Symlin in a second pump

Anyone here on Tu that uses symlin in a second pump? There are a few people out on the web that do and I've talked to my endo about it. He said it makes perfect sense and he knows of other endos that have patients pumping symlin but is reluctant to say I should. Surely there's liability issues with off label use. He does say that there are dual (symlin/insulin) and triple (symlin/insulin/glucagon) chambered pumps in development. Since the non-diabetic does have a small basal amount of amylin trickling with insulin it seems that anything we can do to mimic the non diabetic would be beneficial. It's an important part of that hormonal balance between insulin, glucagon, amylin. I've been injecting symlin for several years and find it most helpful for lower post prandial spikes but I still can get unexplained highs and too many lows partly from absorption variations because of constant bruising at every pen injection.

There is a quite informative website: www.themissinghormone.com (authored by the Amylin Co., makers of symlin)

If there are any symlin pumpers here, lets start a group, I bet it's use is going to be growing soon.
If we wait for the medical community and the FDA for new treatments we'll grow old and die before they make any decisions that could help unless there's windfall profits for someone, the status quo is already their big cash cow

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Permalink Reply by nopucksnosticks on July 6, 2010 at 6:30pm

There is already a symlin group in the site. Interesting idea but I already hate having one site let alone two so I'm holding off with CGM, even though it means extra testing for the symlin low potential. Try being aware of the angle of the pen entry to minimize brusing...the pinch and angle technique works very well for me. don't know how a multiple med pump would work cause you can't mix insulin with symlin....check out the Tag group for the "super bolus" and square/dual wave tag spreadsheet, I found that site very helpful. Did Ican manage the takeover of Amylin? We wonder what's wrong with privatized medicine and then allow that kind of crap to go on....

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Permalink Reply by Joe on July 7, 2010 at 3:33am

I kinda looked into this a couple years ago after seeing a picture on the web of someone with two pumps. I'm a long time symlin user, pumper and CGM user. I would jump on this solution if I didn't have to wear two pumps (if I could afford it). But I think I would have problems hassling with two pumps.I don't have the problem with injection sites that you do, so my motivation is different.

Re the trickle of amylin - I understood that the body triggered amylin release when food hit the stomach - and I don't recall any research saying the body got a trickle - like insulin. I probably just missed the research.

But if somebody developed a pump capable of both insulin and amylin! Sweet! But I'm not holding my breath - if you consider how broad the market is, there really isn't a current demand that would justify the millions and millions needed to develop the technology. But if all type 1's would/could benefit - then the market would be different. No typical company will develop this unless they can make money - and I can't see where it will happen.

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Permalink Reply by Franco on July 7, 2010 at 10:19am

Hi Joe,

Like you I didn't think there was a basal of amylin until I ran across "themissinghormone.com" website and read through the whitepaper (there's a link to the pdf on that site). It says "In healthy adults, plasma amylin
concentrations range from ~4 pmol/L (fasting) to
~25 pmol/L (postprandial)". It references that statement to: Young A. Amylin's physiology and its role in diabetes. Curr Opin Endocrinol Diab 1997; 4:282-290. I don't understand exactly how that static amount of 4pmol/L translates to how much per hour, or how those pmol's might convert to micrograms of Symlin, but if 25 pmol/L (postprandial) converts to 60 mg symlin (suggested dose for meals) then 4 should be roughly 10 mg symlin which would be 1.66 units on our insulin scale, certainly measurable in our current pump capabilities. My old MM pump goes down to .1 u/hr. Does my reasoning or math look reasonable or am I making some blatant errors, as I not a math wiz by any means?

I've actually tried very small doses of symlin during a fasting basal test and I do get a slightly lower insulin basal pump rate with the tiny bit of symlin added and also easier to get a stable basal test, less fluctuations.

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Permalink Reply by 870allamerican on July 7, 2010 at 4:49am

My daughter has been hitting me hard lately about trying symlin. She is on MDI and uses it. I'm using the Omnipod and have a tough time thinking about MDI's along with the pump. I will be seeing my endo in a few months and may bring up the idea.

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Permalink Reply by Franco on July 7, 2010 at 10:44am

Hi 870,

I looked back on your previous posts and see that your diagnosis is exactly like mine, I too just passed 52 years since diagnosis. As I look back on all the treatments and technologies we've seen with diabetes in that time. The big breakthroughs for me were: 1 disposable syringes, no more boiling glass and steel needles sharpened with a nail file, 2 bood glucose testing instead of those old test tubes, 3 insulin pumps, 4 CGM's. And now I place Symlin up with those huge breakthroughs of new treatments. I've used symlin for several years and my overall health has improved and I attribute some of that to better postprandial glucose control, not to mention my improved A1C.

I agree with your daughter, I would seriously consider it, especially if you have elevated post prandial Bg's. Yes, it's more hassle. For me the benefits are worth it.
I would also add that the CGM makes using Symlin easier at least in the beginning when there's lots of tweaking symlin timing and insulin dose adjustments.

Good luck with your upcoming endo appointment, many docs are very reluctant because of the hypo potential, another reason for the CGM which makes that risk manageable.