FIASP not working

General
21

Hi Barry! So very nice to hear from you. Thank you so much for the email.

We are almost twins! I had been going into many different pharmacies and online just to find if there was someone with a similar problem to mine. Nobody had any answers. It was getting quite frustrating and concerning.

I started with the Fiasp in early January, had some success at the beginning and then many periods of up and down when I did not even change any of my regime. I then stopped and switched to the Humalog and it acted the same at the beginning but had a more rapid drop when it started to work (also 2 hours after injecting). I took that for a month in March and then it completely stopped working. I had readings in the 20’s which I have never had, while eating less and exercising more. That was very odd! I then switched back to Fiasp and again at the beginning started working better.

I also have to take my fast acting insulin well in advance of eating, exercise right after eating, take extra injections at times to force it to work. I can get decent BG readings, but we should not have to go to this extent. I exercise a lot too.

I have had T1 for 49 years (yikes!) and will be 55 in April and have been in very good control most of my life. I have an appointment soon with the specialist and am going to run that antibody idea you mentioned above. Thanks so much for that. :slight_smile:

I am not on the pump as the doctors said that was not necessary… yet. I might be in the future though.

I do hope the best for you as well and will keep in touch with you on this.

Dennis
allchin11@gmail.com

22

Hi Dennis

Sorry to take so long to reply - life sometimes just gets too busy! One would think that after all the limitations from COVID (& I am retired too!) that I would have too much time on my hands, but I never seem to have enough.

Some history: I have had T1 for 31 years - I was ‘almost too old to get it’ according to my doctor - I was 38 when I found out I had T1 No hint anything like that would happen, no history in my family, just woke up one morning and was unable to see clearly, walked over to the clinic near my home, and got the news that I had T1, probably for had it for a very short time. The Dr. said I was lucky it affected my eyesight so drastically (pressure n the eyeball caused things to go out of focus) as it meant we caught it very early. Back then I started with a pen and blood tester, . From the start I realized I had to test and micro-inject abut 6 to 8 times a day ((I know, I am on the obsessive side when it comes to T1 care - probably because when I was diagnosed I was put in a room where my roommate was 55 years, drinking beer with his wife when I arrived in the room (she snuck in a 6 pack). He then proclaimed I had nothing to worry about because he was my age when he got it and look at him now, in bed, drinking beer, etc. He didn’t mentioned that one foot had been amputated and he was there to lose the 2nd one. I decided I would NEVER end up like him. It was the best shock therapy i ever had - they should do it to every new diabetic —> this could be you if you don’t take care of your T1!

When FIASP came around I saw the answer to my problems - sometimes my insulin (Humalog) worked very quickly (within 15 minutes), sometimes it took hours. Complicated by the fact that interstitial blood (measured by Dexcom & Libre) is often 15-20 minutes behind your finger-prick blood.

In any case, to manage it all, I depend a lot on my pump (Tandem) and CGM (Dexcom). The pump & CGM makes taking insulin almost too easy. With no needles, I can snack on small amounts (a few potato chips, a cookie, anything that isn’t loaded with sugar) and tell the pump to take into account the 5 grms of carbs i just had. If I go too low, the pump stops delivering basal until it rises. When i am high, the pump calculates exactly how much I need to get back to ideal and delivers it.

Bottom line is that with the pump I only used FIASP twice in the last year, probably didn’t have to.
Between the pump, CGM, awareness that there are delays in both how long it takes food to change to glucose (depends on food), for insulin to get into use after injection - first into the bloodstream, then into the interstitial fluid which the CGM is actually measuring. The pump also indicates how much insulin i still left in your body from the last shot, and how long until it is. That has prevented me from injecting too much when I see my sugar is high but I still have lots of insulin on board - it tells me my insulin is taking a long time to work, even though there is enough in me to do the job. Other times I see I have little or no insulin “on board” and if my BG is high I need to inject more.

In any case, I am avoiding FIASP now, and as you can see, have worked out more or less how to manage. As a result, most weeks I am at 90%-95% Time in Range (TIR) and with which I am satisfied. I still obsess a lot, and check my BG frequently in my Dexcom. But most of the time, all is good.

Hope you had a good holiday season, and that things are going well for you.

all the best for 2021, stay healthy & COVID-free
Barry

1 Like
23

Hi Barry @BarryS , never “too old” to get autoimmune [TypeOne] diabetes. Knowledge in the medical community has expanded from those days in the 1970s when the first “classifications” were applied to the different types of diabetes - obese adult diabetes and childhood diabetes - to the present understanding that there are about a half-dozen diabetes types. I’ve personally known people diagnosed with T1D in their 70s.

From your description of your current insulin therapy, I can see that you are using the Control IQ [CIQ] algorithm on your Tandem t-Slim x2 pump; that is what I use too. Also like you, my TIR has been in the 90 - 96% range since last January when I began CIQ - and I’m satisfied with that. As you probably know, 95% TIR is the recommend goal for an adult who does NOT have diabetes. I have not used FIASP or Lyumjev ULTRA-Rapid acting insulin since I began using the CIQ algorithm - they are not compatible. CIQ locks insulin duration at 5 hours, and supposedly FIASP and Lyumjev have ceased working 1 or 2 hours before that.

Something I have noticed, Humalog has resumed its onset in me within 10 to 15 minutes - just like it did when I first began using that formulation April 1966. For a while, it appeared to me that Humalog was taking way too long for it to begin working. Even now, I can watch my G6 readings begin decreasing within 15 minutes of taking a bolus - under “normal” BGL conditions, I need to avoid very careful that I do not bolus unless I know my meal is at hand.

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Hi Dennis
i guess are “never is too old” - but it was one of the last good things I could find about getting old(er). i still don’t feel like i am ‘old’ (despite the objective evidence) but this last year in particular, with all the earlier emphasis on age & Covid, has made me feel much older & more vulnerable in general.

I am using the Tandem with CIQ - it works well for me, saves me many near-lows. I only use the FIASP when I m going high and want to bring it down fast. I don’t put it into my pump, I just use a pen I keep in the refrigerator to take and injection of 1 or 2 units and hope it works. when it does, it works within minutes, and can bring me back into range where my pump takes over. of course the pump ‘doesn’t know’ i have taken extra insulin, but it is such a small amount (and happens rarely) and its effects are gone quickly, so it doesn’t really mess up anything. I need it because Humalog still has very uneven time-to-onset for me. While most of the time it takes 15-30 minutes, I still have days where it takes 2 or more hours before I see any movement in my BG. There are also times when I have to stuff dextrose into my mouth because it acts so fast my CGM graph looks like someone falling off a cliff (times when CIQ doesn’t help).

Overall I am happy with the pump - the Dexcom was the most important step in getting my BG under better control - even though I used to test my blood 6 to 8 times/day, tracking my BG with the CGM and seeing what happened to it in between tests, was very useful. I had no idea that some times my blood spikes at around 6am (“dawn phenomenon”)because it would be back down by the time I woke and tested. So the CGM made a big difference. Then the addition of the pump with a basal ‘drip’ also made a difference. Between the 2 my control is probably better than ever.

At the same time, I must say that the psychological effect of getting the pump has been large, and mostly negative. Something I didn’t expect. But having a pump ‘permanently’ attached to my body with tubing and medicine 24/7 has made me feel much more vulnerable and “sick” than I used to. Before, I took injections from a pen or tested my blood about 12 times a day, in an operation that took seconds. Now I am continuously hooked up and dependent on the pump working properly. Before, when I tested my blood or took insulin I was 100% confident in what was happening. No bad blood tests, no possibility that an injection didn’t “happen”. With the pump I am dependent on a “back box” and have to trust that I actually got the insulin it said it delivered. Or that my BG is actually what the Dexcom says it is.

I have already had a situation where my Tandem cartridge was faulty (the whole box was). I only ‘found out’ because my BG was going higher and higher no matter how much Insulin I took. So I started checking to make certain I was actually getting a delivery. Turned out the pump was making pumping noises but no insulin was coming out of the cartridge. After trying 2 more new cartridges I called Tandem, who told me I had a box of defective cartridges and I should open a new box (thankfully I had another one). If I had not been checking my BG regularly I would never have known and may have even gone unconscious & died. So I have learned not to trust the pump and that it may not be doing what it says it is doing.

Also, i must admit, having a pump & tubes permanently attached makes me feel like the picture of an old guy walking down the hospital corridor, his ass sticking out of the green hospital gown, and pushing his IV setup as he walks. While the pump doesn’t look like that, (and i never wear hospital gowns :blush:) it does make me feel like i’m sick and vulnerable, and it is there 24/7 (as opposed to 15 seconds 12 times /day) to remind how precarious life can be and how I am dependent on this drug & the software and hardware in the “black box” to keep me alive. Before I managed to convince myself that I was a normal person who just needed a few seconds here and there to manage things. And when I injected X units of insulin, I actually received X units of insulin. Now I am dependent on software & hardware that I have to trust, & makes me feel insecure and my life more precarious. I now have to accept that if e.g., the pump malfunctions while I am sleeping, I may never wake up. (but the pump/CGM have certainly improved my control and BG).

So the pump & CGM have had positive effects on my diabetes control but also some negative effects which I have learned to live with. Also I check my BG very frequently, so any ‘errors’ can be dealt wth quickly.

Hope you are doing well, both with diabetes as well as COVID. Not sure where you are, I am on the east cost of Canada (Fredericton, New Brunswick). Covid hasn’t been bad here - people are very compliant when it comes to social distancing and wearing masks. Also, the government here has been very proactive in shutting down things before they get out of control. There are serious problems in a couple of long-term care homes, but by and large there have been relatively few cases here. So while we wear masks & are limited in activities with other people, my wife and I have often felt like we are watching the rest of the world have a pandemic while we safely observe it from home. But part of us is still waiting for a surge that hopefully will not happen.

Take care, stay safe
Barry

25

Hi Dennis
My mistake! I am using Basal IQ on my Tandem, not C-IQ. C-IQ has only very recently been approved by health canada, and it is not available yet. I am looking forward to it, including the opinions of those in the US who have had it for a while. (My perspective is that I am not late in getting it, I am instead waiting for the big USA “trials” (ie., I’m waiting to see if issues arise during the year or so Americans get to have it while Canadians do not - not that unusual with drugs, meds, even consumer products).
Barry