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Insulin's Super Sidekick

by Gary Scheiner, MS, CDE

The US Food and Drug Administration has approved Symlin for use in adults with Type 1 or Type 2 diabetes who take rapid-acting insulin at meals. Although it is not yet approved for use in children, several studies have shown that Symlin is safe and effective when taken by adolescents in a supervised environment. Doctors have the option of prescribing Symlin off-label to children under the age of 18.

Many people with diabetes have what could be described as an “insatiable appetite.” This may be due, at least in part, to the lack of amylin’s appetite-reducing effect. As a result, people with Type 1 as well as Type 2 diabetes can find it very challenging to lose unwanted weight.

Symlin can be a valuable tool in the “battle of the bulge.” Taking Symlin at meals helps create a sense of satisfaction and fullness, which can lead to eating smaller portions and taking fewer second helpings. And because Symlin’s effects tend to last for 2–3 hours, there is less of an urge to snack between meals. As a result, Symlin users lose an average of about six pounds over the first six months of taking the drug.

On the dark side
Every sidekick has his issues, and Symlin has its share. To start, Symlin is not available in pill form. It must be injected, just like insulin, at each meal (or whenever its effects are desired). Guidelines for storing and replacing injection pens or vials are also similar to those for insulin. But because it is somewhat acidic, Symlin cannot be mixed directly with insulin, and it may sting a bit when injected.

The most common side effect associated with Symlin is nausea. Approximately half of all people who try Symlin experience at least a mildly upset stomach. Symptoms tend to be more pronounced during Symlin’s peak action time, which is 15–30 minutes after injection. The discomfort usually lasts for only a few minutes and tends to subside before dissipating entirely after a few weeks of use.

For people who experience hypoglycemia unawareness (lack of low-blood-glucose warning signs) or are prone to severe hypoglycemia, Symlin may present some additional risks. Because food digests much more slowly when Symlin is taken, hypoglycemia can occur soon after meals, as premeal insulin starts working. It may therefore be necessary to reduce or delay mealtime insulin when taking Symlin. It is also not a good idea to take Symlin if your blood glucose level is low (or close to low) at the start of the meal, if you plan to exercise after the meal, or if the meal consists mostly of foods that digest slowly, such as pasta, legumes, or dairy products.

If hypoglycemia does occur, treating it can be a challenge. For the first hour or two after injection, Symlin blocks glucagon production and slows digestion considerably. Attempts to treat hypoglycemia with traditional methods may take a very long time to have any effect. Instead, glucose tablets or gel may need to be placed under the tongue so that some glucose is absorbed through the tissues of the mouth; otherwise, a glucagon injection may be necessary.

One other concern that comes with using Symlin is the titration process: determining the appropriate dose of Symlin, and then establishing the ideal dose and timing of mealtime insulin. Achieving a stable blood glucose level immediately after and between meals is a process that may take several weeks of trial and error.

Another concern is cost: Symlin is not cheap. Each box of Symlin pens costs more than an equivalent box of rapid-acting insulin pens. Most major health insurance plans cover Symlin for people with Type 1 or Type 2 diabetes who take mealtime insulin, but copays usually apply, and preauthorization is almost always necessary. That typically means paperwork, waiting, and more paperwork before coverage takes effect. A patient assistance program is available through the manufacturer of Symlin (Amylin Pharmaceuticals) for people who have difficulty affording the product.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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