Symlin advice

[Amanda_Jo22]

For those of you who are on Symlin, do you have any tricks of the trade? I'm pretty new on it. I'm up to the full dose, 10 units. After every meal, I keep going hypo. I've reduced my insulin significantly (I use to be at 1:12 pre-symlin, I'm now up to 1:35 for carbs). I use a combo bolus to spead the bolus out but I'm still going low.

[lelggren]

For those of you who are on Symlin, do you have any tricks of the trade? I'm pretty new on it. I'm up to the full dose, 10 units. After every meal, I keep going hypo. I've reduced my insulin significantly (I use to be at 1:12 pre-symlin, I'm now up to 1:35 for carbs). I use a combo bolus to spead the bolus out but I'm still going low.
I'm not on symlin right now, but I will be in about a month or 2. So, I'm sorry that I don't have any tricks or things to tell. But, may I ask you, what do you think of symlin? I have been hearing that so many people have had negative side effects from it, like extreme nausea and vomiting, and other such things. But, what has been your experience thus far?

[koblenz]

Well I don't know about "tricks of the trade..." but here is what I have done. Remember, I only need to take it with breakfast, one meal a day.

- I stopped at 4 units of symlin instead of going all the way up to 10 units. The way my endo explained it is that if I get the desired effect and no side affects at a lower dose, great.

- I take about 60% of my pre-symlin novolog dose in a combination bolus of 30% immediately and the other 70% over 1.5 hours.

- If I am lower than 90 before the meal, I will eat some small snack/carbs about 10 - 15 minutes before meal to make sure my BS is a little higher. If I don't do this, I can end up a little low about 1 hour post meal. If I start out above 95, I am fine.

So I am not a doctor, nor do I play one on TV, but have you tried it at a slightly lower dose? What happened when you were still titrating up to the full 10? But as always, YMMV and consult your physician before making any change to your treatment regimen.

[am1977]

I just started Symlin Monday night (just for dinner time)...so I'm still trying to figure things out myself. Actually, I had to put it back on HOLD, my Endo wants me to continue to test my basals :hmpf:. However, if and when I return to it, I'll be sure to let you know anything I find out...:smile:

[Amanda_Jo22]

I went and saw my endo today. He said to stay on the full dose but to do a combo bolus of 30% now 70% over 2 hours to balance out the bolus and avoid lows.

I haven't had too many problems with it as far as side effects. Right now I'm getting use to the 10 units. It is pretty powerful though and it makes your stomach pretty upset for the first few days and then you get use to it.

Good luck am1977 and lelggren with starting on symlin. It's nice because it dramatically reduces the amount of insulin needed.

[am1977]

Thanks, Amanda :) I'm looking forward to starting back up on it, I really do think it could be beneficial.

Good luck to you, too, with your adjusted boluses- hopefully things will work out better for you. Keep us posted :top:

[Cyborg]

I want some! Wow, cutting your carb ratio to 1/3 of the non-Symlin dose. That sounds too good to be true. End of May (next Endo appt) I'll be asking for some...

Good luck with those lows.

[Amanda_Jo22]

Thanks am1977 and Cyborg :) I admit the reason I mostly wanted to use Symlin is to keep my weight down. I'm pretty thin but I gain weight easily, and I wanted to eat more carbs without gaining weight :thumbsup: I had pretty good control without it but I'm looking forward to that extra piece of pizza lol.

[Belinda]

If my BS is below 80 I don't take it. My endo told me to take 1/2 of the insulin that I would normally take for a meal and then check and correct. He was so right...I cut insulin to about 1/2 and within a short time learned how my body reacted to the stuff and learned how to do the dual bolus on my pump....it was over 2 1/2 hours instead of the normal 1 1/2 so my advice to you is cut back on the insulin and then check. YOu can always correct the wrong later by giving more of a bolus...better to go a tad bit high as opposed to very low.

[Cyborg]

If the pancreas naturally releases insulin and symlin and both are no longer released in type 1 diabetics, then it makes sense that treatment should include not only insulin, but symlin also.

[psilocybin]

may i ask what symlin is? sorry im behind on this topic

[Harold]

Symlin is a synthetic incretin hormone developed to take with insulin. This incretin hormone mimics the bodies own production of incretin homes produced by the gut to signal when it's full. This also signals other organs to respond to help with digestion and other things.

[marked]

This truly is a wonderful drug. When my fasting blood sugars are normal, this drug is close enough to a cure for me. I inject the symlin at meal time. I give no insulin until the blood sugar starts to climb, say at 125 or so. This time to inject the insulin and amount to inject is determined by how fast the blood sugars rises. This is generally not true with breakfast; but lunch and dinner sometimes incredibly, I give no insulin until 3 or 4 hours after the meal is finished, and then just 1 or 2 units. It’s not always like that, mind you, sometimes I have to give it right away. There are days that I peak at 130. Incredible. Of course there are days when I dose wrong that I peak in the low 200's. But those days are getting fewer, as I get better at this thing.
Monday, I go in for my 3 month a1c, I am thinking I could be in the low 5’s maybe.
One reads about this drug being for type 1’s who are having trouble with high a1c’s. I am thinking this is completely false. I am finding that when I am high, as well as when I am low, taking the symlin is too tricky for me;due to the change in insulin sensitivity, this drug creates.
Mark

[Shotokan]

I've been injecting Symlin before all three meals for several months on MDI (Lantus and Novolog) and it's helped a lot. Now I'm doing a pump trial and I've been going hypo after lunch. I cut my I:C ratio a few times, then a couple of days ago I injected my usual 10 units of Symlin, but forgot to bolus with insulin, ate lunch (65 carbs), and 1 hour later my BG had fallen 40 points. I guess it potentiated my basal insulin. Two hours after lunch my BG was at 160. I decided to correct my BG at that time and everthing worked out okay. So delaying part of your bolus seems like a good plan based on my experience.

Today, for lunch I injected Symlin, ate 66 carbs, and remembered to bolus. In 45 minutes my BG was sitting at 36. I started scarfing down the glucotabs while I was still conscious, and amazingly my endo called me 10 minutes later to ask how I was doing on the pump. She told me to either 1) stop the Symlin or 2) stop the insulin at lunch. Since I'm on a pump I'm electing to stop the Symlin for lunch (one less injection). However, I'm still really happy with how it moderates my after-breakfast and after-dinner BGs. I never go above 150 after those meals.

If I decide later to restart the Symlin for lunch, I'll experiment with a combo bolus.

[marked]

You make a good point. The margin for error is narrowed with this drug. The benefit is that it gives me the opprotunity for tighter control, the down side is you can walk the razor's edge on going low. I check my bs's frequently and pop a candy if I start heading into the 70's.
Mark