After 30+ years with T1D Humalog was taking up to 2 hours to work, so I switched to a combo of FIASP and Humalog. The FIASP worked great, started working within minutes. Then, after about a month, it stopped working totally. It was like injecting water. I am (unhappily) back on Humalog (injecting about an hour before meal, a real pain and not always manageable). I am hoping the FIASP will start working again after a while of being off it - if it does, I plan to use it only in situations where my BG has already gone high or I canāt plan a meal in advance. Hoping this way it will keep working for me (if it starts working again!). Has anyone else had this experience with FIASP? Any solutions?
Hi @BarryS Barry welcome to TypeOneNation. Solutions? Just maybe a really obvious one- how faithful have you been in rotating your injection sites? If I had to guess all the way from āJerseyā¦ Iād say scar tissue. Itās possible you have some intermittent insulin resistanceā¦ or maybe not so intermittent if itās all the time now, what does your endo have to say? Cheers good luck.
Hi Joe
Thanks. And yes, I always rotate the injection sites (good idea though!).
For the last 6 months I have also kept a record of where I inject (legs, stomach, etc.) each time so I could compare how quickly the insulin hits. Used to be that injecting in my stomach was generally faster than my legs, but that is no longer the case.
My endo hasnāt said anything except to recommend I go back on the Humalog, which I had already done. He also concluded general (intermittent) insulin resistance as a result of 30+ years of being T1D.
I am in the process of getting my first pump (a Tandem) which was going to use the FIASP, but now ā¦ Hopefully the Humalog will work out - I have yet to get the pump or training on it, but hopefully in a month or so it will all be done.
Thanks again for your response
Barry
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@BarryS A final thought, well, for nowā¦ Have someone you trust shoot you someplace brand new, like the back of your arm. Just poking around for ideas. Pardon the puns.
Hi Barry @BarryS, U know what you are saying when you think that Humalog isnāt kicking-in quickly enough after using it for a while; I began using Humalog the month it was approved bu US FDA - April 1996. I test-drove FIASP for a while and found it too erratic for my body, so beak to Humalog - I also used Novolog for about 10 years.
Even after using Humalog for so long I thought it didnāt kick-in quickly until I began using a CGM - watching the CGM I see it begins working within 10 minutes. Perhaps when you start on your Tandem pump and get your basal rates properly set, you will see the Humalog work better because of the necessary amount of basal working in you.
Hi Dennis
Iāve been using the Freestyle Libre for about 6 months now, and it has been a great tool. It made me a bit OCD, moving from 5 or 6 finder pricks a day to checking it every 15 to 30 minutes (whenever i think about it).
It has made a huge difference in my BG. But it also confirmed how erratic my Humalog is, sometimes starting in 15-20 minutes, other times taking over 2 hours until the rise in BG even slows.
But i am getting a handle on it all, , A1C is better since i started with the freestyle. and then there will be the pump.
so all in all, despite the FIASP problem, things are working a bit better.
thanks for your response,
Barry
Yes Barry @BarryS the CGM was for me an eye-opener. I began using a Dexcom G5 218 months ago and just a couple of days ago upgraded to the G6 which operates Basal IQ on my pump. Prior to the CGM I had been doing 8 finger-sticks per day for many years. The CGM has helped me safely increase my HbA1c while decreasing my wide glucose swings and bring my Time-In-Range [TIR] to around <80% from 70%.
here is an excerpt from a paper recently published by The ADA about CGM use that included a reference to FIASP very similar to what I experienced and monitored with my CGM. Novolog is āusual insulin aspartā, FIASP is āfaster acting insulin aspartā ; FIASP is Novolog with an additive.
āā¦ The double-masked, randomized, crossover study enrolled 20 young adult participants who previously used pump therapy. Participants received each insulin formulation from a closed-loop dosing algorithm based on CGM values for a 27-h inpatient stay. Time in range (70ā180 mg/dL) did not differ between treatment with faster aspart (53%) versus standard aspart (58%). However, glycemic increments after meals were slightly greater with faster insulin aspart under these conditions. These observations illustrate how CGM can provide a way to effectively measure experimental glycemic outcomes and suggest that insulin delivery algorithms in closed-loop devices will need to be refined in order to realize any potential advantages of rapidly absorbed insulins ā¦ā; [Dovc et al.].
The entire paper can be found at : https://care.diabetesjournals.org/content/43/1/19?fbclid=IwAR3ipi2djQsfqieoD3-jMMQwG9LQi_itcIZ773eAXO5xJNBUTekY2_C0deM
That is what Afrezza is for! And I got Medicaid to approve it. Definitely takes work to get through insurance. Also has a few ways to get discounted without insurance. Warning. It is much more time sensitive and much less dose specific. Good luck.
Hi Dennis
I use a Freestyle Libre and i check it pretty frequently after an injection, though I know there is a time lag between actual BG and the Freestyle reading. Last night, e.g., after Humalog, waited an hour to eat, kept going up (to 15.2 mmol) for another 2.5 hours, and then dropped like a stone within 15 minutes, had to have sugar to prevent low BG. Other times, as you say, it starts to work within 10-15 minutes or so. Doesnāt seem to correlate with where I inject or anything else I can think of.
Hope the pump will make this easier. After 30+ years with T1D, i thought i would be better at doing this.
Cheers,
Barry
Hi Barry,
Sounds like youāre being very thorough in tracking your injection sites and blood glucose levels, but have you been tracking what you eat as well? Yesterday my blood sugar was high when I checked it for breakfast and then I ate more protein than I usually do for breakfast but I didnāt adjust for it, I just took the amount of insulin I usually would for the amount of carbs. Instead of dropping slowly throughout the morning like my BG normally would it rose for a few hours and then dropped a little, so by lunch it was about the same level as it had been at breakfast. I donāt think that happened because my insulin wasnāt working, I think it was because I didnāt take the right amount. So Iām wondering if something similar could be happening with you. I switched from Lantus to Tressiba about 9 months ago and increasing my Tressiba dose helped level out swings like that, but variations in my diet still have a huge effect on my day.
P.S. I also use a Freestyle Libre and Iām also trying to transition to a pump. I think having more flexibility and being able to make small adjustments will help.
I try to keep track of what I eat, though that doesnāt always work (particularly if eating out or at a friendās, though having the Libre has helped a lot. The Humalog time to onset is still pretty variable, but I have found after being off FIASP for a a few weeks, it now seems to work again. But I am using it sparingly, only when I have high BG that Humalog has not handled for whatever reason (other health problems mess things up too) and that seems to work so far - but not certain about that yet. Still not sure how all this will work out with my pump (about a month away it now seems) but I hope it will make life a bit easier & that Iāll have better BG control.
Thanks Dennis
Iāll be switching from the Freestyle Libre to the Dexcom 6 when I get the Tandem pump.
Before the Freestyle my TIR was about 55% with 6-7 finger sticks/day . Now it is about 70% but I am still working on it. I am also trying to follow my Endoās advice that āat my ageā (>65) I should worry less about highās and worry more about lowās (presumably I should have less time for long-term complications to set in, but more concern about heart attacks). I am having trouble switching to this attitude after >30 years, when all the emphasis used to be on lowering A1C, controlling complications, etc., particularly because I hope to be around for the long term, But I do get it, lows become more dangerous with age.
As for the FIASP, I am finding that after a few weeks off it entirely, it works if I use i sparingly - only when my BG goes high and Humalog will take too long.I find that if i take it more than once per day, the FIASP starts to lose effectiveness - it is not an issue of how fast it works, it just stops working.
For now it seems to be under control, next month a pump and everything changes
Hi
Thanks for your input. Yes, I am pretty careful with my carbs. I have been a T1D for over 30 years and am careful about all the basics. No signs of retinopathy, a little bit of neuropathy in my feet. However, my BG became much less stable after back surgery about 1.5 years ago. Hence the need for a pump, though I suspect I would have been better off with one years ago.
Good luck with your pump - I will get trained on mine this month and hope life will become simpler and BG control
will get better.
regards
Barry
I have had the same issue. Type 1 for over 20 years and switched to fiasp initially great and fast acting then started getting unexplained highs which were difficult to correct with fiasp. Went back to glargine for a while but got fed up with long waits for it to work. Tried fiasp again and all good for the first 3-4 weeks then back to intermittent random highs. Giving up for a second timeā¹ļø
@Conival99 Hi Bob, and welcome to the TypeOneNation Forum! This Topic has been inactive for about eight months, so you may not get much response to your post.
I do, however, have a comment, a concern. first, I am not a medical advisor, but rather an observer who has had experience living with insulin, many varieties, during the past seven decades.
What caught my attention, is that you are switching between an āUltra-Rapid Actingā insulin [FIASP], and a āBackground insulinā [glargine]; totally different formulations of insulin with very unlike qualities.
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My mistake, novorapid, despite all these years not brilliant with names. At least with actrapid it made sense, āactā and ārapidā.
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Wow. Hi Barry. I have been searching for someone else who has had problems with the Fiasp and it has been a long search. I just signed up to typeonenation today and look forward to seeing all that is here.
I have been type 1 since 1971. Up until January 6 2020, I had been using the old Novolin 30/70 insulin twice a day with very few problems. Towards the end of 2019, I started to get a lot of low glucose readings and the doctors finally convinced me to switch to the fast acting insulin for better control. While I refuse to give up, the Fiasp has not worked well for me at all thus far. I have talked to dozens of pharmacists and my specialist, GP and even someone from Novo Nordisk regarding why it takes so long for my Fiasp to even start working and NOBODY had even heard of it before. As I type this, I took 9 units of Fiast 63 minutes ago when my glucose was 11, it is now 10.2. I work afternoon shift so I cannot exercise to bring down my glucose readings and it takes so long before the insulin does the trick. I do not have scar tissue and rotate my sites very regularly . I exercise a lot during the day and that is the only way I can keep my readings in check. Barry - I would very much like to hear how your progress with the treatment going forward. Thanks all. Dennis
Hi Dennis
Sorry to hear you are having problems with FIASP. As much as I liked the fast action when it worked, i have had to give it up as it was too unreliable. I never got any explanation as to the cause, other than one suggestion that my body is producing anti-bodies which neutralize it.
So I am back to using Humalog. I try to time things better, and also pay attention to my food. Humalog seems to take between about 15 minutes and 3 hours to start working (based on my CGM) and I try to hold off on food until I see the first hint of my BG going down from the insulin (depending on the food & how fast it boosts BG) . That works much of the time but not always, asI find that after ādoing nothingā for an hour or 2. my BG can then dives so fast I need to take glucose to avoid a low.
in other words it is complicated, but i keep working at it. I only use FIASP now for a 1 or 2 unit āboostā if my BG is going too high. That often works quickly to bring my BG down a bit, but I must then wait 2 days before using FIASP again, or else it has no effect again.
I am 69 ears old and have T1D for 32 years. I have recently switched to a Tandem pump and I find management much better and easier. If you are not on a pump & can afford it, I would recommend one. With the Tandem pump, using Humalog, I have managed to get my time-in-range up to 85%-90%, which is apparently pretty good. O course it would have been helpful about 30 years ago, but ā¦
good luck, let me know how you are doing when you are able.
take care
Barry
@DennisA Hi Dennis, and welcome to the JDRF TypeOneNation Forum! BTW, you have a familiar sounding name.
At my doctorās request, I used FIASP for a while and presented her with a report to help her with decisions for prescribing. I will say, that FIASP did not create a āproblemā for me, but I found FIASP to be less optimal for me than either Novolog or Humalog. FIASP gave me less level BGL graphs.
Keep in mind, that FIASP is categorized as ULTRA-Rapid acting like Lyumjev, unlike the much slower acting FAST-Acting Novolin-R in your previous 30-70 mixture. In between the Fast-acting Novolin and the Ultra Rapid-Acting FIASP, there are RAPID-Acting formulations such as, Novolog, Humalog, Lispro; you may be better off trying one of these.
When you changed to the FIASP, what did you begin using for your background / basal insulin - something like Novolin-N? If you continued using the 30/70 mixture, that might be the cause of your problem.
Let us know how things work out for you.