Replies to This Discussion

Permalink Reply by David on December 29, 2008 at 7:19am

Take a look at the Symlin users group. This is where i got a lot of my information from. It's working for me. It take a little experimentation with timing and dose to get it right,but the results are really positive. It's worth a try any way.
http://tudiabetes.com/group/symlin
dave

• ▶ Reply

Permalink Reply by Jason on December 29, 2008 at 6:18pm

I have been using Symlin since September, and I am a Type 1 on pump therapy.

How is it working for me? Very, very well. I have lost weight (about 30lbs), had my best A1c last month in over 10 years, and feel much more in control of my blood glucose levels.

Symlin mimics the action of a hormone produced by the islet cells called amylin. It works in a number of ways, but all completely within the central nervous system. The first thing you will notice upon beginning Symlin therapy is the dissolution of much of your appetite. It is safe to say I eat about half of what I used to eat at any given meal. I just get full on less food and pretty much anything on my plate 15 minutes or so after the Symlin injection is not getting eaten.

The very next thing you will notice is that your digestion is slowed. You will feel full much longer than you otherwise would after your meal. I rarely snack between meals now. This also means your post-prandial blood glucose levels will be much improved as there is no spike with Symlin, rather a gradual increase that is managed much easier than the spike. Total nutrient absorption is not affected by Symlin. Being on a pump is helpful here, as many Symlin users switch to square or dual wave boluses to cover the different (more natural) post-meal blood glucose patterns.

Symlin also signals your liver to stop dumping sugars into your bloodstream, which is part of how it eliminates the post-meal spike. This interesting effect can be useful after very strenuous exercise, which can also cause your liver to dump its glycogen into your blood (however, going by the label Symlin is only to be used with food containing 25 grams of carbs or more).

Finally, Symlin is able to reduce the amount of insulin you need to cover a meal by 30-50%. In my case it is actually more than that, as I use about 65-70% less insulin for meal boluses. My basal rates however, remain the same.

There is some discomfort associated with ramping up to your therapeutic dose, which for Type 1 diabetics is 60mcg. I recommend going for 120mcg, which is the maximum dose for Type 2 diabetics, because the positive effects are much more pronounced at that level. The discomfort includes nausea and some minor gastrointestinal issues, but you increase the dose by 15mcg every few days as your body quickly adjusts to the new medication and the side effects subside. So once the side effects stop at 15mcg, you move up to 30mcg and stay there until the side effects go away again. I noticed less discomfort as I went up the range- it was easier to go from 90mcg to 105mcg than it was to go from 15mcg to 30mcg.
Presently, at 120mcg I have no side effects.

The pH of Symlin is quite low and it can often feel as if you are injecting lemon juice. Insulin it is not! Unfortunately, this side effect does not go away.

All things considered, I strongly recommend all Type 1 diabetics use Symlin. After all, it is an important hormone produced by the same cells that produce insulin.

• ▶ Reply

Permalink Reply by David on December 29, 2008 at 7:20pm

how long before you eat do you take your Symlin? At a 60mcg dose I'm not feeling the same fullness you've experienced. I experiened little nausea building up to the 60 mcg dose. I've also not experienced any dose reduction in my insulin. I bolus 30% up front and the balance over 90 minutes. Any suggestions?

• ▶ Reply

Permalink Reply by Jason on December 29, 2008 at 7:40pm

I inject Symlin typically right before my first bite of the meal, or just a few minutes prior at most. I had decent results at the 60mcg dose, but 120mcg proved more than doubly effective. Move up to 120mcg and I think you will see some changes. I also use primarily square boluses, with dual wave only for when my pre-meal glucose level is outside the normal range (and then only what is necessary to bring it back to that range).

• ▶ Reply

Permalink Reply by David on December 30, 2008 at 4:24am

Thanks for the input! I forgot to mention I'm T-1 using Apidra in an Animas 2020. Like Toni, I'm most insulin resistant in the morning so I mainly use the Symlin with my breakfast meal. My sugars start climbing as soon as i start to eat, Symlin or not. I'm seeing my Endo on Tuesday next week and will ask about her experience with higher doses of Symlin. And........you're right about the burn. Small price to pay for better control. Happy New Year to all. Thanks for being there. Learing from all your experiences has been very helpful.

• ▶ Reply

Permalink Reply by Toni Crebbin on December 29, 2008 at 10:14pm

I am a T1 on a pump who uses symlin. I first used it a few years ago, and after quite some time of getting over the nausea, I didn't see much benefit of using it, so my endo took me off it. However, last year I started wearing a cgm, and it was very obvious that I always had a steep spike after my breakfast meals. My endo had me go back on symlin for just breakfast, and it has been great. I can closely watch my numbers on the cgm, and when I take the symlin, I barely rise after breakfast. For some reason I don't have these spikes after lunch and dinner. I was really glad that I did not get the nausea again when I started back up on symlin, after taking about a year long break.

• ▶ Reply

Permalink Reply by Lindsey on December 30, 2008 at 8:25am

I've been doing the same research as you, Jessie.

For Symlin users, can you use it at select meals? I know people mentioned only using it at breakfast only. But I'm wondering if you can use it less regularly. For instance, if there are certain foods that give me horrible spikes but overall I'm okay, could I use it every once in awhile on those foods? Or do you not see the benefits unless you use it every day?

Also, since it's for meals of 25 grams of carbs and more, what do you guys do if your meal is less? Some of my meals don't go over 30 grams, especially breakfast which is when I see the highest spike.

• ▶ Reply

Permalink Reply by David on December 30, 2008 at 10:09am

I believe the labeling says it's for meals at least 30 grams or over 250 calories. I've used it for breakfasts with less than 30 carbs and just reduced my normal insulin bolus. I suffered no ill effects and it kept my BG from spiking. Mornings are my worse time. It does take a week or two to build up to the clinically significant dose, so if you start skippings days, I'm not sure what might happen. I frequently use it only once/day and have no problems with any nausea. You may have to experiment there. I'm guessing your body will adjust. It's worth the try.

• ▶ Reply

Permalink Reply by Jason on December 31, 2008 at 2:34pm

You don't have to use it with every meal. It is up to you each and every time you eat to inject it. That said, it's half-life is approximately 2 hours, so if you want the appetite-reducing effects throughout the day it is best to take it with every meal. This is a hormone your body would produce on its own if it had the islet cells with which to do so, so thinking of it that way makes it seem as important to me as insulin.

I use it with all meals, even meals that do not contain any measurable carbs at all.

• ▶ Reply