By Donna Itzstein
Diabetes Queensland Pharmacist and CDE
Fiasp is insulin aspart with niacinamide (vitamin B3) and
arginine (amino acid) added. These two extra components increase
the rate of release from the subcutaneous fat into the
blood (1). Fiasp was registered by the Therapeutic Goods
Administration for use in adults with diabetes mellitus in 2017
(2); however, it has only now made its way onto the Pharmaceutical
Figure 1 is a comparison of the formulations of insulin aspart
with and without niacinamide and arginine. In Australia, the single
component is called Novorapid (Novolog in the US).
Fiasp has a faster onset and a faster and higher peak than
Novorapid, as you can see by figure 1. The duration of action is
similar in the two formulations.
Figure 1: Insulin levels after the same doses of Novorapid
(Novolog - USA) and FiASP.
Image courtesy of Novo Nordisk
Figure 2: Blood glucose levels during and after a
So how significant are these changes?
Ideal insulin release is what happens in a person without
diabetes. When blood glucose levels rise rapidly after a meal, the
amount of insulin in the blood increases tenfold within 3 to 5
minutes. When blood glucose levels drop (around 2-3 hours)
the opposite rapid drop of insulin occurs (3). Blood
glucose levels after a meal peak around one hour (see Figure
The human body has the ultimate closed loop system with multiple
intricate feedback systems with glucose metabolism. Without the
presence of this feedback system, the next best thing is an
ultra-fast acting bolus insulin to cover meals. The amount needed
to cover meals will depend on the meal content. The glycaemic index
of the carbohydrates, and fat and protein in the meal, will vary
the absorption rate of carbohydrates.
Another factor is the function of the gut. Any condition that
effects the motility of the gut, such as gastroparesis, will affect
the rise of glucose in the blood after a meal. We cannot
expect that any manufactured bolus insulin will completely match
By reducing the onset and peak time of a bolus insulin we can
come one step closer to matching blood glucose. The duration of
action of Fiasp is the same as Novorapid. This is important to note
to reduce insulin stacking.
Dosing amounts between Novorapid and Fiasp will not change;
however, injection timing with meals will change as per the
recommendations in the table below. Delaying the administration of
insulin, as per the recommendations, may allow your client to
decide how much they are going to eat, and dose accordingly,
improving post meal glycaemia.
Novo Nordisk dosage recommendations
5 - 10 minutes before a
At the bite of a first
Within 20 minutes of
starting a meal
Fiasp is not registered for use in paediatric
patients. The pen devices are 1-unit increments and premarketing
studies did not include paediatric patients.
Limited studies have been undertaken in
pregnancy. Fiasp is not registered in pregnancy
even though no harmful effects have been reported.
Fiasp can be used in elderly patients with
caution. Renal and hepatic dysfunction increases the risk of
hypoglycaemia. Consider gut motility which may slow with age, nerve
damage and use with some medications e.g. GLP-1 agonists.
Fiasp is not approved for use in insulin pumps
at present. The current pump algorithms will be calculated on the
profile of Novorapid.
- Fiasp INSULIN ASPART 100 units/mL injection (fast acting)
solution, 1 x 10 mL vial 5 X 2
- Fiasp® INSULIN ASPART 100 units/mL injection (fast acting)
solution, 5 x 3 mL cartridges 5 Fiasp
- INSULIN ASPART 100 units/mL injection (fast acting) solution, 5
x 3 mL injection devices 5 Fiasp
Prescriber type: Medical Practitioners Nurse practitioners
For more information on this article or general enquiries,
contact us on 1300 136 588.
1. Novo Nordisk. Product information: Fiasp: Insulin aspart
(rys). Therapeutic goods administartion. [Online] July 2017, 2017.
[Cited: May 30th, 2019.] https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2017-PI-02153-1&d=201906011016933.
2. Public Summary, Summary for ARTG entry, FIASP flextouch
insulin aspart (rys) solution for injection. Therapeutic goods
administartion. [Online] July 27th, 2017. [Cited: May 30th, 2019.]
3. Hall, John E. Guyton and Hall textbook of medical physiology.
s.l. : Elseiver, 2010.
4. Australian Government, department of health. PBS schedule
search : Fiasp, Fiasp Flextouch . The Pharmaceutical Benefits
scheme. [Online] June 1st, 2019. [Cited: June 1st, 2019.] http://www.pbs.gov.au/pbs/search?term=fiasp.