It sounds like you are on MDI Teressa, and not using a fast-acting insulin analog for meals. It is going to be a bit more challenging to get the timing right in your situation, but at first glance I would suggest you wait 30 minutes after your meal to take your insulin and then monitor closely, testing say every 20-30 minutes, to see how your blood glucose moves for a few hours afterward. You can make further adjustments to timing and dosage until your numbers stay in your desired range 3-4 hours post-meal.
Is there any chance you could move from Humulin R up to something like Humalog or Apidra? It could certainly make your life a lot easier.
If āMDIā means āmultiple daily injectionsā, then yes, Iām on MDIā¦Iām not on the pump. I take two Lantus injections (one at breakfast, one before bed). I had been taking Humalog with mealsā¦just a couple of days ago I switched from the Humalog to Humulin R with meals, thinking that would be better to counter-balance the rising sugars post-meal with Symlin. I thought taking the Humalog wouldnāt cover as long a period post-meal as Humulin R. But, I can certainly go back to Humalog and do what you suggestedā¦30 minutes post-meal injections. I have been testing every hour post-meal, but I can certainly start every 30 minute testing until I get this figured out. Again, thanks SO MUCH for the advice.
Have you all had any trouble with overnight sugars after starting the Symlin?
Symlin has not contributed to any overnight blood glucose issues for me.
You may even want to wait an hour after you eat with Humalog, but start at 30 minutes and see how it goes. Be careful of hypoglycemia! Humalog should stick around for 3-4 hours, which covers most meals with Symlin, except for maybe pizza. Pizza still screws me even with Symlin, most of the time. About 1 out of 5 times I get it right and maintain normal levels after eating it but most of the time it just seems uncontrollable.
Jasonā¦ I truely commend you, on the behalf of all T1ās, for putting yourself out here & writing this! I am to start on Symlin sometime this week and have been researching for hours about whether or not I should even decide to truly do this regiment. I could not find many, if any, people with Symlin experiences. After the information was released about the effects of the nasal insulin I have become extrememly cautious (as we all should) with what I decide to subject myself to. Please know that it has helped me tremedously to read your blogs and to now feel like Iām not alone. Iāll keep you all updated on my progress and let you know if Iāve lost any of this weight that has plagued me since starting on insulin 6 yrs ago. God Bless you Jasonā¦ Keep it up!
Iām glad you found the blog posts and related discussions helpful. The others who have posted here and are using Symlin are excellent resources as well and always willing to help by sharing their experiences. Look for Part 3 soon.
I canāt imagine you not losing weight if you get on Symlin and stay on. Youāll know what I mean the very first day you begin using the drug! Good luck and feel free to get in touch with me if you have any questions.
I am considering Symlin because of really large spiles after meals. I am on a pump and have not been able to figure out whether to take more insulin up front or if I have delayed digestion and my dual wave settings arenāt correct. I have questions about symlin though. Firstly, when you state 50% of usual dose of insulin, is that of the bolus dose only or one half of the bolus plus basal dose? Secondly, I do not take a large total daily dose of insulin, usually between 20-25 units of humalog, and of that 12 units is basal. Thirdly, does symlin reduce the am spike for dawn phenominon? Thanks for the insight on these questions.
Laura, the post-prandial spike is one problem Symlin addresses well. Symlin does not typically reduce your basal insulin at all, although if you lose weight you may become more insulin sensitive and might need to reduce your basal rate for that reason. So the reduction is purely at the meal bolus level when you begin.
Symlin can stop the dawn phenomenon. However in my experience I need to take an injection of 60mcg between 3 and 4 AM to do that. If my blood glucose levels are already spiking due to the DP it can assist a correction bolus in bringing it down, but I donāt like to advise people to take Symlin and then go back to sleep so only attempt that maneuver if you are already up for the day. I have a CGMS that will alarm if I get too high or low, so I admit I will sometimes take the Symlin and go back to sleep, relying on the alarm to wake me if there is a hypoglycemic episode.
Many Type 1s, myself included, have a much higher insulin-to-carbohydrate ratio in the morning compared to other times of the day. Symlin does alleviate that problem for me to a great extent, sometimes completely.
What a great series of articles! It really explains a lot of what I have been experiencing. I started at 120. I have only been on it for about four months and have lost about 17 pounds. Kind of makes the nausea worth while. Thanks for the education.
Since most people recommend waiting about an hour to bolus - do you also test right before bolusing, or just bolus for carbs only? I am so used to bolusing for carbs and bg adjustment right after eating. Iām nervous about going too low, so now I think Iām over-compensating becuase Iāve been running high. I just started Symlin three days ago. I just went up from 15 to 30 on the pen. Any advice you could give me would really be appreciated. Thanks!
i am a new symlin user (on a pump - have had diabetes for 52 years). i have had none of the ābadā symlin experiences and am now taking 60 units whenever i eat 25 grams of carbs. i have several questions. i am a grazer and donāt frequently eat 25 gr in one sitting. also, my doctor says that 60 units of symlin is the most any type 1 should take. (that a 120 unit regimen is only for type 2ās). any suggestions? should i go ahead and take 60 units when i eat 15 gr carbs? i havenāt lost any weight (after 1 1/2 months) and that is why my dr. prescribed it for me. also - what about the 120 unit/60 unit - type 1 limit? many thanks!! and thanks for the fab article!!
Thank you for posting your experience with Symlin!!! I was diagnosed with LADA 2 years ago and I have been experiementing with my Lantus and Apidra for some time. My Endo just added Symlin to the mix and Iām finding that my post meal spike are not as high and Iām not bottoming out as much. It seems the Symlin is keeping my BG levels in the 100ās which is a nice change from the highās and lows I was consistently getting during the day.
Jason, Iām new to both TuDiabetes and just took my first 15 units of symlin. After the meal of chicken a little breadālike two bites and a spoonful of pasta, I felt great. It was as if the insulin only regime had been missing that other needed amylin. Reading your first two posts on symlin made me feel much better about it, you are such a help! I then took 1/2 my usual insulin AFTER eating about 20 minutes later, and now I am about to test. I was 118 before I took the symlin. I am totally eager to read your post number 3. I was duly scared about lows so that even on my first 15 units I only took 5 units of humolog whereas usually I need ten. Not a pumper here. THANK YOU. Iām hopeful without being dangeously optimisitc. I know pumpers have an easier time all around, but I am too idiotic re: math to learn the pump just yet. Iām 68 and developed type 1.5 at 61 years old; turned to type 1 a year later. Any more advice most welcome but not to be greedy, your time and effort lead to a lot of education in a short time. Wendy O
Thanks Wendy. Feel free to message me privately with any questions you might have. I donāt know everything, but I will do my best to help you and I will let you know if I think I am clueless about your particular problem.
Thanks for the info! I just started on a pump a few weeks ago and I'm having a tough time figuring out the timing with symlin. If I take symlin and start my square wave or dual wave bolus before eating, I will drop steadily and then an hour later I will spike very very high. I usually end up going low after a meal if I'm between 80-140. What do you suggest I do? Take symlin, eat and then square wave or dual? I just hate those annoying highs later on. I usually end up over correcting for the highs and then drop low again before my next meal. I hate this cycle. Any advice?
David14 - you are correct. With a Symlin 1/2 life of 48 minutes - 75% will be in and out in 2 hrs but, there is still 12.5% active at 2.4 hrs, 6.25% at 3.2 hrs, and event 3.13% at 4 hrs after injection. Most of us eat about 4-5 hrs after breakfast, etc. And this assumes we are all the same They advise injecting into the abdomen or thigh only - for most predictable absorption. Keep it away from insulin and CGM sites.
Always check w/ your Dr. but, I think the original post and advice from others like Gary Scheiner of DiaTribe, Integrative Diabetes Management, Think Like a Pancreas:
From the article:
The timing of the dose depends on the blood sugar 1-2 hours after the meal. If the blood sugar drops soon after the meal and then rises over the next couple of hours, the insulin needs to be delayed further or (if using a pump) extended over a longer period of time. If the blood sugar is peaking too high soon after the meal and then dropping before the next meal, the insulin needs to be taken earlier or (if using a pump) the extended delivery duration needs to be shortened; a dual/combination bolus could also be used.
This assumes you are at the adequate dose - feel full, sour stomach about 1/2 hr after injection of Symlin, eat immediately - after taking Symlin, then take insulin after meal.
Read Garyās full article. It was helpful to me - as is this series of posts here on TU. Some of the literature says take them together before the meal but, if you check out the researchā¦ participants went into the meal w/ what I would call a high blood glucose (150-180 mg/dl). I am usually about 70-120 mg/dl so I have no room to drop before the food empties and starts digesting. If I am, I take a correction bolus and follow the normal protocol for the food w/ Symlin. My goal is to get normal BGs and not experience hypoglycemia that is difficult to treat. I have used the under the tongue trick successfully (glucose tablets chewed up and held under the tongue). Agree - get a glucagon script before startingā¦just in case. I was surprised when my Dr. did not offer it. I asked.
Of note, as an update, BioChaperoneĀ® Lispro by Adocia is in stage 3 trials w/ added Symlin ā likely to be used in the more advanced, closed loop pumps due out in 2020-2022. Amylin is an important hormone and should be replaced. It also has a role in bone formation - says the lady who has fallen and broken bones multiple times
Are you still using Symlin?? I donāt see part 3, perhaps because of it needing to be so personalized?? Are those of you who were using it, still using it?? This is very intriguing. I was part of a 3rd level trial for Symlin, but as I best recall it was given only once a day ā¦ this sounds much more promising. Thank you!!
They advise injecting into the abdomen or thigh only - for most predictable absorption. Keep it away from insulin and CGM sites.