# FIASP progress so far



## SB2015 (Aug 11, 2017)

Since switching to FIASP i decided to allow two weeks before doing basal rate tests and just focused on corrections as necessary, but on the way I have fund that:

Spikes
breakfast and lunch spikes have become blips with meals of no more than 30 g without prebolusing.  I am just delivering as I sit down for meal.

Big CHO
things are a lot less predictable with bigger meals ( looking at ideas of using super bolus). This is usually when eating at friends or out.

Cannula sites
I am aware of the delivery of the insulin and find it stings at the cannula site.  I get round this by using an extended bolus over 15 minutes where possible, but do not do this for corrections.

Action time and onset of FIASP
Using Libre I was able to check action time fo correction dose and have now shortened action time from 4 hours to 3 and changed the offset peak time from 1 hour to 45 min.  This may need changing again after proper basal rate tests.

Still more to do, but it has been a busy fortnight: wedding to go to, The Globe, fall resulting in broken thumb, world athletics, late gig in Cardiff, ...  Life is just too busy to fit in any fasting but booked in for slots next couple of weeks.  I know it will take ages as these tend to get interrupted.


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## Pumper_Sue (Aug 11, 2017)

@SB2015 The larger bolus I found splitting the bolus works. Obviously we are all different so will need a different split.
I also found that a lunch split was different to an evening split.

Lunch split I do an 80/20 split over 2 hours as I tend to walk the dog whilst the insulin is at it's most active which then results in a rapid drop.
The split seems to have stopped this.

Evenings I find a 60/40 over 3 hours works very well.


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## everydayupsanddowns (Aug 11, 2017)

Sounds like it is working well for you both @SB2015 @Pumper_Sue - hope that continues 

I have decided to abandon Fiasp after the rapid action I was hoping for kinda disappeared after a few weeks of use. I'm a bit disappointed, but I have to say NovoRapid (for all its faults) has been very stable and predictable since I switched back. 

More thoughts here: http://www.everydayupsanddowns.co.uk/2017/08/fiasp-review-fun-with-5050-and-mystery.html


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## SB2015 (Aug 12, 2017)

everydayupsanddowns said:


> I have decided to abandon Fiasp after the rapid action I was hoping for kinda disappeared after a few weeks of use.


I wonder whether this will happen when the increased resistance due to the addition for speedier absorption balances out the absorption rate.  I shall keep a watch on things, knowing that NOvorapid is still there to go back to.  As you say it is working for me so far, with the convenience of not having to pre- bolus.  However unless I sort out the post meal issues for bigger meals/meals out it may not be worth it.

Another  thing I have found is the speedier corrections help. 

Lots to find out


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## Radders (Aug 12, 2017)

Have any of you tried Apidra? Works much faster for me than Novorapid. Still have to pre-bolus though.


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## Pumper_Sue (Aug 12, 2017)

SB2015 said:


> I sort out the post meal issues for bigger meals/meals out it may not be worth it.


If you are spiking then try a combi bolus and experiment with the split. It might be worth considering just increasing your basal on a temp bases to overcome the problem.
Just don't be caught out by thinking Fiasp only works for 3.5 hours there is a tail to it so you will have IOB without realising it.


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## everydayupsanddowns (Aug 12, 2017)

Pumper_Sue said:


> If you are spiking then try a combi bolus and experiment with the split. It might be worth considering just increasing your basal on a temp bases to overcome the problem.
> Just don't be caught out by thinking Fiasp only works for 3.5 hours there is a tail to it so you will have IOB without realising it.



I've seen others recommend this, so clearly people find it works, but I have never understood this as a strategy for taming post-meal spikes. For me combo and square boluses work when I want to *delay* at least some of the insulin until later (e.g. For slower acting carbs). Spikes for me need the insulin to have a head-start on the food - so pre bolus works better for me. Just shows how different we all are


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## Pumper_Sue (Aug 12, 2017)

everydayupsanddowns said:


> I've seen others recommend this, so clearly people find it works, but I have never understood this as a strategy for taming post-meal spikes. For me combo and square boluses work when I want to *delay* at least some of the insulin until later. Spikes for me need the insulin to have a head-start on the food - so pre bolus works better for me. Just shows how different we all are


Sorry I didn't make it clear as to what I meant.
If you bolus for a meal in a normal way (for you)and then find yourself starting to rise when you shouldn't be then a temp basal does a very good job, esp whilst experimenting with the oddness of Fiasp.


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## everydayupsanddowns (Aug 12, 2017)

Do you mean that 'super bolus' technique Sue, where you add the next x hours of basal to your bolus and set a 0% tbr for those hours?


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## Pumper_Sue (Aug 12, 2017)

everydayupsanddowns said:


> Do you mean that 'super bolus' technique Sue, where you add the next x hours of basal to your bolus and set a 0% tbr for those hours?


I've no idea my brain doesn't work in that league


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## SB2015 (Aug 13, 2017)

The logic for high carb and high GI meals tells me to look at super bolus, but have never tried it yet.
With lower GI or combo I would look at multiwave or extended.

Some of what I am sorting is stuff I did with NR, but lots new as I am being a bit more focused at present with the new insulin.  However life, or hypos get in the way of basal rate testing, so using patterns off Libre, as well as bit of fasting to gradually sort things out.  No point in fiddling with CHO ratios and sensitivity until basal rates checked.  Also bearing in mind what Mike said about sensitivity changing after a while, so no rush.


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## Pumper_Sue (Aug 13, 2017)

My combi is your multiwave @SB2015  Three weeks in and my ratio's and correction have stayed the same so far.
For lunch today I used a combi of 80/20 over the two hours started out at 5.3 and at 2pm was sitting at 6.
This did involve a 30 min walk after lunch with Milly and for a few mins I went up to 10 according to my CGM then started to drop down again.
This was eating 66 carbs.


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## SB2015 (Aug 13, 2017)

Just managed a fasting test from 13:00 (breakfast was a bit late!!!) - 20:00.  No great dips or rises, so not going to check again, apart from checking Libre.  Celebrated with a chilli con carne and rice and as you suggested used a split, with bolus delivered just 5 min before meal.  So much easier.

Just a morning and evening test to do and confirm changes I have made overnight.  Slight reduction since FIASP, but I think it is more to do with not having done the fasting test for a while.  Great having Libre to back up BG tests.


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## Bloden (Aug 14, 2017)

Wow, pumping sounds like a lot of work! So, this question seems a bit basic...Does Fiasp start working more quickly than other rapid insulins? (I read somewhere that it starts working 7 minutes earlier).


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## Pumper_Sue (Aug 14, 2017)

Bloden said:


> Wow, pumping sounds like a lot of work! So, this question seems a bit basic...Does Fiasp start working more quickly than other rapid insulins? (I read somewhere that it starts working 7 minutes earlier).


Pumping is hard work but the end result is fantastic with stable blood sugars day and night (most of the time)
Yes Fiasp does work a lot quicker than other insulin's, hence why some of us are trying to sort out how and when to bolus


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## Bloden (Aug 14, 2017)

Pumper_Sue said:


> Pumping is hard work but the end result is fantastic with stable blood sugars day and night (most of the time)
> Yes Fiasp does work a lot quicker than other insulin's, hence why some of us are trying to sort out how and when to bolus


Thanks, Sue. 
I'm thinking of asking my GP if I can at least try it at breakfast when I need my rapid to be a bit more rapid.
Good luck with the tweaking.


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## SB2015 (Aug 14, 2017)

Bloden said:


> Wow, pumping sounds like a lot of work! So, this question seems a bit basic...Does Fiasp start working more quickly than other rapid insulins? (I read somewhere that it starts working 7 minutes earlier).


As Sue says, pumping is not easy, but well worth the effort as it enables me to get much better BGs throughout the day and night.  

The FIASP is definitely a lot quicker for me and making going out for meals a lot easier, as the spikes are much reduced with this speedier onset.  It is early days though, and I know that some have found that they have needed more insulin overall.  If you do decide to give it a go it will be interesting to hear how you find it on MDI.  I am not aware of anyone else on MDI trying it so far.  Good to hear if there are some around.


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## SB2015 (Aug 14, 2017)

Pumper_Sue said:


> My combi is your multiwave @SB2015  Three weeks in and my ratio's and correction have stayed the same so far.
> For lunch today I used a combi of 80/20 over the two hours started out at 5.3 and at 2pm was sitting at 6.
> This did involve a 30 min walk after lunch with Milly and for a few mins I went up to 10 according to my CGM then started to drop down again.
> This was eating 66 carbs.


I used a multiwave today when we went out to take account of different GI, but also borrowed some basal up front because the first course was higher carbs than I usually have.  Seems to have worked okay.


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