Pumping Symlin

Hi all,

I’m considering loading up an old pump with symlin. I am already pumping insulin.
My question: do people really think it is necessary to have TWO sites- one for insulin and one for symlin?
Would it be possible to just bolus the symlin through the same site? (and yes, I know they aren’t SUPPOSED to be mixed…)

Any thoughts would be appreciated.



Oddly enough theres work on a formulation of Symlin premixed with a rapid acting analog insulin…
It was discussed on Amys Diabetes Mine blog…


Hi Ruth
I find very interesting that idea of using two continuous treatments with the two hormones. I live in Lisbon,Portugal and in Europe we don’t have yet SYmlin. I really would like to have your thougths and experiences about using Symlin and pumping it with an old insulin pump.
How old are you?
Today is my birthday and i’ve just turned to be fifty!!! Have D1 since my 27th birthday and things have been compensated. Any way my major dificulties are with the post prandials and I really have a good feeling that with the use of symlin things would be much better.

I’m also a Medical Doctor practicing Radiology.
Going to Boston next week for a congress

Hope to hear from you
Yours sincerely
Fernando Almeida

Hi Fernando

Happy birthday!

I started on Symlin a week ago and so far so good. I’m not having any side effects as some people have reported. The dosing of Symlin is simple, but I’m still trying out various options for dosing my insulin along with the Symlin. (When to take it, how much to reduce it, whether to take a combo bolus). I couldn’t see being attached to two pumps. I just inject it with the Symlin pen. They are currently doing drug trials in the U.S. for a combination of Symlin and insulin so I think it is the next big step in treatment, but it will take awhile before it’s on the market. Have a great birthday!

I’m still in the research phase.
This thread:


suggests to me that the two can be mixed. While I don’t seek to mix them in the pump, I am interested in infusing them into the same site.
Now the next hurdle is to get the symlin out of the pen and into a reservoir.

I’m 37. dx’d in 1996. Always researching!


Here is a very interesting series of blog posts on the subject. The blogger covers a lot of issues in some depth, especially the question of the different phs of symlin and insulin. In terms of putting both in a pump together, there seems to be a concern beyond whether the mixture changes the absorption rate of insulin, and that concern has to be do with insulin “precipitating out” due to the ph shift, and clogging the infusion site. There are four really interesting and thorough posts. In the first two she explains the research she’s done on the subject, in the third she sets up the experiment, and uses ph strips to determine the exact mixture of symlin to insulin so that the ph doesn’t alter too much, and in the fourth she describes the first couple weeks of trying the mixture.





Thanks Ruth.
I Imagine that being conected to two pumps would be a very disconfort thing and even akward. It would be nice if the two hormones could be mixed as it hapens in a non diabetic. The two hormones go to the blood stream at the same time and in the same blood vessels.
Why did you start Symlin treatment? Problems in post meals?
You know that in my case if the post prandials would be normal, almost everything would be fine.
I’m going to speak to my encocrinologist next week in Boston and talk about the possibility of adjuvant symlin treatment.
Keep up with the research and good news. :slight_smile:

Hi, If you are still contemplating, I have been pumping Symlin for 3 years and if you are interested, will share my expierence.

Hi there Que,

I would love to hear your experience! Are you using 2 pumps? Do you have two sites? Any information would be excellent!


I use 2 pumps (24/7) and 2 sites. Getting used to wearing a second pump was extremely minor, a few adjustments. I was very slow (7 months) and methodical integrating the symlim. With no information to go by it was the safest and most prudent way to go for me, as I live alone and have no one to rescue me. Looking back, for anyone else at this point, it can be achieved much quicker.

For me I have realized some major benefits from it, my general feeling of well being is off the charts tremendous, my insulin sensitivity has improved greatly, from 6/1 to 22/1 on a normal not very active day to over twice that on a fairly active day.
When I started, my goal was to equalize the Insulin and Symlin that I take. The basal rates are a mirror of one another. The boluses turned out a little different, the reason for me was, I did not want it to be complicated as that was the direction it was headed.
My symlin bolus is different than the insulin as I bolus the dose all at one time. As an example for breakfast,
36g carbs, Insulin = 1.6 units (.2 up front and 1.4 over 30 minutes),
Symlin = 1.5 units all at once (up until 6 months ago when they discontinued the vials and the strength changed by 40%, it was 2.5units)

I use Medtronic pumps and have bolus wizard settings set up in both for different times of the day. These are just for normal days, any extra physical activity changes everything.

This report will answer alot of questions, pattern B is my Symlin basal rates. I keep in logged into the pump for my Endo's benefit. Do to the strength differences the rates are 60% of the insulin settings. I still have to think in units. My normal day is me getting up at 4:30 AM, hence all of the preloading starting at 3.

Wow. I am impressed. I started symlin in April 2011 after convincing my endo to give me the prescription. He thought it was worthless. I went up to the 60mcg after a couple of months and I really like it. It keeps me from being hungry. I am not overweight but happy to be 5 pounds lighter. My Hba1c has gone to 6.2. I am just wondering if I should go to the 120 mcg. because the effect of keeping the BG down is not as effective now. I may need more insulin up front. I generallly do 2 u at breakfast and 1 1/2 hours later the rest of bolus, depending on what I ate. I use the CGMS so I can see the rise and fall easily.I do take it 3 times a day. I also have two Revel pumps and thought about doing the symlin also but I didn't know if we needed it all day or only at meals. I also don't know if I can calculate the mcg to pump units. There is sso little information out there about symlin. All the posts I find are from 2005-6 when it was first approved.

Hi Maureen, if you are serious about more of my experience, I would be more comfortable sharing 1 on 1 . I won’t post to this open forum

Hi Maureen and Que,

Que- thanks for your excellent information! I acutally had some similar questions as Maureen. I'm not thinking of pumping the symlin all of the time, just putting a set in and bolusing for meals. Have you tried this Que? Using this method,I'm wondering if it is possible to use the same site for insulin and symlin, just switching the pumps out?
I also have been finding that I get a "tolerance" to symlin. Maureen- have you tried to increase your amount? In the past, I have simply cycled off and back on, which is annoying due to the nausea that accompanies reintroduction.

Hello Ruth,
It would be good to hear from Que also since she is the expert. I have not tried to go above 60 except on a few occasions when I knew I was eating more than normal over the holidays. Yes, I do not want to be nauseated again either. I think my problem is that now I have to give more insulin up front, maybe even using the dual wave up front. Before I would go low, low with the full amount of insulin up front. Now I see I need more insulin up front. Once I gave 120 mcg of symlin by mistake because I just couldn't remember if I had done the injection or not. I did it again and had considerable nausea (not awful) and did go low. Then I knew it was an extra dose. I wish there were more people posting so we could get more information. The few people who tried it seemed to have stopped after a few years.I welcome any more information. Maureen

Actually that is a good question because I have problems finding good sites for the insulin. Also I can't use them more than three days. I run out when my three month supply is up.

Que, I added you as a friend so we can correspond. My email is helins19@verizon.net.
I am interested in your experience with symlin and how you convert the measurements. I don't know if I am ready to wear two pumps but I have two. I don't have extra infusion sets.I do have extra reservoirs because I use them six days and always have many more than I need.

I answered this in a different area a few minutes ago so it is a repeat.
Hello Que,
I am actually finding that since using symlin (April 2011) my needs have changed. I mentioned the total insulin I need is down from 30 units a day to about 25 u/day. When I started symlin with the pen, first at 15 mcg and then up to 30 and now 60, I would go low before the two hour window of the symlin action was complete. I have the CGMS so I watch this very carefully. At 2 hours my BG would rise. So I had to give only 50% of the insulin up front and the rest at 2 hours. Now things have changed and I really think it is because my body has gotten accustomed to the insulin. Remember I have only been using symlin 10 months. Now I do need more insulin upfront, and I am actually using my bolus wizard again. Before I could not do that or I would go very low! Now I am only giving a little insulin boost at the 1 1/2 hour mark. This actually keeps me under 160 all the time. (That is if I avoid the extra cheese cake and fried spinach turnovers I have been eating during the holidays.) I really feel that on a normal day with my life style I can keep the BG below 170 with the symlin. I could never, never do this with the insulin alone. that is the reason I am so interested in this topic. I am going to send this to the group because I think symlin is great. I think most of the people on it dropped off because of the nausea at the beginning. Thanks for your help.

I thought I'd give this a bump.

I started Symlin a few months ago, and started thinking about doing this. I was just curious if anyone had an update on how it's going.

Hi Que, I just started pumping Symlin and would love to compare notes offline.