# Fiasp effectiveness



## bonerp (Dec 24, 2020)

Hi folks.
I changed to fiasp around a year ago but am more and more finding it ineffective to bring down / stop increasing bgs and also have fluctuating lows.
I've read a few others who've had problems with this.
Initially I liked how quick it responded but if bgs go above 12mmol I'm finding it takes a lot of insulin over an extended period to bring it back down.
For instance last night eat a 70-100g roast dinner meal, dosed as usual but couldn't get it below 9 before bed. Did a bit extra and through the night it never went down but went up to 19. Illogical. Did an extra 11 units and by 8am was still 9+. I had a LOT of insulin. Expected lows today but not got under 8.
Moved set and don't reuse sites for over a week or 2 so not problems with sites.
I'm minded to go back onto Apidra which is a bit slower but seemed more reliable to control higher bgs. Fiasp seems very erratic.
How are others finding it?
Thx and happy Christmas.


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## Pumper_Sue (Dec 25, 2020)

Did you split your insulin to cover the high carb and fat in the meal?
The only time I have problems is if I haven't put enough thought into the fat/protein content of the meal then yes it means a correction plus a temp basal to bring things back to normal. Higher carb meals it's always worth thinking about a change in carb ratio as well.


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## rebrascora (Dec 25, 2020)

I have to say, I don't find Fiasp that much quicker for me than NR. It knocks 15 mins off breakfast time (ie 45 mins instead of hour or more with NR) which is helpful but not great still. Otherwise it's still about 20 mins at other times of day, although at the moment I am mostly just bolusing for breakfast and have my low carb evening meal courtesy of exercise. 

I do find that corrections seem very slow to take effect and sometimes have much less impact than I expect so I might jab one unit and then another unit an hour or 2 later because the first one did nothing. Sometimes 1-2units will have no impact for hours, particularly if I am sedentary but if I do a bit of exercise they can drop me from 10 to hypo when I am least expecting it... several hours later. 
So yes, I would agree that it is a bit unpredictable. This is my second trial of it and I was more interested in wanting any corrections to work more quickly this time as that would be helpful with my low carb diet so it hasn't really achieved what I was wanting but I am learning to adapt to it and I am going to give this trial a longer period (like a whole year) before I decide if I want to go back to NR again. I think chopping and changing hasn't been overly helpful for me and I need to stick with it longer to figure out how best to use it.


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## bonerp (Dec 25, 2020)

rebrascora said:


> I have to say, I don't find Fiasp that much quicker for me than NR. It knocks 15 mins off breakfast time (ie 45 mins instead of hour or more with NR) which is helpful but not great still. Otherwise it's still about 20 mins at other times of day, although at the moment I am mostly just bolusing for breakfast and have my low carb evening meal courtesy of exercise.
> 
> I do find that corrections seem very slow to take effect and sometimes have much less impact than I expect so I might jab one unit and then another unit an hour or 2 later because the first one did nothing. Sometimes 1-2units will have no impact for hours, particularly if I am sedentary but if I do a bit of exercise they can drop me from 10 to hypo when I am least expecting it... several hours later.
> So yes, I would agree that it is a bit unpredictable. This is my second trial of it and I was more interested in wanting any corrections to work more quickly this time as that would be helpful with my low carb diet so it hasn't really achieved what I was wanting but I am learning to adapt to it and I am going to give this trial a longer period (like a whole year) before I decide if I want to go back to NR again. I think chopping and changing hasn't been overly helpful for me and I need to stick with it longer to figure out how best to use it.


Thanks that's interesting. Why did you come off it the first time? 
Problem I find is similar in that squirting a fair dose esp over 12-13mmol just doesn't have the same effect that I'd expect. It seems its OK if bgs are low/correct range up to 12 but anything after that it's not having the desired effect when needing corrections and waiting.... And waiting.... And waiting for it to come down esp in the evening when I can crash early morning. 
Is this still the fastest acting apart from nr and humalog?


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## rebrascora (Dec 25, 2020)

I was relatively newly diagnosed and still trying to get my management sorted and I don't really think I gave it a fair chance the first time. I felt that I was using more of it than I would NR but I think it wasn't a fair comparison as I was started on NR in the Spring/summer and then swapped to Fiasp in the autumn winter when my routine is different and I get really stressed in the build up to Christmas, so asked to go back to NR after just one prescription of 5 cartridges.... but then decided that I didn't evaluate it fully because I wasn't aware of all the nuances of my diabetes during that first test period..... and I was sick of waiting over an hour to eat breakfast every morning or trying to get stuff done in that hour and then sometimes getting distracted and end up hypo. Still happens occasionally but I am getting better at the timing. I only use 6 or 7 units most days... so I tend to only use 2 or 3 units at a time and corrections of just 1 or 2 units but there are times when I get frustrated with the lack of response and jab more than I would estimate is needed for a correction and it does seem to favour the brave in that respect. I just resent the fact I have to feel frustrated and brave for me to over egg a correction in order for it to work. The other option is to jab a normal correction dose and go get some exercise to help it along.


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## trophywench (Dec 25, 2020)

Crikey - I have never EVER been able to have a double figure bolus without adding approx another third to it later in the finish - but have to say, it's been quite rare for me to need a bolus that large - because I simply don't need to eat that much food - that isn't a criticism of you so don't think that!

You need whatever your body needs so have a little experiment on yourself when you need double figures - first add 10%, if that's not enough, try 15 or 20% - keep at it till you get about the right result!  And obviously - test test test!


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## SB2015 (Dec 25, 2020)

bonerp said:


> Thanks that's interesting. Why did you come off it the first time?
> Problem I find is similar in that squirting a fair dose esp over 12-13mmol just doesn't have the same effect that I'd expect. It seems its OK if bgs are low/correct range up to 12 but anything after that it's not having the desired effect when needing corrections and waiting.... And waiting.... And waiting for it to come down esp in the evening when I can crash early morning.
> Is this still the fastest acting apart from nr and humalog?


Like others I find that if I need a big dose of quick acting insulin (for me that is anything more than 6 units, which is not common but might be useful today!!) I find I need to add in a percentage, and also spread the delivery.

I tried Fiasp for 6 months.  I did find it reduced my time needed for the pre-Bolus, which Ifound useful when eating out at lunchtimes.  That was useful, but I did find that after a few days I was getting skanky cannula sites with my pump, and it was always painful when I delivered my insulin.  I also found the reduction in pre-Bolus time became less effective and it was heading back to those I needed from NR.  After 6 months I went back to NR.


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## Pumper_Sue (Dec 25, 2020)

trophywench said:


> Crikey - I have never EVER been able to have a double figure bolus without adding approx another third to it later in the finish - but have to say, it's been quite rare for me to need a bolus that large - because I simply don't need to eat that much food - that isn't a criticism of you so don't think that!
> 
> You need whatever your body needs so have a little experiment on yourself when you need double figures - first add 10%, if that's not enough, try 15 or 20% - keep at it till you get about the right result!  And obviously - test test test!


Like you I was always taught to add a certain % to a correction dose the higher the number the higher the correction %


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## nonethewiser (Dec 26, 2020)

bonerp said:


> How are others finding it?



Got prescribed it, meant to have vials being on pump ended up with pen cartridges. 

Tried it few times now find it faster acting than novorapid, used pen yesterday for christmas day, so not long term user but seems ok, just needed insulin to reduce waiting time before eating.



SB2015 said:


> That was useful, but I did find that after a few days I was getting skanky cannula sites with my pump, and it was always painful when I delivered my insulin.



Seen that mentioned before, don't like idea of that, was that happening every time.


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## brassrods (Dec 26, 2020)

bonerp said:


> Hi folks.
> I changed to fiasp around a year ago but am more and more finding it ineffective to bring down / stop increasing bgs and also have fluctuating lows.
> I've read a few others who've had problems with this.
> Initially I liked how quick it responded but if bgs go above 12mmol I'm finding it takes a lot of insulin over an extended period to bring it back down.
> ...


Hi there, try reducing your carb intake (very gradually so that you don't feel too restricted), as well as upping your basal. Low(er) carb + basal+bolus, accordingly = The Law of Small Numbers & therefore less chances of such fluctuations. I'm suggesting the sacrifice of lowering your carb intake because you could be heading for insulin resistance.


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## SB2015 (Dec 26, 2020)

nonethewiser said:


> Got prescribed it, meant to have vials being on pump ended up with pen cartridges.
> 
> Tried it few times now find it faster acting than novorapid, used pen yesterday for christmas day, so not long term user but seems ok, just needed insulin to reduce waiting time before eating.
> 
> ...


My skanky sites and discomfort on insulin delivery was constant when using FIASP.  I had hoped that the benefits would outweigh that, but it didn’t so happily went back to NR.


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## everydayupsanddowns (Dec 26, 2020)

Higher carb loads (90g and upwards) are always a bit more of a risk for me, but I find it perfectly possible to eat occasional high carb meals if I split/time the doses well, and the wind is in the right direction. Conversely I can see huge BG disruption following much more modest 30-40g meal so I continue to enjoy larger meals when I fancy them.

I didn’t have a great experience with Fiasp personally. I found it only worked noticeably faster for the first few weeks, and then settled back to pretty much NR timings, except that it was much less reliable, and I needed ever increasing amounts of insulin, with some correction doses having no apparent effect whatever.

As I was finding it sore and itchy at the infusion sites, I wonder if I had some sort of allergy or reaction to it.

I switched back to NR after my first lot of vials, and ‘normality’ resumed almost immediately.


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## Pumper_Sue (Dec 26, 2020)

SB2015 said:


> My skanky sites and discomfort on insulin delivery was constant when using FIASP.  I had hoped that the benefits would outweigh that, but it didn’t so happily went back to NR.


I found I had to change the site every two days during the warmer summer months but ok with three days during the winter.


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## nonethewiser (Dec 26, 2020)

everydayupsanddowns said:


> I didn’t have a great experience with Fiasp personally. I found it only worked noticeably faster for the first few weeks, and then settled back to pretty much NR timings, except that it was much less reliable, and I needed ever increasing amounts of insulin, with some correction doses having no apparent effect whatever.



Odd how it worked first few weeks then faded off then doses increased, wonder why that is. 

Finding fiasp is used up quicker than NR, tails off sooner which is better for me personally.


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## everydayupsanddowns (Dec 26, 2020)

nonethewiser said:


> Odd how it worked first few weeks then faded off then doses increased, wonder why that is.
> 
> Finding fiasp is used up quicker than NR, tails off sooner which is better for me personally.



Ive seen others also mentioning what seems to be a resistance that builds over a few weeks from approx week 2, which is more or less exactly what I saw. I just get the feeling is doesn’t work for some people, and I seem to be one. 

I think @Pumper_Sue changes sites every 2 days (or at least had suggested that might have helped with the resistance and general weirdness) but tbh once the rapid action has stopped being rapid I was happy to return to NR as there was no real benefit in staying on Fiasp for me.


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## Pumper_Sue (Dec 26, 2020)

everydayupsanddowns said:


> I think @Pumper_Sue changes sites every 2 days (or at least had suggested that might have helped with the resistance and general weirdness) but tbh once the rapid action has stopped being rapid I was happy to return to NR as there was no real benefit in staying on Fiasp for me.


No resistance at all, the site just becomes sore in the warmer weather.
My personal view is that many people expected Fiasp to be the wonder insulin we were all waiting for ie poke and go  What it boils down to though is it does work very well as long as you think before you bolus and it does mean a lot more effort is involved in your diabetes management. A lot of it I suspect is due to the duration and the way it behaves compared to what we are used to so a very steep learning curb for people used to the ways of the older insulin's.


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## everydayupsanddowns (Dec 26, 2020)

I’m glad you don’t get any resistance Sue. But it wasn’t learning curve for me... I was running sensors and had fairly modest expectations of faster corrections. I had lots of information on how it was behaving, and wanted to give it a decent go, so kept going even when I thought it wasn’t working well for me.

TIR leapt up from 50-60% to 85-90% in the first 2 days back on NR.

I am really pleased it works for so many people, but I do think that it doesn’t suit others, and not just in a ‘user error’ way


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## Pumper_Sue (Dec 26, 2020)

everydayupsanddowns said:


> I’m glad you don’t get any resistance Sue. But it wasn’t learning curve for me... I was running sensors and had fairly modest expectations of faster corrections. I had lots of information on how it was behaving, and wanted to give it a decent go, so kept going even when I thought it wasn’t working well for me.
> 
> TIR leapt up from 50-60% to 85-90% in the first 2 days back on NR.
> 
> I am really pleased it works for so many people, but I do think that it doesn’t suit others, and not just in a ‘user error’ way


I suspect the conclusion would be that Fiasp works in mysterious ways


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## rebrascora (Dec 26, 2020)

It has taken me a good 2 months to adjust to the change from NR to Fiasp and get my TIR % back up into the 90s but this last week I have got there. Can't put my finger on why things went haywire but I had 4 months of good results TIR results in the low 90s up to October and then dropped to 80 and then 70% TIR since I started on Fiasp and then slowly built back up now, so there was clearly some disruption. I definitely need to be more confident with correction doses with it. I was toying with asking to revert back to NR a couple of weeks ago but I am going to stick with it for a full year now I think and give it a fair trial throughout the seasons. 
I agree with @Pumper_Sue 's comment that it works in "mysterious ways" and I feel it is less predictable but I also feel like I am developing more of an instinct for it now. Sometimes it seems to be finished in 4 hours and other times it has a sting in the tail. I definitely find exercise changes it's activity and makes it more "enthusiastic" shall we say as regards correction doses. If I am sedentary my body seems to all but ignore it.


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## Pumper_Sue (Dec 26, 2020)

rebrascora said:


> Sometimes it seems to be finished in 4 hours and other times it has a sting in the tail. I definitely find exercise changes it's activity and makes it more "enthusiastic" shall we say as regards correction doses.


I find the sting is at 5 hours for me. It's final fling before it says good bye  Exercise yes as well, very sensitive in that dept.


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## Inka (Dec 27, 2020)

brassrods said:


> Hi there, try reducing your carb intake (very gradually so that you don't feel too restricted), as well as upping your basal. Low(er) carb + basal+bolus, accordingly = The Law of Small Numbers & therefore less chances of such fluctuations. I'm suggesting the sacrifice of lowering your carb intake because you could be heading for insulin resistance.



It’s more likely the Fiasp. I don’t think the OP has stated their usual total daily carbs anyway. A number of people have had issues with Fiasp becoming ineffective.


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## nonethewiser (Dec 27, 2020)

everydayupsanddowns said:


> Ive seen others also mentioning what seems to be a resistance that builds over a few weeks from approx week 2, which is more or less exactly what I saw. I just get the feeling is doesn’t work for some people, and I seem to be one.



Isn't it strange.  

Anyway going to request 2 vials for pump & give it go, nothing to lose really. Thanks for reply.


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## nonethewiser (Jan 17, 2021)

Vials finally arrived yesterday so all systems go. Find insulin is faster acting so pre bolus times is less, even when bolusing just before eating spike is less noticeable than with novorapid.


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## everydayupsanddowns (Jan 17, 2021)

nonethewiser said:


> Vials finally arrived yesterday so all systems go. Find insulin is faster acting so pre bolus times is less, even when bolusing just before eating spike is less noticeable than with novorapid.



Glad it’s working well for you so far @nonethewiser - be interesting to see if things change over the next couple of weeks and you notice differences in the apparent speed and/or sensitivity.


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## nonethewiser (Jan 25, 2021)

everydayupsanddowns said:


> Glad it’s working well for you so far @nonethewiser - be interesting to see if things change over the next couple of weeks and you notice differences in the apparent speed and/or sensitivity.



Used up in use novo vile so only just starting today with fiasp in pump, will report back in couple of weeks on thoughts.


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