for those of you using symilin successfuly, how long before your meal do you take your Symilin dose?
Hi Colorado -
That depends on my BG at the time If it is 85 or more, I take it literally just before eating.
If I am low, I wait until after I have consumed some carbs, maybe 15 minutes.
I also DO NOT take my insulin (at 50% reduction) until 1 hour past the symlin / meal. I then use a combo bolus of usually 2 hours duration, with 25% upfront and 75% over time - most of the time this works, some times I have to adjust based on what I eat & the composition of carbs, protein, and fat. (I use TAG - http://www.tudiabetes.org/group/tagers?xg_source=activity) I know the directions say to take your insulin right after eating, but that is just crazy and will frustrate the stuffings outta ya.
Hope this helps.
Hi Cheri,
If you are below 85, do you bolus 15 minutes after eating for the full total of carbs you ate for your meal, or do you factor in your 15 or so carbs to bring you up and then bolus for anything above the 15 (or treatment) carbs? I am having a hard time figuring out the timing for my bolusing. I currently take 30 mcg. just prior to each meal, eat, and then bolus an hour later, square waving that bolus for an hour. Today at lunch I square waved my bolus for an hour and a half and actually so far so good. For the past few days anytime I bolused for an hour, I ended up dropping soon after eating (even if I wait an hour to bolus). I might try the dual wave bolus as you described above and see if that works for me!
Hi there great teacher!
This is so hard because there are no hard and fast “rules” - I have found it depends on so many factors - how much I use, how many carbs, what kind of carbs, what my BG is in the beginning, and, of all things - where I “shoot up.”
I have found, now that I have increased to 75 mcg, that my wait time is now 1 to 1-1/2 hours before I bolus - and then I found a 75 / 25 is working. If I bolus too soon, I go way low, yet I may still go high 3 or 3-1/2 hours after eating.
Think of it this way - Symlin is a drug-induced form of gastroparesis.
It requires a lot of attention and a lot of testing - I’m seriously considering asking for a CCGM so I can find some consistent patterns. This much I know, however - amount of insulin is reduced by half and as a result, I’ve taken off 12 pounds
thanks so much for the input. I just got up to the 60 mcg dose. like anything else with diabetes, it is all very individual and takes time to figure it out. Congrats on the weight loss, hoping for some myself.
Hi Cheri
I’m just getting ready to start on Symlin so I’m reading through these posts as it’s something brand new to me and I don’t know much about it but think it might be a good idea for me.
Re your not taking your insulin until an hour past the meal: Is this something you did before, or something you do because of the Symlin? Is that what most people do? If so it will be a radical change for me as I have always gotten best results taking my insulin about 20 minutes before eating (unless I’m low). Any clarification appreciated!
My doctor told me to take the insulin after I eat, that way I know for sure how much I have eaten. With the Symlin, you will find you don’t finish your meals
Ah, I see. I can see that the whole process of adjusting to Symlin is going to be complicated! Not just titrating the dose but also figuring out how much to reduce your insulin due to the Symlin and then reevaluating what a good portion is due to decreased appetite. I think once I get used to it, I will want to keep taking my insulin ahead of time because I think I would spike too much otherwise!
one thing that I do, is if I test my BS before I eat and it is high, I take a corrective Bolus. I am on a pump so it is easy. If you take shots, that would be a hassle. It will get better. Like everything else with diabetes everyone is different and it is a lot of trial and error. My good news Friday was that I lost 5 pounds in the last 6 weeks!!! Made me feel a lot better about the cost and hassle of the Symilin
The LAST thing I would do is take my insulin right after I eat - for me, what happens is that, first, I will go way low and second, in 2 hours (or so), I will spike really high and it is as if I never took any insulin at all. Then I wind up bolusing again - not good, not reducing the insulin that way. For me, it is reducing the insulin that allows me to lose weight.
It takes attention - and some type of alarm (I use my iPhone). I highly recommend reading this series of 3 posts, beginning with this one - http://www.tudiabetes.org/profiles/blogs/a-practical-symlin-guide-for
Hi Cheri
I’ve been on Symlin for a few days and quickly building up to my maintenance dose as I’ve had no side effects, but I’m having varying success with adjusting insulin: sometimes perfect, sometimes still going high later (no lows). I’m accepting what everyone is saying that a combo dose is needed. I re-read this thread and looked at your post as you seem to have good experience and results and I wanted to see your method. But I’m confused because you said 25/75 above and then just below said 75/25! I usually use 40/60 for combo boluses but realize this is different.
So could you clairify: You take only 50% of your normal insulin dose for the meal and you do it as a combo bolus one hour after eating/Symlin. You do it as a 25/75 combo bolus for 2 hour duration?
Also, I’m finding my highs don’t hit until 4 or 5 hours out. Would you suggest I do a longer duration? (I have been doing 4.5 hours for meals I used combo for before I started Symlin)
Thanks!
Zoe
Hi Zoe
Actually, adjusting and learning as I go - I no longer use a combo bolus…most of the time, that is (I’ll explain in a minute). I have found another technique that works better.
First, I adjust my dose - between 30 to 60 mcg. depending on the carb content - 30 for lower end, 60 for higher end. Then, I wait…how long? Well, that actually depends on which dose I took. For 30 mcg, the food can start to hit in 1.5 hours, for 60 mcg, it can be 3 to 4 hours later. I pay attention, check my BG a few times after the first 1.5 hours and when it starts rising, I take the whole (50%) bolus all at once.
Combo bolus - If I’ve eaten a large amount (in grams) of concentrated protein (like a protein drink) or a large amount of fat grams (ribs), I will use the TAG method to cover that food (http://www.tudiabetes.org/group/tagers?commentId=583967%3AComment%3A1882511&xg_source=msg_com_group) - with a 0%/100% combo over 1 or 1.5 hour to cover fats/protein.
I know, it sounds complicated, but it’s not really. You just need to learn the rhythms of your body. Feel free to contact me if you have any other questions.
Thanks so much, Cheri, for posting this update. It does seem like we are all pioneers with Symlin and there isn’t a lot of expertise out there yet!
I’m tickled that you’ve changed your technique in this direction. My gut was telling me to “keep it simple” and just look for the right time to bolus (all at once) and the right percentage of my old amount to use, and to only do a combo bolus when I would normally do so before insulin (for higher carb/higher fat meals). But so many people were talking about combo bolusing for Symlin I was starting to think I was being stubborn.
I think I do need to get some idea as to when my blood sugar starts to rise. I’ve been testing at 2 or 3 hours (when I’ve been delightfully in range) and then not again until like 5 hours when I sometimes find myself high. Perhaps bolusing uniformlly at one hour was too soon for me. I realize I’ve been worried about using too many strips and running out (like I did when I started my pump) but I realize this is a learning time and I need to test more now.
So my question is: When you say it hits at about 1.5 hours for 30 mcg, and 3-4 hours for 60mcg, have you found that to be reliable enough to just bolus accordingly or do you plan on always testing a few times to get the exact time of rise? I would hope through trial and error I can come up with a planned time to bolus that will be mas o menos as we say (more or less) accurate for me.
Thanks, I’m very excited about this. I heard from someone that one of the drug companies is looking to put out a combined insulin/Symlin drug! That would fit with my gut instinct that this is the next step in management!
Oh this is not good, I’m responding to my own posts! LOL.
I’ve been thinking over what you said you do, Cheri, and I’m not sure it will work for me. I’ve been uniformly bolusing at one hour and then I’m good at 2 hours and sometimes stay good and other times go high somewhere between 3 and 5 hours. Usually I’ve already begun to rise at one hour. So that means I’d have to bolus sooner than that to catch the rise, right?
Or maybe I really do need a combo bolus, so I can both catch the initial rise and the later rise that puts me high. I actually haven’t any lows at all yet. So I think I can risk pushing my boluses up a bit. I’d rather mess with the timing than the amount. I agree with you, Cheri, the goal is to keep that dramatic decrease in insulin in order to lose weight. So the 50% is the only variable I’m sure about now! Sigh.
I think I may start a new thread asking people to weigh in with their successful dosing methods, because it’s hard to read spread throughout all these threads.
I understand the concern over the strips. I don’t worry about it because I got my doc to push my insurance for an exception - 300 strips a month. The point was - hey people! - how do you think she stays between 5.4 to 5.6? Lots and lots of testing! Duh!
But - when I’m learning like this, I use my good ol’ Wal-Mart meter and strips (cheap). Then I don’t worry about it.
I have heard about the possible insulin/Symlin thing - and about a pump with 2 reservoirs (wouldn’t that be something?
I wish I could tell you that there is a set formula, but since I dont’ eat the same things at the same time every day, so far, it’s just paying attention. However, I have been approved for a CGM - I told my Doc I want to use it to try to nail down the patterns with Symlin and can then hopefully help myself, and others, fine tune. She just smiled - she calls me her “sophisticated diabetic” - lol.
“Sophisticated diabetic”…awww I like that. The only endo I ever saw when I lived in Guatemala wished all her patients could be like me and wanted to know if Using Insulin had been translated into Spanish so she could give it to her patients (it hasn’t).
Yes, I also get 900 strips, but when I started on my pump ran out and hit eBay to supplement.
Thanks for your help, In general this doesn’t seem to be too responsive a group. I see my “list how you do it” post got no responses so far. I’m the same as you, when I figure something out that works I want to share it with others. I’ll let you know how it works for me. I’m going to try both the timing thing and the combo bolus thing and keep records of what works best for me. Last night I had a prefect result with the “timing” thing and ironically when I waited for the rise which came at 1 3/4 hours instead of 1 it worked better! I find what makes logical sense isn’t always what works!
Hi Zoe -
You’re right about this group not being very active - maybe you could try a message on the forums?
I forgot to mention a couple things -
> One of the best benefits for me is no between meal hunger to speak of
> The timing of when the food hits is not just about the # of carbs but the type of carbs; generally, I limit myself to low glycemic / high fiber carbs. Carbs that are higher on the glycemic index hit faster.