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k_dub

New A1C - 4% Club!!

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k_dub

My new A1C today is 4.8%!! My last was 5.9% in August. I added Symlin to my regimen in early September.

Totally shocked! I was aiming for something in the mid-5s. Was not expecting something under 5%!

 

I'm not having many lows. If I do go low, they are easily managed. I've never had a low that I couldn't treat myself...ever.

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PinkRose

Wow that's a very low A1c. I haven't heard of many T1s being able to reach that sort of number before. When you say you have few lows, what is the general lower limit of your BGs as a norm? Are you frequently below the 70 mark?

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rzrbks

Just something to ponder during the long, cold nights in Zuccotti Park

 

 

"SHARED EVIDENCE BASE

 

The evidence base used by AACE and ADA is exactly the same. To my knowledge, there are no studies considered by one organization that are not considered by the other. The major database for both guidelines consists of results from the Diabetes Control and Complications Trial(DCCT)4,5and the U.K. Prospective Diabetes Study(UKPDS).6,7Both studies demonstrated that with declining A1C levels comes a significant decline in the risk and progression of the microvascular complications ofdiabetes. Neither study demonstrated a level of A1C below which further benefit was not obtained. Significantly, the mean A1Cs attained by the“intensively treated group” in these two studies were 7.1% (DCCT)and 7% (UKPDS). In addition, both studies reported a significantly increased risk of hypoglycemia in the intensive groups.

 

FAVORABLE RISK-BENEFIT OR COST-BENEFIT RELATIONSHIP

 

In view of the patient with type 1 diabetes, ADA has considered carefully the risk-benefit relationship, noting that as A1C falls below 7%, the benefit decreases markedly while the risk of hypoglycemia grows. This suggests the possibility that for some patients, lowering A1C into that range will be associated with greater harms than benefits. Thus a target of <7% balances the risk of hypoglycemia with the benefit of this level of glycemic control.

 

In type 2 diabetes, where hypoglycemia is far less frequent, the risk-benefit assessment suggests that lower goals may be desirable.

 

However, we must consider the cost-benefit relationship. Placing the patient on another oral medication or starting the patient on insulin needs to be weighed against the potential benefit of further A1C reduction. If the question is, “What should be done to decrease my patient's A1C from 6.9%(meeting the ADA target) to 6.5% (meeting the AACE target)?” it must be realized that within that range of A1C reduction the potential benefit is small indeed, based on current data.

 

Finally, it is clear from virtually every short- and long-term interventional study that it is very difficult (and expensive) to achieve A1Clevels on average <7%—making the cost-benefit ratio prohibitive for at least some patients.

 

GUIDELINE CONSISTENCY

 

Many argue that the difference between the ADA and AACE A1C recommendations distracts patients and providers from the reality that most patients are not near either goal. It also creates the impression that “even the experts cannot agree.”

 

Although there are not good data to tell us the mean A1C in the U.S.,diabetes experts often estimate that it is 8.5–9%. This suggests that we should spend less time discussing what the goal should be and more time discussing how to improve glycemic control, and thereby get more of our patients to either goal. This point is particularly true when one realizes that, based on available data, we would accomplish far more by targeting those with high A1Cs and decreasing their A1Cs significantly than by arguing about how to further improve the A1Cs of those who, most would agree,are doing well by either standard. ▪"

 

Defending ADA's A1C Target

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k_dub

Sure, Linda...

 

I've been on this kick where I want to replace everything that my body is not making due to autoimmune disease.

 

So I had read a thread on this forum about symlin and then another about c-peptide, and I decided that I wanted both... C-peptide is not available yet, but there are clinical trials taking place on it right now. Symlin is obviously available.

 

I talked to my endo about Symlin a) to replace amylin since I don't make it and B) to help me lose weight and reduce the amount of insulin I use. Their office was really trying to push Victoza on me because they have had success treating T1s with insulin resistance (which I don't have) and for T1s trying to lose weight. I stressed again to them that I wanted to replace amylin. The endo agreed to give me some sample pens of symlin and said that he'd be happy to prescribe some if I tolerated it and found that it worked.

He indicated that many people were not able to get over the nausea and those that could had less success with weight loss compared to the folks on Victoza. The weight loss goal for symlin is a secondary issue to me...

 

You taper up your doses of Symlin, starting in small increments and working your way up to 60mcg or 120mcg doses.

He indicated that symlin on it's own will not reduce your blood sugar or cause a low. I was most worried about having severe lows once starting it. But I haven't had that problem at all... I'm taking 1-3 60mcg doses of Symlin a day, depending on what I eat. Usually breakfast and/or lunch are pretty small meals, so I don't always use Symlin for those meals. It's an injection. You take it with your bolus insulin. The nausea is substantial in the beginning, but only lasts 15-30min. It is supposed to make you feel more satiated and it does. You want to eat less. It took me about a month to get over the major nausea I had from it after getting up to 60mcg doses. I still get nausea if I take it and don't eat a large enough meal. I've found, for me, it's best to take it immediately after I finish eating so there is a little food in my stomach. I wasn't thrilled about having an injection since I'm on the pump and I've gotten used to not having to inject, but it wasn't a big deal once I got in the habit again.

 

The major benefit that I notice is that it drastically reduces my post prandial spikes and I don't spike as long...

Prior to the Symlin, I had an A1c of 5.9%, but I was spiking over 200mg/dl after some meals (especially when I indulged) several times a week. Luckily, those spikes occurred when I was awake and I could correction bolus. I've had my fasting BGs under control for awhile.... Occasionally, I would have a really nasty, persistent spike that was hard to bring down... I haven't had that since starting Symlin. It is extremely rare that I spike over 200mg/dl now... And most days, I'm not spiking above 140mg/dl.

 

I've also reduced the amount of insulin I use, mostly in bolus form, by about 20%. Where I was taking a TDD of 50 units a day, I'm down to TDD 40 units a day. And I'm getting to the point where I will need to do some basal testing to see if my basal could be brought down.

 

I'm using less insulin and my numbers are just tighter all the way around. I'm not prone to severe lows. I'm a believer in the "Law of Small Numbers" - I don't use huge boluses, so I just don't get bad lows. It's been months since I had a number in the 40s... I get occasional BGs in the 50s. I'm still very hypo aware even when sleeping. Anything under 65mg/dl or so will wake me up out of a dead sleep. Whether I'm spiking or going low, I'm pretty quick to correct the issue.

 

As the holidays come up, I may try taking the 120mcg doses of Symlin to take away the spikes of those higher carb meals.

But generally, I'm finding that the 60mcg dose works well for me and I haven't felt like I needed the 120mcg dose.

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PinkRose

Thanks for that good explanation of Symlin K. I've enquired about Symlin with my endo a few months ago but was told that it is not available in Australia. Why I don't know!? It sounds like it really could be a useful drug to many T1s with difficult to manage BGs.

 

From my understanding of it, it works to delay the emptying of food from the stomach, which then would ease the expected spikes after meals. My endo told me that I'm not to test before the 2 hour mark after eating a meal - they don't want to know what the extent of the spike during that time only what my BG ends up being at the 2 hour mark. I am a bit sceptical about this advice because I don't want to find that I am high at 2 hours. I know whether I may be heading for a high by testing 1 hour after a meal & making any adjustments as necessary. I believe I manage my BGs better this way - although I do test & fiddle around A LOT more than most diabetics.

 

Hoping to try this drug at some point in the future.

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Subby
Occasionally, I would have a really nasty, persistent spike that was hard to bring down... I haven't had that since starting Symlin.

 

I have these most days. Insulin can seem to cease to work well for me at any time, I know not why. That's why I'm also keen to try Symlin, and equally frustrated as Pinkrose that it is not here. Once it is, it will be a case of finding an early adopting doctor, which will be more time.

 

Thanks for relating your experiences.

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PinkRose
I have these most days. Insulin can seem to cease to work well for me at any time, I know not why. That's why I'm also keen to try Symlin, and equally frustrated as Pinkrose that it is not here. Once it is, it will be a case of finding an early adopting doctor, which will be more time.

 

Thanks for relating your experiences.

 

I'll be seeing my new endo again on the 22 Nov. I will definitely be raising this with her. Though it is available in the US, I can't say that I've heard many T1s say they take it. Doesn't seem to be as widely used as one would expect.

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Steal
My new A1C today is 4.8%!! My last was 5.9% in August. I added Symlin to my regimen in early September.

Totally shocked! I was aiming for something in the mid-5s. Was not expecting something under 5%!

 

I'm not having many lows. If I do go low, they are easily managed. I've never had a low that I couldn't treat myself...ever.

 

That is awesome! I had mine down to 5.0 while I was pregnant the first time. 5.3-5.5 feels perfect for me and that is where I am happy to remain. Keep up the awesome work!

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Hoping4Cure

My new A1C today is 4.8%!! My last was 5.9% in August. I added Symlin to my regimen in early September.

Totally shocked! I was aiming for something in the mid-5s. Was not expecting something under 5%!

 

I'm not having many lows. If I do go low, they are easily managed. I've never had a low that I couldn't treat myself...ever.

 

Symlin seems interesting based on a quick google search. Might have to try that.

 

Any other type 1s on that? How much are you taking per day, if I may ask?

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DeusXM

Symlin is contra-indicated in T1s, as far as I'm aware. I've asked the question before and once I found a doctor who'd actually heard of it, clinical advice is against T1s taking it....which I think is crazy since it is replacing a hormone that I don't make and presumably need.

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Uff Da

Congratulations on a fantastic A1c, Kelly.  So glad to hear that Symlin is working so well for you.

 

I'd considered it when I first heard about it, as in many ways it would be ideal for someone like me.  I have more than double the usual diabetic's BG increase to carbs, yet because I seem to have a "skinny gene," it is difficult to get enough calories on a low-carb diet.  Therefore my BG can skyrocket easily.  But the thought of all those extra injections when I bruise so easily and have so little territory with adequate fat deposits in which to give the injections really cooled my interest quickly.  I can sure see why others might find it attractive, though.  My current methods to keep postprandial lows down involve getting timing of food and insulin just right and errors lead to a lot of lows.  A method that would allow one to relax the timing of everything and still avoid hypos would really be advantageous.

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DeusXM

I was under the impression that Symlin was FOR T1s only.

 

Ah - my mistake and I know exactly why!

 

I had a conversation with my doc about using Byetta and Symlin - Byetta because it's exendin-4, which is proven to regenerate beta cells, and Symlin, because it helps with blood sugar. I got confused - the doc told me Byetta was contra-indicated for T1s and Symlin isn't available on the NHS. But yes, you're right, Symlin is approved for use in all patients on insulin, which primarily is T1s. Sorry for muddling up the discussion!

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Cormac_Doyle

Symlin is not approved in Europe ... whether you are T1 or T2

the European equivalent of the FDA requested addtional test data ... but instead of providing the additional data, the manufacturers decided not to sell it in Europe ...

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GrammaBear

Symlin seems interesting based on a quick google search. Might have to try that.

 

Any other type 1s on that? How much are you taking per day, if I may ask?

This discussion is over 3 years old.  I tried Symlin for over a year and gave up on it because of the ever present nausea that just never went away for me.  I do know other type 1s who have successfully used it however.  It is expensive and some insurance companies put it on Tier 3 or Tier 4 level.  For me it wasn't worth the nausea I had with it.

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