Symlin Issues...

am1977 · #1 (**permalink**) 10-03-2006, 07:52 AM

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

.

I can't understand why I'm still having problems with this...

. 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

. 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

.

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

.

I'm not sure what to do about this- it seems like my night time readings have been an ongoing problem forever

. I've tried testing my basals and plan on doing more, but I want this fixed NOW!

... Guess I'm looking for any insight I can get on how to improve things- thanks for any help

spike · #2 (**permalink**) 10-03-2006, 08:37 AM

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 · #3 (**permalink**) 10-03-2006, 09:10 AM

symlin is used to help prevent post-prandial spikes (after meal)... which tends to be a BIG problem for me

. 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 · #4 (**permalink**) 10-03-2006, 09:41 AM

Quote:

Originally Posted by am1977

symlin is used to help prevent post-prandial spikes (after meal)... which tends to be a BIG problem for me

. 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 · #5 (**permalink**) 10-03-2006, 09:54 AM

Quote:

Originally Posted by spike

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 · #6 (**permalink**) 10-03-2006, 09:56 AM

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 · #7 (**permalink**) 10-03-2006, 10:05 AM

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.../full/20/3/137

Regards,

Joe

statdeac · #8 (**permalink**) 10-03-2006, 10:06 AM

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 · #9 (**permalink**) 10-03-2006, 10:18 AM

Quote:

Originally Posted by 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.../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 · #10 (**permalink**) 10-03-2006, 11:21 AM

Quote:

Originally Posted by statdeac

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 · #11 (**permalink**) 10-03-2006, 02:11 PM