Pumping Fiasp - 3 Months In

Prior to Fiasp, I had pumped with Humalog for about 18 years. It worked fine, but I was always frustrated with the fairly slow action (which tended to slow even further when I was running high).

So, I was extremely excited when Fiasp became available here, and started in early March. There have been a lot of notable ups and downs.

The positives:

1) Fiasp is fast for me. With Humalog, I would bolus as much as 30 minutes ahead of time and still have a noticeable spike (while being nervous the whole time about the insulin acting before my food). With Fiasp, I bolus at the time of my meal, sometimes even during or after, with much less spike.

2) Fiasp definitely peaks earlier for me - not only does it bring down my highs faster, I even find that I tend to go up earlier from using a low temp basal than with Humalog. As a result, I've had fewer highs AND lows.

This has definitely shown up in my control - my median BG is down about 4 points since starting, with my standard deviation down about 2 points. These are small changes, but combined with an objectively better quality of life from not having to prebolus as much, that's pretty great.

Unfortunately, the negatives have started to emerge, and seem to be getting worse over time:

1) I've needed about 6 early set changes since I started in March, with some odd unexplained highs. I've managed to catch them before they got too crazy (in the worst case I peaked at about 250 and it took 4-5 hours to get below 200), but they seem to happen fairly randomly after about 1.5-2 days. And I don't want to just start changing at 2 days because plenty of the time it works for the full 3 days. These set changes seem to be getting more frequent.

2) I've occasionally just had random resistance to Fiasp at certain meals. Not sure why.

So, overall I'm not sure what to say. About a month in, I would have given Fiasp an "A". A week ago, an A- or B+. Now I'm going to stick with it a bit longer, but am starting to get a little tempted to go back to Humalog.

There seems to be some evidence of occasional Fiasp issues with the pump (see http://www.diabettech.com/faster-insulin/enough-is-enough-i-cant-go-on-details-of-the-ema-submission-fiasp-csii-study/) and maybe I'm just experiencing those issues as well. Provided they don't get any worse, I'll probably stick with it, but am starting to get a bit cautious.