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Fiasp vs Novolog
Introduction
For patients with diabetes, certain types of insulin can help in managing blood sugar levels and mitigating the symptoms of both type 1 and type 2 diabetes. Fiasp and Novolog are two such insulins that are commonly prescribed for this purpose. Both Fiasp and Novolog are forms of fast-acting insulin, which means they work quickly to lower blood sugar after meals. They each impact glucose metabolism but have slightly different onset times and durations in their effectiveness. Fiasp is a newer formulation that includes an added ingredient (niacinamide) to speed up its absorption, allowing it to start working within approximately 2.5 minutes compared to the approximate 10-20 minutes start time for Novolog. However, both do most of their work within the first hour or so after injection and continue lowering blood sugar for up to five hours afterwards.
Fiasp vs Novolog Side By Side
| Attribute | Fiasp | Novolog |
|---|---|---|
| Brand Name | Fiasp | Novolog |
| Contraindications | Allergy to any ingredients, episode of hypoglycemia, certain oral diabetes medicines may increase risk of serious heart problems | Allergy to any ingredients, episode of hypoglycemia, certain oral diabetes medicines may increase risk of serious heart problems |
| Cost | Around $340 for five 3ml flexpens (100 units/ml) | About $375 for five Novolog flexpens (3 ml each, 100 units/ml) |
| Generic Name | Insulin aspart | Insulin aspart |
| Most Serious Side Effect | Signs of allergic reactions, low potassium levels, changes in fat tissue at the injection site, vision problems, rapid heart rate | Signs of an allergic reaction, symptoms of low potassium level, signs and symptoms of hypoglycemia, hyperglycemia signs, rapid weight gain with swelling |
| Severe Drug Interactions | Certain oral diabetes medicines may increase risk of serious heart problems | Certain oral diabetes medicines may increase risk of serious heart problems |
| Typical Dose | Administered by injection at the start of a meal or within 20 minutes after starting a meal, dosage varies based on individual needs | Initiated at a dosage fulfilling 50-70% of the total daily insulin requirement, adjusted based on glucose levels, normally taken within 5-10 minutes before a meal |
What is Fiasp?
Fiasp (the brand name for fast-acting insulin aspart) is the most recent arrival in the class of rapid-acting insulins, offering a significant advancement from the earlier generation of insulins such as Novolog. Fiasp was first approved by FDA in 2017. It works by controlling levels of glucose in your blood, reducing it effectively and promptly after meals. This insulin is prescribed to manage both type 1 and type 2 diabetes. Fiasp includes an added ingredient - niacinamide - that enables faster absorption into the bloodstream than Novolog and therefore starts working quicker, generally within half an hour after administration. Its influence on glucose control is more immediate compared to Novolog which makes it less likely to cause low blood sugar later on during its effect period.
What conditions is Fiasp approved to treat?
Fiasp is approved for the management of diabetes, including:
- Type 1 diabetes, which requires insulin for survival due to a lack of endogenous production
- Type 2 diabetes, where patients have resistance to their own insulin and may require extra help controlling blood sugar levels
- In both types, it can be used by adults and children over the age of one. It offers faster absorption and onset action than Novolog due to its added ingredient, niacinamide.
How does Fiasp help with these illnesses?
Fiasp helps to manage diabetes by increasing the amount of insulin available in the body immediately after meals. It does this by adding a naturally occurring amino acid, which speeds up absorption into the bloodstream, so levels can be elevated faster and for shorter periods of time. Insulin is a hormone that regulates blood sugar levels, crucial in maintaining energy supply for various bodily functions such as heart rate, brain activity, digestion and more. It is known that individuals with Type 1 diabetes have an absolute lack of insulin while those with Type 2 diabetes have relatively lower levels or resistance to it. Therefore, by increasing insulin availability rapidly post-mealtime when blood glucose rises most significantly, Fiasp can limit negative effects like hyperglycemia (high blood sugar) and help patients manage their condition effectively.
What is Novolog?
Novolog, also known as NovoRapid or insulin aspart, is a fast-acting insulin analog that helps to control blood sugar levels in people with diabetes. It works by allowing glucose to enter cells and be used for energy. This action assists in preventing hyperglycemia (high blood sugar). Its rapid onset means it starts working quickly after administration, usually within 15 minutes. Novolog was approved by the FDA in 2000.
Unlike other types of insulins which have a slower response time, Novolog's quick action allows it to more closely mimic the body's natural insulin response during meals thus providing better glycemic control immediately after eating. Unlike Fiasp, an ultra-fast acting form of insulin aspart which contains an added ingredient niacinamide that further accelerates its absorption, Novolog has been around longer and its safety profile is well-established through years of use and research studies.
What conditions is Novolog approved to treat?
Novolog is approved for the treatment of both type 1 and type 2 diabetes. This fast-acting insulin analog helps to control high blood sugar levels during meal times. Novolog can be used in the following ways:
- Subcutaneous injection, which involves injecting it under your skin
- Continuous subcutaneous infusion pump, a device that delivers a continuous flow of insulin into your body
How does Novolog help with these illnesses?
Novolog is an insulin analog with a rapid onset of action that plays crucial roles in many metabolic processes, affecting blood glucose levels, absorption and storage of glucose by the body's cells. As with other types of insulin, inadequate levels can lead to hyperglycemia (high blood sugar) which is a hallmark symptom of diabetes. Novolog works by supplementing or replacing the insulin normally produced by the pancreas and allows for more flexible mealtime dosing than regular human insulin due to its fast-acting nature. Its effects on glucose uptake may also play roles in its action as an antidiabetic medication. Since it does not significantly affect glucagon levels, it is sometimes prescribed when a patient does not respond well to traditional human insulins (such as Regular), or may be combined with longer-acting insulins for better glycemic control. Comparatively, Fiasp has been formulated to act even faster than Novolog making it effective at controlling post-meal spikes in blood sugar.
How effective are both Fiasp and Novolog?
Fiasp and NovoLog are both rapid-acting insulin analogues, widely used in the management of diabetes. Initially approved by the FDA a few years apart, Fiasp came later on the market than NovoLog. Both aim to mimic physiological insulin secretion after meals and share similar safety profiles.
A double-blind clinical trial in 2017 directly studied their effectiveness at controlling post-meal blood glucose levels. The study found that while both Fiasp and Novolog effectively managed postprandial hyperglycemia, Fiasp had a faster onset of action and higher early mealtime insulin exposure compared to Novolog. This suggests that Fiasp may provide better control over immediate rises in blood sugar levels following meals.
A 2018 review indicated that Fiasp is effective starting from the first injection at mealtime or within 20 minutes after starting a meal, making it more flexible for use around mealtimes than other fast-acting insulins like Novolog. It also has been shown to improve HbA1c (a long-term measure of blood glucose control) when compared with conventional insulin aspart from baseline to week 26 and up until week 52 of treatment.
On the other hand, although less robust data is available for stand-alone usage compared to combined therapy with basal insulins such as Lantus or Levemir, studies have demonstrated good glycemic outcomes with patient-guided dosing adjustments based on patterns identified using continuous glucose monitoring (CGM). Though typically not considered as an alternative option if previous treatments have failed like third-line antidepressants would be in depression treatment, choosing between these two options often depends on individual preferences regarding flexibility around mealtimes due to their different onset times.
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At what dose is Fiasp typically prescribed?
Dosage of Fiasp varies between individuals and is typically administered by injection at the start of a meal or within 20 minutes after starting a meal. The amount needed is determined based on an individual's blood glucose monitoring results and glycemic control goal. Similarly, Novolog dosage also depends on factors such as one's blood sugar levels, diet, activity level, and other diabetes medications being taken; it can be adjusted to meet individual needs. Children with type 1 diabetes may begin treatment under close medical supervision. Regardless of which insulin you use, regular monitoring of blood glucose is essential for adjusting doses accordingly to maintain optimal glycemic control. It's important not to exceed your prescribed dose without consulting your healthcare professional.
At what dose is Novolog typically prescribed?
Novolog, an insulin analog for individuals with diabetes mellitus, is typically initiated at a dosage that fulfills 50-70% of the total daily insulin requirement. It's generally administered in combination with long-acting insulin. Exact dosing will depend on glucose levels and should be adjusted based on frequent blood glucose monitoring. The dose can then be modified according to individual metabolic needs, blood glucose monitoring results and glycemic control goal. For mealtime use, Novolog should normally be taken within 5-10 minutes before a meal due to its fast onset of action; however, it may also be taken soon after meals if necessary.
What are the most common side effects for Fiasp?
Fiasp and Novolog are both rapid-acting insulin analogs used to manage blood sugar levels in individuals with diabetes. Side effects commonly associated with these medications include:
- Hypoglycemia (low blood sugar)
- Headache
- Weight gain
- Allergic reactions, such as rash or itching at the injection site
- Lipodystrophy (changes in fat tissue at the injection site)
- Swelling of hands and feet
- Diarrhea
- Upper respiratory tract infection It's crucial to note that everyone reacts differently to medications, so not everyone will experience these side effects. If any of these symptoms occur or persist, it is essential to seek medical attention promptly.
Are there any potential serious side effects for Fiasp?
While both Fiasp and Novolog are fast-acting insulins, there are some potential side effects you should be aware of:
- Signs of allergic reactions: hives, difficulty breathing or swallowing, swelling in your face or throat. If these occur, seek medical help immediately.
- Low potassium levels (hypokalemia): symptoms include muscle pain or weakness, leg cramps, irregular heartbeat.
- Changes in fat tissue at the injection site (lipodystrophy), including skin thickening or pits at the injection site.
- Vision problems: blurred vision can be a sign of low blood sugar levels but also an early symptom of diabetic retinopathy.
- Rapid heart rate: if you experience this along with sweating and anxiety it could indicate hypoglycemia (low blood sugar). Conversely rapid heart rate with dry mouth and frequent urination could mean hyperglycemia (high blood sugar).
If any severe abdominal pain occurs accompanied by nausea and vomiting - which might signify acute pancreatitis - discontinue insulin use and consult a healthcare professional promptly.
Note that while rare, serious systemic allergy to insulin can cause rash over the whole body, shortness of breath, wheezing, reduction in blood pressure, fast pulse or sweating. In such cases emergency medical care is necessary.
What are the most common side effects for Novolog?
Some potential side effects you may experience with Novolog include:
- Hypoglycemia (low blood sugar)
- Injection site reactions such as redness or swelling
- Fluctuations in weight
- Mild itching or rash
- Sodium retention and edema, leading to increased urination
- Headache, dizziness
- Upset stomach, including nausea and loss of appetite
- Fast heartbeat under certain circumstances such as overdose. Please note that while these side effects are possible, they do not occur in everyone. It's essential to monitor your body's response when starting this medication and report any concerning symptoms to your healthcare provider.
Are there any potential serious side effects for Novolog?
While Novolog is generally well-tolerated, there are instances when it can cause serious side effects. These may include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Symptoms of low potassium level such as muscle weakness or twitching, abnormal heart rhythm
- Signs and symptoms of hypoglycemia (low blood sugar) which includes headache, hunger, sweating, irritability, dizziness/fainting
- Hyperglycemia or high blood sugar signs like increased thirst/urination/hunger and dry mouth
- Rapid weight gain with swelling in hands and feet
If you notice any such adverse reactions after starting treatment with Novolog insulin aspart), seek medical attention promptly.
Contraindications for Fiasp and Novolog?
Both Fiasp and Novolog, like all other insulin medications, can cause low blood sugar (hypoglycemia). If you notice symptoms of hypoglycemia such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision or dizziness please treat your low blood sugar immediately and seek medical attention.
Neither Fiasp nor Novolog should be used if you are allergic to any of its ingredients or while having an episode of hypoglycemia. Always tell your doctor about any medications you are taking; some drugs can affect the way insulin works in the body and may require you to adjust your dose. Certain oral diabetes medicines may increase your risk of serious heart problems when combined with insulins like Fiasp or Novolog.
Furthermore, both these insulins have specific storage requirements which should be adhered strictly to prevent them from losing effectiveness. They should not be exposed to extreme temperatures and once opened they need to be used within a certain period of time.
How much do Fiasp and Novolog cost?
For the brand name versions of these insulin drugs:
- The price of five 3ml Fiasp flexpens (100 units/ml) averages around $340, which works out to approximately $22.67/day if you are using 50 units per day.
- The price for five Novolog flexpens (3 ml each, 100 units/ml) is about $375 on average, or around $25/day at a dosage of 50 units daily.
Thus, if your dose is in the typical range (i.e., up to 60 units/day), then Fiasp tends to be less expensive on a per-day treatment basis compared with Novolog. However, please remember that cost should not be your primary consideration when deciding between these two medications.
Currently, there are no generic versions available for either Fiasp or Novolog as they are both insulin analogs and biosimilars have yet to enter the market in most countries. Therefore, prices remain high for both medicines irrespective of dosage requirements.
Popularity of Fiasp and Novolog
Insulin aspart, in generic form and under brand names such as NovoLog, was estimated to have been prescribed to about 6.8 million people in the US in 2020. Insulin Aspart accounted for just over 29% of insulin prescriptions in the US. It has a fast-acting profile which makes it essentially suitable for mealtime use.
Fiasp is another form of insulin aspart but with an added ingredient (niacinamide) that helps it work faster than standard insulin aspart formulations like Novolog. Fiasp was approved by FDA relatively recently, in 2017 and hence its prescription rate has not reached those seen with long-established insulins yet.
However, many doctors are beginning to prescribe Fiasp instead of other types of mealtime insulin because it starts working more quickly - within approximately 2.5 minutes compared to about 10 minutes for most rapid-acting insulins such as Novolog.
Conclusion
Both Fiasp (insulin aspart) and Novolog (insulin aspart) have a long-standing record of usage in patients with diabetes, backed by numerous clinical studies that indicate they are more effective than placebo treatments. They both work by mimicking the body's natural insulin to control blood sugar levels. While these two insulins are essentially the same, Fiasp has added niacinamide, which accelerates its absorption and starts working faster than Novolog.
Novolog is considered a rapid-acting insulin taken shortly before meals to manage postprandial glucose spikes, whereas Fiasp is even quicker and may be taken closer to mealtime or within 20 minutes after starting a meal for those who struggle with pre-meal dosing.
Both drugs are available in generic form representing significant cost savings especially for patients who must pay out of pocket. Both Fiasp and Novolog might require an adjustment period depending on individual response meaning effects may not be noticeable right away.
The side effect profile is similar between the two drugs; common ones include low blood sugar (hypoglycemia), weight gain, injection site reactions like redness or swelling. Patients should closely monitor their blood sugar levels when starting treatment or changing doses and seek medical help immediately if experiencing symptoms of severe hypoglycemia such as confusion, seizure, or loss of consciousness.
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Refrences
- Davis, A., Kuriakose, J., & Clements, J. N. (2018, July 6). Faster Insulin Aspart: A New Bolus Option for Diabetes Mellitus. Clinical Pharmacokinetics. Springer Science and Business Media LLC.http://doi.org/10.1007/s40262-018-0696-8
- Senior, P., & Hramiak, I. (2019, October). Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective. Canadian Journal of Diabetes. Elsevier BV.http://doi.org/10.1016/j.jcjd.2019.01.004
- Ozer, K., Cooper, A. M., Ahn, L. P., Waggonner, C. R., & Blevins, T. C. (2021, April 1). Fast Acting Insulin Aspart Compared with Insulin Aspart in the Medtronic 670G Hybrid Closed Loop System in Type 1 Diabetes: An Open Label Crossover Study. Diabetes Technology & Therapeutics. Mary Ann Liebert Inc.http://doi.org/10.1089/dia.2020.0500
- Christiansen, J. S. (2007, September). Insulin aspart: rapid control for postmeal glucose excursions. Expert Review of Endocrinology & Metabolism. Informa UK Limited.http://doi.org/10.1586/17446651.2.5.587
- Chapman, T. M., Noble, S., & Goa, K. L. (2003). Spotlight on Insulin Aspart in Type 1 and 2 Diabetes Mellitus*. Treatments in Endocrinology. Springer Science and Business Media LLC.http://doi.org/10.2165/00024677-200302010-00006
- Keith Campbell, R., & White, J. R., Jr. (2002, July). Insulin Therapy in Type 2 Diabetes. Journal of the American Pharmaceutical Association (1996). Elsevier BV.http://doi.org/10.1331/108658002763029580
- Fath, M., Danne, T., Biester, T., Erichsen, L., Kordonouri, O., & Haahr, H. (2017, February 6). Faster-acting insulin aspart provides faster onset and greater early exposure vs insulin aspart in children and adolescents with type 1 diabetes mellitus. Pediatric Diabetes. Wiley.http://doi.org/10.1111/pedi.12506
- Grosman, B., Wu, D., Parikh, N., Roy, A., Voskanyan, G., Kurtz, N., … Vigersky, R. (2021, June). Fast-acting insulin aspart (Fiasp®) improves glycemic outcomes when used with MiniMedTM 670G hybrid closed-loop system in simulated trials compared to NovoLog®. Computer Methods and Programs in Biomedicine. Elsevier BV.http://doi.org/10.1016/j.cmpb.2021.106087