Symlin Update

[koblenz]

As requested by some, I am providing an update on my progress since having started using Symlin.

Background:
I am type 1, diagnosed Feb 2004, male, 36yo. My BS control has always been pretty good, highest A1c is 6.8. I have a problem with a morning BS spike post breakfast. I eat breakfast around 7:00 AM every morning. Regardless of what I eat, I would soar to over 200, then, by 10:00 AM my BS would crash and I would have to eat to prevent a low. If I took less insulin, I would go into the high 200’s then by lunch be normal. If I took more insulin, I could keep my mid-morning number under 160, but then I would really crash. I tried eating different foods, taking insulin sooner, later, yadda, yadda, yadda. Nothing seemed to help much. This doesn’t happen with lunch or dinner. If I wait to eat breakfast until after about 9:30 AM, this doesn’t happen: just when eating earlier. VERY FRUSTRATING.

Like the commercials said, I asked my doctor about Symlin. He said he had been thinking of talking to me about the same thing. So he prescribed and the adventure began.

The first 3 weeks or so were “interesting”. I take one manual injection a day, just before breakfast. I worked my way up to 5 units of Symlin, and only took about half my “usual” morning Novolog dose. Had a few mornings of lows (no lower than 54) but nothing to unsettling.

Results:
After playing with the Symlin dosage and adjusting my morning insulin dosage, I have found the “magic” balance and I have what I consider to be impressive results. I take 4.5 units of Symlin and about 45% of my normal morning Novolog in a combination bolus from my pump (45% immediately and the rest over 1.5 hours).

During the morning hours and until lunch, my BS never goes above 120 and the lows are GONE! Prior to the experiment beginning, my 30 day average BS was about 135. My current 30 day average is 112. Have not gone back for a new A1C yet, but am now anxious to.

Conclusion:
Works for me, but YMMV. YAY!

[am1977]

OMG! That's awesome ! :top:

I've been discussing this with my Endo, but they don't want me to try it yet. They want me to test my basals first, before I add another thing into the mix... I guess that makes sense, but I've heard so many good things about it...I'm getting anxious :frown:.

Thanks for the update :smile:

[JasonSmithMT]

Rumor from my endo is that there is a once a day long acting or maybe even a once a week Symlin in the works. I haven't heard anything about these myself and I didn't get a lot of time with him to go into the details. It is the three or more additional injections that makes that drug a hard sell for most people. Once a day or once a week dosing and the drug would be huge.

Jason

[MarkMunday]

.... I have a problem with a morning BS spike post breakfast. I eat breakfast around 7:00 AM every morning. Regardless of what I eat, I would soar to over 200, then, by 10:00 AM my BS would crash and I would have to eat to prevent a low. If I took less insulin, I would go into the high 200’s then by lunch be normal. If I took more insulin, I could keep my mid-morning number under 160, but then I would really crash. I tried eating different foods, taking insulin sooner, later, yadda, yadda, yadda. Nothing seemed to help much. This doesn’t happen with lunch or dinner.....
Have you been able to figure out what was causing the the post-breakfast blood sugar spikes? The way I see it, there are basically three options. The spikes could be caused by :


Hormonally induced insulin resistance
Excessive carbohydrate in the breakfast meal
Glucose produced by the liver


Or it could be a combination of all three. The fact that Symlin is doing the trick for you suggests that it is dealing with 1 and 2. Symlin retards the supply of glucose to the blood stream after a meal. And I would have thought that you could achieve the same effect by simply reducing carbs in your breakfast meal. Did you try elminating breakfast carbs entirely?

I found that that my blood sugar would still spike after breakfast, in spite of the absence of carbs in the meal (breakfast is eggs, cheese and sausages). And my conclusion was that the glucose must have been coming from my liver. And I am dealing with it by taking metformin in the morning.

Cheers,

Mark

[duck]

This goes a long way (in my mind) toward convincing me that there is much more to blood sugar management than insulin alone, and it is amazing that in 80 years since the discovery of insulin, that is still about the only focus medical science has on diabetes management.

Good news for you, Koblenz, glad to hear it!

[koblenz]

Did you try elminating breakfast carbs entirely?
Mark
Yeah, many experiments of going without breakfast. BS was as steady as a rock! Tried low/no carb breakfast and I would still rise quite a bit more than eating the same thing at different times of day. I tried eating breakfast (foods I usually eat) at lunch and dinner time and I do not have the same spike reaction.

Endo says it is a morning release of cortisol and other hormones, along with a morning resistance to insulin.

While these are good facts to know and I keep them in mind, I am glad I have this solution for now. I refuse to give up my morning treat of carbs unless I HAVE to. One little shot in the morning and I can luxuriate in my morning oatmeal, eggs, cheese, sausage & OJ without spiking through the roof! YAY!

[MarkMunday]

..... it is amazing that in 80 years since the discovery of insulin, that is still about the only focus medical science has on diabetes management.....
Tell me about it! Reminds of a post on another forum in which it was suggested that trying to control blood sugar levels using only injected instulin is a bit like trying to fine-tune a racing car when the only tool you have is pipe wrench. Injecting insulin is, at best, a high-risk guessing game.

The metabolic processes are incredibly complex. And the medical profession has unrealistic expectations of T1 patients, bearing in mind the limitations of the conventional treatment method - injecting insulin. It seems that doctors and endocrinologists are blinkered and simply won't deviate from the official line.

It is great that Symlin has been accepted as an adjunctive therapy for treating postprandial blood sugar spikes. But, once again, it only addresses one relatively minor element of a complex process. And I find it incomprehensible that they haven't come up with something for T1s that controls the amount of sugar the liver produces. Especially since Metformin does exactly this and has been around for 40 years.

Part of the problem could be that Metformin has only been approved by the FDA for use with T2 diabetics. As far as I can see, contra-indication of use with T1s has never been demonstrated, or even suggested. I guess the clinical trials that motivated the FDA approval were done with T2s and the rest of us simply missed out.

Cheers,

Mark

[Belinda]

I have had the same results with the symlin....except some mornings I wake up low (44) and don't take it and later after bfast it spikes. I like the fact that I now ;use the dual wave bolus and have a steady BS reading.......

[gettingby]

Way to go Koblenz. Sounds like you are on your way to figuring this diabetes "stuff" out. You may end up giving an "oldie" (me, lol) at this some new pointers.:five:. I really need to get that A1C back down but I feel as though I have run into the proverbial :banghead:

[middnite03]

I have been using this since december 27th, and so far great,... I did have a little problem with the side effects, but they quickly gone... I am at full type 1 dose now, and the biggest thing I noticed was that I have to use the dual wave bolus for meals now,. but I am using less insulin and post meal spikes are less. the biggest gotcha I noticed is if you dont use the deal wave, you bs will go low, then rise up again about 2 to 3 hours after a meal....

[koblenz]

the biggest gotcha I noticed is if you dont use the deal wave, you bs will go low, then rise up again about 2 to 3 hours after a meal....
OK, good, I am not crazy! I found the same thing. It took me a few weeks to figure that out to, but now, with the combination (dual-wave) bolus, it seems to come out perfect.

did have a little problem with the side effects, but they quickly gone
I started having side affects when I got up to 7.5 units, feeling full, a little stomach cramping, but when I went back down to 5 units, Poof, gone.

Sounds like you are on your way to figuring this diabetes "stuff" out.
HA.... I don't know if I will ever have it "figured out"... I seem to be having similar success as when I tried to "figure out" women. I don't think I will ever really figure either out, just nod and say "yes dear" a lot! :D

[middnite03]

HA.... I don't know if I will ever have it "figured out"... I seem to be having similar success as when I tried to "figure out" women. I don't think I will ever really figure either out, just nod and say "yes dear" a lot!

i've got this one figured out!!!!! just say it's your fault, and your sorry, no matter what it is, even if it has nothing to do with ya.. :) works like a charm ....:argh:

[middnite03]

well at last, it's working,.. it took me over a month to figure out how to set my bolus and take my symlin... right now, I take the symlin about 15 min's before eating, I actually eat alot less, have lost about 7 pound already, and my tdd went down about 30 units so far,.... it was **** for the first month,.. but with the symlin the trick that works for me... I take about 30 percent less of a bolus, and then use the dual wave feature, taking a 50 percent now, and the other 50 percent over 2 hours..... this week, I have not had 1 spike over 40 to 50 points after eating a meal, and no matter what my bs is down to 110 in 2 hours....
I was not too impress when I first started symlin, and after a month of side effects, and crazy blood sugars, I can actually say it was well worth it.... my sugars are constantly in the 85 to 95 range with reduced basils and boluses.... if you have an endo that wants to try this,.... and you can put up with the side effects for a bit, i'd say give it a shot...... (no pun intended)...

again YMMV but now I have better control then I have had in years.......

:eating:

[gettingby]

well at last, it's working,.. it took me over a month to figure out how to set my bolus and take my symlin... right now, I take the symlin about 15 min's before eating, I actually eat alot less, have lost about 7 pound already, and my tdd went down about 30 units so far,.... it was **** for the first month,.. but with the symlin the trick that works for me... I take about 30 percent less of a bolus, and then use the dual wave feature, taking a 50 percent now, and the other 50 percent over 2 hours..... this week, I have not had 1 spike over 40 to 50 points after eating a meal, and no matter what my bs is down to 110 in 2 hours....
I was not too impress when I first started symlin, and after a month of side effects, and crazy blood sugars, I can actually say it was well worth it.... my sugars are constantly in the 85 to 95 range with reduced basils and boluses.... if you have an endo that wants to try this,.... and you can put up with the side effects for a bit, i'd say give it a shot...... (no pun intended)...


again YMMV but now I have better control then I have had in years.......

:eating:
Way to go Paul (yes, I know you are male, lol). Keep up the good work and keep us updated. You too, Koblenz !!!!!

[lelggren]

That is great to know because my Dr. is planning on me starting it this fall. Have you noticed any not so good side effects or anything like that? I'm glad that it is working well for you!

[koblenz]

You can read about the "officially" published side affects at: http://www.symlin.com/pcg/sideeffects/default.cfm

Only things I experienced were a "feeling of being full" (like after Thanksgiving dinner, but all the time) and a little stomach cramping. Both only lasted a few days, and now I am as right as rain!

[middnite03]

I actually had a **** of a time to get started,. a little bit of stomach cramping, and the very full feeling. and it took me a little while to learn NOT TO EAT so much food LOL... for me the hardest part was learning when how to bolus and when to inject the symiln.. for me, what I find is the best... is I take the symiln about 20 to 30 mins before a meal, and when I bolus I always use the dual wave bolus, taking about 50 percent now, and 50 percent over the next 2 hours... for me this works great, my post meal never rises more then 30 to 40 points, and i'm usually back in the 90 to 110 range after 2 hours and back to 85 to 95 an hours after that. again YMMV, ad with everything with diabetes, different things work differently with everyone..

good luck if you try it, and remember to be patient, it pays off in the end.....