Symlin (new drug)

[Human Pin Cushion]

My doctor just gave me information and samples of Symlin.  This new drug was recently introduced to mimic the role that amylin would normally play in slowing down the rate that sugars leave the stomach.  Generally, people who do not produce enough insulin (or any insulin) also do not produce enough amylin.

Unfortunately, it is another injected drug, at meals similar to humalog.

My doctor said she was hesitant at it's launch to prescribe simply based on the fact that she hated to ask her patients to take yet another series of injections.  But after hearing actual patients speak of their experiences at a medical meeting she was more open.

I recognize the benefit.  But have some concerns and questions.  There was a very good posting a few weeks ago on a Lantus question about Symlin.  I thought we could move this to a new subject.

Question - I don't always see a "spike" in glucose after meals.  Would I now be at risk for lows after a meal?

Question - Nausea seems to be a common side-effect.  Wouldn't the nausea cause more lows if not able to eat normally?

Question - They recommend reducing Humalog by 50% when taking Symlin, does this help prevent the before-mentioned lows?

Is the benefit really worth more injections?  I have never minded injections and prefer injections to a pump.  So, I did tell my doctor I felt I was a good candidate to try.  After 40 years, I am extra cautious in preventing surprise lows.  I test before driving and have never had any serious problems.  I guess this is why I'm nervous to throw another wrench into the mix.

[Human Pin Cushion]

There was a very detailed posting from a new user to Symlin on the 11/06 posting "New Lantus User with Quirky BG counts".  The poster was "smiles111077".  Other than my doctor, this was the first I had read about Symlin.  I thought it was a very honest evaluation.

[Human Pin Cushion]

Sounds like there is very little feedback on Symlin.  When the general diabetic population (and doctors) say "after meal glucose" does that mean 15 minutes, half-hour, one hour, or two hours?  

My two-hour is normally within target if I've taken adequate humalog for the carbs consumed.  Sometimes, it is even low if I've consumed a slow-to-digest carb such as pasta.  Pasta, I normally take two lesser injections spread about an hour apart.

Since not all carbs move through the stomach the same, I'm worried about lows with Symlin.

Also, you only take a dose at meals where 30g carbs are consumed.  Many meals, I eat less that 30g.  

I'm not overweight and my A1C is usually in the 6-7 range.

There was a good posting about Symlin on a previos "ideal glucose" posting earlier.  I'll try to locate.

[Markie]

As far as I can see, Symlin effectively treats "post-prandial glucose excusions". In other words, it helps if you get high blood sugar readings after meals. It does this by inhibiting the secretion of Glucagon, which activates the release of glucose by the liver. The effect is that you don't need to bolus as much and your after-meal blood sugars become more predictable.

To the extent that your after-meal glucose readings are satisfactory, the beneficial effects of Symlin will be limited. And you will have to decide if using it is worth the effort.

Cheers,

Mark

[JDRF-Team-LRS]

Another volunteer here and long time DMer.  I'm not a physician, so do check in with your doc on what I'm saying or what others may suggest here, too.

I've read a little about Symlin and it seems to be recommended for folks who've had a hard to get their a1cs within their targeted range and/or folks who're are somewhat insulin resistant due to weight issues or, perhaps other meds or underlying conditions.  Some folks -- especially those who are constantly "feeding their lows" -- have trouble to lose weight safely and Symlin is thought to allow folks to have an easier time to shed a few pounds because it helps folks feel satisfied after eating.

With most new insulin routines, docs start out very conservatively -- accepting that the dose might need to be upped over time -- but recognizing it's far more important to avoid serious lows.  I would think the introductin of Symlin would follow a similarly conservative approach. I would agree with your assessment that lowering mealtime Humalog is done for just that reason.

Here're some reliable websites (altho' 2 of them are commercial) with info -- in case you or others want to read more on the medication.  

http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01345.html
http://www.medicinenet.com/diabetes_mellitus/page8.htm (scroll down to the meds area where Symlin is discussed)
http://www.diabeteshealth.com/read,4,4300.html

Good luck.  If you do use it, would you consider posting here again with your assessment?  

[JDRF-Team-ES]

Your questions are great ones.  I have also had diabetes for 40 years and am hesitant to try something new, especially when the old mehtods work fairly well. Unfortunately, I am not knowledgeable enough to answer your questions about symlin.  If anyone out there has more information, please respond to these questions. I would like to add my own question which is what are the indicators for using symlin?  Should every type I diabetic be on it or only if you are having after meal highs?
Es