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Just How Quick is Fiasp,
Novo Nordisk’s FasterActing Insulin?
May 17, 2017 By Alex O’Meara
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Fiasp, a new, faster-acting insulin from Novo
Nordisk, is generating a lot of interest and
carries with it much potential for improved
diabetes care. A sort of acronym for faster
acting insulin asparte, Fiasp starts working
within two minutes of injection and can
even be effective in lowering blood sugar
when taken up to 20 minutes after a meal.
Existing fast-acting insulin formulations
such as Humalog, Apidra and Novo Nordisk’s
own NovoLog (called NovoRapid in Europe
and Canada), take 10 to 20 minutes to begin
lowering blood sugar after injection.
According to Novo Nordisk, Fiasp, “has its
maximum effect between 1 and 3 hours after
the injection and the effect lasts for 3 to 5
hours.”
“Our goal in developing Fisap was to try and
get closer to mimicking the body’s own
insulin response to food,” says Michael
Bachner, Associate Director for Product
Communications for Novo Nordisk. “Doing
that creates a lot of opportunities for how
this might be applied to improve care.”
Fiasp was approved for use in Europe in
January and approved in Canada in late
March. Approval in the United States is
pending with Novo Nordisk expecting to
hear back form the FDA in the fourth quarter
of this year, Bachner says. (The FDA
application is the Danish pharmacy giant’s
second attempt at U.S. approval.)
Interest in the new insulin is keen, according
to chat boards and as reported by Mike
Hoskins for the DiabetesMine team in late
April. Tim Street, a diabetes writer, reports
an uptick in views to his site since he
started reporting on Fiasp. His website
diabettech.com—“Where diabetes and
technology meet”—says when he started
writing about Fiasp visits to his site went
from between 200 and 500 per day to
between 500 and 1,000 per day. To date,
Street has penned six articles about the new
insulin.
“It’s generated a lot of interest because it
holds a lot of promise,” Street says. “The
faster onset could certainly cut postprandial
spikes in blood glucose levels.”
Street put Fiasp to an interesting and unique
test to find out whether the new insulin
actually, or only theoretically, worked within
two minutes of injection, as well as to test its
peak and drop times.
Street pitted a 4.7 unit dose of Fiasp against
one Krispy Kreme doughnut, which was a
force to be reckoned with at 47 grams of
carbohydrate. Street did his bolus of Fiasp 10
minutes before he downed the doughnut.
The result, according to Street, was in line
with what Novo Nordisk said about how the
insulin behaved in clinical trials.
Two exceptions, according to Street, who
holds an engineering degree, appear to be
that doses taken together or quickly one
after the other might cause hypoglycemic
reactions and Fiasp does not appear to
prevent postprandial high blood sugars if a
lot of carbs are eaten. However, he admits
more research is needed and that his tests
were fairly anecdotal.
“But the biggest question, by far, is whether
or not it’s truly faster?” Street said. “My initial
cautious response to that is, yes. It seems to
be.”
That speed in effectiveness is key to making
Fiasp a potential blockbuster drug for several
reasons. For Street, Bachner’s comment that
Novo Nordisk aimed to create insulin that
acts as similar to human insulin as possible
makes it a perfect candidate for being the
fuel that an artificial pancreas can most
effectively run on.
“Novo Nordisk is very interested in
expanding the use of fast-acting insulin
aspart in an artificial pancreas setting,”
Bachner says, although he was unable to
provide details regarding those plans. “While
Fiasp is approved for use in insulin pumps in
Europe, it is not yet approved for use in
pumps in Canada.” He says additional trials
are needed to gain approval for that use.
Whether or not Fiasp becomes the first
choice of insulin for use in an artificial
pancreas, or pumps, is almost beside the
point. Fiasp is poised to potentially become
the overall leader in the enormous market
segment of fast acting insulin.
NovoLog, which was launched in 2000 in
Europe and 1999 in the U.S., has carved out
and maintained a significant segment of the
insulin market. It was the third best selling
diabetes medication in 2015 with $3.03
billion in global sales, according to the
pharmaceutical industry tracking website
pharmaceutical-technology.com. However,
Fiasp won’t only be competing with segment
leader NovoLog. Fast acting insulin
Humalog, from Eli Lilly, was right behind
NovoLog with $2.84 billion sales that same
year, meaning that Fiasp could become a
blockbuster not only by replacing its related
insulin NovoLog, but by also overtaking
Humalog.
Bachner cautions that sales data are not
available to see how Fiasp is selling since it
hit the market so recently. He also says that
the price point for Fiasp in Canada and
Europe is on parity with NovoRapid. Whether
the price will be on the same scale with
NovoLog in the U.S. when Fiasp is
introduced has not yet been determined.
“I’m not sure if there is a willingness to pay a
premium for new drugs,” Bachner says. “But,
so much with Fiasp is so new that it’s still a
wait and see game regarding almost every
aspect of it.”
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Alex O’Meara
Alex was diagnosed with type 1 diabetes 36 years
ago. Since then he has run six marathons – the first
when we was 15 – and the latest a few years ago. In
2006 Alex underwent islet cell transplant and was,
for some time, insulin independent. He now lives in
Southeastern Arizona where he is working on a
novel, teaching college English, pursuing a Master’s
degree, and training to run his first 50 mile race.
View Author Blog
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Steve
&
I’m using Fiasp, just started last week, I have to
say it’s not dramatically different from
Novorapid/Novolog. It does work faster, it seems to
reach it’s peak after 1.5 hours and then drop away
completely whereas with Novorapid it’s more like
2 hours and it hangs around a bit. I don’t think it’s
any better than Novorapid at mealtimes, but it is
really really useful if you go hyper. What I’ve
decided to do is carry on with Novorapid at
mealtimes but use Fiasp to treat hyperglycemia.
Definitely less sleep disruption due to hypers,
either because it goes high before… Read more »
+ 2 '
! Reply
# 2 years ago
"
LEM
&
I have similar experiences with Fiasp. I take care
to consider the what, when, where, how, and why,
of my meal combo and or my high glucose. Then I
use my NovoLog or Fiasp accordingly. There have
been times this past week when I have taken a
dose of each pre meal i.e. 1 unit of Fiasp with 2
units of NovoLog or the reverse; 2 units of the
Fiasp Pen with one unit of the NovoLog Pen, again
considering the situation. It would help if Fiasp
might be dosed in 1/2 units as is available with the
NovoLog “Echo”… Read more »
+ 1 '
Reply
# 1 year ago
Jay
&
What I’d really like to know is, if it IS quick to start
lowering blood sugar, will it also STOP lowering
blood sugar sooner and faster? That would be a
huge help for me. Currently, when I take a large
enough bolus to handle carbs or correct for a carb
spike, I end up “stacking” and end up with a low
about 2-4 hrs postprandially. In addition to the
severe hypoglycemia, that makes me gain weight
from eating when I just want to get my blood sugar
back up. I hope Fiasp stops as quickly as it starts.
+ 3 '
! Reply
# 2 years ago
"
Steve
&
Yeah it does drop off pretty quickly, I know what
you mean with stacking. You might want to try
Clif glucose powder, that’s what I use to counter
hypos, much less weight gain than eating.
Between that powder and this insulin I can really
fine tune my blood sugar now.
+ 2 '
Reply
# 2 years ago
Jim
&
Given the issues you describe, you should look
into Afrezza. Ultra-rapid action and out of your
system in 1-2 hours. My wife is on it and it
dropped her A1C from the 8.3 to the 6.5 in 3
months and she hasn’t had a single hypo since
she started on it. You can watch on her CGM how
fast it starts working, almost instantly, and then
!at lines around 90 after 60 min or so. It has been
a life changer for our whole family and greatly
reduced stress throughout the household. Best of
luck.
+ 4 '
Reply
# 2 years ago
Jay Rudin
&
I had hoped for good results from Afrezza and I
know it has worked for a lot of people. I was
optimistic and excited about trying it but for some
reason, which my endo and Sanofi AND Mannkind
could not figure out, it had no effect on me. In
other words, I didn’t absorb it through the lungs
for some reason. I passed the spirometry test, tried
it several times in different doses and even tried a
different lot number. It just didn’t have any effect
on my blood sugar. I am an ex-smoker but I quit
about 15 years… Read more »
+ 3 '
Reply
# 2 years ago
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