

If anyone's interested, this just came out in the news:

https://www.sciencedaily.com/releases/2017/06/170623100408.htm

As I had tried nasal inhalation of my humalog before with no ill side effects and a pleasant sensation, I figured why not try it with Fiasp too. Works fine. Took 80 IU.

If it boosts cognition while helping me lose weight too, I can't complain about that.

Here's another guy talking about it:

The Benefits of Intranasal Insulin and How to Make It Legally at Home Without a Prescription – Lostfalco.com

Sorry to go off topic. So far Fiasp seems like a good upgrade in terms of lowering sugars faster. It's already resulted in me not wanting to stack shots to bring it down faster. Apparently it also requires only 80% of the dose of humalog to get the same effect. My current goal is to lower insulin to 40 units a day without fail. Then 30, then 20, then 10. On fasting days I can certainly get by close to 15 units of fast acting already. In a few months if my endo is happy with the results he'll put me on Toujeo instead of Lantus and also let me try Invokana (they prescribe it to type 1s in a study). I'm fine with monitoring my ketones so not worried about DKA. And since I'm a guy I'm not too worried about UTIs (though I know it can happen to us too, it's just much less likely).

One thing I learned during my visit yesterday was about metformin, apparently it boosts your endogenous GLP-1 production by 25% (boosting beta cell replication and function). That I was not aware of, I thought it just reduced insulin resistance directly. Another cool thing is that it's an ancient root that the greeks used to give their diabeticos patients. Or something along those lines. I asked him to get on metformin but he said no. (for now). This endo is really the most knowledgable doc I've ever met about the various experimental drugs and is quite on top of these things. I got about a four month supply of Fiasp samples for free. Bonus!

 

[Steve_]

Most reviews I have seen have not said that the dose is double, or half as effective. I wonder if perhaps something else is going on? One person (another forum) noted that at first it worked really well, but over the period of 1-2 months found that it wasn't as effective and that they needed larger doses. I'm wondering if there's something about this insulin that some people's bodies are reacting to?

From the very first day, I had to take twice as much. Like I said, exactly twice as much. And my friend noticed the same thing. Having had discussions on other forums, people tend to "stack" it, because they take it nothing happens, then they take more and sometimes overdo it and go hypo. The basic trick to it is to take more from the outset, then you don't have the stacking effect.

Bear in mind I'm talking about bringing down hypers. I don't use it at meal times.

I'm also on Toujeo but I was taking Fiasp before I started Toujeo.

 

[Steve_]

Here's another guy talking about it:

The Benefits of Intranasal Insulin and How to Make It Legally at Home Without a Prescription – Lostfalco.com

That article looks flaky to me, nasal insulin isn't going to cure Type 1 diabetes for starters, he seems like a bit of an odd individual.

Sorry to go off topic. So far Fiasp seems like a good upgrade in terms of lowering sugars faster. It's already resulted in me not wanting to stack shots to bring it down faster. Apparently it also requires only 80% of the dose of humalog to get the same effect.

Not my experience, more like 200%, although I only use it to bring down hypers.

My current goal is to lower insulin to 40 units a day without fail. Then 30, then 20, then 10. On fasting days I can certainly get by close to 15 units of fast acting already.

Why would you fast? They always tell me never to do that because of ketoacidosis. Also dangerous if you have high BP.

In a few months if my endo is happy with the results he'll put me on Toujeo instead of Lantus and also let me try Invokana (they prescribe it to type 1s in a study). I'm fine with monitoring my ketones so not worried about DKA. And since I'm a guy I'm not too worried about UTIs (though I know it can happen to us too, it's just much less likely).

One thing I learned during my visit yesterday was about metformin, apparently it boosts your endogenous GLP-1 production by 25% (boosting beta cell replication and function). That I was not aware of, I thought it just reduced insulin resistance directly. Another cool thing is that it's an ancient root that the greeks used to give their diabeticos patients. Or something along those lines. I asked him to get on metformin but he said no. (for now). This endo is really the most knowledgable doc I've ever met about the various experimental drugs and is quite on top of these things. I got about a four month supply of Fiasp samples for free. Bonus!

Apparently in Montréal you get to see your endocrinologist on a regular basis, lucky you. Interesting about the drugs for Type 2 diabetics, never once has an endocrinologist even raised the subject with me.

My GP had never heard of Fiasp and he referred me to an endocrinologist, six month wait.

 

[Cricket]

Recently, I have been seeing some research (in the news) regarding the possibility of prescribing Metformin for Type 1 diabetics.

Metformin does not improve glycemic control in patients with long-term type 1 diabetes (T1D), but the treatment does have a role in managing cardiovascular (CV) risk in these patients, according to data from a recent international trial published in Lancet Diabetes and Endocrinology. CVD Risk Management in Type 1 Diabetes Improved With Metformin

 

[MtlKnight]

That article looks flaky to me, nasal insulin isn't going to cure Type 1 diabetes for starters, he seems like a bit of an odd individual.

Definitely a sketchy source, but that guy was doing it for kicks and the brain boosting power, so I read up on his and other experience doing it to make sure it wouldn't kill me if I tried it. I did and it didn't. The reason I went there is because of that other science link isn't the first time I've read about nasal insulin being used for type 1 diabetes. There's another study about reversing the autoimmune response to the insulin molecule, where participants inhale a precursor of insulin, pro-insulin, to "tolerize" the immune system to the insulin molecule, similar to eating tiny traces of nuts to get over an allergy or to become immune to various poisons. I spoke to the researcher about it directly and he said it might work with normal synthetic insulin too.

Not my experience, more like 200%, although I only use it to bring down hypers.

Yeah, I wanted to really test this new insulin by giving it a challenging task: I ordered a steak sub for dinner. And boy was my sugar high. I had to take like 2 shots of 30 units. Ouch. I might be in line for a hypo later but I guess I was expecting too much out this insulin. I'll have to adjust my dose, and my expectations, accordingly.

Why would you fast? They always tell me never to do that because of ketoacidosis. Also dangerous if you have high BP.

It's not really fasting, it's pseudo fasting. From Dr Longo. Idea is you eat 500-700 calories a day for seven days, with very low protein and higher complex carbs and fat, which your body takes as being effectively in starvation mode. When it does that your glycogen stores deplete and your weakest cells go into pre-programmed cell death, while your muscles and healthy cells are undamaged. This applies to your immune system too, (they use this for cancer patients, so it's legit). Then when you re-feed your IGF-1 goes back up to normal and when that happens, your internal organs (including beta cells) start rebuilding themselves. Something to do with triggering stem cells replicating or differentiating again.

In terms of DKA it's no different than monitoring your ketones on a ketogenic diet, and my levels were fine. (midrange values on ketostix)

Apparently in Montréal you get to see your endocrinologist on a regular basis, lucky you. Interesting about the drugs for Type 2 diabetics, never once has an endocrinologist even raised the subject with me.

My GP had never heard of Fiasp and he referred me to an endocrinologist, six month wait.

I had a real hard time over the years finding an endo, especially one that I liked who was up to date on the latest research and drugs, especially cross-over drugs like Victoza (GLP-1) which have been studied for the past five years or so to help type 1s. I originally got on Victoza by going to a walk-in clinic and telling them I had type 2 diabetes and my main doc was on vacation and I needed a refill. Best move I ever did, that drug is the single best drug I've ever taken, cut my sugar variance in half overnight. As well as my dose. Post-meal excursions were really slow, allowing my short-acting insulin time to work. This year I started on Trulicity which is a 1/week version. Works pretty good although I don't have private insurance any more so I can't afford it. Bummer.