Symlin help!

My doctor just recently started me on Symlin about 4 days ago. I noticed the Symlin seemed to work with very low carb meals during the weekend but it has never worked in the morning between 6am - 12pm for me. I'm experiencing major highs during this time. For example, yesterday morning I ate one packet of oatmeal and took 15mcg of Symlin. Within an hour, my BG was 323. This morning, my BG was 219 when I woke up, so I took a few units of Novolog to correct before I ate. However, I increased my Symlin to 30mcg and my sugars are sitting at 202 an hour later. My doctor has me cutting both my basal and bolus insulin doses. I have read what other users have done to correct highs but even raising my Symlin dose and bolus does not seem to work effectively. Maybe I need to go back to my usual basal dose? I really hope I don't because I feel my lantus has contributed to my weight gain. Any help on this?

I increases my dose from 15mcg to 30 mcg myself. I may increase tomorrow to 45 mcg if this keeps up.

Symlin is just synthetic amylin that is produced by healthy beta cells. The symlin just slows the digestion down for a while. This can help to prevent the spike in BG after a meal because without amylin on board we will digest with full speed. I can not see why an adjustment of the basal might be needed. Even the lowering of the bolus is more a security measure for some days. You obviously had spikes after meals, you obviously tried to wait after the injection before you ate, now you try to moderate the spike with symlin. In my opinion it is time to ask your endo about reverting the basal and bolus adjustments.

I was waiting to eat around 15 minutes when I first started, but I know take it right before I eat. I have bumped up my insulin for all meals just to help lower my overall readings. I just don't understand why the Symlin isn't doing its job initially. If it's suppose to prevent the hikes right after eating, how come my BG's randomly spike on some days and are fine on others? It seems to be a very very unpredictable drug.

It sounds like you may have a pronounced dawn phenomena. My DP is larger and seems to change a little bit quite frequently. It makes it difficult to set my basals so that I wake up within range. Then when I do that I may have my BG spike after waking up at 112. That was yesterday morning.

Breakfast is a difficult meal for me as my DP leads to pronounced insulin resistance. I suggest you consider changing your breakfast meal to help with your hypers. For breakfast I rarely eat over 20 carbs or anything that is quickly digetsted to sugar (high glycemic value). Instant oatmeal is very high glycemic and I would spike if I ate that for breakfast. I have had some success with protein bars in the morning, like the detour bar (orange) with 17 g carbs. The detour bar digests quickly, but the carbs are low enough that I have managed reasonably. I think the best choice for breakfast would be eggs or nuts for my insulin resistance.

Breakfast is so frustrating these days that I usually just decide to have black coffe instead. Nutritionist hate this, but it is the best way I have found to deal with my BG which I think is more important. It also sounds like your basal dose might be a little off and it may be time for basal testing?

Well here's the main problem I'm having. I take both my Symlin and Novolog right before I eat. However, because Symlin slows down the digestion of food, my Novolog immediately lowers my insulin during the first hour or so after my meal. However, within two hours, my BG's are spiking. I have no idea how to stop the spike...

I was originally on 30 units of Lantus before starting Symlin. My doc cut that in half and I have seen amazing results with my weight in already one week. I really don't want to increase my Lantus back up but I may have to to prevent these obnoxious spikes for no reason.

Can anyone give me help with this issue?

A spike like that is pretty clearly the result of food, so a basal insulin such as Lantus wouldn't be the answer anyway. The way to counteract a meal is with a bolus or correction, i.e., Novolog if that's your fast acting insulin of choice. If this were happening to me, I would change the timing of the Novolog, increase the dose, or add an additional correction some time after eating. Most probably the latter. If the symlin is doing its job as an appetite suppressant, I would still expect to see weight loss.

Yeah I understand my spike is coming from the digestion of food at a slower rate but I'm not sure why my doctor told me to take insulin before I eat still. It doesn't make any sense to take it with Symlin before I eat if the insulin doesn't really do anything. He should have instructed me to take my insulin an hour after eating. I'm a bit hesitant to try this though but what harm could it cause I suppose?

Trying it once or twice shouldn't be a problem, and then you'll know whether it makes things better, or worse. (My money is on the former.) Only thing I would do differently than what you suggest is that I would creep up on it by small stages -- first try half an hour, next try 45 minutes, then an hour, etc., to find the "sweet spot" -- the time that produces the very best result.

This sentence makes no sense: "my spike is coming from the digestion of food at a slower rate". Your spike is from the insulin coming too late to catch the digested carbs. The symlin is supposed to slow the digestion down so that the insulin can catch up with the digestion. Of course you inject the insulin and symlin before you eat. It has to be absorbed by your skin and from there it slowly enters the blood stream. This takes time and the slow insulin absorption is the root cause for the spike. The added symlin just gives the insulin more time to unfold its activity before the carbs hit the blood stream. Without symlin you most certainly will need a waiting time after the injection of the insulin (in general 15-20 min). With symlin you might eat directly after the injection if the symlin dosage is correct. Taking the insulin one hour after eating is just wrong and will cause a huge spike (300 mg/dl or more).

Incorrect. Actually, taking insulin with Symlin right before the meal resulted in my BG’s shooting high a few hours later. So I did exactly what I said earlier. I began to wait to take my insulin an hour and a half after eating and guess what? BG’s have stabilized. Holger, maybe your assumptions are “just wrong”?

I will not argue with your experience. But please read the presciption and ask your endo. Symlin should not be taken without insulin. It can not control the blood glucose but only the speed of digestion. If you can eat something just with symlin and inject the insulin one hour later something is definitely not working as it should. Perhaps the symlin dosage is too high or your body reacts very strongly thus your digestion is not only slow but short before being stopped. That is the only explanation I can think of. Your general experience that insulin and symlin can result in a spike few hours later is pointing into the same direction. The digestion is that slow that the insulin loses potency before it has finished processing the digested carbs. For the then coming carbs there is no insulin left resulting in a spike (comparable to high fat meals). At the same time it is strange that the insulin did not cause any low in this situation.

Holger, your last point is exactly why I took the original post at face value. If the symlin were slowing digestion TOO MUCH, I would anticipate a (possibly serious) low before the digestion was able to catch up, and he says that was not happening.

Just my two cents, keeping in mind that I do not take Symlin:

I can see pretty serious dawn phenomenon setting in when I do not eat breakfast or delay breakfast. If Symlin slows digestion as others mention... maybe it is slowing digestion/absorption just enough for dawn phenomenon to set in and may actually be increasing your insulin needs at that time of the morning.

Dawn phenomemon is actually the "bizarro world Superman" of bg control for me. If I don't eat, or delay eating, my bg will end up higher and I will need more insulin than if I did eat.

Good catch, Tim. Yes, DP can really screw up an otherwise perfect calculation. I know mine does if I don't stay right on top of it.

I found one additional information. Symlin has the capability to reduce the glucose conversion of the liver - similar to Metformin. The missing glucose in combination with a high basal dosage might cause the blood glucose to go lower than normal. This does not explain your experience but might be part of the puzzle.

I have no idea. This is the most unpredictable drug I have ever been on. Some days it works great and then other days I have high BG all day long. After reading others experiences, seems to me Symlin should have been tested a bit more. Everyone’s experiences are so vastly difference that this drug just seems so unpredictable and dangerous.

Hi, I have just started on Symlin today. I wait 20 minutes to eat after insulin. Both my doctor and a symlin nurse told me to do the same and then take symlin directly before eating. Do you wait at all before bolusing?

For a 270 calorie meal with 9 carbs I took 15mcg symlin and 2 units novolog, lately I have been needing more insulin even for low carbs and I would normally take 3.5 to 4 untis for this meal now.

I haven't reduced my basal at all. I'm taking Lantus too. I will let you know how this goes for me bg wise.

I have had some weight gain too, I'm back to my pre dka weight now, I didn't want to gain anymore- I don't think I was eating more, so my endo is switching me from Lantus to Levimir. He thinks this will keep me more stable than Lantus as well as stop the weight gain.

So far I have noticed I definitely don't feel hungry after eating the way I often do with only insulin.

Have you thought about switching the basal insulin to another one?

I forgot to say that my doctor told me to start on 45 mcg but with the possible lows and nauseau I'm going to start slowly and just see what happens. I think this variable for everyone in terms of how to manage it... and the nurse said it will take a few weeks to adjust things.

Ok heres my comments :)

Ive been on Symlin for about 6 months. I started on 15mcg and now am at 30mcg. I dont have the nausea I had when I first started, but it does sting a bit when I inject it.

Question: Do you know your insulin:carb ratio for different parts of the day?

I personally have no idea why your doc would reduce your insulin by adding Symlin. It doesnt reduce your need for insulin to digest carbs, but rather slows down the digestion as others have said.

Its a bit easier for me being on a pump though. I take my Symlin right before I eat, bolus right after I eat, and extend that bolus over 1 hour. That works best for me. At first, I just took my regular bolus. But, 30-45 mins after I took it I crashed. To the point I needed OJ to correct right away. Then of course because of the added carbs, I would spike 2 hours later.

If I were on MDI I would take the normal amount of humalog/novalog/apidra but split it into 2 when I ate, the other about 45-60 mins after. But, the key is knowing your correct I:C ratio.

You need to talk to your endo again about getting back on your normal doses of insulin. Symlin doesnt necessarily negate the need for insulin, but rather WHEN its needed.