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Introducing Fiasp

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 Benefits Scheme.

 

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.

 

 

Graph _Insulin Levels _Novorapid

Figure 1: Insulin levels after the same doses of Novorapid (Novolog - USA) and FiASP.

Image courtesy of Novo Nordisk

 

Graph _BGL During And After Carb Meal 

Figure 2: Blood glucose levels during and after a carbohydrate meal.

 

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 2).

 

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 every circumstance.

 

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

Novorapid

Fiasp

5 - 10 minutes before a meal

At the bite of a first meal     OR

 

Within 20 minutes of starting a meal

 

Special circumstances

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. 

 

Prescribing detail

  1. Fiasp INSULIN ASPART 100 units/mL injection (fast acting) solution, 1 x 10 mL vial 5 X 2
  2. Fiasp® INSULIN ASPART 100 units/mL injection (fast acting) solution, 5 x 3 mL cartridges 5  Fiasp Penfill®
  3. INSULIN ASPART 100 units/mL injection (fast acting) solution, 5 x 3 mL injection devices 5  Fiasp FlexTouch®

 

General Schedule

Prescriber type:  Medical Practitioners Nurse practitioners (4).

 

For more information on this article or general enquiries, contact us on 1300 136 588.

 

 

Bibliography

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.] https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=CA8A668CFB6C319DCA258392003CB6F7&agid=(PrintDetailsPublic)&actionid=1.

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.

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