I’m still struggling with dosing and ending up high some of the time at 3-4 hours. I was just looking at the Symlin Support Program which I just joined and the website mentioned needing to increase basals to decrease the highs between meals!
https://www.symlinsupport.com/medicationguide.aspx See the section under Type 1 diabetics, “staying on symlin”. I’m going to call this program on Monday and ask more about this. It seems if the amount of increase were equal to the decrease of the boluses, it would kind of defeat the purpose but I find that a very small amount of basal makes a difference I’ll post what I find out.
Zoe- I do hope you figure this out (I would like to too) but it makes me start to wonder why on a website of so many highly motivated PWD there are not more that use Symilin which has it’s obvious benefits? Could it be that it is simply too unpredictable to dose properly for?
I’ve noticed that as well, Moss Dog, and worried about the same thing. I know in my realtime Type 1 Group many of the women were pretty negative about their experiments with Symlin, but a lot seemed to come down to side effects, so maybe that eliminates many. But I also think there is just so little info out there and none of the Symlin literature discusses insulin dosing other than to say, “reduce by 50% and watch for hypos”. I have noticed that in general people seem to get frustrated with medicines that don’t work or have side effects, and perhaps give up too easily.
Perhaps this Symlin Support Group was created to help with this, because it’s to Symlin’s advantage to assist people in using their drug successfully. I am still trying variables and have increased my basals a bit, and will talk with those people on Monday.
yes, this is very common…timing of your insulin bolus is key. I like to have a bit of insulin onboard before eating. I take my symlin just as I’m about to eat…then set an alarm for 35 minutes…and take another bolus…I watch it closely and take sometimes even a third bolus as it starts to rise (2 hours later)…BUT…you calculate your carbs…if you are eating a 40 carb meal, your TOTAL bolus is only going to be for 20 carbs and you can give several small bolus’ to reach your 20 carb bolus limit…sometimes I find I don’t need the 3rd bolus and end up using even less insulin than intended. you’ll just have to experiment with timing as timing is EVERYTHING when using symlin (at least in my experience). hope this helps!!!
Thanks, Debbie, it helps to hear about everyone’s experience. Did you find that combo boluses didn’t work for you? Have you eliminated highs at 4 or 5 hours?
As I mentioned up in this thread, I am experimenting with increased basals for the times I rise, and am going to speak to the Symlin Support Group people on Monday about this. I’ll let you know my results.
yes, please keep us informed! some people do a bolus 1 hour after eating, but I find If I wait a full hour, my BG levels are already high and rising. everyone is different and I’m still trying to find the perfect combinations of times/bolus’ etc…it’s frustrating but when it works out and everything is ON, the symlin is priceless!!
I agree, Debbie. I’m still not having success as much of the time as I like, but when it works and I have in target blood sugars on 1/2 the insulin dose, and eat significantly less due to fullness, it’s very exciting! That’s what keeps me pushing forward trying to figure out what works for me!
same here, Zoe!! I’ll keep trying and experimenting with times, bolus’s etc and will keep you all informed. with all of us working at this, we are bound to get it right eventually. ha ha. Have a great day!
ok…I’ve had my best couple of days yet with Symlin…experimenting with timing. Here is what has worked FABULOUSLY for me for 2 days.
*take symlin right before meal.
AFTER I’m finished eating, I set my watch timer for 20 minutes and take my first bolus of roughly HALF of what I will give for a dose. (if having a 40 carb meal, my total bolus will be for UP TO 20 grams of carbs). so here, I’ll bolus for 10 grams or slightly less.
*set my timer for 40 more minutes and do a small bolus at this time if it’s not dropping. (perhaps bolus for 3-4 carbs)
watch the levels closely… set timer for 20 more minutes…if going down, no bolus, if rising…I’ll do my final bolus here. (7 carb bolus).
this is what has worked for me for 2 days. you’ll need a watch timer and a CGM to closely monitor. I know some people wait a full hour or more before bolusing but I tried this and my levels were out of control and hard to bring back down by then…so I switched to 35 minutes after meal and that was still too long, levels were climbing fast …so I’ve settled on 20 minutes AFTER i finish eating and this is working very well…so far. As you know …with symlin, this could change depending on the foods I’m eating. But after over 2 months of experimentation, I feel I’ve made some great headway this week!!! I’ll update if I learn more. and all of you, please do the same as well. thanks everyone!!
Congratulations, Debbie! And good for you for hanging in for 2 months!
I was going to wait to post my results, because I’m only on my 3rd good day, but now I can’t resist. On Monday I started my current regimen and EVERY meal since then has been in target! (I didn’t have that good a record before Symlin!)
My method is quite different, showing unfortunately, how individual this all is, but I know I wanted other people’s experience to try so I’m posting mine. I take the Symlin 15 minutes before eating, and have done this for a few weeks. All the literature says to take it right before or after starting to eat, but the reason I do it 15 minutes before is because that gives me a chance to experience the feeling of fullness that makes me eat significantly less. (weight loss/maintenance is my goal). Then I test and take my bolus at the one hour mark. This seems to work perfectly for me. I rarely seem to start rising before that. (The only exception is if I’m already high I take a correction before my meal). I take 50% of my normal bolus rate. Sometimes at dinner for a higher carb/fat meal I’ll do 60%.
But for me the above method was one of many I’ve tried already. I started 5/18. And I wasn’t even getting in target range half the time. The key for me which I read on the Symlin Support website and made sense to me is to raise my basal rates that cover the time periods about 3-5 hours after my three meals which is when I was experiencing highs. (I calculate 2 hours ahead, so if I want it more coverage from 9PM to Midnight I increase rates for 7PM to 10PM) No matter how I timed the bolus I couldn’t prevent this a lot of the time. I’ve raised those basal “time zones” by .050 each (I started at .025 which wasn’t enough). After the second raise of basals, every meal has been in target (and few lows). I no longer measure my blood sugar at the 2 hour mark but at the four hour mark because that is when the highs were hitting. I’m very excited, too Debbie, and just holding my breath that it will continue to work this well!
Hi Debbie. I have a pump and I’m really considering going on Symlin.
How do you manage symlin for example on vacations ,when I presume you stop or significantly reduce workout?
Loved your profile.
Does raising the basal profiles give you any concern about- “What if I don’t eat?”. I find myself skipping meals occasionally and have concerns that I might forget that my basal is set high for the Symilin. My only other concern is if I end up getting busy a half hour or hour after I eat and forget to take the bolus (as you might guess I am a quite forgetful person). Hmmm I am going to have to really consider if this is a good med to try and maybe get a sample. I realize everyone is different but it seems like the most success is coming from giving the bolus AFTER you eat. Thank’s Debbie and Zoe for sharing your experiences.
All valid concerns. For me, this works in part because my life is very predictable and low stress, and I never skip meals. I don’t know that the basal change is significant enough to be dangerous. I do think that new “time habits” can be formed, like testing at 2 hours (or 4) or bolusing one hour after. I thought combo boluses might do the same thing and then I could do that up front, and maybe combined with the basal change it would, but I’m reluctant to change when I’ve found a formula that works. But it is definitely a time consumer. so I’d say someone would have to be motivated to do it.
Yes, it seems that everyone I’ve heard takes some variation on a combo or some timing after eating for the bolus. For me, though the critical factor seemed the basal change to counter those late rises.
It would depend on how large the sample is because you’d have to titrate up to your full dose (a week mas o menos) and then it took me quite awhile of trial and error to find what worked. It also took awhile with my doctor and Medco to get the damn amounts for the prescription figured out.
The basal changes make a lot of sense. Then you can “target” the exact time you will need that little kick of insulin. It would be extremely difficult to figure out how to do that with a combo bolus if indeed it would even be possible. When you make a change it effects the whole bolus and not just one time period. Thanks again.
Ah, thanks for the explanation, MossDog. I’m a little “unclear on the concept” sometimes with combo boluses. That seemed like it should solve the problem, but, at least with my experimentation, it didn’t. That explains why.
You’d think it would be worth it for Symlin to do more educating (of doctors and other professionals and/or of patients through their literature). They could miss a chance for Symlin to be much more widely used if people give up when they can’t figure out concurrent insulin dosing!
hi sugarDoc…I never skip workouts, when we vacation, we workout daily…I’m a bit OCD and skipping workouts is just not an option for me. I really have stuck with the symlin through a lot of bad occurrences because I can see that with proper timing, it can really be an effective tool in my type 1 management. In other words, when everything comes together, this stuff is amazing…post meal highs don’t go past 126!! my goal, and I know its a stretch…but like I said, I set high demands for myself and am a bit OCD about them…my goal is to never go above 140 after a meal…like a normal person. so with symlin, I can achieve that goal much of the time. Now before you all jump down my throat, I know that isn’t a very realistic goal for type 1’s, but like I said, I will work very hard to achieve as close to it as I can get. I will , however , forewarn you about symlin cost. it is DAMN expensive. 3 pens (a 1 month supply) is well over $400…just wanted you to know this as I was downright SHOCKED at this price!!!
Cheri,
Thanks for sharing your experiences with symlin. You use your inner thigh for injections, right? I just started injecting there and it seems to be working well! I’m also going to try waiting to take my insulin as I’m usually LOW for about an hour after eating. This all gets so frustrating it’s nice to be able to relate.
So Zoe - what did you find out about raising basals? I did that - just a bit - and am having some success. Problem is…I don’t understand why. Why should reducing my bolusing with Symlin, over the long haul, necessitate a raise in basal? It’s not a big raise, so I’m ok with it, but I just want to understand it.
