Tag Archives: Novo Nordisk

Fun with Fiasp.

As I mentioned in my previous post on this subject, my endocrinologist provided me with a sample vial of Fiasp so I could try it out in my insulin pump. This is only my opinion… before starting or stopping a medication, especially insulin, check with your doctor.

For anyone who hasn’t heard of it yet, Fiasp is Novo Nordisk’s faster acting insulin– in fact, Fiasp stands for Faster-acting Insulin ASPart. It was approved by the U.S. Food and Drug Administration last September. I was able to try it out in my pump for about a week.

When I did an informal poll of this new insulin via Facebook, I got a series of answers. Some people love it, some hate it, some made adjustments, some went running back to their previous insulin. I really didn’t have an idea of what to expect before beginning my trial.

But I did think of some of the experiences shared on that thread when considering my own experience with Fiasp.

To begin with, let’s talk about the faster acting part of the equation. Maybe I’m a little more sensitive than I thought, but the first two or three boluses really hit me hard. Even if it took a little more time to kick in, when it hit me, my blood sugar would plummet.

The science behind this is a combination of Vitamin B3 and an amino acid known as L-Arginine. The first is to speed up the insulin’s absorption time, and the other is to help maintain the insulin’s stability.

After the first couple of boluses though, there didn’t seem to be any more of an impact with Fiasp than there was with the Novolog I’ve used up to now. The only difference I could notice was with pre-bolusing. I like to pre-bolus for a meal, but like anyone else, I’m not always perfect… sometimes I forget.

When that happened, the Fiasp allowed for some forgiveness of forgetfulness, allowing me to bolus late without any measurable post-meal BG spikes.

A couple of people mentioned feeling a burning sensation when injecting Fiasp. I didn’t really experience that. For me, it was more of a feeling like the insulin was thicker somehow, like something oversize was trying to squeeze its way past the tiny constraints of the cannula and under my skin.

Both times I changed out infusion sites while using Fiasp, I found blood about a foot up inside the tubing of my set. I don’t know if this phenomenon had anything to do with it, but blood in the tubing is a very rare occurrence for me.

It should also be noted that I’m using the now defunct Animas Vibe pump, which dispenses insulin at a rapid rate. If I had been using, say, a t:slim pump, which delivers insulin at a glacial pace, the result might have been different. You never know.

As far as in-range or out-of-range blood sugars go, there wasn’t really much difference between Fiasp and the Novolog I use on a regular basis. I had one post-workout BG in the upper 200s (mg/dL), which is not common for me. Otherwise, my highest highs were around 200.

Looking at the entire experience of my time on Fiasp, I can say that there just wasn’t much difference other than what’s noted above. In the end, yeah, there were differences… but not so much of a benefit using Fiasp that it’s going to make me want to go away from Novolog. Especially since Novo Nordisk products are not on my prescription provider’s formulary anyway.

If my out of pocket cost was less than what I’m shelling out now, I might make the switch. Same price? I’ll stick with what I have.

Again, this is just my experience using this drug. I’m not a medical expert. I also encourage you to learn more about Fiasp, by reading THIS from Diabetes Mine and THIS from diaTribe.

You can get additional first person accounts of Fiasp by reading about Julia’s experience HERE and Anna’s experience HERE.

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My turn.

I went for my quarterly visit with my endocrinologist last week. We talked about a great many things.

My A1c is still excellent, but she’s concerned about night time lows. We lowered my overnight basal rate, and that seems to have solved my problem for now.

But I’ve been concerned about the amount of insulin I’m injecting these days. Along with the overnight lows, I’m seeing more numbers over 200 mg/dL than I’m used to.

For the first time in the eight years I’ve been seeing her, we used the words “insulin resistance”. As in, I feel it’s taking a lot more insulin to bring me within range than it used to. I’m very concerned about that, especially because extra insulin not used means extra insulin stored as fat around my midsection. I have enough of that already.

We talked about the fact that I’m active, but also in my mid-50s, which means my metabolism is crap. I eat less now than I probably have at any time as an adult, but I’m frustrated that I can’t seem to drop the weight in measurable numbers.

For now, the plan is to let my endo manage my basal rates, and I will handle the boluses, possibly including dropping my insulin to carb ratio. The change in basals is keeping me from going low overnight. I haven’t lowered the I:C ratio yet, but I’m thinking about it. Those post-meal spikes are really bothering me.

At the end of the visit, she asked if I was considering another pump to replace my Animas Vibe (Animas is out of business in the USA). I told her my general feelings about the various pump options out there today.

I also told her if those options don’t change by the time my warranty is up, I may consider going back to multiple daily injections. After all, a faster-acting insulin is available now, and maybe that will make a difference. She excused herself for a moment, and came back with this:

A sample vial of Novo Nordisk’s Fiasp, the faster-acting insulin we were talking about. I was under the impression that it could only be injected via a syringe. I don’t do that often, but I told her if I ever needed a correction bolus or my pump failed, I would give it a try.

She encouraged me to try it with my pump. I took the sample home, and then took to Facebook to see if there was anyone else who had used Fiasp in a pump.

If you ever want opinions, just ask what People With Diabetes think about a product, and you will get all kinds of responses. I certainly did. Some people love Fiasp. Some hate it. Some see it as very effective in their pump for a day or two, and then not effective at all after that. Some have no desire to try it at all.

I was glad to get all of that feedback. In the end, the decision will be up to me to decide how I like this new insulin. For a little while though, it’s my turn to try it out in my insulin pump. More to come on this in a couple of weeks.

What has to happen?

I’ve wanted to ask this question, and know the answer to it, for a long time, even before I started blogging:

Why does the cost of insulin continue to skyrocket?

What I’ve found out so far is very little. At least very little that allows me to point my finger in a definite direction and say “this is why”. It’s complicated, and if I were to begin to point a finger in a particular direction, that’s where I would start. We can’t find the forest of cash for the trees.

The information on drug research, side effects, production costs, costs to file with regulatory authorities like the U.S. Food and Drug Administration, efforts to build marketing campaigns and pay sales reps to visit endocrinology practices is…. Non-existent. Nobody knows how much it costs to bring a new insulin onto the market (and keep it selling), and depending on how each phase of research, development, and rollout goes, the costs might vary.

Let’s not forget about the rest of the overhead. In Novo Nordisk’s latest financial results, 11.2 percent of their 4 billion dollars in revenue from January through June went to administrative costs, which includes things like pay and benefits, but not only pay and benefits. That’s 448 million dollars.

That seems excessive. And maybe it is. Maybe it’s not. The point is, we don’t know what’s excessive and what’s not in a financial statement for a company that grossed 4 billion dollars in the first six months of the year and published all of its financial line items in a one page document.

Eli Lilly did a much better job, I thought, of detailing their latest quarterly financial statement, but then again, they’re on the other end of the spectrum, and I had to search a little to find Humalog sales listed in the 28 page statement. In case you’re wondering, it was $1.3 billion year-to-date. For a drug that’s nearly 20 years old. Even if it cost a billion dollars or more to develop and produce these drugs, they have certainly more than paid for themselves by now.

But let me back off here. Maybe I shouldn’t point at Lilly and Novo. It’s not just about how much money is being made.

Actually, it’s about the right of a patient to get medication they need to survive, at a price that won’t have to make them have to choose between staying healthy and putting food on the table. Make no mistake: As insulin gets more expensive, this type of decision is already being forced upon a growing number of People With Diabetes here in the USA.

How companies (by companies, I mean drug makers, insurance, hospitals, etc.) reach the point where they charge as much as they do, and we get closer to the breaking point budget-wise, is a matter of great confusion. I really don’t know if this is by design, or if I just don’t have a good handle on the numbers. Here’s what I know:

Insulin should be more affordable.

When I’m tasked with solving a problem like this, I often think back to when The Great Spousal Unit and I bought our house. We knew we were ready to buy, but we didn’t even know if we could even get a mortgage, let alone whether we could afford one. So my solution was to find out what needed to be done to buy a home, and complete each step along the way, until we either moved into our house or knew where we didn’t qualify.

So in this case, I begin with the overarching statement: Insulin should be more affordable. Now the idea is, what needs to be done to make insulin more affordable? What are the steps? Can they all be accomplished? If they can’t all be done, what can’t be done? Why? How do we break down the barriers? What would have to happen to make insulin more affordable?

Why is a drug discovered nearly a century ago more expensive than ever?

Why is a drug approved in 1996 more expensive today than it was when it was approved?

I don’t know if I will get anywhere. But I really want to have a better working knowledge on this subject. I don’t know how long it will take, but I’m going to try to find out as much as I can.

In the meantime, feel free to give me your knowledge, if any, on why the cost of insulin is getting farther and farther out of reach. I’ll let you know if I find out anything.
 
 
There are programs dedicated to helping those who have difficulty meeting the cost of insulin and other diabetes drugs and supplies. Including programs run by Novo Nordisk and Eli Lilly & Co. Rather than re-inventing the wheel, I’ll refer you to this helpful post on the subject from Christel at The Perfect D:
Need Help with U.S. Diabetes Supplies and Medications?
 

A lot of zeros.

Like many, I’ve seen and heard the recent NPR story:
Why is insulin so expensive in the U.S.?

The story is based on research from Dr. Jeremy Greene from The Johns Hopkins University in Baltimore (still trying to get an interview), where he is a professor of medicine and history of medicine. He did some research on the history and cost of insulin, and published his findings in The New England Journal of Medicine.

The truth is, we all know insulin is very expensive here. And we all have our own opinions on why we think insulin is expensive here (where are the generics?). After reading a few of these stories this week (because diabetes stories with an impact aren’t reported for months, then the same story is reported by everyone in a few days), and then reading comments below each piece, I started to become overwhelmed.

Partly, it was because of the numerous “facts” presented by commenters; and partly, it was because of the fact that I felt the really difficult questions haven’t been asked or answered on this yet. Regardless, I started to feel information overload coming on.

For me, when that happens, I usually try to pull back and simplify the subject at hand. I may not solve the problem this way, but it gives me a good starting point. So that’s what I did. I did some initial research into market share for the three big companies selling insulin in the States. I also researched how much insulin costs me, about how much I use on a monthly and yearly basis, and then I extrapolated that (which is fancy talk for multiplied) by the number of people taking insulin in the USA. I wanted to be conservative in my calculations.

This is not scientific… this is just designed to take a typical Type 1 customer (me), and consider the cost of the life-giving medication that I need every day. How much are me and my D-peeps, and our insurance providers, shelling out for insulin?

According to Dr. Greene’s research paper, there are currently 6,000,000 patients taking insulin in the United States.

I looked at the cost of insulin from my prescription provider for Lantus, Apidra, Novolog, Levemir, and Humalog. According to my prescription plan, the cost of a 100 unit insulin vial (my cost plus my employer’s cost) breaks down as follows:

Lantus (made by Sanofi-Aventis): $250.01
Apidra (also made by Sanofi): $204.56
Novolog (made by Novo Nordisk): $204.65
Levemir (also made by Novo): $250.01
Humalog (made by Eli Lilly & Co.): $204.01

Humalog is not my insulin of choice, but it’s the cheapest in the list, so let’s go with that as a benchmark. In fact, let’s just round that number down to $200.00 to make the math easier. And to make it even easier, let’s say that I use one 100 unit vial of insulin every month. At that rate:

$200.00 per month X 12 months per year = $2,400.00

Now, let’s go a bit further (but not too much), and multiply again:

$2,400 per year X 6,000,000 insulin users in the USA = $14,400,000,000

That’s a lot of zeros, people. And this is just the United States we’re talking about. In fact, research from 2013 suggested a worldwide insulin market of $21 billion dollars in that year alone. And we know that there aren’t any fewer people living with diabetes in this country, or around the world today.

But still, let’s take that conservative $14.4 billion number and break it down by market share across these three companies. Again, there is no way this is science, but it should give us some sort of ballpark estimate of the amount of gross revenue that Sanofi, Lilly, and Novo are generating. The only data I could find on market share goes back to 2011, and is contained HERE. Since that is all I have, that is what I’m going with. Again, I’m just ballparking here. I’m not trying to arrive at the actual-to-the-dollar accounting involved, because how could I? Here we go:

In 2011, Sanofi-Aventis had a 37% value share of the market. Of our $14.4 billion, that would be:
$5,328,000,000

In 2011, Novo Nordisk also had a 37% value share of the market. Of our $14.4 billion, that would be:
$5,328,000,000

In 2011, Eli Lilly had a 26% value share of the market. Of our $14.4 billion, that would be:
$3,744,000,000

Let’s be honest here, and recognize it takes lots of research and development, plus a lot of clinical trial testing, plus building out production of the drug, providing documentation to patients and doctors, and a lot of other things to bring a new insulin to market. What would that cost, exactly? A billion dollars? Two billion? If it cost three billion dollars for Lilly to bring Humalog, my lowest costing insulin to market, they almost certainly would have made a profit on their investment in one year alone. In this country alone.

You know, we still haven’t solved the “Why are there no generic insulins?” question. But really… why would there be? If you’re a director of one of these drug makers, or a shareholder, and you, or someone you love, doesn’t live with diabetes; or you can afford insulin regardless of the cost; why would you not want to fight tooth and nail to keep low cost alternatives out of the hands of patients?

This is where I like to remind people that making a profit is good… until it starts to affect someone’s well-being in a negative way. Then this practice must be stopped. Just like patients should trump proprietary, patients should also trump profit. Believe me… there is still plenty of money to be made.

Guess what? It costs a lot of money to buy insulin to stay alive too. I think… I hope… we can find a—dare I say it—Happy Medium here. I’ll be okay with drug companies making money on insulin, if they’ll be okay with me affording said insulin so I can stay alive. For a long time to come.
 
 
 

Know Diabetes? Help Send a D-Kid to Camp.

DoYouKnowD

I saw a Tweet from Cherise Shockley this morning about the Do You Know Diabetes quiz. Novo Nordisk has partnered with the Diabetes Education and Camping Association to help send kids to D-Camp.

Take the Do You Know Diabetes quiz at www.doyouknowdiabetes.com

Novo makes a donation for every completed quiz. So share this everywhere today, help bust some diabetes myths, and send some kids to camp this summer!
 
 
Happy Friday
 
 
 

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