Going Back to Symlin

Hey all,

I finally joined the group because my nurse educator/practitioner wants me to try Symlin again. I’m more than willing to try anything at this point.

Anybody have any good starter tips for me? I also have a Symlin info pack to read, plus I’ll check out Scott’s other posts here…any suggestions would be really appreciated! Thanks!

You say “again” - were there problems last time? The one thing I found with Symlin and that I keep on hearing from others is that 10 units isn’t necessarily the best dose for everyone (type 1, that is). Makes sense - we all have different insulin doses, so why would we all need the same Symlin dose? I found this page to be helpful:
http://www.diabetesnet.com/diabetes_treatments/symlin.php, or rather, it jives with many of the things that I had already found out myself.

I think my problem last time was that I tried to increase my doses too quickly, or I’d stop for a day or two, then go back to a full dose instead of building back up again. Just some wicked episodes of nausea, which happened while I was at work, so they were even more unpleasant than they should have been.

But I’ve been on the 2.5 unit dose for a few days now, and so far, so good!

From what everyone has told me, the manufacturer’s recommended titration schedule should be disregarded. Instead, I have been told to increase the dosage slightly once the nausea is not as bad, and you may continue that adjustment process over time – don’t let someone rush you into it. Also, I agree with Emily in that several people, including doctors, have said that the full dosage may not be necessary for all people with type 1.

According to Dr. Steven Edelman, assistant professor of medicine at the U.C. San Diego School of Medicine, “I always tell my patients that the ‘perfect’ dose of Symlin is the dose that induces satiety but does not cause nausea.” In his experience, the nausea is not really as big an issue in type 2s - most likely because most type 2s are still producing some amylin and so the “return” of the hormone to their system isn’t so jarring. But in type 1s, the nausea can be acute, and Dr. Edelman may recommend a slightly different titration schedule to reduce it.

My doctor has me take pheneragin an hour before I take the symlin to reduce the chances I get sick after I eat. You might want to talk to them about that.

Wow, I feel so weird after reading everyone’s replies. I’ve only been on Symlin for a little over a month and at first it was just with one meal…now I take it with every meal. I have never felt nauseous from taking it, I take 10u with each meal. I have felt a little queasy but nothing that make me feel like I needed to vomit. I have had two Symlin lows and I’m lucky to have caught them, one was at 26 and one was at 24. I have hypo-unawareness. Good luck going back on it!

I had problems with nausea at first, but worked my way up to 30 units, TID no matter how many carbs I’m eating with the injection. Works like a charm!

My doctor had me up my dosage very slowly. We started at 2.5 units per meal until I was nausea free for 3 days. He had me stay at 7 for a long time, because I lost 8 pounds (I’m lean to begin with). When I went back to my regular weight, he pushed me up to 10, where I’ve been at ever since (about 1 1/2 years now). Also, I couldn’t imagine using symlin and not being on the pump. That would be very challenging to time. I eat a fairly low fat/high carb diet, so my square wave time for breakfast and lunch is one hour, with a 1:20 carb ratio. At dinner, where I eat a bit more fat or meat, I square wave over 2 hours, and my insulin to carb ratio is 1:15.

Don’t give up if you experience side effects. My stomach was generally ok, but I was exhausted for nearly a month.

You might consider going on half doses. I’m on half doses (only 5 u instead of 10) 3x a day. It’s given me much better control.

I was very resistant to Symlin at first, and put it off for 6 months. Now that I’m on it, I’m never getting off of it!

Hi Rachel,
I just went on symlin a week ago. I have had a little nausea…not bad. I am taking 5u now…and I have been exhaused this week also…glad to know that it gets better!

I take 20 units of symlin with each meal that is over 300 grams. My endo told me under no circumstance should I take symlin without a full meal. Started with 10 units and up to 20. I’ve have been on symlin for over a year now with little to no side affects. Since taking symlin I have been able to control my weight gain, I am not as hungry and my HA1c is coming down slowly. I start the pump next month and I am anxious to see if the pump with symlin will help my overall diabetes condition.

Cheryl