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?
Fiasp
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.
Secondly:
Afrezza
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.
Faster Pussycat…
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!
Hi there I am an MDI/FGM user and had tried Fiasp as I travel with work with all the timing/carb counting issues which go with eating in a strange twon/restaurant/pub…
After my initial enthusiasm i found that the speed of onset was up to about 40 minutes plus so the recommendation to take it as you eat/after you eat did not work for me, and in fact has led to a number of hypers (none dangerous but my HbA1c has drifted up over the same period). It was super rapid on the tail and i sometimes got caught out here needing sugar before the hypo hit. Have now asked to go back to Novorapid – will see if this is me being less attentive or (as I suspect) an impact of the insulin.
It seems fab in pumps/loops and I hope others on MDI are doing well on it as the promise is great!
Dave
Thankyou Tim. I find the contrast between drug companies push to research, produce and market high-fast acting insulins whilst in places like USA people cannot even afford basic insulins at times. They suffer from having to ration it, are deprived of other essentials through crippling financial circumstances and some of them die.
And insulin companies seem to have been slow to actually market cheaper insulins and to ensure they are distributed widely enough to be accessible.
If more research money went into production of affordable insulin, and research money was not found accessed by these companies by price gouging lives unnecessary loss of life could be prevented and suffering eased.
As we eagerly look at these new insulin treatments we have to realise the two-faced nature of these manufacturers and morally be prepared to call them on their duplicity.
Nor unfortunately can be be sure that these same companies will not use the BREXIT situation in some way to enrich themselves at diabetics’ expense, financially and physically.
And here in Oz we are a long distance out from the source of insulin manufacturing and supply which has the potential to leave us vulnerable to market forces from rapacious drug companies in future.
I don’t think there’s any disagreement on the points about lack of access. The key thing is that it doesn’t take R&D to produce cheaper insulin. It simply takes a decision by a company that has been annually ramping up the cost of an insulin that is 23 years old not to do so and to bring the costs down. Lilly have released their “generic lispro” in the US which is exactly the same as Humalog, without the brand name and still it costs dramatically more than other parts of the world.
Unfortunately we’re not really consumers with insulin and can’t boycott the high prices where they occur, so it needs government intervention to stop the rapaciousness.