Symlin Issues...

[am1977]

I've been on Symlin for a while now... and, overall, have had mixed results. But mostly things haven't been going as well as I have hoped. I can never predict how my post meal readings will be :dontknow:.

I can't understand why I'm still having problems with this... :confused:. I only use it with dinner and I usually eat relatively low carb at dinner too. I don't think I should even need it with most of the dinners I have.. But whether I take it or not, I usually always end up high :frown:. Once in a while, I'll get a good number thrown in, but it's few and far between. It's very frustrating, b/c things are so unpredictable :argh:.

Last night came home after the gym and made dinner- it was a big salad with a small pepper steak, and dressing. I took my Symlin at least 15 minutes ahead of time, and then ate. I took my bolus- which should have more than covered it. As I was sitting down to eat, I started to have a stomach ache... which I've never had before. Not sure it was from the Symlin or what, but I've never had that. And it lasted through most of the night. Then when I tested after dinner, I was in the 290 range :eek:.

I'm not sure what to do about this- it seems like my night time readings have been an ongoing problem forever :rolleyes:. I've tried testing my basals and plan on doing more, but I want this fixed NOW! :motz:... Guess I'm looking for any insight I can get on how to improve things- thanks for any help :)

[spike]

I've no answers for you, but I sure have a question!!

WHY are you using an additional med along with your insulin to level out your bg's if it is so unpredictable? I just don't follow the logic of adding yet another variable to the already complicated mix of carb counting, bolus amount, activity level, timing of bolus, extending the bolus...what does one really gain by using Symlin. Is it worth the aggravation? I don't want to appear argumentative on this subject, as I'm NOT--I just want a Symlin user to try to explain to me the rationale behind taking that drug, as I've not yet tried it. Thanks!

[am1977]

symlin is used to help prevent post-prandial spikes (after meal)... which tends to be a BIG problem for me :rolleyes:. It has been very inconsistent in how it works for me, but a lot of people find success with it. Also, it's supposed to help with delaying your stomach from emptying too quickly- which makes you feel fuller- and some have lost a considerable amount of weight from using it as well.

Saying that, I'm not sure why I'm running into problems using it. It is another variable, I realize that, but if it's supposed to help, I didn't think I had anything to lose.

I am going to see how things go. I'm thinking of increasing it to 3x a day (for all meals) to see if that makes a difference- maybe if I use it more, it will work more consistently.

[spike]

symlin is used to help prevent post-prandial spikes (after meal)... which tends to be a BIG problem for me :rolleyes:. It has been very inconsistent in how it works for me, but a lot of people find success with it. Also, it's supposed to help with delaying your stomach from emptying too quickly- which makes you feel fuller- and some have lost a considerable amount of weight from using it as well.

Saying that, I'm not sure why I'm running into problems using it. It is another variable, I realize that, but if it's supposed to help, I didn't think I had anything to lose.

I am going to see how things go. I'm thinking of increasing it to 3x a day (for all meals) to see if that makes a difference- maybe if I use it more, it will work more consistently.


Thanks. I noticed you wrote "supposed" in regards to delaying stomach emptying, which in turns reduces hunger. So, have YOU noticed that effect?

How many times have you taken it? Once you started on it, have you used it every day?

Post prandial spikes are an issue for me too...which is why I use insulin... sorry!!! couldn't resist that one!

Other than the full tummy feeling that Symlin might provide, would you say there isn't a whole lot of other practical use for Symlin? (Not that I'm discounting that as being of great value).

[kidvid]

I just want a Symlin user to try to explain to me the rationale behind taking that drug, as I've not yet tried it. Thanks!

I use it solely for spike control. A year ago my pancreas produced amylin as well as insulin. Now it doesn't produce either. So I take a hormone analog to replace what my pancreas can't make. Simple as that.


No complex insulin bolus keeps my PP spikes away without whacking me with a severe low. Symlin keeps my post meal levels in the 130-160 range instead of ~250. Yeah, it takes some careful data analysis to make it work, but for me, it works.

am1977 - I don't take Symlin if my BG is below ~80, and it is not recommended to take if you are going to eat low carb or low calorie. In order for it to work for me, I needed to use a 60/40 combo bolus (by pump) over 2 hours.

I've seen where some users do have inexplicable highs when using Symlin. I did when I restarted it after a 5 month hiatus (moving from MDI to pump). If you haven't seen it, try the bulletin board just for Symlin users at:
http://diabetes.blog.com/683857/?page=last#cmts

Good Luck,

Joe

[spike]

Very interesting, Joe! Thanks for sharing your experiences with it. Do you use it for every meal (if over 80), or just those with a carb count above a set amount?

[kidvid]

I use it every meal, unless under 18-20 carbs. I use 12.5 units, slightly more than the max of 10 recommended for T1's.

I've experienced no nausea, and I titrated to the max dose in about 3 days. My theory is my body has just recently become acclimated to having no amylin, so readjusting to it may not be as traumatic. Obviously this is just a lay person's conjecture.

There's a pretty decent paper on the subject at http://clinical.diabetesjournals.org/cgi/content/full/20/3/137

Regards,

Joe

[statdeac]

I tried it for a while and its impact was too unpredictable for my comfort level also.

I was also having an issue with post prandial spikes which insulin alone could not control. (Actually, I mostly solved this through a highly controled diet, but it was frustrating to be avoiding SO MANY foods...even those that you wouldn't suspect would spike you.) So part of the decision to use it was to expand the flexibility of the meal options.

I consider myself to be quite skilled at data analysis, but who knows why it didn't work for me? The worst part of it was the unpredictable low that was difficult to correct due to the Symlin-induced gastroparesis. Add to that, I was on MDI at the time and was highly aggrivated by having to use syringes 2-3x/day and there was a major PIA factor!

This one is definately a YMMV type of drug imo, but for those who can make it work...my hat's off to ya.

[spike]

I use it every meal, unless under 18-20 carbs. I use 12.5 units, slightly more than the max of 10 recommended for T1's.

"
I've experienced no nausea, and I titrated to the max dose in about 3 days. My theory is my body has just recently become acclimated to having no amylin, so readjusting to it may not be as traumatic. Obviously this is just a lay person's conjecture.

There's a pretty decent paper on the subject at http://clinical.diabetesjournals.org/cgi/content/full/20/3/137

Regards,

Joe

WOW! Thanks for the link, Joe. I think the most illuminating paragraph in the article for me is:

It should be remembered that subcutaneous insulin delivery presents a compartmental mismatch of insulin in the peripheral and portal circulation. In nondiabetic subjects, insulin is secreted into the portal vein, and as a result, the liver is exposed to two- to fourfold higher insulin concentrations than are the peripheral tissues. In diabetic patients treated with subcutaneous insulin injections, the periphery is exposed to higher insulin concentrations than is the liver. This mismatch becomes most important in the postprandial period, when portal hypoinsulinemia results in an inability to appropriately suppress hepatic glucose production, thereby favoring postprandial hyperglycemia."

That addresses a fundamental problem we all experience by subq injection and relates to my constantly reminding people that an external "closed loop" pump ain't happenin' anytime soon. :)

(and now I know why you included a seldom used word, "titration". <g> )

Bookmarked the link and hope to discuss it with my wife later today if she's interested. (She's a nurse and reads plenty of medical related articles as a matter of course).

[kidvid]

Actually, I mostly solved this through a highly controlled diet, but it was frustrating to be avoiding SO MANY foods...even those that you wouldn't suspect would spike you.)

I agree with the controlled diet approach - I tried a "Bernstein-like" super low carb diet for 2-3 weeks but unfortunately I lost 6 lbs in that time. But, my spikes disappeared and my insulin use dropped a lot. I just couldn't get enough food to sustain a reasonable weight. I'm still pretty low carb, but Symlin is a lifesaver in terms of meal variety for me.

Joe

[Cyborg]

I've been on Symlin for a while now... and, overall, have had mixed results. But mostly things haven't been going as well as I have hoped. I can never predict how my post meal readings will be :dontknow:.

I can't understand why I'm still having problems with this... :confused:. I only use it with dinner and I usually eat relatively low carb at dinner too. I don't think I should even need it with most of the dinners I have.. But whether I take it or not, I usually always end up high :frown:. Once in a while, I'll get a good number thrown in, but it's few and far between. It's very frustrating, b/c things are so unpredictable :argh:.

Last night came home after the gym and made dinner- it was a big salad with a small pepper steak, and dressing. I took my Symlin at least 15 minutes ahead of time, and then ate. I took my bolus- which should have more than covered it. As I was sitting down to eat, I started to have a stomach ache... which I've never had before. Not sure it was from the Symlin or what, but I've never had that. And it lasted through most of the night. Then when I tested after dinner, I was in the 290 range :eek:.

I'm not sure what to do about this- it seems like my night time readings have been an ongoing problem forever :rolleyes:. I've tried testing my basals and plan on doing more, but I want this fixed NOW! :motz:... Guess I'm looking for any insight I can get on how to improve things- thanks for any help :)

Have you tried taking your meal bolus at the same time as the Symlin? Try taking both of them 15 minutes prior to eating. And don't have anything to eat for about an hour before taking it.

What is your dosage of Symlin? How are you bolusing your insulin?

[spike]

Have you tried taking your meal bolus at the same time as the Symlin? Try taking both of them 15 minutes prior to eating. And don't have anything to eat for about an hour before taking it.

What is your dosage of Symlin? How are you bolusing your insulin?

That takes the spontanetity out of eating. One of the things I love about Humalog is how fast it works, so that I don't have to know 30 minutes ahead of time, when a plate of food will be placed in front of me. Also, because I pump, my meal times can vary all over the place with no bg repercussion, unlike MDI. With Symlin usage, it seems you've lost that feeling of being almost "normal", no??

[Cyborg]

There is no spontaneity with Symlin...

[spike]

There is no spontaneity with Symlin...


LOL!


Seriously though, do you know what I was getting at? The advances in insulin formulations, and pumps have given me a greater feeling of "liberation", or normalcy, if you will, then the **** I went through on MDI, without Humalog or Lantus availability.

[Cyborg]

Yeah, but it's worth it personally. I can eat a 12 inch Subway sub or a big plate of spaghetti with homemade sauce and barely see my bg go above 140, if that...

[Jenn L]

I also had unusually high bg's while on Symlyn. I took it for the post meal highs, but after a bit, I decided it was doing more harm than good. My doc said some people have this problem, some do not. I wish I could take it, I lost 8 pounds when I did. I just did all the basal tests, and had to make some changes. I won't try it again though.:wavey:

[am1977]

Have you tried taking your meal bolus at the same time as the Symlin? Try taking both of them 15 minutes prior to eating. And don't have anything to eat for about an hour before taking it.

What is your dosage of Symlin? How are you bolusing your insulin?

I didn't take my bolus when I took my symlin, but I guess I'll try that- it's worth a shot (no pun intended :D )... and, no, I don't usually eat anything the hour before I eat dinner. I'm usually at the gym and then I make dinner, shower, change, and then sit down to dinner.

I am taking about 7.5 units of Symlin and I take half the bolus of what I shoudneed without symlin. So I estimated 50 carbs- which I thought would be more than enough , which I took about 2.5 units, but apparently it is not nearly enough.

I'm going to try and give my Symlin and insulin at the same time tomorrow and see what happens- I'll let you know :wink:.

Thanks for the help :wavey:

[Cyborg]

What I notice is that most of the time I still need all of the insulin required to cover my carb and protein intake. The problem is that the pumps only allow simple combo boluses. If I do a 60/40 combo bolus over 2 hours, then at the end of the 2 hours I need to take the other % of insulin that I never took. For example, the 60/40 combo only used a % of the total insulin needed. On the Symlin instructions they say to use approximately 50% as that starting bolus. I've found I can go up to about 66%. More than likely, you will see a spike at the 2 hour mark when you need another bolus. This is where I should bolus the other 33%, but I usually just ignore my IOB and do a correction bolus.

Ideally, I'd like to see Symlin boluses on the pumps. Such a bolus would allow a certain % up front, a certain % over a time interval, and a % at then end (balloon payment).

[koblenz]

OK, I just had time to read this and I think I agree with Cyborg.

Now, granted, I am one of the few it seems where Symlin has done wonders for me. I only take it at breakfast. If I am below 80, I still take the symlin right before I eat, but delay my meal "Combo" bolus until about 20 minutes after I eat. Does the trick for ME! (YMMV) If I am at normal BS (say around 100), then I take symlin just before eating and combo bolus at the same time.

Now, I, like cyborg, do need to take an extra "booster" about 1.5 hours after eating breakfast. I typically eat about a 70gm carb breakfast. 7.4 units of novolog, 20% immediate, 80% over 1.5 hours. Then about 1.5 hours after eating, I take about a 2.2 unit "booster". Like cyborg, my numbers rarely go over 140 until lunch.

I used to get fairly frequent lows, not severe lows, during my "experimentation" phase, but now I have it dialed in. I take 6 units of symlin.

So my questions for you Am, would be the following:
1. Given you take the symlin and insulin, what do your numbers look like 1, 2, 3, and 4 hours post.
2. If you are seeing a consistent rise at about the same time post, have you considered a "booster"?

Lots of good information covered by others here and that is all I can think to ask at the moment. Good luck and I hope you whip this thing. Keep us up to date!

[am1977]

See, that's what confuses me :confused:... I thought one of the main purposes of Symlin was to reduce the amount of insulin needed, but it doesn't sound like that's always the case, huh?

At my last appt. my CDE, basically said what you both are saying... that they suggest that you cut your bolus at first by 50 %, but that's just an estimation and that people may still require more than that. I guess that's the case for me. But it just doesn't make sense, b/c I feel like I am already taking much more than I should need for what I eat. Unless, my carb calculations are way off- which could be the case... but I usually am pretty good at my carb counting, so I don't know :dontknow:.

Usually, my post meal levels are high... At 2hrs post, I'm usually in the high 200 range. SO I do correct for that and I even have a protein snack in hopes of bringing it down. But then I'll test 2 hrs from then and I'm even higher :argh:.

It may be that my nighttime basal rates are way off and that my carb ratios are off in addition and this is leading to all these problems. This is my guess anyway.

I'm beginning to think that I'll never find a solution to this problem- My God, nothing about this disease can be easy :rolleyes:...

Sorry- I know my mood's probably not helping my or anyone else's situation. I really do appreciate the help you have all offered!

[Cyborg]

I'm not so sure that one of the main purposes for Symlin is to reduce insulin requirements. Reducing bg spikes is where I see the benefit.

[jillsp]

I have definitely NOT been able to reduce my insulin at mealtimes with Symlin. I kept my same carb ratios and I'm up to the full dose of Symlin now and it's OK. I will say that now that I'm up to the full dose I do get the full/nauseated feeling. Haven't lost any weight though (it's only been a few days on the full dose). I don't know if I'll stick with it. To Spikes point, it totally sucks going back on injections and with syringes!!! I can't believe they don't have a pen. I end up not taking it at several meals b/c I'm out and about and don't want to wait the 15 mins. It is only pratical to take when I'm at home and not doing much and can plan. The benefits don't seem to be great enough for me to put up with what a pain it is to pump and inject. that's just me, I wish I were like some of you guys that have had such a great experience. I'm wishy washy on it.

[MamaCat]

A Symlin pen is now awaiting FDA approval (this month, I believe).

This is my second go-around with Symlin. I gave up the first time 'cause of the shots and stomach cramps and high post-meal bGs. But this time I've had success with it -- for me, the secret to more level bGs is "don't bolus too soon." Typically, I inject the Symlin and eat immediately. Then I bolus for the meal an hour later.

And, yes, one of the goals for using Symlin is to reduce the amount of insulin to get the same result. When I use Symlin, I bolus 70% of my usual insulin and use my pump to square-wave it over 2 hours.

My endo told me last week that they're finding that the longer you take Symlin the better the benefits. I hated it the first time I tried Symlin, but now I'm sold on it! I'm feeling really good these days and my A1C is down, too!

[am1977]

I'm not going to give up on Symlin just yet... I think it has the potential to help me with known post meal spikes, but it's just frustrating that I'm not getting the results I want yet :frown:... LIke I've mentioned in my other post, I probably don't need to reduce my bolus by 50 % and my basal rate could probably need a little adjustment too...

I'm going to try and be patient, though it's definitely not one of my strong suits :rolleyes:... Hopefully, things will improve as I continue.

Thanks so much for sharing your experiences and for all the support and advice :)

[Cyborg]

A Symlin pen is now awaiting FDA approval (this month, I believe).

This is my second go-around with Symlin. I gave up the first time 'cause of the shots and stomach cramps and high post-meal bGs. But this time I've had success with it -- for me, the secret to more level bGs is "don't bolus too soon." Typically, I inject the Symlin and eat immediately. Then I bolus for the meal an hour later.

And, yes, one of the goals for using Symlin is to reduce the amount of insulin to get the same result. When I use Symlin, I bolus 70% of my usual insulin and use my pump to square-wave it over 2 hours.

My endo told me last week that they're finding that the longer you take Symlin the better the benefits. I hated it the first time I tried Symlin, but now I'm sold on it! I'm feeling really good these days and my A1C is down, too!

I've actually started taking a full dose of insulin when taking Symlin. Now I do a 50/50 combo bolus over 2 hrs.

I have never heard or read of anything stating Symlin helps glucose be absorbed by your cells. I have read that it slows digestion. I'm curious as to what your 3 or 4 hour post meal bg is...

[Angelique]

am1977, are you using your bottle longer than 30 days? I remember being told it would only be potent for 30 days after opening and to discard it after that point.



I will say that now that I'm up to the full dose I do get the full/nauseated feeling. I had the same thing happen to me. If I didn't eat within 5 minutes of taking it I could not stomach eating.

I stopped taking Symlin b/c I don't enough carbs in a meal to justify it and I was having to many ups and downs with my bg's. After I had tried it for a couple months my A1C was much higher than normal. Once I quit and had my next round of bloodwork done my A1C was back to it's normal level. It is great stuff for those who can work with it and use it but for me, it was not worth it.

[Twister212]

Re: closed loop. I agree. It is a fantasy. BG monitors measure the results of what have already happened, and insulin/symlin is taken for what is going to happen. No closed loop system can know that you are going to have a Pizza in 15 minutes. Not until "back to the future" technology is invented.