Does anyone out there experience a drop in bs with in the first hour of taking symlin? I’m struggling with this new medicine, but really want to embrace it.
It certainly can and often does happen. To what extent are you experiencing this? When are you bolusing insulin for your meal when you take Symlin?
I notice it within the hour. It seems to drop my bs by almost 100 pts. Several times, I’ve taken symlin before lunch, had a bs of 130 or so, felt hypo, and found myself at 42, or 39 with no insulin bolus. I’m scared to take it now unless my bs is higher than 150 pre meal. When I do take symlin, I don’t bolus until about 1.5 hrs later, and at that, only half of what I’d normally take. Then, at the 3 hour mark, I often find myself high as a kite because I’m being too conservative with my bolusses.
I know that symlin in and of itself isn’t supposed to drop your bs, so I wonder if it is halting my normal glucose production from my liver, and it’s my lantus that’s dropping me at meal time. I called my endo to discuss this, and was called back by someone in her dept who suggested that I try taking it one hour before eating. I’m scared to try this, as I’m afraid it would be even worse with no food.
I have cut my Lantus back a few units as well due to the fact that I have been having 4 am lows (high 30’s, low 40’s) that wake me up…Symlin is helping around the clock???
Thanks for your reply…I’m finding it tough to get input on this medicine…maybe not too many people on it??
I don’t have any experience using Symlin while on MDI but it appears your basal insulin is causing you to go hypoglycemic. Symlin’s half life is a relatively short 45 minutes so it shouldn’t be doing a whole lot “round the clock”.
For this reason, I don’t see why taking it an hour ahead of time would do any better than simply halving your dose. You also run the risk of destroying your appetite before you even begin eating. What dose are you taking right now? The best way I have found to bolus the insulin is to wait one hour and then do a regular or 30 minute square wave bolus (I realize you can’t do the latter on MDI).
So try cutting the Symlin dose in half and taking your insulin at the one hour mark and see how you do. Good luck.
I’m on 15mcg…starter dose. I guess I need to schedule an appt to sit and talk to my endo. I am in the process of going on the pump, but finances are a big concern for me, and may not do it.
Tell me about square wave bolus…is this a little push at first, and a slower release of insulin over a give period of time, say one or two hours? This differs from mdi because all the fast acting is one big hit, then a serious drop off?
I’m trying to figure out how the pump will serve me better besides avoiding multiple injections. I’ve never had a problem with the actual injecting, but wonder if the timed release would assist with my post meal numbers with a pump.
Hi Sharla,
Did you adjust your carb ratios when starting the symlin? I think I ended up taking about 20% less insulin than I did before symlin, but the folks at symlin recommend a 50% change to start with, ie changing your carb ratio from 5 to 10. This will cause you to take less insulin. If you are not a pumper, cut your dosage and move it back up every couple of days until it is right.
How big a dosage of symlin are you taking? At lunch when you go hypo, how many carbs are you eating? I never take mine when I am eating less than 30 carbs or so.
Bolusing 1.5 hrs after meals will throw your timing all to heck, your insulin just will not be working when your food peaks. The conservative bolus may not have as much of an effect as just taking it so late.
Symlin does slow down your liver, your digestion and causes you to feel full so you eat less. This threw my carb counts off when I first started because I just could not eat what I had dosed for.
Taking it one hour before eating really doesn’t make much sense to me. I take mine with my bolus most times (20-30 min before eating), though I might take it when I sit down to eat if my numbers are borderline low or are trending downwards.
The symlin, insulin, and meals all need to be timed together. Symlin an hour before, then eating, and bolusing 1.5hr after that will not have them working in sync.
Why did you try symlin in the first place? Were you having highs after meals?
A square wave bolus is when the pump delivers a bolus equally over a block of time. So I can tell my pump to give me a 30-minute square wave bolus consisting of 4 units and those 4 units are spread equally over those 30 minutes. When you tell the pump to deliver a regular bolus at first and then a square bolus, it is called a dual-wave bolus. Both are options on my pump along with the regular ol’ bolus option. These techniques certainly do help when using Symlin (and when eating things like pizza).
So you are just starting out on Symlin. . .I suspect these issues will go away as you acclimate to it but I am not a doctor so I could be wrong. Either way, it is hard to acclimate to the type of situation you are describing! If you are using the Symlin pen then I realize the lowest dose you can take is 15mcg so perhaps you can switch to the syringe and bottle method to take an even smaller dose.
From what I understand, Lantus is a peak-less insulin (I switched to a pump before it came to market so the only long acting insulin I know first-hand is NPH). I don’t really feel qualified to give advice on adjusting Lantus doses so your best bet is to sit down with your Endo. Does he have a lot of experience treating Type 1 diabetics with Symlin? This is important.
Lantus is peak-less for the most part (I was on humalog/lantus for several years before pumping). The main problem lantus has is duration. Depending on the person, it can last from 18-26 hrs.
Sharla, did you check out Jason’s page? He has a couple of great posts there about using symlin
Hi Scott,
My endo suggested that I start symlin to help with my desire to lose weight. I’d like to lose (and never find again) about 20 lbs, but my desire to eat was interfering my ability to be shed those pounds. Also, my A1c was at 7.8 I think, and it was determined that it was my meals because my a.m. bs was usually very good, w/no hypo’s at night. I wasn’t much good at checking post meal numbers, but I am sure getting that way now, dangit.
I am currently on 15mcg, and only take it if my bs is above 150, which is too high to start with. arg. In the beginning, I couldn’t eat squat. My survival instincts have overridden what the symlin did, and I can now blow through a meal with no problem, but am trying to respect the medicine and give it its due. Since this is the case, I feel that at least part of me is ready to go up to 30mcg, but am hesitant to do it until I figure out why it’s dropping me so low shortly after lunch.
I’m in the process of going on the pump, but hesitating due to finances. I noticed on your page that you’re on the minimed 722. You like it? Thanks for your input. I need someone to talk to and endo is getting tired of hearing from me I think. 
not had this prob, but sounds like your long acting might be too high with the symlin. I wouldn’t try taking it an hour early
For me, taking Symlin before breakfast when I’m most insulin resistant does little except cause me to cut my insulin does by about 30%. That’s how it’s supposed to work. At lunch, if I’m undre 120, i wont’ take it unless I’m having a high carb meal. if I do, I’ll drop to the 40’s in 10 minutes. I then bolus about 50% less at 1 hour with the square wave for 1.5 hours. this causes me to stay almost flat. I also won’t take it if I’m going to have a high fat meal. Those lows are very scary and hard to treat. Talk to you endo. I you get a good answer, post it. I know how Symlin is supossed to work; I understand the physiology and the chemistry, but sometimes it just seems to defy reasoning. So what’s new? Just when we feel we have this disease figured out, it throws us another loop. Good luck and keep those gluscose tabs handy.
Hi Scott…
Yes, you’re right about the Lantus. I’ve loved it because it’s stopped my middle of the night hypos…much more predictable than anything I’ve taken before. Love, Love, Love the stuff.
I did read Jason’s page, and I’ve heard from him about this…he’s a great source of information. In fact, I read his articles several times before actually starting the medicine. It was partly because of his success that I decided to try it.
In the past 26 years of this roller coaster, I’ve had moments of serious concentration on my diabetes…this another of those “moments” that I’m hoping will serve me well, and for a long time. To tell the truth though…sometimes I get tired of the attention required of me to get there.
Thank you Denise. That was my initial reaction, but didn’t want to argue with the advice given, so I called Symlins support group. Wow…they’ll keep you on the phone all day, if you let them. Nice people. Their response was that this was not the recommended timing of the medication.
OMG David…you’ve just summed up my experience better than I could. You’re right about the drop…it’s quick, and it’s awful. Ok, so if you find that your bs is under 120 at meal time all day, and you don’t take symlin, do you find that it’s a tough adjustment when you do take it the next day, after being symlin free for over 24 hours? Or have you gone 24 hours?
I’ve not gone through this many glucose tablets in years. I’m eager to see my A1c, but am not sure it’s going to be great since, at the 3 hour mark, my bs’s are sometimes very high. Sigh.
what are your 2hr post numbers when you don’t take symlin? How much higher are they than your mealtime numbers? I started taking it because I could be a 90 at mealtimes and usually be in the 250-300 range at two hours. My carb ratio was 1:4 and my pump would literally not let me bolus more. I was taking nearly 100 units a day, since symlin I’m running at about 60, but still have some adjustments to do.
Have you considered having your endo putting a CGMS on you for a week? That way you can see exactly what your patterns are during the day. If not, test more so you can see what your patterns are.
I’m not a doctor, but alarms went off in my head when you said your endo suggested symlin for weight loss. It can have that effect, but it does it by reducing appetite and liver function, which can cause those lows after meals
I’m going to second the recommendation to get hooked up to a CGMS. It makes a world of difference, especially with Symlin use.
I’d love one, but it’s not in the cards for me at this time, I’m afraid. I’m still working on justifying the cost of the pump.
well, they can do the CGMS at the doc’s office as an outpatient test. You come in, they attach it, you go home, come back a few days later and unhook you and look at the results
Really?? Hmm…good idea. I’ll ask about it. Thank you!
Jason, I appreciate the explanation on the square and dual wave bolus. Being that I’m considering the pump, I’m trying to learn the terminology that goes with it so I won’t be so lost when I start.
Your suggestion to try the vial option sounds like a good idea. I happen to be in possession at the moment though, of a small fortune in the 60mcg pens. Ironic, huh? Still, worth considering. Thank you.
Yes, I believe my endo is well versed in symlin, but I’m not so sure about her cohart that called me back the other day. I’ll make sure and talk to her about his suggestion to dose one hour before eating, and see what she says about that. My endo tried to talk me into starting symlin a few years ago, but I was leery…seems with good reason.