Symlin in pump- WITH insulin?

Just wondering if anyone has tried this with success? I tried it a while back (few months) with some success but wanted a more “tried and true” ratio. I’ve read anywhere from 1:8 to 1:4 (units of symlin to insulin)- I KNOW about the different pHs but I am all about off-label (: I have a teleconference with Dr. Edelman in early Nov. and supposedly he has some off-label experience with this- but darn it, that’s a month away (: Anyone???

Unlike c-peptide, the hormone amylin is not secreted in direct proportion with insulin, so mixing a synthetic version of amylin (Symlin) with insulin could create problems with, for example, larger-than-normal boluses. The titration of Symlin reaches a maximum dose, the same cannot be said for insulin. Once you hit the maxium, it does not increase if you eat more as your insulin would. The manufacturer recommends that patients with type 1 diabetes should be started on 15 µg just before each major meal (250 calories or 30 g carbohydrate) and it is recommended that patients reduce the dose of rapid acting insulin by 50%. However, if you eat less than 30 g of carbohydrate, then you would skip Symlin, which cannot be done if it is premixed with your insulin. If titration is required, the steps are to move up to 30 µg, then 45 µg, and finally 60 µg (which is about 10 units), which is the maximum dosage.

Type 2 diabetes patients typically should be started on 60 µg just before meals, which is the maximum dosage for patients with type 1. Their dosages may be titrated as well, and insulin (including rapid or pre-mixed insulins) should be adjusted accordingly using the same recommendations for type 1. The dose for patients with type 2 can be increased up to 120 µg. Note that the maximum for anyone is 120 µg (about 20 units). Could you guarantee you would not exceed that even if you're sick and had to increase your basal rates by 50%? I would guess that might be tough.

I am also not aware of anyone who has ever combined Symlin and insulin in a pump, but theoretically, it could be done, but I am curious why you would want to? For example, your basal rates could create a major issue since you are getting Symlin every few minutes (albiet in micro dosages), which I could imagine could create issues with ongoing nausea as well as total daily dosages of Symlin. I would advise speaking to Dr. Edelman before doing so you are sure to avoid any surprise issues with hypoglycemia due to the fact that you are always getting some Symlin, as that is not currently in the dosage recommendations approved by the FDA.

I tried mixing SYMLIN and Humalog in my pump – it wasn’t pretty! The end result was a suspension that continuously got clogged. I called customer support and asked that they develop a dual-chamber tubing and reservoir (sounds militaristic and utilitarian, right?). Customer service at MiniMed wasn’t having it. Just an idea but apparently Allies Voice was ignored – back in 2005!

How are you doing on it now? I agree it wasn’t pretty-lol- Not doing Symlin at all now but debating on giving it another go…

Hi Cari,

My endo said to give my symlin shot at least 3 or 4 inches away from my infusion site because it will interfere with insulin absorption. To make it easy, I just give my shot on one side of my belly and have my pump site on the other side. I switch every 3 days.

He mentioned that he knows someone who actually wears 2 pumps, one on each side of her belly, with one pump for insulin and one pump for symlin. Another way he’s seen it done is to have two canulas: one connected to the pump and one to give a shot into.

Hope that helps.

Two pumps at the same time? I hated wearing a single pump, I think wearing two would be just awful! On the other hand, I would say that one potentially useful option might be using an iPort for Symlin injections, and a regular infusion set if you wear a pump.

My experience with the iport was horrible. There is no inserter and the cannulas kept getting bent. They bruised me and were quite bulky. No where near the size of an infusion set. They also showed when you wore clothing. I tried them for 2 months and just hated it.

Cari, are you meaning mixing the symlin with the insulin? My endo was very adamant that the two had to be kept separate. I was told under no circumstance should I allow them to be mixed. Separate syringes and sites for them. Also, my understanding was you had to eat within 20 minutes of taking symlin, so I don’t understand the concept of administering it through a pump.

I wish we could blend it though. I keep forgetting y symlin, and or cannot conceivably inject in front of ppl. one of the major points of having a pump, y’know? And I know with forgotten symlin, I shall be higher than liked HBQ’s this visit.

I’m wondering if we could lower that mix. Say 1u Symlin to 10 Humalog? instead of 1:6 or 1:8?

I’m just so frustrated that despite having a pump, I have to do freakin’ shots again! I hate it very much!