My first Symlin Use: Reposting here in Type 1

I am going to try Symlin for the first time & I'm not sure what to do-
my Endo said to reduce my insulin dose by 25%-50% depending on the dose... I can't find the paper I wrote what he said on: it was either 25% insulin reduction for 45mcg & 50% reduction for 60mcg or the other way around. The Symlin dose is 45mc on the rx directions, however, the packaging says to start with 15mcg and to eat directly after injecting it.
I'm low carb at around 50g per day- my last A1c was 5.1. I usually eat around 25g for dinner nad 8-14g for other meals... my calorie intake is prolly 250 or more for each meal so I think it satisfies that requirement.
For the dinner meal I take anywhere from 5-8 units novolog and I always wait 20 minutes now to eat.
So what do I do? Do I inject my insulin, wait 20 minutes and then inject Symlin and eat directly? I have no idea how to time this and I don't want to go too low.
I'm still insulin sensitive overall, but I have gained back my lost weight and I usually need a lot more novolog for meals & corrections now than before, although I still go low sometimes afterwards...
I'm trying Symlin to help with my hunger feelings from being on insulin.

It seems that your endo has not found the correct way to communicate his ideas. If he is recommending symlin he should communicate the kind of improvement he would like to see.

Symlin is just synthetic amylin. Beta cells naturally produce pro-insulin that will dissolve to insulin and amylin. The amylin can regulate the glucose synthesis of the liver down (comparable to metformin). But the main effect is that the digestion will slow down. Both effects will help the insulin to become active before the digested carbs are starting to raise the blood glucose. With active I mean the process of absorbing the insulin from the skin to the blood stream. So the main idea is to reduce the spike many T1 diabetics will experience due to our unnatural way of insulin delivery and digesting with full speed. This of course depends on the amount of beta cells we have left. To describe the idea in other words symlin should help to overcome waiting times between injection and eating. An improvement in your quality of life because waiting times are inconvenient or not practical in some working conditions or even dangerous if you wait too long.

The correct dosage of amylin is hard to find it seems. So far no manufacturer of insulin has combined insulin and symlin in one product. Perhaps the correct relation is very individual. This also means that it will need many repetitive food experiments to find a working dosage. In general I would start with a very small dosage and to increase it gradually day by day. This way you can experience that your post meal spike will get smaller and smaller with every dosage adjustment.

Thanks Holger,

I asked my endo to rx symlin because I feel hungry all the time on insulin.. I don't generally have big post meal spikes now beyond 120's if that.. I go low overall but not terribly so unless it is a later night snack... I sometimes go up with no explanation, no food etc.

I guess then from what you said I should try taking symlin and my insulin at the same time directly before eating and see what happens.. I'm just afraid that I will spike a lot because I now wait 20 minutes to eat... I'm going to call them on Monday and see what he thinks as well as calling the symlin help line.

I do plan to start with the smallest dose recommended of 15 mcg and not with 45mcg.

It might help because the stomach emptying will be delayed. Well, you have the direct experience. Has your feeling of being hungry changed?

yeah that is what I'm hoping Holger- I haven't tried it yet because I'm not sure when to take it along with the insulin... I called my endo and they will call back tomorrow. A Symlin nurse said I should bolus, wait 20 minutes( this what I normally do when I eat otherwise I will spike to 150- 200 usually no matter what I eat) and then take Symlin directly before eating.. I'm afraid that could drop me too low though. I'll late you know what my doc says. Symlin said to start with 15 mcg and reduce insulin by 50%. I'm kind of on a roller coaster today due to not feeling well maybe so it's better to wait till I stablize a bit... I will let you know if this helps me or not.. I think it takes a while to know.. the nurse said it can take a few weeks to get your dosage and timing right, so it will be a learning curver for sure.

so far on 15 mcg symlin my hunger is gone after eating and I'm eating a little smaller meals maybe... but if I go up enough to need a correction the hunger returns when taking novolog for corrections... it does give me some relief. but I'm having a low every time I take symlin.. the dinner lows are the worst so far the others I can just eat one candy or ignore it if it's in the 60's. I had one tonight that I took 25 grams g tabs for, and ended up at 83, which is amazing.. I would normally jump over 150 with that amount of sugar, so it does really slow release of glucose but not enough to stop me from reaction to it quickly.. it still brings me up... I will see if I go higher eventually.

my morning meal today was small so I didn't take symlin and I eventually jumped up at 5 pm from 93 about 1-2 hours earlier to 150.. I felt it at 93 but didn't go up till later apparently.