# FIASP in a pump



## SB2015 (Jul 24, 2017)

I have just been offered the new insulin FIASP, in the hopes it reduces the need for pre-meal blouses.  Has anyone experience of switching to this in their pump.  I just wonder if it requires any changes to basal rates.  I suspect it will be try it and test, but logic would suggest that the basal rates might just need moving an hour later a bit to account for more rapid absorption.

Any ideas.


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## Northerner (Jul 24, 2017)

I think @Pumper_Sue mentioned she was just trialling it in her pump in another thread


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## Pumper_Sue (Jul 24, 2017)

Thanks @Northerner
I started a trial at 3pm on Friday 21st. My basal rate pattern has stayed exactly the same but with a 20% reduction for a couple of days I'm now starting to tweak things a bit more to iron things out.
For me personally it lasts about 3.5hours with a bit of a kick at the 3 hour mark. (Obviously we are all different)
Bolusing for meals be very careful as it does kick in very quickly. I would suggest if on the low side then eat and then bolus.
I've also discovered that a complete set change is required every two days as it does not like being in the pump that much.

Tim has a post on the main forum with a link to his blog regarding FIASP have a good read of his start and I think 5 month journey using it. I found it a very useful guide.


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## everydayupsanddowns (Jul 24, 2017)

I have been using Fiasp for a couple of months.

In some cases it does seem noticeably faster, but I am still needing to prebolus just perhaps not quite as long.

Initially I was quite cautious and was using many more Dual and square waves, but things seem to have settled to more NR-like timings for me, with the odd 10-15 minute improvement and generally faster acting corrections.

TDD is very similar, but initially fell.

I did find I seemed to have a bit of a kick in insulin requirement after 2-3 weeks, so my TDD is pretty much what I would expect at this time of year now. 

To be honest I nearly gave up on it after about 5 weeks, but then I made a few more tweaks and things seemed to click in a bit better.

I suspect it is to do with learning the Fiasp 'workarounds/exceptions' for various things, which are different things and different strategies than NR needed.


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## HOBIE (Jul 24, 2017)

Next time I go to the DSN they will be asked for a go of it. Tks


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## SB2015 (Jul 26, 2017)

everydayupsanddowns said:


> I have been using Fiasp for a couple of months.
> 
> In some cases it does seem noticeably faster, but I am still needing to prebolus just perhaps not quite as long.
> 
> ...



Hi Mike

I have about a month before giong on holiady.  I am unsure whether that will be sufficient time to get used to FIASP or whether it would be better to wait until I get back which would delay it until mid October as I have two trips coming up.  Any advice based on your experience?

I like the idea of not needing to prebolus as early especially when away so having less control over carbs etc.


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## everydayupsanddowns (Jul 26, 2017)

I think if you can time the switchover alongside a Libre sensor or two you will be fine. Just be prepared for a few frustrations, and a couple of false starts before you see things improving. I would think a month would be fine


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## Pumper_Sue (Jul 26, 2017)

I've just come off of bovine insulin so a slightly different kettle of fish for me to deal with, this is day six for me and yesterday I started to drop dramatically so sliced my basal again and again today also changing the profile so far 7 units off since my start date.
I'm wondering if my needs will go up again or if the reduction is due to the change of insulin.


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## SB2015 (Aug 1, 2017)

One day of using FIASP so far.  

With carbs of no more than 30g I find that even if I deliver just before I eat the spikes have changed to a blip.  I am being sensible about food choices, but now am away in London for a visit to the Globe, so no control over carb quantities as I am staying with friends or eating out.  

However having started with a bang as I fell when crossing the road and ended up in a and e, I had the chance to check how speedy the correction dose was.  Nothing broken, not even my pump which I landed on flat out along with my elbow.  The correction bought the levels which had shot up after the fall, a bit more quickly.

So far so good, and I am quite enjoying the challenge of something new.


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## everydayupsanddowns (Aug 1, 2017)

Good news  about the early results @SB2015! Sorry to hear about the fall. Ouch! Sounds painful.


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## Pumper_Sue (Aug 1, 2017)

After  1.5 weeks my ratios have changed as has my basal profile and my basal is also gradually increasing.
I knew it wasn't going to be easy so can't complain but the frustration sure is setting in big time now.


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## SB2015 (Aug 2, 2017)

Confused at present.  Levels rising even though I ate four hours ago.  It could be
The amount of fat in our Turkish meal delaying carb release
Wrong carbs
The pain I have in my arm, hip, hand, ... from the fall
Possible infection in elbow wound
The new insulin leading to a bit more resistance.
....
And I forgot to bring my charger for the Libre which has now died on me (iPad charger, phone charger, ...loads of space taken up with these.

I shall check I am safe for sleeping, then deal with any rise in the morning, and wait until I am home before I start playing with auditioning increased basal rates, as I can eliminate other factors.


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## Pumper_Sue (Aug 3, 2017)

SB2015 said:


> Confused at present. Levels rising even though I ate four hours ago.


Yep I have this problem as well, I know my basal is correct as have tested it on more than on occasion.
I'm beginning to wonder if it's worth doing two lots of bolous for a meal (What a pain and totally inconvenient) a combi certainly does not help.

I'm rapidly coming to the conclusion that FIASP isn't as good as the manufactures claim.


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## everydayupsanddowns (Aug 3, 2017)

Fwiw my basal pattern changed shape with Fiasp. As did my bolus ratios. I also had a few late rises after meals, which I managed to fix just by throwing extra insulin at them, often all up front. 

There was a sense of having to relearn workarounds and 'exceptions to the rules' for Fiasp which were very different to the Ines I instinctively used with NR. 

Perhaps standard NR would be worth a try Sue,  if Fiasp keeps giving you the runaround. Just the Aspart, without the F additives?


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## Pumper_Sue (Aug 3, 2017)

@everydayupsanddowns  I knew I would have to rewrite my basal as obviously so different in action and duration to bovine so don't have an issue with that. The actual pattern is correct, yesterday I had perfect numbers all day long until evening meal when I bloused went low within an hour and ended up at 8 before bed woke up at 9.8,
This is my biggest bugbear what is ok one day is completely different the next.
It's a steep learning curb for me obviously as a rule I don't give up easily so will keep plugging away until I find a happy medium if no joy will try novo.


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## everydayupsanddowns (Aug 3, 2017)

After 3 vials I have decided to swap back. Just using up the last vial now. Continued oddities and uncertainty, plus the fact that the rapid onset seems to have largely disappeared and I'm still needing to prebolus just like I would for NR mean that while I'm sure I *could* make it work given enough time and experimentation, I think I'm better reverting to the insulin I've used for years and have already worked out its foibles.

Glad it's working fast for lots of people, but I don't appear to be one of them


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## SB2015 (Aug 3, 2017)

I shall stick with it a bit longer and see if I can iron out some of the oddities.  It has sent me back to Pumping insuiln, and I shall benefit from rereading parts of thwt on testing ratios and rates.  There is always something new in there that I missed before.

I will keep posting on this thread and let you know if it end up continuing.  As I ended up with a prescription from both my Consultant and GP I have quite a few vials!!  I shall see how it goes,and it would be good to hear if anyone else is sticking with it.


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## SB2015 (Aug 4, 2017)

My plan over the next month is to:
- check basal rates using a combination of Libre info and some fasting tests where necessary
THEN 
- check carb ratio for each time block
- check sensitivity (correction ratio) for each time block
- check the duration of insulin action (DIA). I had not realised the importance of this in the bolus calcs

In reading other blogs I shall also be watching for:
- any issues with cannula sites, and change more often if necessary
  Some have found it necessary to change every day as the sites are a 
   lot more lumpy but this may be related to bigger doses of insulin
- whether the insulin stays stable in the cartridge.
  Some have fund that it is not as active after three days, so are changing cartridges more often.

So lots to do over this month when I am also away intermittently (World Athletics Champs next week!!!) so it may take some while to get things sorted.


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## Pumper_Sue (Aug 4, 2017)

Today I tried blousing 20 mins after the start of my meal and it has worked very well.
It's taken two weeks to sort the basal and as the week has gone by I've needed to increase the basal every other day so now using more than I was on bovine.

I make sure a complete set change is done every two days.
Not to sure it's 100% practical blousing 20 mins after starting to eat or even convenient. I also wonder how many will remember to bolus if like me they have to bolus after 20 mins.
At 6pm I was sitting at 4.4 and at 8.30pm am sitting at 6.5 that's after eating a bacon sarnie plus a doughnut.

Lowest today has been 4.1 highest 8.7 an hour after the doughnut.


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## SB2015 (Aug 4, 2017)

Pumper_Sue said:


> Today I tried blousing 20 mins after the start of my meal and it has worked very well.
> It's taken two weeks to sort the basal and as the week has gone by I've needed to increase the basal every other day so now using more than I was on bovine.
> 
> I make sure a complete set change is done every two days.
> ...



That sounds like a good range of values for today, especially with the doughnut in there.
It is good to hear from others trying this as well.  As ever lots to learn from each other on this forum.


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