Friday, 5 July 2019
By Donna Itzstein
Diabetes Queensland Pharmacist and CDE
Fiasp, a fast-acting insulin, has featured in many blogs and forums after it was added this month to Australia’s Pharmaceutical Benefits Scheme (PBS).
Novo Nordisk has produced this variation of insulin aspart, which is absorbed faster from the fat layer under your skin. The product has niacinamide (vitamin B3) and arginine (amino acid) added. (1)
Fiasp was approved for use in Australia in 2017; however, it has only now made its way onto the Pharmaceutical Benefits Scheme. This means it will cost the same amount as your other rapid acting insulins.
What is the hype about?
Fiasp has a faster onset and a faster, higher peak than Novorapid. See the diagram below from Novo Nordisk in the USA (2). It highlights the increased onset and peak of Fiasp compared to Novolog (US name for Novorapid).
Insulin levels after the same doses of Novorapid (Novolog – USA) and FiASP.
Image courtesy of Novo Nordisk
This difference may not look significant; however, Fiasp provides quicker insulin cover at meal-times. Please note that the duration of its action is similar, at about 300 mins.
Why is this significant?
You may be pre-bolusing for a meal about 15-20 minutes before eating with rapid acting insulins. The time gap makes it difficult to gauge how much you’re going to eat.
The use of Fiasp allows you to delay the administration of insulin, as per the recommendations, which may allow you to decide how much you’re going to eat, and dose accordingly, improving post-meal glycaemia.
Novo Nordisk dosage recommendations
- 5 – 10 minutes before a meal
- At the bite of a first meal OR
- Within 20 minutes of starting a meal
There are cautionary points to remember:
- Be careful not to leave it too late to eat with Fiasp as hypos are a very real possibility.
- Fiasp is not registered for use in anyone under the age of 18 years.
- Fiasp is not recommended in pregnancy as there are not enough studies to support its use.
- Fiasp should be used with care in an older person or if you are hypo unaware. This increases the risk of hypos.
- Fiasp is not recommended for insulin pumps. It has been used overseas; however, not in Australia. Pump algorithms are based on Novorapid.
As with any medication discussion, please contact your GP and pharmacist for further information about Fiasp and whether it’s the right product for you.
For more information on this article or general enquiries, contact us on 1300 136 588.
1. 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.
2. 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.