# 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 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 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 wish I'd known how aggressively it works up front.
4 Pump 4 days Yes Action time 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 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 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 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 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 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 Overall I’m impressed with Fiasp and think it’s a great step forward from Humalog.
Reduce active insulin to around 2.5 hours.
12 Pump 3 weeks Yes Action time need 20% more insulin. acts fast. less of a tail. still fair enough.
?
13 Pump 1 week Yes Action time 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 The action time is noticeably faster than with Novorapid, so there is no room for delays between bolusing and eating.
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 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 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.
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
Interested in hearing if others have more bubbles in there pump tubing with FIASP?
18 Pump week Yes Action time Changed from animal insulin so trial and plenty of error has been the name of the game.
Nothing really as I had read plenty of blogs/reports from other people before I started.
19 Pump 3 months Yes Insulin Tail 1.Not as much tail as novo rapid. It does kick in more quickly, bringing a high down faster.
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
Using in a 6 year
Check check
21 Hybrid Closed Loop 1 month Yes Action time Prebolus time is best at 0-8 minutes for me. 10-15 is to long, resulting in lows during or right after the meal.
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.
22 MDI 1week No Action time 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 I have previously used APIDRA and couldn't get spikes after eating under control, even if I injected half an hour before meals.
Anecdotal evidence is always useful but in true diabetes fashion the experience appears different for everyone.
24 Pump 3 months Yes Action time 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 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 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.
27 Hybrid Closed Loop 2 months Action time No prebolus required - in fact, now we don't prebolus until he sits down to eat. On Humalog, he would bolus while the meal was being prepared. Doing so now causes an almost immediate low. Corrections are fast. Highs, when they do occur, crest quickly. For a child who wants to eat when he's hungry and often wants seconds this is nothing short of a miracle.
Basal rates increased across the board, probably 20% or more over Humalog. ISF is more aggressive. Modify pump rates <1 hour before you want to see a change.Fiasp plus Open APS has improved my son's life considerably. I plan to drive to Canada every six months to stock up until it is available here.
We started using it following a family vacation to Canada, when we bought 3 vials to experiment, and then came back to an erratic summer schedule. I'd recommend (for a child, at least) working with Fiasp when life is as steady and routine as possible (ha). Also expect to need much more insulin and don't freak out that these are new rates and ratios that would be comical on the previous insulin. Don't make any decisions without using it for at least a month.
28 Pump 5 month Yes Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) I have 2 children with diabetes type 1 (using 640g and cgm) and have done a data study. I have these findings (without any adjustment):
1) Fiasp have helped on hyperglycaemia - the higest blodsugar values was cut off.
Adjustment
My conclusion is that my children are better of with Fiasp than Rapid after the adjustment.
I have more visual results to be shared.
I don't understand this question. My children continues using Fiasp.
29 Pump 2 months - now stopped Yes Action time Hi Tim,
I used it for a couple of months and gave up. Results were random - random highs, random lows, and generally unpredictable results. I thought it was necessary to change canula more frequently. Overnight was random and I just felt out of control. The tail end was interesting - I often spiked!
The response time was better and it helped prevent spikes. Maybe it would work well to have Fiasp for bolus and something else for basal.
It did help me though - now back on Apidra it has helped focus on the things that are wrong, but for me I don't think I will be going back to Fiasp.
That it is unpredictable, particularly at tail end.
30 Hybrid Closed Loop 7/1/17 Yes Unexpected results after bolusing I did very well on Fiasp until I switched to the Loop model that used DCA. Then I seemed to have a lot of problems day & night. I lowered my basal rates and also decreased the number of of my meal bolus, increasing my insulin all around. That seems to have solved the problems at least temporarily. My next step will be to go back on Novolog and see how that works.
Things may change and you may require more insulin as you develop an .immunity" to Fiasp.
31 Hybrid Closed Loop 3 weeks Yes Hypoglycaemia I am noticing that anytime I eat and bolus I am rising at a very steady pace, even with precise carb counting. Autotune thinks my rates are correct.
I also have been having a lot of severe bottom out lows when I finally come down from those highs. I also have perfect flat lines overnight and whenver carbs are not involved.
Worth noting that I also take Metformin
How difficult it would be
32 Pump 1.5 month Yes Action time I use the Freestyle Libre, not CGM.
I suddenly had problems at night with unexpected rises th could not be explained. This didn't occur every night but sometimes so difficult to find a pattern when I needed to change my basal.
I also noticed that the insulin seemed to be working better while at home doing nothing but as soon as I did something else, bg rose and was very hard to lower.
I also had a lot of problems starting up Fiasp where I had to change just about everything, basal, carb ratio, acting time. This evened out after a while and I was at the end back to the same levels as I had with Humalog.
I am now back with Humalog again atleast temporarily because it seemed impossible to get it working as it should again.
That it will require so much timing in. I started at a very bad time for me and I really didn't have the time for all the work it took to start it up, it took a lot of energy and testing to tune it in.
33 Hybrid Closed Loop 2 months Yes Action time No more than 5 minutes pre-bolusing required for meals if in range pre-meal. Brings down a carb caused high or a stress caused high nice and fast, but struggles with protein caused highs.
Overall reduced basals but increased boluses compared to humalog. Timings of basal didn't significantly change. DIA changed from 4 with humalog to 5 with fiasp.
Stinging happened on bolusing for the first few weeks but then reduced to nothing.
Get it set up on prescription early as any delays in getting a refill will make you realise how much you value Fiasp when you have to temporarily return to slower insulin!!
34 Pump 8 weeks Yes Action time Initially action time seemed markedly shorter. I needed to adjust well-known dose strategies for food, reducing the time between bolus and eating and using dual wave/combo bolus where I would have expected 'all up front' to work well.
Rather strangely I initially saw greater spikes after food than I would have expected with NovoRapid so had to alter meal ratios.
After about 2-3 weeks I noted a change in insulin sensitivity and needed to adjust basal pattern, meal ratios and correction factors again.
Breakfast was particularly challenging and needed substantially more insulin than identical breakfasts would have with NovoRapid (I always eat the same thing to make things easier).
Between weeks 4-5 I thought I was making progress and seeing some promise. This lasted approximately 10 days, before sensitivity changed again and I was seeing more sustained high blood glucose with little effect of significant correction boluses (2-3u) within 1-2 hours.
Earlier rapid action had also pretty much disappeared by this point. I was needing to pre-bolus in just the same way I would for NovoRapid, I no longer needed the additional dual/square wave boluses to slow the insulin down for some foods and corrections were taking at least 1-1.5 hours to begin to affect CGM trace. Meal doses were also behaving unpredictably such that I felt I could only reliably use Fiasp while wearing CGM (which I can oly afford to fund occasionally) so that I could catch the raging highs from standard meal/bolus pairings that were intermittently failing.
I reverted to NovoRapid and have had significantly fewer hypos and post meal spikes since, with much more reliable action.
How unreliably it would act for me, and how the faster action would disappear after a few weeks alongside increasing insulin resistance. I see no need to try it again.
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36 MDI Five months Yes Action time It certainly kicks in faster and harder than Novorapid.
I've found myself with increasing insulin resistance and have had to increase my dose by 30%.
It's not predictably effective when correcting highs. Sometimes it seems to work very quickly and sometimes it takes forever. Novorapid was consistently slow.
That it very quickly made me more resistant to insulin and that it needs a much shorter pre-bolus time. It's not much faster to correct high blood sugar usually.
37 Pump 4 months Yes Action time 38 MDI 10 Sometimes Action time yes
yes
39 Pump Of and on for a few weeks Yes Action time I found Fiasp to cause pain when it was delivered via my pump.
?
40 Pump Of and on for a few weeks Yes Action time I found Fiasp to cause pain when it was delivered via my pump.
?
41 Pump did 9-10 weeks Yes Action time I used FIAsp for around 10 weeks.
Initial responses : predicted fast action didn't really happen only some slight drop, up to 1 mmol, occasionally.
My general health is often not good but in the summer sun usually ok, Tiredness can be a major problem.
Symptoms of other diseases have become worse/developed. Whether this would have happened anyway I don't know, it is unlikely. Asthma remains difficult.
Realised around 6 weeks in that it may well be that FIAsp was not ok for me but didn't want it to be; I ignored it and ploughed on.
Site sore, 3 or 4 red marks still on my arm caused by irritation.
Prior to using FIAsp I had no problems with attaching or removing pods. Post FIAsp the first pod I used caused several layers of skin to come off with the adhesive, this was very sore, left two dark red shiny patches. These are still slowly regrowing skin and a litlle sore. This has never happened before.
As yet I have not discussed this with my GP or clinic.
T1D, asthma + unspecified autoimmune disease(s)
That allergy and insulin resistance are likely to occur.
42 Pump 3 months Sometimes Action time No need to pre-bolus, and require less insulin for carbohydrates eaten as the insulin seems to act more effectively.
Did my research, but I’d advise not trying to change anything too quickly. Only change one thing at a time and give yourself a few days to adjust to changes before considering changing anything else.
43 Hybrid Closed Loop 2 months Yes Action time In short, I often have to "chase" his, my basal rates are higher than Humalog, and, in general, resistance seems to not be getting better after 2 months.
I began openaps using Fiasp. I wish I had started with Humalog so that I could compare.
44 Pump 5 months Yes Action time First experiences of Fiasp were very positive, fast action so cut out spikes with high GI carbs. Shorter DIA and better ISF (less insulin for bolus). HOWEVER, by 3rd reservoir, MAJOR site problems started. Big red bumps, significant stinging on blousing. Poor insulin absorption from inflamed sites. Problem got worse so inflammation and pain within 4-6 hours of putting in a new set. Decided to try to acclimate myself to the Vitamin B3 by mixing Fiasp with Humalog. Started with 1:4 which alleviated site problems and seemed to work almost as quick as pure Fiasp. Now using 1:1 Fiap:Humalog. Still some site inflammation on day 2 of site and some stinging but absorption usually OK. Sites sometimes degrade a bit on 2nd night.
About site problems.
45 Pump 2 weeks Yes Other things worth considering Painful, I could not take it :(
As above.
46 Hybrid Closed Loop 1 week Yes Action time After 1 week I've learned that it hurts with bigger boluses sometimes. After one week we have noticed higher insulin resistence on sixth and seventh day.
Have not stopped yet
47 Hybrid Closed Loop 1.5 weeks Yes Hypoglycaemia Increase in glycemic variability with current settings (more unexplained lows and highs). Faster insulin onset. Starting day 3 on site, significant decrease (~20%) in overall sensitivity that returned to normal on same site with Novorapid reservoir.
It does not act as expected (requires setting adjustments), and may be much less stable than Novorapid (2-3 day site changes required).
48 Hybrid Closed Loop 2 weeks Yes Action time I'm using Fiasp in my 670g and I'm really liking it.
I can tell it works faster at mealtime boluses and (rare) corrections for high. I can also "graze" on low-medium snack meals without going out of range.
But I do notice I tend to get more painful pump sites after 2 days, whereas I went 3-4 days with Apidra.
How accessible it is outside of U.S. Buying Fiasp in Canada was the easiest experience I ever had buying insulin. No insurance or prescription nonsense.
49 Pump Three months Yes Unexpected results after bolusing It’s pretty unpredictable
Won’t
50 MDI 5 months Yes Action time Initially Fiasp proved true to it;s claim to have a much reduced absorption rate, this was reflected in the onset peaks shown in Xdrip+ via LibreAlarm. However at the 5 month mark, the fast onset seems to have disappeared and has actually become markedly worse that traditional rapid insulin such as Humalog/Apidra. I've also found that my insulin:carb ratio's have almost doubled.
Nothing other than understanding why the reaction has become so poor and why it has changed my carb ratio.
51 Hybrid Closed Loop 8 months Yes Action time Initially the results were very good. There was a gradual creep of high blood glucose - needing increased basal rates and I:C ratios.
Random sustained high days - ‘Fiasp as water’ phenomenon.
I had some improvement switching to a N:F mix of 1:0.8 but this seems to be less effective as time goes on.
All of the above.
52 Pump 3 months Yes Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) No advise given. I was told it was going to be a case of just trying different things. My insulin requirements did increase. I have found that I do not have any of the spikes that I had when using Novorapid.
Probably that insulin requirements would increase.
53 MDI 1 week Yes Action time yes its fast, but I feel I need more after eating. have been very stable 0 despite a mad lifestyle on Novarapid for the last 10 years, T1 for 30 year.. Monitoring with Freestyle Libre. very big highs and unexplained lows. Going to stick with MDI nova rapid and use MDI FIASP when perhaps i need a quick hit for a strange meal or hadn't pre bolused.
not much - happy to experiment
54 Pump 3 months Yes Action time Occlusions subcutaneous. Infusion site scaring. Takes weeks to dissipate slight reaction. Bleeding upon removal of infusion set. Shorter insulin active time required 2x insulin use per month due to increased bolus/basal amounts. More hypoglycemia incidents initially. Weaker tail action.
Weaker tail and shorter action time.
55 Pump 6 months Yes Action time My experience with Fiasp has been excellent. Not a single problem or issue. My HBA1c was 6.6% on Novorapid. On Fiasp, it is now 6.0%!
I have had no occlusion problems, no infusion site problems or even any suspected problems.
My 2 hour post meal BGs are running 6 to 8 mmol, compared to 8 to 10 mmol on Novorapid.
Count me as 100% satisfied with Fiasp.
NA
56 Pump 3 months Yes Action time When starting, I experienced a lot of hypos. I had been told to swap dosages like for like (previously on Humalog) but this clearly wasn't correct. I have reduced everything - ratios, basal rates and correction doses. My blood sugars are much more stable and I don't experience the post-eating spikes anymore.
To try reducing my doses straight off to avoid hypos.
57 Pump 1 week Yes Action time Hello I switched from using Humalog in my pump for over 15 years to Fiasp. I am a lean 155lb man who is 6’1. I noticed that Fiasp is much more potent than humalog for me. I’ve had to lower my basal rates by 15% and my ISF which was 4.3 (77) with humalog is now 7.5 with Fiasp (133). It also will lower my blood sugar very quickly (will drop me from 10 to 6 in 1.5 hours). I have found it to be occasionally even more potent with the odd time that it will drop my bgs even more than the typical 7.5 ISF. My carb ratios are not quite nailed down but it looks as though there is a similar 15% increase in them like my basal.
It acts so quickly for me that I can rarely take a straight bolus anymore without going hypo. I have to take dual waves and square waves just so the insulin doesn’t hit me hard before the carbs do. There has definitely been a learning curve to the bolusing but I think overall it will be good. I am considering starting to loop with it as I think that might be an even better solution.
I wish I had known that even though most reviews state it is a 1:1 switch between other fast acting meal time insulin’s that for some it can be much more potent. I also wish I knew that the bolusing would need a drastic change due to the speed.
58 Pump 2 months No Action time When I had high glucose levels, fiasp oftentimes showed no effect over several hours.
During nights I needed more Insulin than on NovoRapid.
Moreover I had many unexplained lows and had to change the infusion set way more often.
Information on Hypos
59 Pump 2 months Sometimes Action time The faster action time was great but my infusion sites were a lot "red-er" than normal and I experienced a lot of skin irritation all over my body. And there were times when it just didn't seem to work.
I thought it was going to be a straight swap for novorapid but the costs of faster action time outweighed the benefits and I decided to go back to novorapid.
That it is not a straight swap for novorapid.
60 Pump Since June 2017. Initially on MDI until i moved to the omnipod in December Yes Action time So far it has been excellent. It has minimized spikes and it way easier to correct highs.
Nothing - it was exactly as I hoped and my dosing didn't change.
61 Pump 10 weeks No Other things worth considering Yes, thank you for the opportunity. I am a type 1 so far for 63 years. I began using the new Fiasp insulin about ten weeks ago in my insulin pump. I have recently ordered another 3 month supply from a Canadian pharm. that offers not only the availability but at prices that are far less than I could find here in the USA.
Initially, for the first 3 or 4 weeks, the Fiasp seemed to be working fine, with a just slightly faster onset than Novolog, my previous insulin for 17 years.
I have had to increase my basal rates to cover higher blood glucose reading
Not sure that I will continue with Fiasp or revert back Novolog. I suspect that there may be some insulin resistance going on here with the Fiasp.
I would like to hear from other about their experience using Fiasp. If I need to change, I would like to take action ASAP.
Be Well, Brian
See above
62 Pump 6 months Yes Unexpected results after bolusing I started using Fiasp in my pod just over 6 months ago and initially loved the speed at which it worked. Then gradually I had to keep increasing the amount of insulin I needed to keep in range. Then after about 4 months I noticed that sometimes it acted rapidly and on other occasions it didn't, definately unpredictable. This month my doses have increased again - on a 40%+ basal and still not the results I want
I wish that I had a better idea of its unpredictability. I have been a Type 1 for 42yrs & this is the first time that an insulin has not lived up to it's expectations.
A warning before I started on it would be helpful. I thought that I must be doing something wrong for months and I resent how that had made me feel
63 Pump 6 months Yes Unexpected results after bolusing I started using Fiasp in my pod just over 6 months ago and initially loved the speed at which it worked. Then gradually I had to keep increasing the amount of insulin I needed to keep in range. Then after about 4 months I noticed that sometimes it acted rapidly and on other occasions it didn't, definately unpredictable. This month my doses have increased again - on a 40%+ basal and still not the results I want
I wish that I had a better idea of its unpredictability. I have been a Type 1 for 42yrs & this is the first time that an insulin has not lived up to it's expectations.
A warning before I started on it would be helpful. I thought that I must be doing something wrong for months and I resent how that had made me feel
64 Pump 5 days No Action time Past five days using FIAsp. I’d love to share my perspective on the new formulation and how I have adjusted to its action.
Because FIAsp shaves off the “meal peak,” I needed to reduce my basil rate and decrease the insulin carb ratio. In addition, my insulin sensitivity is higher, but not by that much (e.g., 1 unit of FIAsp will reduce my BG by 117 points in 2 hours). And, I can confirm that it remains “active” between 3 to 4 hours.
During exercise, I don’t seem to need as many carbs to boost my BG (about 15 to 20 grams compared to 30 or 40 carbs with Novolog) if I start within range. Yet, I still need to eat or drink something, especially if I bolused 2 or 3 hours earlier. But, if I start exercising with my blood sugar > 160, then I’m okay to start without carbing up and it stays steady afterward.
That timing is everything.
65 Pump 3 weeks No Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) Fiasp worked well in my pump for approximately one day. It appears that the stability decreases the with each additional day in the pump until by day 3 it does not appear to be working at all or very little. I have now been taking injections of Fiasp ac meals and to bring down highs but use Novolog in my pump for basal insulin. I have wondered if it loses stability when exposed to air or the fact that the insulin is no longer contained in a glass vial has something to do with the possible decrease in stability.
I am still using it.
66 Pump Four months Sometimes Action time In short: When it worked, it was much faster than novorapid, but it didn't work consistently enough so I couldn't rely on it.
I wouldn't start if I had known how unreliable it was and how many people seem to have found the same. Would have liked to have been told that I would probably need to change basals.
67 Pump 2 Weeks Yes Action time Replaced Novolog with Fiasp approximately 2 weeks ago, have had a great experience. Have not noticed any worse irritation than Novolog (which is already more painful than humalog). Infrequently, I notice sudden spikes in blood sugar, but it doesn't seem to be significantly worse than Novolog (will compare reports once I've been on Fiasp for 1 month). There has been no need to change either carb ratio or bolus, and I haven't seen any decrease of effectiveness towards the end of reservoir (possibly this is temperature related? It is still <70 DEGF here).Due to aggressive treatment, I prebolus 99% of meals by 20 mins with Novolog. This frequently leads to risky situations when schedule changes, food isn't ready on time, restaurant has a long wait etc. Having Fiasp has changed my treatment entirely, as I am now able to bolus while starting the meal. Additionally, I can treat any highs that occur quickly and return to <120 much faster than with Novolog.For background: Medtronic 670G, A1C 5.2%, T1D 10.5 years
I plan to remain on Fiasp (even though it is not FDA approved in USA), unless I start experiencing significant complications.
68 Pump 10 months Yes Action time fiasp seems to be instable compared to novorapid. it seems to break into monomers fast, these seem to polymerise soon(?). as a result my steel cannulas suffer from occlusion very early. with more flexible non-steel cannulas there is almost no problem even on 72+h of c-age.
a nasty effect of such an occlusion can be that the occlusion will often be broken by higher pressure in the infusion set (without even triggering an occlusion alarm). it goes like this: your cannula gets stuck yet unnoticed by you. all you see is a climbing bg (for no reason at all). you now give a small bolus to correct but nothing happens since the cannula is still stuck with fiasp. the hydraulic pressure inside your infusion set is rising. after a while or after another small bolus the pressure in your infusion set breaks the occlusion and a whole lot of insulin (of which you thought it had arrived already) is released into your body. as a result the bg, which was climbing despite of all the corrections you did, falls rapidly now. this effect might be related the some users experience with freak effects and unexpected hypos with fiasp.
the occluding effect of fiasp can easily be reproduced: if you fill a single-use steel needle syringe (normally used by me as a backup device) with fiasp and another one with novorapid, you will find out that the fiasp needle has a massive occlusion within hours, while this effect does not appear with novorapid.
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to me fiasp is a lot less effective than novorapid. i seem to need 30% more insulin on basals and boluses. on a fallback to novorapid for two weeks, i reduced the amount of insulin correspondingly and came out with almost the same result as with 130% fiasp before.
of course fiasp was doing the job much faster than novorapid and it seems to have a lesser insulin tail. that is why i cling to it. but i guess a more strict low-carb-diet would allow me to go back to novorapid without worsening my therapeutical perfomance.
at the moment the good effects of using fiasp equal these sideeffects as long as i use non-steel-cannulas. but i will most likely get back to novorapid for the lesser insulin consumption and the much cheaper steel cannulas.
that it is less effective and tends to occlusions with 24G steel cannulas.
(i really destoyed one pump with bolusing against an occluded cannula. i disconnected the infusion set from the cannula and discovered a free-flow. after reconnecting and bolusing the pump's dc motor broke the pump's casing by hydraulic pressure. that was no fun at all.)
69 Pump 6months Yes Action time Much faster action time- reducing pre bolus from 25mins to 5mins
be aware of potential site deterioration after 2days
70 Pump 7 months Yes Action time At first Fiasp seemed great. I adjusted the duration of insulin action in my pump settings (from 4 hours to 3.5) for more accurate calculations of the "tail", and I used a lot more combo boluses for dinner (where I eat a ton of veggies as well as ~60g of carbs) to spread half my bolus over about 1.50-2 hours depending on the food. In general, I cut my pre-bolus time down by about half for most meals.
As warned by my doctor, it often does sting a bit on bolusing, but I can live with that. After a few months, though, I'm finding that I need to change pump sites more often (some make it less than 2 days) and some meals seem to require more insulin than I expect. In particular, after dinner even if I'm confident in my carb counting I will find that my bg goes up to 8-10 mmol/L and just sits there for a few hours, despite me watching my Dexcom and taking anywhere from 1-3 units that I'm pretty sure I didn't need. At first I blamed the new variability on hormones (I'm a 40 year old woman and had been pregnant or nursing for several years until, coincidentally, shortly after starting Fiasp) but reading about other people's experiences, now I'm not so sure.
I really liked the faster onset and felt like with the help of my Dexcom I could really fine tune things to keep my BG where I wanted it... but now it feels like things have gone off the rails and I never am quite sure what to expect. I switched back to Apidra last night and am going to give that a couple weeks and see if it's just me or if it was the Fiasp.
Just knowing that it works well for some people and seemingly not others would be helpful.
71 MDI 2 days Yes Action time At dinner it lasted about hrs before big started to rise. Using same dose as humalog. Injecting at start of meal. 2 correction doses so far have not produced good results. Over 1 hour to see any change, and then not a good drop. Don't have to worry about hypos I guess that's the good thing
Too soo your tell.
72 Pump 30 days Yes Action time Whenevr exercising after taking bolus and food had to reduce bolus amount by 30%.Need to pre bolus before meals from 20 min.to 5 Exercise consists 2_5 HR fell races.
How to get it prescribed sooner!
73 Pump 6 months Yes Insulin Tail Postprandial spikes are a lot easier to control. 10-15 mmol/l on Novorapid, with Fiasp I can stay below 10-12 mmol/l when bolussing right before a meal.
Basal and bolus rates increased by about 20% (0.4U/hour to 0.5U/hour and from 10g/U to 8g/U)
Less hypoglycaemic events 3 to 5 hours after bolussing when compared to Novorapid.
On occasion I can't seem to be able to get back into range after correcting for hyperglycaemia.
Redness after site changes, feeling small lumps below the skin as well. Sometimes bolussing can be a bit painful. Site issues disappear when changing every 2 days (instead of 3).
Known problems related to painful sites. Increased basal/bolus rates.
74 Uv14tm0CE Artciles like this make life so much simpler.
Artciles like this make life so much simpler.
75 Pump 4 months Yes Action time -Fiasp has a shorter action time. I had to change the action time in the pump from 4 hours to 3 hours.
That I had to been aware of the insulin sensitivity and carb ratio changes, as well as a shorter action time. I was told about the irritation problems by my doctor, so I was prepared for that.
76 Pump ~ 2 months Yes Action time Initially I found FIASP to be faster acting (as advertised) and that it lowered my blood sugars quit a bit more during exercise than did Humalog. I liked the idea of bolusing when I started eating a meal - as opposed to waiting 20-30 minutes. I made only minor adjustments to the timing of my dawn effect basal rates (pushing the onset times back half an hour), but kept my ISF, I:C ratio, and DIA the same as I had with Humalog. After about two weeks of use, I began experiencing unexplained hyperglycemia. That is when I began a web search and discovered that this has been reported by others. Based on recommendations of others, I tried switching my injection speed from high to low on my Animas pump and changed pump cartridges and insets every two days. This reduced the number of hyperglycemia episodes - but did not eliminate them. When my pump was set at high rate of infusion, I thought the reason for these episodes might be that the inset might be leaking insulin at the injection site. With the lower injection rate, I’m not so sure anymore what is causing the problem. All I know is that I need to replace the inset (and not necessarily the cartridge) to get my BS back under control. I also get the red marks at infusion sites.
Bottom line: I’ve decided to go back to Humalog due the questionable reliability I find with using FIASP in my pump.
Increased risk of hyperglycemia and inset failure in using FIASP with an insulin pump.
77 Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) Email subscription
Email subscription
78 Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) doi:10.1038/protex.2015.007
doi:10.1038/protex.2015.007
79 Changes required on pump (e.g. basal rates, ISF, DIA, I:C Ratio) 1982-2014 CSRC.2015.007
1982-2014 CSRC.2015.007
80 Pump 3 months Yes Action time I started using Fiasp at the end of Feb 2018 (I’m in the U.S.) and immediately loved it. I am on a 670G MiniMed closed loop. It’s off label to use Fiasp but my doctor was all for it. Things were wonderful. I was barely needing to pre bolus for meals because it was getting in my blood stream so quickly. On Tuesday this week (writing this on a Friday) it all came to a sudden hault for absolutely no reason. I cannot get Fiasp (tried three diff vials) to bring my blood sugar down into range (with a auto mode pump, manual mode pump, OR syringe) of course I changed my site and tubing. Just at a loss here. Even my doctor was confused
That sudden insulin resistance was a concern
81 Pump About 14 months Yes Action time The first week my son was on Fiasp was amazing with the smoothest trend lines we had ever seen. Over time, his basal needs increased noticeably, and I found that it took longer and more insulin to bring him down from a high, but it was worth it given that we no longer having to pre-bolus by at least 15 minutes before eating breakfast (though we would still pre-bolus by about 5 minutes). However, after about a year, my son started developing insulin resistance. After first dismissing it as being due to warmer weather, then growth hormones, I decided to take him off Fiasp in case he was resistant to the Fiasp, which is something I had heard other people report happen. We then put him back on Novorapid which seemed to help a bit, but he was still running high and we were back to post-meal spikes. After two doctors visits, we found out he had had a non-symptomatic strep-throat infection. After a course of antibiotics, his levels improved. We started mixing Fiasp and Novorapid. The results have been good...but his levels are not as good as they were before we started having the insulin resistance. I plan to put him back on pure Fiasp as a trial to see if it will work better for us or if his levels will go up again.
1) You will likely need more basal insulin after a few weeks.
2) You will need more insulin to bring down highs.
3) Some people appear to develop insulin resistance to it after a few months of use.
4) Some people report that it "burns" them at their infusion sites.
5) When you first use it, you may feel low even when you are not low.
6) A lot of people find mixing Fiasp with fast-acting insulin gives them better results than using just Fiasp or fast-acting insulin.
7) You may still need to pre-bolus by a few minutes (but less than you would with just fast-acting insulin).
8) People who don't have resistance to Fiasp love it and appear to have significantly smoother blood-sugar levels around meal time.
82 Pump 3 months Yes Action time Using openaps with smb, no manual changes required for fiasp other than the insulin curve setting. Still working great, hoping we don't hit resistance. A1c lowered by about 0.4.
Not everyone has issues, at least within 3 months...
83 Pump 6 months Yes Action time I switched from Humolog to FIASP in spring of 2018. I've seen a 12% increase in my 'in range' period and have had less low blood sugars during and post exercise with FIASP (using temp basal). I love it.
It's still not perfect, there are still days where blood sugars don't make any logical sense.
84 Pump one month Yes Unexpected results after bolusing Unexplained hyperglycaemic events postprandial - high fasting sugars which do not readily respond to correction doses.
issues around hyperglycaemia and the question over whether it is suitable for pump use.
85 Pump 4 months Yes Insulin Tail I decided to switch to Fiasp as my job as a critical care RN does not allow me to pre-bolus before meals.
I have been disappointed with the Fiasp. For one, though my BG does not spike as fast immediately after eating, I experience frequent delayed 2-3 arrow up spikes. These are not explained by incorrect bolusing, as this happens with commercial/known carb content foods.
Second, whether I take a correction bolus or not for the unexplained high, I frequently experience a 3 arrow down periods after the highs, oftentimes having to take fast-acting carb to pull out of the tailspin.
I also am having more reddened/infiltrated sites.
Having read that I am not alone in my experience, I plan to go back to Ol' Reliable aspart.
Thanks for doing this!
Lisa Hill RN BSN ACCN
86 Pump 3 months Yes Action time Faster and with less tail. I had big overshoot after the breakfast, they are lower now
The doctor did not tell me about lowering the IOB factor in the pump (the time that the insulin remains active)
87 MDI 8 months No Action time I've been using Fiasp since April (8 months) on MDI and for the first three weeks it was an absolute dream. My blood glucose levels were perfect. Then the spikes started - random and completely uncontrollable. I am struggling in particular when I get a hyperglycaemic episode - the higher I go, the less it seems to work. If my blood glucose is around 15 mmol/l or higher, it is like injecting water, although it works just fine when my BG is in range. As an extra kick in the teeth, sometimes when I give myself a correction dose - I get HIGHER QUICKER. No idea what's up with this but it happens a lot. I still experience a lot of hypo's and I thought Fiasp would make these easier to avoid (as there's less active insulin still in my system). It seems not. Hypo's got worse in the summer with the heat speeding up my insulin absorption which completely messed up my studies as I was treating hypo's rather than working. I'm thinking of switching back to Novorapid.
I was happy to try it out but I would have liked to have been informed to inject AFTER meals in summer heatwaves. Would have saved me a lot of hypo headaches.
88 Pump 2 months Yes Unexpected results after bolusing I am also experiencing a ton of occlusion alarms on my pump. Usually, I just hit resume insulin and finish the remainder of the bolus and I’m okay. But usually around the 2 day or 2.5 day mark I get unexplained highs as if my basal stopped working, and then I have to change the set prematurely. The occulusion alarms really only happen when I try to give bolus. This is a very predictable regime I have using FIASP in the t:slim x2. It’s really annoying, but at the same time I’m not sure if it’s enough for me to switch back to Novolog or Humalog. My body reacts to insulin VERY VERY VERY slowly. FIASP takes about 1.5 hours to peak for me and continues working for 4. Novolog/Humalog/Apidra takes at least 2-2.5 hours to peak for me and works for 6+. I think I would still spend more time high on the other insulin’s than I do with FIASP, just from the spikes and whatnot. I am overall very frustrated and discouraged that it seems we have to pick from the “best cons” for our insulin experience.
I was using afrezza before I started the pump/FIASP. I loved afrezza in every way, but for other reasons I simply had to start a pump. My endo told me nothing about problems with FIASP in pump, I assumed it would be okay. Only after a while of these patterns and confusion did I go online and find everything out. I just wish I was told that there could most likely be complications like this. I probably would still have opted to use Fiasp due to my concerns with other insulins, but it would have been nice to know beforehand.
89 Pump 2 months Yes Action time I can't express enough how much I LOVE this product. Not only has my time-in-range increased, but general inflammation in my body has changed. For the 1st time since I was diagnosed 6 years ago, I feel amazing! I can control my blood sugar with ease. My brain fog has diminished. Let me give you some insight... I am a 46 year old female. I weigh 130 pounds and I run marathons. My insurance had forced me to use Humalog. Holy smokes, my blood sugar would increase and increase and increase then come crashing down. The roller coaster was mentally defeating. I was constantly babysitting this disease and all of my devices. Now I bolus and I'm done. Blood sugar is handled. I go on with my life. In 2017, my rings suddenly didn't fit. Nothing had changed... running the same amount, still eating healthy. I was tested for RA and it came back negative. Since using Fiasp for 2 months, I probably need to get my rings sized down and diabetes is finally a side note to my life--- it doesn't run it anymore. This is probably the best I'll feel until there's a cure! I might be in the minority, but this product is amazing!
That I could have started it sooner than November 2018.
90 Pump 14 days and now 2 days Yes Other things worth considering 12 months ago I tried Fiasp in my pump, but didn't feel well. I didn't think about the feeling before I check the net to figure out what others felt. Dizzy, like I had "hangover".
Yesterday, I started testing Fiasp outside the pump, just running bolus (Novorapid) in the pump, but I got the same feeling after 45 min.
Last night I brought my BGL up to 14 just to test another 2 units of Fiasp.
I cannot remember any redness or pump issues last time.
The feeling that you can get from using it
91 Pump 60 days Yes Action time I used two consecutive 10mL bottles provided by my endo recommended I try FIASP. The absorption for boluses was very fast action action resulting in reduced Postprandial hyperglycemia (highs after eating) and the ensuing BG reduction occurring rapidly as well.
I did not see a need to change basal rates other than when exercising. The basal changes were similar to Novolog changes I used for exercise for more than 30 minutes. I did not experience a reduction in my A1C score dueing this time-frame, nor did I experience any irritation with pump sites. (Omni POD)
When I used injections for unexplained high blood sugar reading after this 60-day period, the reduction in blood sugar (glucose) was in minutes rather then hours. This alone tell me the FDA needs to approve Fiasp ASAP for pumping.
I think a the way I approached it was fine. I would encourage people not to wait if/when they can afford it. I beleive the additional cost to be worth it.
92 MDI 2 weeks Yes Action time Started taking fiasp to stop highs after meals. I was previously on humalog and my long acting is a split dose of Levimer. Initially fiasp was working great, bloods dropped really quickly so no post meal highs. The last 7-10 days it doesn’t seem to be working all the time. The last 3 days I’ve had to give myself up to 3 injections on fiasp after meals before my blood starts to lower and have not had hypos as a result which makes me think it’s just not working sometimes.
More detail on how long it works in the body for and any experience people have with it not working at all.
93 Pump 4 months Yes Action time I was on Humalog. I changed to Fiasp because of the faster duration of action. My experience with Fiasp is very positive. When changing my Medtronic 670 pump fro Humalog to Fiasp I adjusted: basal adjust to act 1 hour (vs 2 hours prior with Humalog), i adjusted my Duration of Insulin Action to 2 hours 45 minutes with Fiasp (vs 3 hrs 45 minutes Humalog), my bolus calculations remIn unchanged. With Fiasp I now use Dual Wave for high carb meals more often than with Humalog. When doing this particularly at my dinner bolus, I bolus the same amount as with Humalog, but with Fiasp I square wave about 20% of the bolus over one hour. I do The is because Fiasp seems to have a significantly shorter Duration of Insulin Action (DIA) time from Humalog. I am also using the Dexcom G6 now. My A1c is on target to be the best in years. Fiasp and Dexcom 6 are wonderful. I do not get burning from Fiasp. I change my site every 3 days like clockwork.
Adjust basal to act one hour before impact vs two hours with Humalog. Fiasp does not burn for me. If it burns so what? Diabetes hurts so much worse.
94 Pump 5 weeks Yes Insulin Tail post-postprandial is much better but experiencing more hyperglycemia episodes overall. Fixed one problem but opened up a larger one.
Potential for hyper events. And seems to use more insulin than when on Humalog.