Ultra-fast Insulins Curb Mealtime Spikes

Today I am going to talk about two ultra-fast–acting insulins. The first is the newly approved faster-acting insulin aspart, called Fiasp®. The other is an older, inhaled insulin, Afrezza®.

First, let me explain why we need ultra-fast–acting insulins. If any of your patients with type 1 diabetes are on a continuous glucose sensor, they will be somewhat disturbed when they give their insulin before a meal and still see a fairly high postprandial glucose excursion. This happens largely because the insulin they have injected takes 15 to 30 minutes to begin to bring down that postprandial glucose level. The insulin has not had a chance to start working, and they are ingesting carbohydrates and seeing these postprandial spikes.

To address that, we tell patients to take insulin 15 to 30 minutes before the meal. But that is highly inconvenient for many patients, and often they do not do that. Thus, there clearly is a need for faster-acting insulin.

The faster-acting insulin aspart Fiasp has been available in Canada and other countries for a short while. This insulin works faster than the usual insulin aspart, much closer to the time it is injected. A person can actually give it right before the meal and it will start acting as the food is being absorbed.