Been a type 1 for 26 yrs. My doc wants me to try Symlin. I am very sensitive to insulin and use a 1:45 insulin:carb ratio. I use exercise & diet to control my bs and use a pump. My high’s seem to be related to stress. She wants me to start with 15 mcg, but I am really afraid of lows. I’ve read that many delay their bolus before they eat. I usually dont bolus more than 1 unit at a meal. Also, what is square bolus? I sure could use some tips because now I am feeling unsure. Thanks
Thanks, I agree. My largest meal is lunch 42 carbs. Im glad I started checking into this because I didnt think about having a hard time recovering from a low. I am under a lot of pressure in school right now and this stress is taking a toll on my sugars. I asked about doing a combo of insulin and metformin because it sounds like that would help my problem but she said its too risky so suggested this (sounds risky in other ways now).
Thanks Dave, I’ll check out the book. I definately need to do more checking before I take the Symlin. It amazes me how I could have this disease for so long, yet learn new stuff about it all the time.
I respectfully disagree with most of what you have written about Symlin. It is certainly possible to bring one’s blood glucose back up while using it and I can personally attest to that, having pulled myself out of severe hypoglycemia a few times less than an hour after my Symlin injection. It isn’t always easy, but Symlin does not lower blood glucose on its own. At all. Only insulin does that (and some types of exercise can cause muscles to uptake glucose in the absence of insulin, but that is another discussion), and hypoglycemia while on Symlin can definitely be avoided. It is not difficult to juggle once you have a routine- JUST like starting on insulin when you are diagnosed with Type 1. And the benefits, while not as significant as insulin, are nothing short of remarkable. There is a reason it is only the 2nd drug ever approved to treat Type 1 diabetes.
Symlin, for those that don’t know, is an analog for an endogenous hormone called amylin, produced by the islet cells. I have written a 2-part (soon to be 3) guide to Symlin for Type 1s on my blog here at TuDiabetes. Part 1 can be found here.
It certainly is not for every Type 1- I point that out early in my guide. Anyone who struggles with hypoglycemia is not a good candidate. My point about Symlin not lowering blood glucose was made only to emphasize that while using Symlin, hypoglycemia is managed the same way as it is managed while not using Symlin- by modifying one’s insulin dose to match your insulin-carb ratio and physical activity.
I would say it is an appropriate therapy for most Type 1 diabetics. Yes, it certainly can add a layer of complexity to treatment, as do our insulin pumps, fast-acting insulin analogs, and other modern developments in Type 1 therapy.
We certainly do not need Symlin to survive as Type 1s, and I would go so far as to say that very good control can be had without it, for some people. But then again, we could survive on beef and pork insulin instead of Humalog or Apidra. I don’t think either of us would recommend to any diabetic that they use pork insulin via MDI over say, Apidra in a Paradigm 522/722.
I have to agree with Dave on getting low blood sugars up while on Symlin. I was on it for about a year and I had a lot of problems with keeping my sugar up if I went low after I took it. At that time I was going through 4 glucagon shots a month and since I quit using it I am not using glucagon that often anymore. It makes no sense in putting someone on it that is that sensitive to insulin at all.
Hi Kim,
A 1:45 ratio is incredibly low, esp after 26 years as a Type 1.Wow! Have you had a C-peptide done recently to see how much insulin you are producing on your own?
Can’t weigh in on your Symlin questions because I’ve never used it. Wish I could, but with gastroparesis I can’t.
Timing insulin to meals is important, of course. When do you take your bolus now? For rapid acting insulin, most people bolus about 15 minutes before meals. But this can vary.
I am insulin sensitive–not that snesitive–and am subject ot lows. That being said–I an very brittle/labile/reactive —everyone seems to have a different word for it. My bg swings widely and wildly–especially after a meal. No amount of tinkering with timing or dual wave, square wave etc has been able to match it. I have been on symlin less than 2 weeks and already see improvement in my daily rollercoaster ride. and have halved my bolus insulin use–it may need to go down more–my life has been a little hectice these past two weeks and especially these last 3 days (wonderful birth of grandaughter)
No nasea so far (only one dose at 45 so far), but I will take the flatter bg line—of course we’d have never known about my roller coastering without the wonderful CGMS due to the timing of them around conventional finger sticks…so the advice may not be all bad, but might just need some clarification from the dr who looks to need some better communication skills.
I appreciate everyones response. My bg also are very up and down. Before dinner last night bg was 309, no bolus, ate dinner 20 carbs, walked brisk for about 30 min, bg 66. The only time I can see me benefiting is at lunch, when I eat about 42 carbs. Thanks again
Symlin has really been good for me and frankly I am afraid I might be taken off. My lows are more more severe with symlin. But my appetite without it is unquenchable. It has been a good product for me.
Rick
How difficult is it and how do you best correct lows? If you correct it with say juice, are the effects delayed? I read many use glucagon.
I have found coke the best for me, but doc said any liquid digest quickly-I don’t like OJ because it hurts more the throw up than coke (sometimes going low really upsets my stomach) The coke seems to help the tummy upset as well as the low.
The difficulty depends on how soon after the Symlin injection you go into hypoglycemia. It has a short half-life- about 45 minutes, so it doesn’t stay in your system nearly as long as insulin. I have never needed my glucagon kit since starting Symlin last summer. One trick that works well is keeping glucose such as honey or glucose tablets in your mouth for as long as possible. The glucose will be absorbed through the blood vessels in your mouth and will act quicker than if you simply consume it.
It sounds like you have some endogenous insulin production still. There is no way a Type 1 can go from 309 to 66 after eating 20 carbs and taking no insulin. A 30-minute brisk walk certainly is not going to be enough to normalize the 309 in an hour, much less allow 20 grams of carbohydrate without insulin. As far as I know, Symlin is only approved for Type 1 and Type 2 diabetics and has not been tested for LADA, and you seem to be a member of that club.
Ive been a type 1 for 26 years. I was tested many years ago and I do not produce any insulin. Exercise and eating healthy, low glycemic, unprocessed foods had been the trick, I think. Thanks for the tips on treating the lows!
Hi Kim,
The trick to correcting lows is knowing how much to take to get to your target BG without over correcting. Everyone’s different, but for me 1 gram sugar raises my BG 10 pts. You can test to see what your ratio is. Since a little bit sends me up predictably, I use dextro tabs (mine are 1 gram each), jelly beans (1 gram each) because it makes it easy for me to count when I’m foggy low & they’re also easy to carry around. I’ve got baggies of jelly beans stashed everywhere. In my desk, car, nightstand, After taking correction sugar, test every 15 minutes. I’ve read that it takes about 1 hour to see the full effect of a rise. Of course, you want to stay away from anything with fat because that slows it done.
How do you correct lows?
Glucagon, an important thing to keep around, is for treating very serious lows.
I can’t believe your BG went from 309 to 66 after eating with no insulin. Is this common for you? I would have corrected that high immediately, but that would have sent you dangerously low. I’ve got gastroparesis. Makes control hard because impossible to know when a meal will hit my bloodstream. I have to take insulin after eating. I was low or normal two hours after eating & spiking high 4-5 hours later when the insulin was gone.
One good way to avoid hypoglycemia while using Symlin is not to bolus until you are done eating, or even 30-60 minutes after you finish the meal.
I think you should have another test done to see if you might be making insulin. I am not a doctor, but what you describe does not sound like a purely Type 1 phenomenon. Many of us exercise and eat healthy, low-carb foods (myself included) and you are the first I have encountered in the 14+ years I have been diabetic that can eat 20g of carbs while at 309, take no insulin, and then drop to 66 in a short amount of time with no insulin injection.
I’m not a doctor either (nor have I stayed at a Holiday Inn Express lately), but I agree with oneless on this one. Something just isn’t adding up. I would get re-evaluated to make sure you got a correct diagnosis 26 years ago.
Want to third the suggestion to have another C-peptide. Misdiagnosis is common more is known now than 26 years ago. Without insulin, how could you drop this much after eating? Even taking huge doses of basal insulin wouldn’t cause a decrease like that.
When you have lows after eating, do you keep testing to see if there’s an increase several hours later?
Dave,
Here’s what Kim said Before dinner last night bg was 309, no bolus, ate dinner 20 carbs, walked brisk for about 30 min, bg 66.
There was no bolus involved, hence the reference to a high basal rate I believe
My basal rate from 12am - 9pm is .625. I definately dont think I produce any insulin. A couple years ago, I had a problem with my pump not working (middle of night of course) and I didnt have any syringes. Anyway, within a few hours, my bg was up in the 500’s. I dont know why but I’ve always been this way. The reason I had the 309 before dinner was because after lunch I walked and turned off basal for an hour a few hrs later I ate a snack, which normally dont bolus for, forgetting the pump was off earlier.