I’ve been taking Symlin for a few months now. I began taking it in April as part of a comprehensive weight-loss/diabetes management program at Joslin called Why WAIT? Symlin is a synthetic verion of amylin which is a hormone secreted by a normally functioning pancreas along with insulin and it functions in three ways: First, it slows digestion, which increases the time that food spends in the stomach. Second, it decreases the release of glucagon at mealtime which then decreases the liver’s release of stored glucose. Lastly, it effects satiety, the sense of fullness which means that you feel full sooner and eat less. A constant dose of Symlin is injected at meal time in addition to the meal time insulin.
Here are my thoughts and experiences regarding Symlin in bullet form (the good, the bad, then the ugly):
- Good: With the help of Symlin, I cut my daily bolus down to a quarter of what it was previously. This was partly due to my eating less because I feel full more quickly and partly due to my need for insulin to combat the liver glucose went down. My basal rates were also was cut almost in half. Less insulin computes to huge monetary savings between the cost of insulin and pump supplies.
- Good: I lost almost 30 pounds while taking the Symlin. Some of this weight was a result of my increased physical activity and better diet, but some was definitely a direct result of the Symlin. For example, I had a couple weeks in the middle of the Why WAIT? program where I stopped following the meal plan and stopped exercising but I still lost an average of 2 pounds per week.
- Bad: The only method of delivery of Symlin is via injection. I’ve been pumping for almost 10 years by now and one of the biggest upsides to the pump is the decreased number of injections. Shots suck.
- Bad: Symlin is outrageously expensive. Luckily my insurance was willing to foot the majority of the bill but the cost could easily be a hindrance. I calculated the cost of Symlin for a year without insurance (using 2-3 pens/month) and I would need a full time job just to pay for it.
- Ugly: Symlin delays the release of food from the stomach. Thus it also delays the BG peaks that we all know and love. So, blousing appropriately get really difficult. If I take my insulin with the meal/Symlin I find myself crashing severely low immediately post-meal. These lows are hard to treat because, 1) I’m full and don’t want to eat, and 2) The carbs I consume for the low are also somewhat held up in my stomach due to the presence of the Symlin and take longer to take effect.
- Ugly: For this reason, I skip the Symlin anytime my BG is below 100 prior to any meal. This doesn’t sound like such a terrible thing, but when I without Symlin my insulin to carb ratio increase by 10-20% so I end up having to bolus more when my BG is low. This is so counter-intuitive that I often don’t increase my bolus for fear of going lower and have to deal with the frquent wicked high that results.
- Ugly: So, like I said, meal time insulin cannot be taken with or before the meal per usual. Instead I’ve had to figure out the appropriate delay in order to keep my postprandial numbers in check. Bolusing approximately one hour after eating seems to work really well. The problem with this is that insulin pumps are not designed to delay a bolus. I have to find ways to remind myself to take this post-meal bolus. As one might expect, this often results in my forgetting until I see Dex start to creep upward and the resulting highs can be almost as devastating as the crazy lows.
So, for me, the result is an obnoxious medication that is difficult, at best, to deal, with but produces results above and beyond what I had hoped. I plan to continue using it for the time being but I’m thinking of reducing my use down to one meal a day. Ultimately, the beauty of Symlin is that I don’t need it to survive so I can make the choice to take it or leave it. For now I’m going to continue to take it.
I am not a doctor and am not trained in any medical field. Please consult your doctor before making any changes to your own diabetes management routine. Your diabetes may vary.