“I’m a little bit low,” I told Sarah the other morning when she came to drop 6-month-old Ryan off for the day. “But I ate one of those”—gesturing to a box of snack bars one of my grandchildren had left on the table—“and I’m not shaking any more.”
Sarah has Type 1 diabetes, so my confession didn’t faze her. “You want me to set Ryan down on the floor?” she asked. Then she further demonstrated her understanding with one questioning word: “Symlin?”
As it happens, I had injected Symlin (pramlintide) that morning. And, while it doesn’t always cause my blood glucose to go too low, I’ve had my moments with it.
Symlin is a synthetic form of amylin, a naturally occurring hormone that, like insulin, is produced in the pancreas. No insulin; no amylin. Used with insulin, Symlin controls how quickly glucose enters your bloodstream after you eat.
And, of course, it has to be injected, and no, you can’t mix it with insulin. So why, after seven years of using an insulin pump, (and, therefore, not injecting insulin several times a day), did I opt to add something that needed to be injected? Not only that but, as mentioned, that has the potential to cause hypoglycemia?
To be truthful, I have mixed feelings about Symlin. Besides the fact that it can contribute to hypoglycemia, my list of negatives ranges from the occasional “Symlin burn” when you inject it to the tough membrane on the vial that tends to dull the needle even before the injection. The latter should be a moot point (pun not intended) when the U.S. Food and Drug Administration gets around to approving the use of Symlin in a pen, hopefully sometime this year and the earlier the better. Having Symlin in a pen will also make it convenient enough for me to take it when I go out to eat. Currently, I don’t.
Though I had been taking Symlin for a year or so, I wasn’t really serious about it until after I got a continuous glucose monitor and got a good “picture” of what it could do.
I tried an experiment by eating a bowl of cereal both with and without Symlin. In both cases, I began when my blood glucose was around 90 mg/dl and I weighed my cereal on a gram scale to ensure that I was eating the same amount both times. (For the curious, the cereal was frosted mini-wheats.)
When I took Symlin, the line indicating my blood glucose value took a sharp slope downward, then gradually came back up, but never went higher than 130. Without Symlin, the line quickly spiked to over 200 and gradually came back down.
That experiment also changed the way I take insulin after an injection of Symlin. Because I use an insulin pump, I can program it to deliver insulin either immediately, over a period of time, or a combination of the two. Before I got my continuous glucose monitor, I took about two-thirds of my insulin immediately and stretched the rest out over two hours. I now take only one-third right away and stretch the remaining two-thirds out over two hours. I’m thinking about fine-tuning it even more. I just need to get myself into the mood to experiment.
On the plus side, taking Symlin can contribute to weight loss—which, by the way, didn’t happen with me.
If you’re thinking about starting on Symlin, don’t let the possibility of hypoglycemia or occasionally uncomfortable injections scare you off. In my opinion, a blood glucose graph that looks less like the sharp peaks of the Alps and more like the gentle hills of West Virginia far outweighs the negatives.