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Cyborg

Symlin

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Cyborg

Thought I'd start a proper Symlin thread in the right place so us Symlin users can start exchanging war stories and questions, etc.

 

I've got a couple to start:

 

I know we are supposed to ideally take our Symlin about 15 minutes prior to eating. Are we supposed to bolus (type 1's) at the same time as when we take the Symlin or when we start to eat? Or does the insulin timing depend upon our bg values?

 

Here's another... We are supposed take approximately 50% of our insulin dosage (as a starting %) while taking Symlin. Does this mean 50% of the insulin required to cover the carbs when we dose at meal time? Or does it mean 50% of the total meal time bolus (carb + correction)?

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Harold
Thought I'd start a proper Symlin thread in the right place so us Symlin users can start exchanging war stories and questions, etc.

:topic:

Other Medications or Ask about others experience with meds taken for related problems with diabetes. Back when I requested this forum be included the idea was for the meds given like statins, ace inhibitors, and other meds for other complications. Some may have noticed that meds posted here like insulins and oral meds for type 2 have been moved to the respective forums. To avoid confusion I am leaving this one here for two reasons. 1 because it should have the same affect on the weight gain that insulin causes for many, as Byetta does for oral meds. 2 For some time, have been considering to ask Tony to drop the Other to avoid confusion and to centralize all of the meds. Please no responses to changing this forum in this thread. Start another thread with a poll or something if you want. However noted weight loss would be interesting. :flybye:

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Cyborg

Do I do bad? Or is was it ok to post a Symlin thread here? I'm not quite clear. After re-reading your post Harold, looks like I'm ok...

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Cyborg
Haven't posted here in a while. I'm finishing week 4 on Symlin.

 

Looks like the Symlin conversations are occuring in other threads. I was hoping we could get most of them directed here so it would be a good reference location for current and new Symlin users.

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koblenz

In an effort to help Cyborg resurrect the Symlin thread….

 

So I had my scheduled checkup with the Endo today, and I asked a few Symlin questions. Here they are and the answers; at least the best that I can remember and translate.

 

Question: If I were to take a shot of Symlin and not eat, would I go low?

Response: Most likely yes. Symlin works to slow digestion (that part I understood), and to help the body “regulate” the release of post-meal glucagon. Glucagon raises BS by causing the liver to release glucose. (OK, that part I get)

 

Symlin doesn’t completely suppress the release of glucagon, but aids the body in the proper regulation of it in relation to the amount food and insulin in the body. (he then began giving me a bio-chem lesson on how Symlin and Insulin binds to the blah blah blah receptors, causing the blah blah blah… at that point it went over my head). But then he summed up by saying that if I did take JUST Symliin, and not eat, and I did go low, the body’s natural counter-reaction to a low would kick in and that Symlin doesn’t affect that response. Sure you would be low, but the body still can react and dump glucose in response.

 

He then began to explain how the effect of Symlin was directly proportional to the amount of insulin active in the system at the time. So if you have only a little insulin, it has a lesser effect. If you have more insulin, more pronounced effect. Thus, you are supposed to take less insulin when you take Symlin. (that part I understood). So if you took it and had ANY insulin in your system, like your basal dose, it would lower BS.

Question: If I find that I am starting to see a BS rise about 2 hours after eating and taking Symlin, is this “normal” and in your opinion? What would be the best strategy to adjust?

Response: In my experience, that is pretty common in patients taking Symlin, not all, but most. (I have been seeing this in the last three weeks, didn’t happen for first 2 or so months using). He then explained that if you look at the action of Symlin over time, it VERY closely matches the action of “R”, or regular insulin. He then said that for some of his patients on Symlin and NOT on the pump, he has prescribed “R” when using Symlin and it seems to work better for them. (for me he just recommended playing with the extended bolus ratios a little more until I find the “sweet spot”).

 

So, I now have a little better understanding of it's "action" and will make some adjustments accordingly. Hope this helps. Sorry it is so disjointed, but that is all I can remember.

 

Standard Disclaimer: So take that for what it is worth. That is the best of my recollection and understanding. I AM NOT A DOCTOR and you shouldn’t make any treatment decisions based on my ramblings on!

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Cyborg

Very helpful. And thanks for trying to resurrect the Symlin thread. If we can continue to build questions here, more of us can find a common question list from which to hit up the endo's or the support line for more clarification.

 

You da man, Captain Chaos! :top:

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bigsapper

koblenz,

 

Thanks for the very informative thread. The idea of playing with the extended bolus of my pump sounds logical.

 

I'll post a detailed message of my experience with Symlin soon. Probably Sunday as I'm playing in a golf tourney on Saturday.

 

P.S. WOW! Cyborg, you have a huge post count for being such a recent member. I don't remember this board being so active. I'll have to research all your posts. ;)

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Cyborg
P.S. WOW! Cyborg, you have a huge post count for being such a recent member. I don't remember this board being so active. I'll have to research all your posts. ;)

 

I had lots of questions... ;)

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Jorj Gaidin

I have a simple question... should I start Symlin

 

but a complicated situation... my bg levels are not the same as they have been the last few weeks. It's almost like asking the repair man to come over and take a look at the fridge and he can't find anything wrong. I was having post meal bg values regularly above 180 (although my bolus was correct and I evenutally came down). However, Thursday and Friday, I was in the 300's all day with no apparent explanation (I changed my pump out twice). Then yesterday I got on the bike for the first time this summer and went low 6 times even though I essentially turned my pump off.

 

So... should I wait for my bg levels to stabalize before starting symlin or do you think that the symlin with help smooth out my swings?

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Cyborg
So... should I wait for my bg levels to stabalize before starting symlin or do you think that the symlin with help smooth out my swings?

 

I don't think the Symlin will help with the hypos and it probably would make things worse if you took it while near hypo. The Symlin seems to only have an effect for about 2-3 hours so you would take it when eating and it helps with the spikes in your post meal bg. Your normal spikes to 180 would come down, maybe to 120-130, and they wouldn't stay there long before coming back down to target. I have not gone low on Symlin once, but I've been very careful and conservative. I am up to the full dose, but I only find myself eating the required 30g carbs probably 1 time/day. I'm trying to reintroduce carbs into my diet, but old habits are hard to break...

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Jorj Gaidin

One of the biggest questions I have about going on it is whether it will be safe and overall beneficial in the long run. What is your general feeling about the safefty given that it has only been on the market for a short time?

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Cyborg
One of the biggest questions I have about going on it is whether it will be safe and overall beneficial in the long run. What is your general feeling about the safefty given that it has only been on the market for a short time?

 

It's been around for awhile, but available to the public for a little over a year when it received FDA approval. It essentially is the synthetic form of a hormone called Amylin that is naturally created by the pancreas along with insulin. When the beta cells on the pancreas are destroyed, the pancreas fails to create insulin and amylin, which naturally work together to control bg. I personally, think that it is a major breakthrough in diabetes control because it mimics how the pancreas normally controls one's blood sugar. If I were a betting man, I'd bet that some day pumps will contain 2 reservoirs, 1 for insulin and 1 for Symlin.

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Jorj Gaidin

one more question... or at least for now. I'm sure I'll have many more posts on this in the future.

 

Is symlin typically covered by insurance?

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lelggren
one more question... or at least for now. I'm sure I'll have many more posts on this in the future.

 

Is symlin typically covered by insurance?

Right now, with many insurance companies, symlin is considered a "tier 3" drug, and so the insurance coverage is very minimal. But, I expect that to change someday soon. It seems to be becoming more common, and people are seeing significantly better results in their bg's. So, I think we are headed somewhere good as far as the coverage is concerned :)

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JediSkipdogg
Right now, with many insurance companies, symlin is considered a "tier 3" drug, and so the insurance coverage is very minimal. But, I expect that to change someday soon. It seems to be becoming more common, and people are seeing significantly better results in their bg's. So, I think we are headed somewhere good as far as the coverage is concerned :)

 

Now if it could just be pre-mixed with insulin somehow, I'd be all for it.

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lelggren
Now if it could just be pre-mixed with insulin somehow, I'd be all for it.

I liked the post I saw about maybe having a pump someday that has one reservoir for symlin, and one for insulin. I think that is a pretty nice idea :)

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JediSkipdogg
I liked the post I saw about maybe having a pump someday that has one reservoir for symlin, and one for insulin. I think that is a pretty nice idea :)

 

I'd like one with 4 resevoirs. One for insulin, one for symlin, one for pure glucose, and one with rum. OK, we can forget the rum one, just wanted an easy pick-me-up, lol. Personally, in the overall idea of a closed loop system it would need to include the above (minus the rum.) The reason being it needs insulin to bring a BG down, glucose to take a BG up, and then symlin to help keep the peak of the BG at a low, which will greatly help the system predict future levels since they won't peak as fast.

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lelggren
I'd like one with 4 resevoirs. One for insulin, one for symlin, one for pure glucose, and one with rum. OK, we can forget the rum one, just wanted an easy pick-me-up, lol. Personally, in the overall idea of a closed loop system it would need to include the above (minus the rum.) The reason being it needs insulin to bring a BG down, glucose to take a BG up, and then symlin to help keep the peak of the BG at a low, which will greatly help the system predict future levels since they won't peak as fast.

I think that we are on to something ;) Also, you don't necessarily need the rum part. Just bolus some happy glucose into you, and you could be in happy land in no time.....lol :) JK

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lelggren
With minimal insurance coverage, how much are you paying for your symlin?

Well, I am using the dr's samples right now because they are working on my pre-auth for it. But, my insurance coverage would be that I have to pay 50% of it. And, insulin runs about $80/bottle, and so for symlin, I'm expecting $95 or so. Someone told me once that it is around there. So, I'm planning for $50/bottle after insurance.

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JediSkipdogg

Humana has it quoted at about $90 a bottle retail price. And I believe every insurance has it as their highest priced prescription. For me that would level 3 and that would cost me $30 a month.

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bigsapper

Before starting Symlin, My carb-insulin bolus ration was 5:1. I'm on an insulin pump (Minimed 515).

Started on the Symlin April 1.

Week 1: 2.5u Symlin - 5:1 bolus.

Week 2: 5.0u Symlin - 7.5 bolus.

Week 3: 7.5u Symlin - 9:1 bolus.

Week 4: 10u Symlin - 10:1 bolus.

 

I've consistently felt ill/bloated after taking the Symlin. However, I've reached a point where it's tolerable. BTW, neither Pepto-Bismol nor Gas-X provided any relief. My BGs have improved but not dramatically so. By Week 4, the best improvement was in morning BGs being consistently lower (~100). My afternoon after-meal BGs are still high. I think due mostly to not enough bolus. My weight is down 8 lbs. for the month.

 

My overall impression is mixed right now. My weight loss combined with using less insulin I appreciate. No longer being able to enjoy meals sucks.

 

:dontknow:

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