Tag: insulin

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Review of Insulin Fiasp

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:

  1. Humalog® (insulin lispro; Lilly)
  2. NovoLog® (insulin aspart; Novo Nordisk)
  3. 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.

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Groceries or Insulin

The high Cost of Insulin

Many patients are finding themselves unable to afford insulin, they must make a choice between buying groceries or insulin. As a follow up to my blog the High Cost of Insulin , the human cost of insulin. NBC News (8/15) reported on patients rationing insulin and leading to death. One of my favorite bogs also addressed this topic, E&M Blogosphere . In the article Hyma Gogineni, Pharm. D, MSc, BCACP, TTS, talks about why the high cost and list available programs that both insured, and uninsured can use to help afford insulin.

Recently USA today published an article calling for free medications for those who need it and can not afford it. This is a growing problem that is only getting worst. In January the New York Times wrote an article about drug makers accused of fixing insulin prices, that lead to a law suit. It seems like everyone from manufacturers, PBM and all middle players are getting rich while the neediest patients go without much needed insulin as reported by PBS news hour.

President Trump promised to lower prices of high cost medications as reported by AARP and Bloomberg.  We are still waiting for something to be done about high price medicines. Many practitioners have taken to petition state and federal law makers to curtail the cost of much needed medicines but not much has been accomplished. Meanwhile, many patients find themselves going without or rationing insulin to last them longer leading to many complications and in some cases as reported above to death.

Biosimilar

Two biosimilars recently approved with lower prices but still too high for patients to afford. Basaglar a biosimilar to Lantus and Admelog biosimilar to Humalog.  Whole sale prices of $348.78 for 15 milliliters (5 pens) of Basaglar and $251.83 for 10 milliliters of Humalog. Compared to Lantus price $430.14 and Humalog $294.85, the difference is not much. These biosimilars (almost an identical copy of an original product) are still too expensive for needy patients to afford.
Rightcare Alliance a petition directed to manufacturers to help patients afford insulin.

The Story behind  Rightcare Alliance was reported on WBUR, A Mother’s Day Message To Pharma: Lower Your Insulin Prices. Many more petitions can be found and many more tragic stories. Contact your senators and congress representatives and tell them make insulin affordable.

Sign the ADA’s petition

The American Diabetes Association has set an online petition to make insulin affordable: Sign the petition now.