Fiasp® (insulin aspart; Novo Nordisk)
Is the first of the next generation of faster-acting mealtime insulin analogues.
How does Fiasp differ from other fast-acting mealtime insulins?
Fast-acting analogues include:
- Humalog® (insulin lispro; Lilly)
- NovoLog® (insulin aspart; Novo Nordisk)
- Apidra® (insulin glulisin; Admelog® (insulin lispro, Lilly)
This next generation insulin, resulted in a more rapid appearance of insulin in the blood after injection and a better coverage of the mealtime excursion in glucose that is associated with Type 1 Diabetes, resulting in fewer peaks and troughs in insulin levels 3–4 hours from injection of the insulin at mealtime.
After the development of continuous glucose monitoring (CGM) systems, we discovered that these fast-acting mealtime insulins were still too slow and that peaks and troughs in glucose levels still occur after meals. We discovered that these insulins should ideally be injected not immediately before meals but 10–20 minutes before the meal.
However, this is not convenient for patients before breakfast when trying to get ready and even before some of the other meals. Many patients inject during their meal or even after the meal if there is uncertainty about what patients will eat (for example children and elderly patients). Hence Industry has been working on extra-fast insulins.
These have altered the excipients in which the insulin aspart is solubilized. They have added L-arginine and vitamin B, two natural agents that are approved by the European Medicines Agency and the US Food and Drug Administration. These facilitate the rapid movement of insulin through the capillaries into the blood. The pharmacokinetic profiles show 5-minute shift to the left. Fiasp is also 2.5-minute absorption into the blood stream. This will have a great impact on the quality of life of our patients as it will allow them to inject insulin at a time closer to the meal and will better cover glucose excursions.
Insurance coverage
For information go to: https://www.fiasppro.com/getting-patients-started/savings-and-coverage.html#
Are there any limitations of Fiasp?
Studies have compared injections of Fiasp immediately before a meal with insulin aspart and found that Fiasp gives smaller glucose excursions as well as a small but statistically significant difference (around 0.1%) in glycated hemoglobin (HbA1c) after 6 months and 1 year. We have also demonstrated that injection of Fiasp within 20 minutes after starting a meal gives the same effect as if it was injected before the meal. This is useful if people forget their injections or if it is not possible to predict what a patient will eat.
