Help with symlin not working to lower BS

Just started symlin 4 days ago… started with 15 mcg for 3 days and today started 30 mcg’s… I get better control with insulin alone… less spikes.

Symlin feels great to take and the fullness is wonderful but no matter what so far… there is a rise in BS about 80 points… if starting BS is 83… 1/2 hr later the BS is111 and another half hour the BS is132 then up to 164 even with insulin taken in increments before the meal… 1/2 hr after the meal and one hour after the meal. MORE insulin is needed than without symlin and the insulin doesn’t even seem to work until 3-4 hours to come down!! HELP!!! Today only ate 20 carbs and gave 0.6 units before ate, and 0.5 units one hour after eating.

ANY suggestions greatly appreciated.


A couple things Bella. First of all you need to build to your full dose (60 mcg if you are type 1) before you get the full results. Second of all you need to spend significant time figuring out what dosing of the insulin is right for you. I take it an hour after my meal (unless I’m high) but it seems very variable for people and once you get to your full dose you need to play with it. Finally, one thing I found was that I needed to raise my basals a bit for the time 3-5 hours after each meal in order to reduce the late spikes.I also take the Symlin 15 minutes before meals. I now am taking 50% of my former insulin for breakfast and lunch and about 60% for dinner and am in target at the four hour mark more often than not (I didn’t have perfect numbers before Symlin and I don’t expect perfect numbers with it). So I feel pretty good about Symlin. The only thing bothering me is despite dramatic reduction of insulin and significant reduction of how much I eat, I haven’t yet lost any weight…Yikes!

Any way hang in there, get to your full dose, then try different dosing regimens (some people use combos, that didn’t work for me), and keep track of your experiments until you find one that works.

ZOE, Thank you so much for your comment. how long have you been on Symlin?? I am hoping to lose a little weight and yes Type 1. DId you find the same in the beginning that you needed at much insulin?? Sorry for all of the questions… I guess I thought the insulin reduction was instantanous.

I’m glad to answer, Bella, even though I’m frustrated that I haven’t lost weight and have only been on Symlin for a little over a month, so I’m no expert. But I found that there is so little information out there about it!

Well, I didn’t go about it the same way, it sounds like. Because that is what I had read to do (and worried, unnecessarily about lows), I just automatically lowered my insulin by about 50%. Then I just kept track of the results. I test at four hours now due to the slower spikes. For the first few weeks I wasn’t in target range for even 1/2 the time, so I guess that is the same as your needing more (or the same) insulin. But I just kept doing it that way despite the highs so I could experiment with different dosing regimens.

Thanks Zoe… today out of impatience I bolused 1.0 unit with the symlin and then another 1.0 unit after eating… the result was a level 65 BS for the first 3 hours but I felt fine… of coarse 2 lollipops were needed to keep above the lows… but no scarry low… and no spike at 4 hours!!! Plus only ate 20 carbs… so no spike but the same insulin I would have needed anyway… ok… maybe less. But still better than sitting at 170 for 3 hours.

I am just curious how other people say they go low 1 hr after symlin and if they experienced that at the start or when they got to higher doses of symlin… I don’t want to have a scary low but don’t want to run high either

Sounds like you’re getting there!

There are warnings about lows in all the Symlin literature (but we all know the medical profession is paranoid about lows) and I have read people on here saying this happened to them, I don’t recall at what Symlin doses. Perhaps others will respond. I had very little experience of lows from it. When I get down around 20 carbs at dinner I am often at risk of lows even with my usual I:C.

Great post Zoe. You seem a suceesfull case of Symlin user. I believe in KIS. “Keep IT SImple” Combos are too complicated . I’ve just started and I’m now using 45 mcg.Next saturday I’ll be in full dose (60mcg). I’m using square bolus of 50% insulin dose after Symlin when I’m eating and no hypos. Actually I tend to be high ( 180). I have a question for you: Before SYmlin I used to compensate a post prandial high with 2 or 3 Units of insulin. How do you do it? DO you also have to give sometime a compensation bolus because you are high after eating? Do you also use a 50% reduction rule? I have already lost 1 kilogram in one week, but that comes easier with males. You´ll loose weight also! You are eating less and using less insulin! But women are slower in that particular matter. REgards

Thanks for the words of encouragement, SugarDoc, and good for you that you are already losing weight! I’m hopeful that the higher dose I’m on now (120mcg) will help my stubborn body lose too!

“Combos” are actually the name that the Ping gives to what you call Square Bolus and Dual Bolus. We just determine whether some is given right away and the rest later or all of it spread out by how we set the numbers.

I definitely still correct highs which still happen to me sometimes after eating, though I find if I go high with Symlin the spike is more like 4 hours than 2. No, I don’t reduce my correction bolus due to Symlin. I use the same ISF I used before Symlin (mine is 1 unit lowers me 45 points)