No problem! What kind of accelerants do they add to the Fiasp and why do they add it? I have heard that the Humalog does take a full 15 mins to work, where as the Novolog works immediately for a High blood sugar. I think this is why his Endo kept him on Novolog all these years. Humalog is definitely a go try, so thats not a problem. Just giving you some background.
Thank you all for your help, time and understanding.
Humalog has 2 of the amino acids in the human insulin protein chain switched with other amino acids. The changing of the amino acids changes the structure of the insulin protein, and allows it to migrate through the subcutaneous tissue and into the blood stream faster. As a general rule, it takes 15 min to start to reduce BS.
Novolog has 1 amino acid removed from the human insulin protein chain. The deletion of this amino acid likewise changes the structure, so it migrates into the blood stream faster. As a general rule, it takes 5-10 to start to reduce BS.
Fiasp is Novolog with Vitamin B3 added to the solution. The structural change of the Novolog, plus the B3, allows a larger volume of insulin to migrate to the blood stream quickly. As a general rule, maximum serum concentration is at around 7 minutes.
Humulin is regular human insulin (no amino acid manipulation). It generally takes 30-45 minutes to migrate through the sub cutaneous tissue and into the blood stream. It doesn’t have to be injected with a syringe. It can be used in a pump, but obviously because it takes 30-45 to start to lower BS, takes some fine tuning in regard to timing when you switch from a rapid acting insulin. Myself, and I’m sure others here, can attest to the fact that we used it in a pump before rapid acting was developed. I bet there are folks here who even may have used beef or pork insulin in a pump in the early days.
“While it is certainly true that a central objective of for-profit corporations is to make money, modern corporate law does not require for-profit corporations to pursue profit at the expense of everything else, and many do not do so. For-profit corporations, with ownership approval, support a wide variety of charitable causes, and it is not at all uncommon for such corporations to further humanitarian and other altruistic objectives.”
Well, indeed, public for profit corporations can do non-profit activities:
While asking for approval for employer and employee bonuses is frequent and approval for political contributions does happen my wife couldn’t remember voting about a charitable contribution; my wife handles our portfolio. This doesn’t apply to privately held corporations; no shareholders, just owners, but they are still “for-profit corporations”. LifeWise was a privately held Oregon health insurer, it stopped operating in 2017 however I was really referring to the large public healthcare corporations.
Ok, $800 insulin, right? We know that that $800 is value-added, I’m using that term to avoid the healthcare industry complaint that they have to spend a lot of money on research; the base cost of the insulin we inject is probably only a few dollars of that $800. So how much reduction might we see if the healthcare industry persuaded the whole of corporate US, not individuals, to donate an amount matching their current charitable donations solely to reduce the cost of prescriptions? That’s a doubling of “giving” by corporate US, including privately held corporations:
So the corporations have (using 2018 figures) $20.05 billion dollars to spend reducing prescription costs. There are a whole series of articles on Bloomberg bemoaning the rise in prescription costs; these are certainly worth reading for those of us who depend on increasingly expensive drugs but they don’t really seem to give hard numbers. Getting to the hard number, total consumer spending on drugs, is a little more difficult 
However I found this extremely boring page:
It’s to the point, seems to list all the issues I’ve been able to identify and then some and, unlike Bloomberg and other news outlets, it’s not written as pulp fiction. Here’s the executive summary:
In 2016, the U.S. spent $3,337 billion, or 17.9 percent of the gross domestic product (GDP), on national health expenditures, of which $329 billion was spent on prescription drugs.2
So we have $20.05 billion to apply against $329 billion of expenditure. Notice how ridiculous this example is; I’m assuming the whole of corporate American will step up and double their charitable giving just to reduce prescription costs.
However this noble act would reduce our $800 spent on insulin to $750.
On the other hand Eli Lilley reduced my Humalog costs from $685.29 for a 30 day supply (15ml; one box of KwikPens) to $100, not out of charity but because they were running [* * *] scared of the “diabetics can’t get insulin” news from last year and at the same time Humalog was out of patent. Public pressure on companies does work, but it works on a drug-by-drug, situation-by-situation, basis.
The actuaries analysis also suggests that US drug prices are only 5% higher than those in Germany, but take note of what prices they are using; they are quoting prices paid by the end payer which, in the UK and Germany, is the central/federal government and in the US is our insurance companies. The patient in the UK pays a fixed “prescription charge” for each item regardless of cost, if I were in the UK that fixed charge would actually be 0 (because I’m a diabetic). In the US we pay a fixed cost per year; I will end up paying about $4000 this year for all the treatments (not just prescription drugs) that I need, although ironically the poorest people will pay a lot more because they fail to get insurance, about 8.5% of the population in 2018 according to Federal statistics on various news sites (pick your spin 
The actuary article also ends up with a set of suggestions, there’s some spin in there; they choose to look at prescription prices, not our costs, as in my previous paragraph and they don’t consider the more radical changes at the regulatory level of Congress. They do mention the non-negotiation issue of Medicare Part D; the CMS cannot negotiate prices, I consider that one of the elephants in the room.
Wow @Dc53705 are you a Dr? That was some great break down of the insulins, Thank you!
I don’t even think their is a question left after that break down to be honest.
Jesus I have to get this reply thing down. Ugh
Yes, it is, thanks to Dc53705
The information is in the package inserts, except these days you don’t get those if the pharmacist splits the package (I got no package insert with my Fiasp pens; I had to rely on the one with the vials.) Unfortunately the information is written in a highly abbreviated scientific form readily comprehensible to endos and the scientists who produced it but incomprehensible to the rest of humanity. We who are not part of the secret society and think chickens are meant to be eaten have to put up with the marketing blurb:
Fiasp starts working[1] in 2.5 minutes [endo-truth: it appears in the blood stream in 2.5 minutes].
Humalog/Novolog start working in 5 minutes.
Humalin is maybe more like 10.
[1] “starts working” is a total mis-translation of “insulin aspart appeared in the blood circulation ~2.5 minutes after administration” - quoted from the package insert, “~” means “approximately”; it’s a mathematical term widely used by empirical scientists [[troll]]
The Fiasp insert does actually give a set of data under the heading “pharmacodynamics” which is, I suspect, far closer to what we want to know but, given the past marketing in this field, is probably an unacceptable truth. I haven’t seen the pharmacodynamics section reported in this way before and, indeed, I haven’t seen it measured this way before. I find the Humalog insert to be obfuscated compared to the Fiasp one.
With Fiasp Sanofi tested 46 T1Ds using a “euglycemic [sic] clamp study”, the greek word means “good glucose”, i.e. they tested what happened while maintaining a constant blood glucose in the testees. The Humalog approach reported by Eli Lilley involved injecting Humalog into 10 T1Ds then giving them a big mac, “a high carbohydrate meal”; so that is more realistic of what happens in our very real world, yet all Eli Lilley produces is a graph of blood glucose going up then coming down.
Sanofi, on the other hand, injected varying (actually quite large, IMO) amounts of Fiasp then monitored how much glucose they had to pump in intravenously to keep the venous blood glucose constant.
The figures from Sanofi are interesting and scary for all those 5 minute marketing guys. I’m using the figures here for what would be a 32 unit jolt of Fiasp to me; these show the fastest results, the smallest jolt they used as 8 units, I personally never do more than 5 at a time:
Time to first measurable effect: ~16 minutes. This is the time delay before they needed to increase the intravenous glucose.
Time to peak effect: ~133 minutes [sic: 2 hours]. This is the time at which the rate of glucose infusion reached its maximum.
Time for effect to return to baseline: ~7 hours.
How I would love to see the same study results for Novolog and Novolin; I don’t have the package inserts for those.
Remember this is intravenous glucose; most people don’t deliver big macs intravenously, so there is one delay, the food, competing against the other delay, the insulin. This is what makes Afrezza so interesting; it is effectively intravenous insulin so it gets there right away. Eli Lilley used intravenous insulin as part of their pharmacodynamics analysis, not the part I was quoting above obviously, but rather to analyze what happened to blood glucose when someone mainlines Humalog.
jbowler
Good lord if you look at the break down of the insert your head would spin. Lol
But Fiasp seems to be pretty good eh?
Fiasp seems to have a higher degree of variability for different individuals as compared to Novolog or Humalog.
Bottom line is you have to try Fiasp to see how it works for you.
@Winterprincess - I was not clear from your posts. Is there an out-of-pocket cost difference for your son for Humalog vs Novolog?
I think of fiasp more as like a plan B
Wow Gramma Ethel, the turkey is extra moist and delicious this year!
Say, speaking of the cat…I haven’t seen her in a few hours. Where IS sweetums?!?
Well, Humalin is pretty good compared to the stuff I was on before genetically engineered insulins were available. Humalin isn’t genetically modified - it is straight human insulin - but it is produced using genetically engineered bacteria, Humalog and Novolog are chemically modified human insulins which are produced by genetically modifying human DNA. Fiasp is Novolog with additives.
My own opinion is that they are all the same; they are all so much better than pig and cow insulins but telling the difference between one and the other, then saying which one is better, seems to be a matter of personal preference.
All four variants have a single very real problem for people who pump; they stick in our systems for approaching 8 hours. This messes up with calculations within that 8 hour window. Fiasp rates slightly better than Humalog/Humalin for this; at normal dosages it is gone within 6 hours, whereas Humalin takes 8 hours and Humalog slightly over 6. This is from the package inserts (“pharmacokinetics”), not real experience.
But honestly, 6 hours is still too long so we all have to adjust to that source of error. Once you’ve learnt one insulin changing to another might be a significant step back in learning. The Novolog package insert is available on the web. It uses the same approaches as the Humalog one. The pharmacokinetics section shows it leaving the system faster than either Fiasp or Humalog; about 5 hours, however the dose of Novolog was 3/4 of the dose used for either Fiasp or Humalog so this isn’t surprising.
Seriously, I don’t think it matters which I use.
From a practical point of view and specifically how the Fiasp works for us, we consider any remaining effect after 2-1/2 hours to be too small to consider in subsequent Bolus calculations.
In terms of size of Bolus, it would be very unusual for us to do a regular Bolus greater than 5 units.
My experience with Humalog on the Omnipod was to set the insulin action time to 3 hours; so no effect after 3 hours and linear reduction to 0 until then. Unfortunately from the UST400 the Omnipod has ignored food, so the bolus calculations are actually useless until all the food has gone from your system and this makes my food timeout more important; it’s about 2 hours.
Generally I think I might be seeing a little faster decay from Fiasp and that’s good because if the Fiasp decay matches the food decay Fiasp food boluses could be completely ignored. (So this is not the onset time, it is the ‘offset’ as it might be called.) Of course correction boluses still have to be discounted when re-correcting though I do sometimes get fed up and stack the insulin.
The irony of all this complexity is that the manufacturers do give us the data: All it would take is. Oh, I’m not going to say that; it’s obvious how to do it but if I say it a manufacturer will patent it and a patent lawyer will say it is not obvious. Rest assured the data is staring everyone who reads the package insert in the face.
Of all the insulins I’ve tried over the years, the best one still seems to be afrezza…worked in about 5-20 minutes depending on my glucose level, and seemed to be done within an hour or two at the most…I did end up coughing and was sick of storing all of it In the refrigerator after a year, plus optum RX would often send expired Insulin and told me if I didn’t want expired, I could wait 3 months, and afrezza was double the copay, etc… my current Cigna insurance doesn’t cover it, however, I do miss correcting while driving
This is/was my problem with afrezza - coughing. I haven’t attempted it in a few months, but I’ll give it another try soon!
My apologies, but I got bogged down in this discussion of variations in insulin. Have you called Lily to see about programs they offer?
A little while back someone posted in the Honest Exchange that Novo Nordisk and Lily had increased their income limits for providing free or no cost insulin (I have to assume out of shame and guilt on their part). I couldn’t find the post, but if I recall correctly, Lily offered assistance for single individuals making under $38,000. It never hurts to ask the manufacturer what programs they have available for ANY savings on ANY drug or equipment used.
Lilly gave me a $100/month discount (“coinsurance”) card but I earn more than that. I did not lie to them, I just worked through the set of questions the representative asked me; none of those included any statement as to income, can they even ask that question under US law?
When I say “$100/month” I mean that the coinsurance covered everything over $100/month, i.e. my out-of-pocket was $100 a month, which was a considerable reduction from the ~$530 that I was paying per month before my not too painless consultation with the lower gods.