Low Carb & Symlin

I'm picking up my first symlin pen this afternoon and starting tomorrow at breakfast.

I follow a low-carb diet (specifically Dr. Beirnstein) and I was curious if any of you are using symlin and eating low carb.

I generally eat under 6g carbs for breakfast, and 12g for lunch and 12 for dinner.

I looked in to Symlin a few years ago but since I was following Bernstein's plan, I was told I was eating too low carb for Symlin. I'll be interested to hear how you're doing on it, so please post!

If I may ask, why are you starting it? And are you type 1 or 2?

I was wanting to use it specifically for weight loss but instead started Medifast in February of 2011 and have lost 60 pounds so far. Interestingly, Medifast is about 80 grams of carbs per day compared to my 30 a day I did on Bernstein.


Hi, I would be VERY CAREFUL. Especially if you are under good control, eat low carbs, and have good A1c's. I have a feeling this product benefits people who are not in good control and who have higher insulin resistance. I tried and after 3 weeks said "the heck with this..".

I never got over the nausea feeling when taking it. Never take it if your BS is below 100-110. The final straw for me was taking it before a dinner. My BS was 120. I took my bolus for dinner. Soon my BS dropped like a rocket. It was VERY hard to get my BS back up due to the fact that the Symlin delayed the food absorption. Even taking glucose was a feat to get my BS back up.

So, with that said. Be careful.

For me, it wasn't worth the hassle using it since I am basically doing good without it....so why take it. At least I can say..I tried it and didn't like it.


Hey Valerie,

My doctor is a huge Bernstein advocate...and she prescribed the symlin for me. We've been talking about it for a couple of months. At my last appointment I asked her about the "250 calories/30g carb" requirement. But she clarified that it is "250 calories OR 30g carbs" and I'm eating plenty of calories.

I am a type 1...and I've been using an abnormal amount of insulin. So I'm hoping this symlin will help fight the resistance.

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Thanks Ken!!

Hi Mike
I haven't been very active on the site for awhile, but when I saw your message come across, I just had to write.

I am at work right now, so can't go in to too much detail yet but I have a lot to share. I am on Symlin and have been for over a year. I am also highly insulin resistant and for me that meant weight gain when I didn't really have a problem before. My A1c's were good before and are good now. I was on Bernstein before but am not now - Symlin & Bernstein don't go together well. What you wind up with is the Somogyi effect.

So I ask, if you're following Bernstein - how is your weight and how are your A1c? And, what do you consider an "abnormal" amount of insulin? What's your I:C ratio?

However, PLEASE don't start until we have a chance to discuss. It can be very, very dangerous.


Hey Cheri,

I'm interested to hear your experience.

My doctor prescribed me both Bernstein & Symlin so I feel safe and prepared to do this. My a1c has been increasing since this resistance problem has started. My last a1c was 7.3.

My I:C is somehwere around 1:6(ish)...and I'm taking 60 units of Levimir (basal) per day.

As this resistance has grown, so has my weight. I'm 6foot and weigh just over 200 pounds. I'm not extremly overweight but overweight nonetheless.

Hi Mike, How long have you been eating 30 grams of carbs anyway? You should be loosing weight with that carb count. If you just started on 30 grams you will be loosing weight soon I would think. If you can get down to 175# being 6 feet you won't need Symlin nor 60 units of basal insulin.

Hi Mike
Just a quick note. On the one hand, you sound like a good candidate - on the other, the red flag to me is that you are only using Levimir??? That is probably the issue. If basal insulin is not doing it for you, you likely need to add bolus insulin. THAT is the problem. I would certainly try that first before taking Symlin. No wonder your A1c is in the 7s (mine is 5.4).

More after work..................

Oh! I'm bolus with novolog too. You didn't ask me about my bolus. Hahaha.

Well that's a relief! As for your basal - is that 60 units split up in two doses? It works much better that way, esp. for insulin resistant types.

You may also want to consider the pump - it offers so much more consistency - you only need one type of insulin - and it affords so much freedom.

Additionally, you might also consider switching to Apidra - as well as being insulin resistant, I have a high tolerance to any drug, so the stronger Apidra worked much better for me. It can be used in the pump or as your bolus.
If you are doing Bernstein, you may be consuming quite a bit of fat - I have found that is counterproductive for insulin resistance because fat also requires more insulin (see TAGers United - http://www.tudiabetes.org/group/tagers)

Symlin has worked very well for me - but it is NOT easy; it has a very complex pharmacology and the materials out on it aren't that helpful. If you want to use it, you need to have a glucogon kit nearby until you learn how it works for you, because once you have injected it, if you go low - no amount of food will stop the low for the duration of the Symlin...period. Also, no matter what it says, DO NOT take the Symlin and then immediately dose for the carbs. Symlin delays the carbs from hitting your system so dosing right after is light wasting insulin. Additionally, if you don't eat at least 30 carbs with the Symlin, you could be in trouble. I found that the extra fat that goes with a very low carb diet did more damage than a moderate-carb diet.

I would start by reading Jason's guides - http://www.tudiabetes.org/profiles/blogs/a-practical-symlin-guide-for - then we can talk some more and I am happy to answer any questions.

I now have a CGM which makes dealing with Symlin much easier.

The other challenge is that if you take too much Symlin (and they don't tell you this), you will wind up with highs you never had before - due to the Somogyi effect. This is what drives most people away from Symlin.

Hi Mike,
I'm also doing Bernstein style low-carb and am hoping to start using Symilin soon. I'd be very curious to hear your observations on using it and eating low-carb. It seems like the effect on glucagon release and liver glucose release might work well for us.
I'm using lower amounts of insulin, but notice that I get post-meal rises no matter how much how I time it, and no matter how much I take. I think having the hormones straightened out might help.
What do you think so far?
Do you use a CGMS?

I'm not on a CGM.

So far, I'm rather pleased. My fasting numbers have been great and I've had almost no nausea. I'm only on 15 units of symlin at meal time. And in a couple of days I'll increase that to 30. And eventually to 60.

I've already seen a slight decrease in appetite, but not much. I know nausea is really typical, but I've only had brief moments of really slight nausea that goes away in a couple of breaths.

As far as low-carb'in. With my doctor's help, we decided to cut my basal's by 1/3 and my bolus by 1/2. And now I'm adjusting those numbers to match what the effects of the symlin.

So far, my experience has been very positive. I'll keep this thread updated.

Great info, Mike. Looking forward to hearing more about it. Thanks!

How'd the last 2 weeks go? Were you really able to use less insulin?
Any issues as you up the dose?
I'm seeing my doctor tomorrow and I'm going to see if he'll prescribe it for me to try out for a while.

I'm using it now too. I've had a good couple of days on the ramp-up period. No nausea or hypos, and things seem to work as described. Today I'm going up to 30 mcg. I'm on a normal/low insulin dose and haven't seen the 50% bolus reduction to be totally accurate. I'm still needing most of my insulin bolus, but will be watching it as I go to a larger dose. Dr. Bernsten recommends a 30% reduction for people on his eating pan, and so far, that seems to work for me.

I'm giving a square bolus for 90-120 minutes to cover my meals, and using a CGMS to watch the effect. I bolus after I finish eating so I know what I was actually able to eat. My blood sugar stays the same for about an hour post meal, and then seems to rise a tad to indicate that digestion is happening, slowly.


Nice update. I agree that my bolus reduction wasn't as strong as I was advised...I think my doc was just really afraid of me going too low, so she aired on the side of caution.

I'm on 45 units with meals...and I feel a little nausea. Eventually my doc wanted me to go to 60 units, but after our last appointment she said that if I wanted to stay at 45 that's fine. My numbers are looking really good.

Yesterday I was between 80 and 120 all day.

I have been on symlin for nearly a year. I am type 1 and I eat low carb. A bit more carbs than Bernstein, but very low carb just the same. I am on the minimed medtronic pump and have the CGM. I use Apidra in the pump and my last A1C was 4.9. I love symlin, I take 120 mcg right before eating and then bolus within 10 minutes after my meal. If my meal has lots of protein in it and very few carbs, I will wait up to 20 minutes before I bolus. I usually use a dual wave bolus, meaning that I bolus upfront for the carbs and do an extended bolus for the protein and fat. I eat no bread, no pasta , I eat NOTHING that contains flour. (flour makes my BG uncontrollable) so I choose to just eliminate those things from my diet. I also, of course, eat no sugar at all....so yes, my diet is limited, but it is worth it to me to be healthy and fit. I eat lots of lean proteins, not a lot of fat. I eat very little fruit but lots of veggies. (green beans, asparagus and field greens, tomato etc. (no carrots , peas or high sugar veggies). you should all visit the TAG forum on here as there is valuable info there. remember that even protein and fat turn to glucose (a smaller portion of it) so you'll need to bolus for that also. I've learned a lot on here and am thankful to have a Dr. that supports my Bernstein low carb choices and she is very proud of my success. My A1C was 14.9 at diagnosis and I was near death. I am thankful for all the help I've received on here!!

That's great info Debbie. Did you find it difficult to go up to 120 mcg from 60? I'm at 60 right now, but wonder if I'd benefit from more.

Also, I eat Paleo/Primal and it looks a lot like what you described, but probably includes more fat. I'm getting good results too. It's the only thing that's worked well for me. Having a pump and CGM has made figuring out the Symilin part much easier.

I have scoped the TAG forum a bit, but with your recommendation I'll go read everything and get caught up. I know it's good stuff.

Thanks for adding to this discussion!

I didn't have any trouble going to 120 from 60..sometimes I do get some slight nausea but nothing that I can't handle and it only lasts a very short time. (very slight). I found the TAG forum to be most helpful so I know you'll learn a lot over there, too. I've learned over the past year that if I were to follow the ADA recommended diet of 30-60 grams of carbs per meal that my A1C would be a disaster. we must take control of our own health as I truly believe the ADA does not have our best interest at heart. I cannot fathom why the medical community is so resistant to promoting a lower carb lifestyle to diabetics. It must be so frustrating for Dr. Bernstein!! I credit him with saving my life and I thank goodness I read his book early on after diagnosis. I eat 30-60 carbs per day and those carbs are from healthy leafy greens, green beans or asparagus. I eat lean proteins and I find high fat foods give me a delayed high later on. it's a journey and if we are diligent, we all find what works for us.