Replies to This Discussion

Permalink Reply by Zoe on June 15, 2011 at 4:50pm

All valid concerns. For me, this works in part because my life is very predictable and low stress, and I never skip meals. I don't know that the basal change is significant enough to be dangerous. I do think that new "time habits" can be formed, like testing at 2 hours (or 4) or bolusing one hour after. I thought combo boluses might do the same thing and then I could do that up front, and maybe combined with the basal change it would, but I'm reluctant to change when I've found a formula that works. But it is definitely a time consumer. so I'd say someone would have to be motivated to do it.

Yes, it seems that everyone I've heard takes some variation on a combo or some timing after eating for the bolus. For me, though the critical factor seemed the basal change to counter those late rises.

It would depend on how large the sample is because you'd have to titrate up to your full dose (a week mas o menos) and then it took me quite awhile of trial and error to find what worked. It also took awhile with my doctor and Medco to get the damn amounts for the prescription figured out.

Permalink Reply by MossDog on June 15, 2011 at 5:01pm

The basal changes make a lot of sense. Then you can "target" the exact time you will need that little kick of insulin. It would be extremely difficult to figure out how to do that with a combo bolus if indeed it would even be possible. When you make a change it effects the whole bolus and not just one time period. Thanks again.

Permalink Reply by SugarDoc on June 15, 2011 at 3:17pm

Hi Debbie. I have a pump and I'm really considering going on Symlin.
How do you manage symlin for example on vacations ,when I presume you stop or significantly reduce workout?
Loved your profile. :-)

Permalink Reply by Zoe on June 15, 2011 at 5:33pm

Ah, thanks for the explanation, MossDog. I'm a little "unclear on the concept" sometimes with combo boluses. That seemed like it should solve the problem, but, at least with my experimentation, it didn't. That explains why.

You'd think it would be worth it for Symlin to do more educating (of doctors and other professionals and/or of patients through their literature). They could miss a chance for Symlin to be much more widely used if people give up when they can't figure out concurrent insulin dosing!

Permalink Reply by Debbie on June 15, 2011 at 7:21pm

hi sugarDoc...I never skip workouts, when we vacation, we workout daily...I'm a bit OCD and skipping workouts is just not an option for me. I really have stuck with the symlin through a lot of bad occurrences because I can see that with proper timing, it can really be an effective tool in my type 1 management. In other words, when everything comes together,, this stuff is amazing...post meal highs don't go past 126!! my goal, and I know its a stretch...but like I said, I set high demands for myself and am a bit OCD about them...my goal is to never go above 140 after a meal..like a normal person. so with symlin, I can achieve that goal much of the time. Now before you all jump down my throat, I know that isn't a very realistic goal for type 1's, but like I said, I will work very hard to achieve as close to it as I can get. I will , however , forewarn you about symlin cost. it is DAMN expensive. 3 pens (a 1 month supply) is well over $400........just wanted you to know this as I was downright SHOCKED at this price!!!!

Permalink Reply by Wendy Orange on June 27, 2011 at 8:17am

I am learning the same. I take the 15 units of symlin (it's my first week) and go so high so fast with hardly much food, that I now inject the insulins in 15 minutes. We shall see. I do love symlin. What dose are you on? Since I just started and I fear the lows my doc and I agreed to stayon 15 mg for three weeks. Might be a mistake. Thank you for saying what i was feeling. let's get this symlin/insulin right for ourselves. Here's hoping!

Permalink Reply by Zoe on June 29, 2011 at 11:08am

I think the protocol for dose increase is to raise it another step each time you haven't experienced nausea for 3 days. As far as lows, it seems we are all different, but I have experienced very little lows. On the other hand I don't bolus before one hour unless I'm already high before my meal. Just keep careful record of how you take your insulin and your results. The spikes to look for don't generally occur at 2 hours but at around 4, as one of the main actions of Symlin is to slow down digestion. I now do my testing at the 4 hour mark instead of the 2. I'm almost always in range at 2, it's the 4 where the spikes might occur. When you are on your full dose, Wendy, you might find you don't go high that fast at all and will probably want to take your insulin later. The dosing of Symlin is the easy part, it's the dosing of insulin that takes a lot of trial and error to figure out and is very individual. For me, no dosing timing worked until I upped my basals a bit for the periods 3-5 hours after meals.

Permalink Reply by Debbie on July 28, 2011 at 2:29pm

I have been so busy and have had little time to jump on here...I've been on symlin for months now...and still have a love/hate relationship. ha ha. I'm eating very low carb, I've submitted to Dr. Richard Bernsteins way of eating...and love it....I've always counted carbs and eaten very healthfully...so his teachings are not a huge stretch for me...I'm taking symlin once daily, sometimes twice daily. I am taking symlin with my first bite of food and bolusing 20 minutes after my meal is finished. (I bolus about 80% at this time)....I then set my timer for 1 hour (after first 80% bolus) and check glucose then. if rising high, I do my 20% bolus now...but usually end up waiting for another 20-40 minutes depending on how much active insulin I have let and dependent on how high the the BG is going...I usually take my full 80/20 bolus by the 2 hour mark. Occasionally I go high at the 4 hour mark but it's only occassional....and usually a hormonal time for me, and I attribute it to hormones (liver kicking out glucose).
Again, I'm eating 100 grams or less of carbs per day (usually closer to 60 grams) , I drink a health shake that gives me 5 servings of fruits/veggies in one shake to keep up with my nutrition needs, I'm eating lots of lean proteins. Last appt my A1C was 6.1 and I'm striving for 4.6. I set lofty goals for myself, I know...I'm a bit OCD. I'm taking an average of 18-23 units of insulin in a 24 hour period. my highest has been 23 units and my lowest has been 16 units in a 24 hour period and 13 of those units are basal. I'm on a 60 dose of symlin.

Permalink Reply by Zoe on July 28, 2011 at 2:43pm

Question, Debbie: When you talk about taking 80% of your insulin and then later the other 20%, I'm wondering what amount you've reduced your insulin compared to before you started Symlin? Have you lost any weight, or was your goal taking Symlin more to have been blood sugars?

Oh and by the way I eat 100 grams or less carbs a day as well, but that's not Bernstein. Bernstein's program is 30 carbs a day. I follow some of his ideas, like the "law of small numbers" but I'm not willing to reduce my carbs that low, though I know it seems to work very well for many people.

Permalink Reply by aliraeu on September 8, 2011 at 9:19am

Wow! Thanks for sharing! I'm going to give this staggered approach a try.

Do you find that you need a different approach for different types of meals or do you use this every time?

Permalink Reply by MaureenH on September 8, 2011 at 2:17pm

Well I have refined my procedure even more because I have a blood test coming up next week and want to stay under 200. I do change the bolus amount according to what I will eat but otherwise I use the same procedure. I will give maybe 1/2 of the required insulin before the meal and do the 60 mcg of symlin. I do the symlin 3 times a day with every meal .Now I have the reminder set for 1 1/2 hours when I give the rest of the insulin. I decided the 2 hours was when the BG rise started so I have to get the insulin in before that time. I might even be a little low then-70 or so- but I know for me the symlin is completely finished at 2 hours. I tried doing the second dose of insulin with a square wave for 1 hour and this seems to be working. I even used the symlin during a trip to Germany with students for four weeks this summer. I never stopped and I like it. Sometimes I had to inject through clothes because it was not convenient to lift my clothes.This worked pretty well but at that time I just wanted to keep from going low. Now I am trying tighter control. I think the symlin works and it cuts my appetite. I feel better.

Permalink Reply by MaureenH on July 28, 2011 at 6:43pm

I am now taking 60 mcg three times a day (with each meal). I only take a portion of the insulin before the meal, about 1/4, and then when the two hour mark comes I take the rest. I have the BG reminder set for 2 hours. I also see the rise with the CGMS. I like the two hour rise. I know I won't go low after two hours.

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