Has anyone tried symlin right after vs right before eating? My though is you would avoid the lows by digesting a few carbs and slow digestion to avoid the spikes along with appetite suppression?
Hi Frances -
Yes, I’ve done this - but only when I was already going low before eating. So I ate a few carbs, then 10-15 min I injected the Symlin. This works fine. But normally, I do it before because first, I’m on a very low carb diet already and second, Symlin before helps me avoid that awful “narcoleptic” reaction when I eat any food.
I did this as well to avoid the low. The problem really was that I was on too much symlin. My usage of it has titrated downward as I have lost weight.
One other thing to think about is that you will lose the appetite suppression effect. For me, if I eat too much and then take my Symlin, it is entirely possible that I will get sick because there is too much food in my stomach
Thanks Scott. Im new to Symlin and not totally understanding the dosage. I was told by my NP to increase the dose every few days in 15mcg increments up to 60mcg. I was having lows in the 40s at 45 mcg, then spiking to the 300s. So I cut back to 30 then 15. I like the appetite suppression at 30, but still had the lows and rebounding highs. I would like to get back up to 30mcg to cut appetite more. Any suggestions? Right now I take 15 before meal, eat, then square insulin for 30 min. Also, do you ever adjust the amount of symlin according to what you will eat/ time of day/ activity level like we do with insulin?
Thanks Cheri. When you do take the symlin post meal, when do you take your insulin? Do you do an extended bolus? On a low carb diet do you take less symlin than if you would eat more carbs?
One other thing to watch for is changes in your carb ratios? Did you reduce them when you started? If not, you are probably taking much too large a bolus with meals, leading to the low and then the rebound high. Symlin recommends cutting your bolus by 50% as you get started. As my resistance has gone down, so have my bolus amounts, And my basal rates as well, now that I think about it
I take 15 mcg with breakfast and lunch (if I have enough carbs) and 30 with dinner. I also have 4 different basal rates and carb ratios throughout the day
I found I still take the same amount i:cho ratio, but my basals are way lower because my daily total is less ( I dont snack all day between meals anymore). It seems the timing is what is important. Actually, one night I took 45 mcg Symlin, ate a big meal (75 cho) and took no insulin. I tested every 15 minutes to see the effect. I started at 170 and went down to 70 in one hour. I felt fine so I did not treat the 70 ( I normally only treat if I feel low unless it is below 70). Then I started going up, back to 170 within another hour. Then kept climbing above 200, then I took insulin to correct.
Is your dinner the largest meal of your day?
Dinner is usually my largest carb intake of the day. I try to stay around 100 carbs a day.
I’m not a doctor, don’t play one on TV and didn’t stay at a Holiday Inn Express so this is definitely not professional medical advice…
Reading the pattern you described, the symlin and your basal rate covered the slowed release of food from your stomach while the symlin was active. Checking your profile, you’ve been a T1 for quite a while and it’s doubtful you still produce any of your own insulin. If you add a bolus into that pattern, your sugars will plummet, ie too big a bolus. If it was me, I would adjust my carb ratios and lower the amount of symlin.
Have you checked your basal rates lately to make sure they are still tuned properly for you?
Yeah, thats what I thought too. I dropped my symlin to 15 from 45. Now I dont get the lows. Ive had a few highs. Not sure if I miss counted carbs or if I should take my symlin at those meals. Also still playing with the timing of bolus. Square wave seems to help a lot. Basals are good, though a few fasting lows so I lowered basals a bit. I think because I dont snack between meals anymore and my TDD is about 25% lower. Also trying to work more exercise in 
I take it on any meal over 30 carbs or if I am high at meal time. I never take it when my sugars are low. I miscount carbs too upon occassion, happens to us all. How high did your sugars go? My doc is happy with anything under 180 at 2hrs PP, but I like them to be closer to the magical 140 range.
Before I was on Symlin I would aim for 70-80 before meal, <140 2hrs post meal. Part of my problem was I was always hungry and eating so I would never have a time when I didnt eat for 2-3 hours. I also work as a hairstylist and never know if or when I will sit down for a meal, so I snack a lot. No 2 days are ever the same! Symlin has solved that problem. I can now go 5 or 6 hours without eating and no hunger or cravings. However I know I will be very hungry/crabby if I dont eat regularly so I try to eat ever 4 hours.
What Im finding on the symlin is my sugars are pretty even at 15mcg 2hrs post meal, then start climbing. Im going to try a longer square wave right after eating and symlin before eating. I read your comment on getting sick taking symlin after eating and I dont want to experience that.
I know diabetes is not a “cookie cutter” disease and there is no magic formula that works for everyone. I like the ideas though, thanks!
Hi Frances -
Sorry I didn’t reply earlier - I forgot to “Follow” the discussion.
When I take the symlin post-meal, I still check my BG in one hour and take my insulin then (much less than before Symlin, anywhere from 30-40% now that I’m on a full dose).
No, I don’t take less Symlin on low carb. If you read the literature, it says your meal should be at least 30 carbs OR at least 250 calories - so I go for the calories versus the carbs.
By the way, I didn’t really notice the dramatic and positive impacts until I hit a higher dose. It was kind of all over the place before then. Let me know if you have any other questions.
I’ve only been on Symlin for 2 weeks now, but I find that it’s ALL about the timing - which, of course, is very individual.
I do take a half dose in the afternoons sometimes if I want to have coffee (I drink it with cream which tends to raise my BG) - it seems to work well.
I’ve just started a new exercise program, so we’ll see how I do. Right now, with my regular 1.5 mile brisk walk, my need for a bolus (if I’ve eaten & taken Symlin) or any correction (after eating) totally disappears.
I have done it once and it made me a little sick. But make sure you dont double up prior to meal, it will really cause problems to your system as in Throwing Up like you never done before.
But may I add to this reply: May I suggest that you talk to your doctor and request using the symlin pen. It is easier to use and you wont be bending the needle points trying to break through the rubber gasgit. I’ve been using the pen for 3 months and boy what a difference in the shots.