Symilin

[jeggeman31]

Well I got back from the DR and I start on Symilin today. Looking forward to this.


My DR has started me on 10 units at dinner for one week, then 10 units at lunch and 20 units at dinner, then up to 20 units lunch and 20 units dinner over the next month.




Now did I read that I should inject 15min prior to eating ?

[bbrian]

I have been on Symlin for 8 weeks now taking 20u before meals (yes 15min before) and the nausea has been unreal. I also jusst came from the doctor today and he told me to go back to 15u or even 10u if the nausea is too much. I am to go back in 2 months to see how things are going...but he did hint that this may not be the way to go with me I have not lost weight and my bgs are still about the same as they were w/o Symlin and I have had to increase my Humalog and Lantus back to where they were when i started.

Brian

[JediSkipdogg]

Jim, I'm confused on the fast past of increasing. Usually it's only an increase each month and I thought the max was 20 units. I'm not on Symlin, so I may be wrong, but that fast of a change each level and going that high just seems kinda crazy to me.

[ProudNanaof5]

I started out with 2.5 units of symlin, then 1 week later went to 5. 2 weeks later I went up to 7.5 with no problems. She then increased me to 20 units.....woeeee... sick oh sick. And was having lows. She told me to go back down to 5. I have worked my way back up to 7.5 in morn 10at lunch and 7.5 at Dinner. Very rarely do I get sick...I guess it depends on everyone.

[Cyborg]

I started Symlin at 5 units and increased the dosage every couple days as long as I had no nausea. At 20 units I do experience fairly strong nausea so I've backed off to 17.5 units, which is much more tolerable. On the pump, I've experimented with many kinds of boluses while taking Symlin. The best one I've found to date is a 50/50 combo bolus over 2 hours, taking the normal amount of insulin.

[Mr Jensee]

Hi, I have a question. Seems my Dr. Just put me on Symilin and I am not on insulin. I am on glimipiride (amaryl) and was on Byetta. I am not getting any results from the Symilin, 20 units at meal time, and definitely no nausea as I did when I was on 10 mcg. Byetta. Before going on Symilin I was on 5 mcg. of Byetta twice a day. My blood glucose seems to stay near 300mcg/kg. and and this is disturbing me. Question, should I be on Symilin when I am not on insulin?
Thanks.

[Keezheekoni]

I started Symlin last Friday. My endo has me following a pattern that her office wrote up...
Days 1-3: 2.5U 15 mins. before every 30gm CHO meal (up to three times a day)
Days 4-6: 5U " " "
Days 7-10: 7.5U " " "
Days 10-15: 10U " " " and reduce insulin bolus to half of normal
Days 15-20: 15U " " " and reduce insulin bolus to half of the above rate
Days 20 on: 20U " " " and reduce insulin bolus to half again (or 1/4 of normal)

She also gave me her email address and cell number in order to call and let her know if I'm overly sick or my adjusted boluses aren't quite correct. However, I'm doing good thus far. Have had a few highs, probably from not waiting an entire 15 minutes sometimes...I'm not used to having to bolus and then wait to eat. When I'm hungry, I'm *hungry*!

Now, she's only having me go to 20U because I want to lose weight. She's giving me two years to get to my "goal" weight, and then she wants me to back off the Symlin to 10U for those over 30 gm meals.

I did find it interesting to read in the Symlin patient info box that most Type 2s are started at 10U. Why is that? Less possibility of hypos? I'm confused!

[Mr Jensee]

Well I have taken as much as 30 units and so far nothing. This morning my blood sugar is still high, 284. Last night when I went to bed it was 294. Called them and the nurse said to just keep increasing the dosage. WTF?? 5 mcg of Byetta did fine for me this **** isn't doing a thing. My vision right now is so blurred I can't read fine print anymore. I feel like **** and all I want to do is sleep. Can't though, I am offshore, at work and have nearly 2 weeks left out here before I go in. This is starting to worry me. I can't even eat one meal a day now, it spikes my glucose levels. I think this Symilin is ****.

[JediSkipdogg]

Mr. Jensee....Without insulin symlin is pretty pointless. I don't know if you are type 1 or type 2, but I don't see how symlin will help a type 2 without insulin. Symlin is designed to work WITH insulin injections. Also, I would think as a type 2 with insulin resistance one would have a symlin resistance as well.

Is they any reason they took you off Byetta? If it worked, why change?

[Cyborg]

I would not go above the max dosage of 20 units....

[Mr Jensee]

Mr. Jensee....Without insulin symlin is pretty pointless. I don't know if you are type 1 or type 2, but I don't see how symlin will help a type 2 without insulin. Symlin is designed to work WITH insulin injections. Also, I would think as a type 2 with insulin resistance one would have a symlin resistance as well.

Is they any reason they took you off Byetta? If it worked, why change?
I spoke with the Dr's nurse on Friday. She told me that initially it was used for only insulin dependence but the medicine has been cleared for type 2 non-insulin dependence for a year now. She said they have had great success using it on their patients. I told them last time I was at the office that the 5 mcg Byetta was not reducing my appetite and asked them to put me on the Byetta 10 which I was on initially. Instead they put me on this stuff. It is like injecting saline. Nothing is happening. Even double dosing my glimpiride has had no effect on my blood sugar the last 2 days. I have been without any food now for over 24 hrs. and my blood glucose is still 220. I am not hungry of course but I can't see how starving myself is going to help either. Can't contact the Dr. until at least Monday.

[Cyborg]

Do you exercise?

[JediSkipdogg]

It sounds to me like you also need to add insulin to your treatment. Many type 2s use some insulin a day. I betcha that would help some now.

[Cyborg]

Have you ever had a C-Peptide and/or GAD Antibody test done to confirm diabetes type?

[jeggeman31]

I spoke with the Dr's nurse on Friday. She told me that initially it was used for only insulin dependence but the medicine has been cleared for type 2 non-insulin dependence for a year now.


The below is from Symlin website. I would think their website would be changed a year ago if your Dr's Nurse was correct. I have always been told that Symlin is always to be taken with insulin and no more than 20 units.


I would check into it more, because my DR even told me it was 100% only taken with insulin. But then again, I am not a DR nor do I play one on TV





It is always used with insulin to help lower blood sugar during the 3 hours after meals

[Mr Jensee]

Well regardless I am screwed till Monday when the office opens. My Doctor is an Endocrinologist and yes all the tests necessary have been performed. I have seen him for the past year and have managed to lose weight and keep the blood glucose in check. I checked the Symilin website and the package directions and nowhere does it say anything about using it without insulin therapy. This is why I called them. I am also a Paramedic and know a lot about diabetes, insulin resistance, etc. I am insulin resistant. I am increasing my excersize to see if this will make a difference. I am definitely making a move to get back on the Byetta. I am not interested in starting insulin as I know how much harder it is to regulate. While I still have pancreatic activity I intend to not become dependent on insulin. Studies have shown people who go to insulin before cesation of natural insulin production tends to cause the pancreas to shut down all together. Why do this unnecessarily?

[Cyborg]

Studies have shown people who go to insulin before cesation of natural insulin production tends to cause the pancreas to shut down all together. Why do this unnecessarily?

Are you sure about this? Perhaps it could offset some of the workload from your pancreas until you are able to reduce your insulin resistance through exercise and weight loss. It would also help get the bg down and reduce your chances of complications and help the Symlin to work as designed.

[Mr Jensee]

Yeah I am pretty sure. In type two diabetes, my diabetes the immune system attacks the islets of langerhans, the cells that produce insulin, slowly killing them off. By introducing insulin the body sees no reason to produce the insulin on its own. The cell destruction can intensify. The old adage, if you don't use it you lose it applies here as well.

[JediSkipdogg]

Yeah I am pretty sure. In type two diabetes, my diabetes the immune system attacks the islets of langerhans, the cells that produce insulin, slowly killing them off. By introducing insulin the body sees no reason to produce the insulin on its own. The cell destruction can intensify. The old adage, if you don't use it you lose it applies here as well.

What you just said right there is type 1 diabetes. Type 2 has nothing to do with an immune system killing off.

Also, I find it odd that you say type 2s can use Symlin without insulin and that nothing is wrong with your dosage yet it's not working for you and the company's website says to be used with insulin and that the max recommended dosage is 20 units. :hmmmm2: Just puzzles me there.

[Mr Jensee]

What you just said right there is type 1 diabetes. Type 2 has nothing to do with an immune system killing off.

Also, I find it odd that you say type 2s can use Symlin without insulin and that nothing is wrong with your dosage yet it's not working for you and the company's website says to be used with insulin and that the max recommended dosage is 20 units. :hmmmm2: Just puzzles me there.

Obviously you are misinformed then. Type 2 diabetes is not just one diabetic malfunction. There can be insulin resistance, mine is. There there can be a dying off of insulin producing cells mine also is. There can be problem with the Liver processing glucose a problem I may be having as well. The immune system can attack the iselts of langerhands. The only thing that differentiates them is that Type one or Juvenile Onset diabetes is a total non functioning pancreas early in life. Type 2 more times than not will revert to total insulin dependence, it just develops later in life as mine did. Both of these versions of the disease (dysfunction) are progressive. the type 1 type 2 are used to differentiate if this was early onset, or adult later onset diabetes. Nothing more. Type one BTW is always insulin dependent. Type 2 will most likely progress to insulin dependency but that won't make it Type 1.

And if I could figure out the rationale of why my doctor's nurse practitioner put me on this stuff then I would probably not be in this fix. I plan to get documentation on what she was talking about when I speak to her Monday.

[Cyborg]

All I can say is: Please read up more on the differences between type 1 and type 2. Jedi is correct...

[JediSkipdogg]

Obviously you are misinformed then. Type 2 diabetes is not just one diabetic malfunction. There can be insulin resistance, mine is. There there can be a dying off of insulin producing cells mine also is. There can be problem with the Liver processing glucose a problem I may be having as well. The immune system can attack the iselts of langerhands. The only thing that differentiates them is that Type one or Juvenile Onset diabetes is a total non functioning pancreas early in life. Type 2 more times than not will revert to total insulin dependence, it just develops later in life as mine did. Both of these versions of the disease (dysfunction) are progressive. the type 1 type 2 are used to differentiate if this was early onset, or adult later onset diabetes. Nothing more. Type one BTW is always insulin dependent. Type 2 will most likely progress to insulin dependency but that won't make it Type 1.

And if I could figure out the rationale of why my doctor's nurse practitioner put me on this stuff then I would probably not be in this fix. I plan to get documentation on what she was talking about when I speak to her Monday.



You are totally incorrect in all of your thinking. Age has NOTHING to do with type 1 or type 2. The old term Juvenile Diabetes is now 100% without a doubt called type 1. Adult onset is 100% wihtout a doubt called type 2. If you don't believe me then go to the JDRF (Juvenile Diabetes Research Foundation), ADA (American Diabetes Association), or IDF (International Diabetes Federation.) Those are the three largest diabetes organizations in the world.

Type 1 is caused by an autoimmune disease that attacks the islet cells. It can occur anytime in life, but it generally occurs in early childhood, but not always. There is no cure at all for type 1 and all type 1s WILL REQUIRE insulin. There is a surgical procedure going on a few places with islet cell transplants, however, the results are not very promising in terms of long term.

Type 2 is the one that is greatly on the rise and is many times preventable. This is what is setting a red flag off in every medical office across the country as more and more teenages develope type 2 by being overweight. It is not always sparked by weight, but generally most cases have some weight issues. Type 2 though is when the body has either a low production of insulin or the body has the inability to use the insulin produced (generally called insulin resistance.) Many times the islet cells will die off though as they are being overworked. If they are attempting to produce more insulin that they can, then they slowly die off faster than they replenish. THat is why sometimes type 2s are started on insulin (generally just a basal insulin like Lantus.) The insulin gives their islet cells a break from overworking and can prevent them from needing a bolus insulin (Novolog, etc.)

Therefore pal, I think you need to read up on diabetes.

[Mr Jensee]

So WTF?? You just reiterated what I said. Nothing new added to the conversation. Think you need to learn how to read...

[JediSkipdogg]

So WTF?? You just reiterated what I said. Nothing new added to the conversation. Think you need to learn how to read...

No I didn't. You said type 2 can be an immune disorder. You also stated that age plays a role in determining type 1 vs 2. Both of those are not true.

[jeggeman31]

I think someone woke up on the wrong side of the bed!

[linda53]

I started on Symlin last week. He started me on 10 units before each meal....I have been so nauseated and vomiting and want to know if this goes away after a while as it is really helping my PP readings actually so low I have cut my nightime insulin.

[linda53]

mmmmm I thought I had posted to this....well I am new and my endo started me on 10 units before each meal well breakfast lunch and dinner. I have been so sick so I called him up today and he himself not the nurse always returns the calls he feel are the most needy at the moment. He told me to cut down to 5 units starting with breakfast in the morning...then after a couple of days try the 10 units again....I am also on Humalog 75/25 50 units am and pm but last night my bedtime number was 52 so I skipped my normal insulin dose and when I woke up it was still under 100....so maybe this will work...yeah I know we are insulin resisitant but its about time they have an insulin that is man made...what do you all think?:heeeellll

[JediSkipdogg]

Symlin and a mixed insulin? That is nothing but deadly in my opinion. It will be IMPOSSIBLE to have good numbers on that. And here's why....

Symlin is short acting and made to work with the short acting insulin in the mixed insulin. Therefore you need to cut that short acting down. Well, when you cut that down you cut the long acting down as well meaning you are going to go high hours later. There's no way to fix that.

You need to talk to your doctor about a true MDI regimen of one long acting insulin shot a day and multiple short acting shots of Humalog. Also, a type 1.5 is not initially insulin resistant.

I would talk to your doctor a little more.

[Cyborg]

I started on Symlin last week. He started me on 10 units before each meal....I have been so nauseated and vomiting and want to know if this goes away after a while as it is really helping my PP readings actually so low I have cut my nightime insulin.

Your doctor should be following the manufacturer's recommendations. A type 1 typically starts at 2.5 units and when you get used to it without nausea, you add another 2.5 units. You repeat this until you reach the max. recommended dosage for a type 1, which is 10 units. The whole process may take weeks and you may never reach the max dosage.

I'm sorry, but your doctor is a quack, IMO...

[It Ain't Over]

Have been using Symlin with some real benefits for a year and a half. Took at least six months before the nausea faded. Had me on 10 units max at first, then a couple of months ago the endo asked me to increase up to 20 units.
I got all fouled up trying that and backed down to 10 again. I think I was using too much insulin and I went for a ride on the hypo roller coaster.
I will retrench and ebb up the Symlin, and reduce the insulin one small step at a time. Also noted that with that much Symlin I had a hard time feeling like eating, felt full at first bite. Nice to get rid of the hunger pangs, but that was hard to handle, as I would not eat enough and go low, them over eat and go up and then down... roller coaster.
Hope this adds something to the discussion. Since backing off have been off the ride for a week now. Nice.

[Cyborg]

The problem with Symlin is that is slows digestion. For someone on a pump, this is not a problem. I had a CGMS when I started Symlin. A simple 50/50 combo bolus over 2 hours works perfectly for me. On MDI, you may need to split your bolus into 2 boluses to avoid going low.

On another note, I have found that I need the same amount of insulin and that the Symlin does not decrease the overall amount needed to cover my meal. I just need to bolus differently.

[ricknhouston]

yes it does go away ... somewhat! :>)

[solox316]

Your doctor should be following the manufacturer's recommendations. A type 1 typically starts at 2.5 units and when you get used to it without nausea, you add another 2.5 units. You repeat this until you reach the max. recommended dosage for a type 1, which is 10 units. The whole process may take weeks and you may never reach the max dosage.

What you wrote here is exactly as it was explained to me, as does the packaging and startup kits...

I am shocked to hear so many people starting right at 10units! The first time I used it, I never made it above 5 units. I eventually stopped coz I was sick of using a syringe and vial again.

I just picked up a symlin 60 pen today, and plan to start again... at 2.5 units (15mcg), then 5 (30mcg) after a few days... Hopefully it will be easier to carry the pen around instead of syringes and whatnot...

On the type 1 type 2 thing... My nurse prac says the symlin has really shown to work best with type 1s, and the byetta has shown to work best with type 2s.

[solox316]

Started my new pen last week, up to 5 units now. It is quite the amazing addition to my care...

Last night, with pizza, bread, and salad, michelob ultra... over 100 carbs, never went above 150 (hung mostly around 120) the rest of the night, and woke up perfect...

breakfast this morning, waffles and syrup (i know, two really carby meals in a row...) never above 130.

I haven't cut back my insulin with this, which you are supposed to. Will continue to see how it works out. I never made it up ao 7.5 or 10 units last time, too much nausea... we shall see.

[dgrilli]

I use Symlin and Symlin will cause a massive drop in blood sugars that fall faster then a Lead Zeppilin like a rock.

I started on 2.5 and went up from there with as upping the dose of Symlin I'm backing of the Insulin.

It come to a point that the Symlin does not even work til the insulin is added.

So a 20unit shot of Symlin and a 20unit shot of Insulin would be enough to take me down from over 400 to 100's withing 20 minutes.

So I'm very careful about this stuff it works real good with injected insulin. It doesn't seam to do much without Insulin though.


Great Secret weapon if I go high like My inset stopped working while I slept. Then it's time.

Tried it with Pizza one night not a good thing, try forcing yourself to eat and drink and take honey when it;s that last thing you want. One good thing the half life its not so long with me about an hour and half.

Good stuff if you can get right.