Why November 14th is Special

Banting birthday

November 14th is  World Diabetes Day.  Those who live with diabetes often remark that every day is diabetes day! That is true but November 14th is special.

The 14th is the day that Sir Frederick Banting was born. For those who don’t know, Banting was a Canadian born medical scientist.  He received the Nobel prize for his work isolating insulin for therapeutic use with his colleague Dr. Charles Best.  He is the reason that my son is alive and thriving today.

Before 1922, a person with Type 1 diabetes was not expected to live long. The only way for them to survive was on very strict diets and those diets often left them malnourished.  Injected insulin came along and changed that.

The incredible before and after image of Leonard Thompson shows us just how dramatic of an impact insulin had on the lives of those living with diabetes.

From https://www.trumanlibrary.org/histday/insulin/impact.html

While my own son wasn’t as emaciated as poor young Leonard. He was gaunt and skeletal before he was diagnosed. My youngest child had always been a thin child. He had been sick but seeing him teetering in the bathroom after he began to receive insulin sent me into shock,however. His skin was hanging off of his tiny body and it had happened so quickly.

Thankfully on November 14, 1891 a man was born who would find this miracle elixir.  He would discover a way for my child, and millions like him, to receive the insulin that they were lacking in their own bodies. Dr. Banting gave them their lives back.  He gave parents back their children.

Those of us who use insulin, no that it is not a magic pill. We understand that it must be respected.  People living with diabetes quickly learn how the smallest doses of insulin can have life-threatening consequences. Despite the risk, the reward is incredible.  We have our children, our partners, and our friends.  They thrive, contribute and enrich our lives.

On this day we say “Happy Birthday Dr. Banting!! Thank you so very, very much for giving us this incredible gift of life.”

Fiasp Insulin. The New Kid on the Block

Fiasp Insulin the new kid on the block

It has been a long time since the diabetes world has seen a new rapid-acting insulin brought to market.  The last one that I can remember was  Apidra released back in 2004.  It is not surprising then that the release of Fiasp by NovoNordisk is creating a lot of buzz.

Not to be left out, my son recently began using this insulin. Since Fiasp insulin is the new kid on the block, I thought I would give everyone a brief rundown on the highs and lows associated with it.

What is Fiasp?

Fiasp insulin was released by NovoNordisk onto the Canadian market in March of 2017.  Many of us scrambled to get a prescription because it promised better blood glucose levels without pre-bolusing for meals! According to the press release, you can dose up to two minutes before a meal and up to 20 minutes after starting a meal without compromising overall glycemic control or safety!*

How is it different?

A Medscape article states that  Fiasp is absorbed twice as fast as its counterparts. It does this with the help of  two excipients–Vitamin B3 is responsible for the increase in the speed of absorption and Amino Acid (L-Arginine)  has been added for extra stability.**

But what do Fiasp users think?

All of this science is great but most people are wondering how well it works in real life settings.  From what I have seen, the bulk of users really like it.  I could only find one person out of about a dozen users who had returned to their old insulin aspart.

When I asked my son for his review I was told “I still have highs. I still have lows BUT if I have a heavy carb  loaded meal, Fiasp kicks butt and I don’t have the same crazy swings that I always did before.” For a 19-year-old who can definitely binge on carbs, this is huge.

Other users seem to have had similar results.

Some people with diabetes found that the insulin peaks were no longer as pronounced.  They had some difficulty battling highs with Fiasp however while others found it perfect for corrections. In fact, some people are purchasing Fiasp just for corrections.

Other users explained that faster insulin action allowed them to more quickly respond to rising blood glucose levels.  This, in turn, meant resulted in much tighter control.  The quick action has also left one user to caution about the timing of any pre-bolus.

Most seemed to agree that Fiasp insulin resulted in fewer food spikes and more stable blood glucose levels but as I said not everyone loves it.  For some users, their traditional rapid-acting insulin seemed to work better.

Final thoughts…

All in all, most people with diabetes who are trying the new kid on the block seem to be happy with it.  It offers another insulin choice for those who struggled with post-meal spikes or don’t pre-bolus meals.

It must also be noted however that while Fiasp is not currently approved for use in insulin pumps in Canada, both those on insulin pumps and MDI are using this insulin aspart.

I was also happy to see that the price of Fiasp insulin was par with NovoRapid. This meant that there was no need to worry about an increased cost for out of pocket insulin expenses.  My understanding is that Fiasp insulin is not yet on many (or any) provincial formularies.  This most likely will mean that if you decide to use the insulin and are currently using a publicly funded program, you may have to either pay for this insulin out of pocket or speak to your doctor about having special authorization added to your benefits to ensure full coverage.

Please remember to check with your diabetes team before starting any new insulin regimen. 

You can read about all of the types of insulin available in Canada here.

Insulin 101…It Saved My Sanity

I recently began thinking about the most liberating thing that I learned after my son was first diagnosed with Type 1 diabetes. I have always said that it was to take life four hours at a time.  That did help but before I could learn that, I think I had to learn one more important lesson…how his insulin worked.

Once I understood how my son’s insulin worked both of our lives took a dramatic change for the better. As I have said many times, when my son was first diagnosed he was in DKA and given hours to live.  I knew that they gave him insulin and that is what helped him to survive.  That connection stayed with me long after we left the hospital. I knew that he had to have insulin injected to live but I didn’t understand the roles of insulins that he had been given. This lead to battles and frustrations on both my part and that of a confused two-year old.

At diagnosis, my son’s doctor believed in using the most up to date insulin regimens.  That meant that he was given NPH and humalog for his meals.  Again, I didn’t really understand this in my newly diagnosed, muddled mind.  I just knew that he had to have insulin to live.  I had to give him both insulins and he had to eat what the dietitian told me.

In fairness to my dietitian, she also told me that if I wanted I could learn to count carbs and feed my son only what he wanted and give him just the insulin that he needed for that meal.  What she said made sense.  Not all bread was created equally and therefore not requiring the same amount of insulin.  Despite knowing that on an intellectual level I was blocked on an emotional level.  He must have all of the insulin I was told to give him in order to stay alive.  This blocked thinking lead to struggles and trauma for everyone involved at each mealtime.  Breakfast could last until lunch and supper could easily run into his bedtime snack.  There were tears on both sides.

One day I found an email support list.  I asked for help trying to make my son eat.  A woman, who went on to become a great friend, replied to my email instantly.  She said “Don’t force him to eat and just don’t give him his humalog.”

For whatever reason when she said it (or wrote it) everything clicked!  The NPH had a peak. That was what the snack times were all about but the humalog was a rapid acting insulin meant to cover his meals. No meals? No problem. No insulin.  He would always he his small snacks so that was not a concern.  Smaller meals? Well my dietitian had told me how to count carbohydrates and figure out his carb to insulin ratio so that was okay too.

My world changed completely…and so did my son’s.  We no longer fought about meals. If he didn’t want to eat he didn’t.  There were no more special meals or catering that I hated to have to do.  I could treat him the same way as I did his older brother. In other words, he could be a kid first and a child with diabetes second.

This also meant that we could handle birthday parties in a whole new way.  I learned the carb counts of most party food and he could enjoy meals with the other kids.  He could have cake! Most cake was around 25g CHO which was his snack amount so I would save it for 2pm (which often was when they settled down enough to have some anyway) and he could eat with everyone else.

Learning how his insulin peaked and what it was used for was the most liberating thing I could do for my son and my own sanity.  Once that was under my belt, I could work with the other factors.  I could break life down into the four hours of rapid acting insulin life.  One major hurdle was overcome. A small piece of my sanity saved! Humalog