I have been taking Symlin - now twice a day - began with one dose affter evening meal - now also taking at lunch time. I have great sucess in the four months I have been taking it. Also have the perk of some great weight loss after being diabetic closing to 28 years. i’ve lost 35-40 pounds.
My problem and the issue my doctor and I are trying to tweak is an upswing in blood sugars - 2 hours after the symlin. We have tried to address this with basal and carb to insulin ratio changes and also square wave bolus but doesn’t seem to be helping.
Anyone else experienced this problem and how did they address it.
Hi - this is very, very common - you should poke around some of the other discussions and you will find all kinds of answers.
For example, I DO NOT take my insulin until 1.5 to 2 hours AFTER eating - when the food starts to hit. If I take it before that, it’s like “wasting insulin,” it doesn’t prevent the high 2 hours later - plus, I don’t need it at the same time as the insulin or for a long time, because the Symlin lowers your BG significantly (especially if you are at normal BG when you take it)
Hi Donna. Yes, that is definitely the challenge with Symlin. I generally find I’m great at two hours but then jump up sometimes at 4. (and sometimes I’m fine!). So I’m experimenting with different dosing. I have tried both what Cheri mentions, dosing the insulin an hour after eating, and combo boluses. For me, I have not found any of the significant early drop from Symlin, so I have started trying out either taking the insulin sooner or doing a combo bolus of either 0/100 or 25/75. So far I seem to succeed some of the time and fail some of the time whichever approach I use. So I’m still working on it. The only thing I’m definite on (for me) is that I take the Symlin 15 minutes before eating not just before like the literature says. I eat fairly quickly and find I need the extra 15 minutes for the Symlin to take effect and provide that feeling of fullness that causes me to eat less food and lose weight, which is my main goal. Speaking of which, congrats on the weight loss! You must have been doing something right with the Symlin for that to happen!
Do post when you find the right dosing method that works for you. There are so few of us successfully using Symlin that we really need to share info! (I will do the same) What reduction of insulin are you using? I’m doing 50% (unless I’m high before my meal) and so when it works I’m delighted to take that much less insulin!
50% less insulin is what the Symilin rep tells me to start at. He said most will end up being 30-40% reduction in meal time dose. Zoe I know from previous posts you have your basal rates tied down pretty good. I was wondering if you had to make any changes there when you added Symilin?
That’s useful info to have, Moss. I may be a bit too attached to the 50% figure (“half” sounds so good!) and need to consider that variable as well for the times my bolus doesn’t “work”.
As for my basals, the jury is still out on that. I’ve had an increase in some of my bedtime and sometimes even my waking blood sugar levels. I’m reasonably sure that it represents late highs from dinner which seems a bit more problematic for me with Symlin. Perhaps I’ll try experimenting with less reduction (as you say 30-40%) for that meal. My dinner I:C ratio is a lot more generous than my breakfast and lunch (1:18 vs 1:6 and 1:7) so perhaps the 50% is just too much reduction. My intuition tells me the basals are fine, it’s just late rise from the slowly digesting food during the time of day I’m the least active.
Your basals were dropped 50%?? When you started Symlin? Were you getting lows in between meals? What about your boluses? How much do you reduce them by?
I would be very surprised to have Symlin reduce basals - there’s no relationship - unless basals were wrong or unless Symlin led to weight loss, which certainly reduces basals.
This is interesting. My rep told me that most people’s basals are decreased (although certainly I do not trust most of what reps tell me). Didn’t make much sense to me which is why I asked Zoe if it had changed it for her.
Wow, that sounds the opposite of what I’m trying! I have been trying 0/100% or 25/100. My thinking is that with Symlin I either go low or don’t move much for the first hour and then spike at about 3 or 4 hours. Does the 20% cover those late spikes for you?
What percent have you reduced your boluses? I’m working on 50% for breakfast and lunch and maybe like 70% for dinner.
See, that absolutely doesn’t work for me - since I rarely go to eat when my BG is not already well in range / controlled - this would send me so low, I would be grabbing the glucogon kit. Then, several hours later, when the food actually hit my system, it would be like I never took any insulin at all - and I would spike.
Ah, thanks, that makes sense. I’m actually starting to rethink even my 0/100 done before eating. I don’t seem to have very many problems with going low before eating, so I was thinking that would be a good way to catch the later highs. But I think you are right that any insulin done too early is just a waste (even if you don’t have the problem of going low) because I’m perfect at 2 hours but often spike at 4 hours even with the 100% being spread out. I think my next experiment is to do the combo at the one hour mark.
Tomorrow is my day to sit down with the records I’ve kept of my 3 weeks of different dosing options and see what my data tells me. I have to remind myself that I wasn’t in range 100% of the time before Symlin either!
Good luck! I just got a CGM - haven’t even unpacked it yet, but I’m goign to use it to try to identify the patterns, but so far, it seems like 2 hours and, unless it’s a high fat meal (unusual for me), I’ve been taking my 50% all at once right at the point of it hitting…although I’m going to have to begin to reduce that 50% at some point.
Good for you, Cheri, sounds like you’re honeing in on your method and the CGM will just help with that. I do like hearing your experience, but unfortunately like much with D it sounds like our needs/approaches with Symlin also vary!
You are so right - we are all different. Which is why it makes me crazy when medical folks lay down the info as if one size fits all.
About your question - the flip answer is - almost always - but that’s because I test 10 to 12 times a day and correct as necessary (not that often anymore). I find that if I dose at the 2 hour mark (using 45 to 60 mcg), I don’t spike at 4 hours.
I keep my carbs confined to fresh fruits and veggies and breads/grains with the highest fiber count - but try to limit breads/grains. And I use the TAG method for any foods that are protein or fat rich. My goal is to be as “flat-line” as possible. My normal range is a narrow window between 85 - 105.
I don’t use Symlin for appetite control at regular meals because I don’t eat that much and I eat healthfully - I use it to (1) reduce the amount of insulin - because “full use” causes me to gain weight for no reason and (2) to suppress the “insulin munchies” between meals - I find insulin creates a false hunger between meals. I’ve lost 12 pounds (only 8 more of insulin pounds to lose).
My A1c hovers between 5.4 to 5.6.
Thanks for the response, Cheri. I was feeling a bit discouraged last night and feel a bit better knowing that you are having regular success. When I say “in target” I do mean without need for correction though you did say “not that often”. I also test that often and correct as necessary but my goal is not to have to correct as that kind of defeats the purpose.
Today is my day to look through my records and modify my approach again. I know I’ve been succeeding more than I’ve been failing, but that’s not good enough. Onward!
So I sat down with my 3 weeks of records today and realized I’m making this way too complicated. My first efforts were the simplest and had the most success! But somehow I got it into my head that perfection was the only measure of success! My blood sugars were never perfect before Symlin, so I’m not sure why I thought they should be perfect after! I’d accepted my previous success rate as good for me (we are all different) but somehow had started seeing Symlin as the answer to all my Diabetic problems! Yikes!
So I’ve been trying all sorts of different options and having way less success and getting really frustrated!
So I’m going back to my simple dosing methods with just a couple variations. Diabetes (and Symlin) are complicated enough without me making it harder looking for some mythical (for me) perfection!
I’ll let you know what I end up selecting as my ongoing dosing method in the next few days! (Thanks Cheri it’s probably going to be a combination of your approach and that of the guy who wrote the blog).
