Saturday, March 10, 2012

Thinking about trying Symilin

I have been doing some reading lately, and keep coming across mentions of Type 1 diabetics using Symilin to reduce insulin requirements and even out post-meals rises. I like the idea of using less insulin. I'm curious if any of my readers have used it, and whether it worked well for them. Anyone?

As I have read accounts on discussion boards it seems like everyone has different results and I don't know whether the best results are with a high carb diet or low-carb diet. The manufacturer says that you should use it with meals with more than 30 grams of carb, but I also see info from Dr. Bernstein, and he is a proponent of very low carb eating. My daily carb intake is usually under 30 grams. I also wonder whether the greatest benefit is for people who already have decent glucose control, or those who are outside the recommended control parameters.

I will be seeing my Primary doctor next month and I'm compiling some of the things I'd like tested (thyroid function and testosterone) or things I'd like to experiment with. I think I may want to try Humalog because it seems to be more potent and faster acting than Novolog. When you use an insulin pump, you can slow down the deployment as much as you want, but there's nothing you can do to speed it up. I find that many times I'd like a faster action. Not more insulin, just a quicker response. You know, like actual human insulin.

Symilin might be interesting to try too. I like the idea of reducing the amount of glucose secreted by the liver. I feel like my post meal rises in blood sugar might be largely related to a glucose/glucagon release by the the liver. I would only try this while using a pump and CGMS. I think it might get tedious, but seeing what's going on all the time might help work out the proper timing and size of insulin doses with Symilin.

One other "benefit" of Symilin is that is creates a feeling of satiety that diabetics are sometimes lacking because of the missing hormone, Amylin (also made by the pancreas). In other words, you might feel full sooner when eating with Symilin in your system. Some people lose weight while using it. This is might be because of the lowered insulin, raised satiety, or maybe even nausea. Yes, early on, for some users, the "satiety" comes across as nausea.

I do notice that by dinner I get a bit ravenous and eat enough that I'm uncomfortable for the rest of the evening. What can I say? I love dinner at home. Most days I only have trouble with blood sugars after dinner, and sometimes they are out of range all night while I sleep. Some of that effect could be from over-filling my stomach and causing the "Chinese dinner effect" (as coined by Dr. Bernstein) and a release of glucagon from the liver.  If Symilin can help with that, one way or the other, I'd be happy.


  1. Humalog is slower than Novolog, if anything, and in very large trials, Novolog users have very slightly lower A1cs compared to Humalog users, who have the same A1cs as Regular users. Of course, the way they work for particular individuals may be significantly different so it's still possible that Humalog would be faster for you.

    Maybe you meant Apidra? Apidra is generally ranked as the fastest of the insulins for sale in the US (technosphere insulin is supposed to be faster but it's still in trials).

    I recently was considering symlin but reading the literature on it convinced me otherwise. Nausea? Weight loss? No thanks. I'm not convinced that satiety is what's coming accross as nausea.

    I initially tried Regular as an adjunct to Novolog with my dinner to combat evening highs, although it didn't really work, because as it turns out Regular doesn't last longer than Novolog for me.

    Glucagon causes release of glycogen from the liver, btw- glucagon is made in the pancreas.

    1. Jonah, I was basing my choices of insulin on Dr. Berstein's descriptions of the insulins, which are from his empirical studies, not the manufacturer's data. He says Humalog is the fastest and most potent insulin, and for him and his patients Apidra seems to be about the same as Novolog. I don't know, I'd be willing to try both Humalog and Apidra and see which seems to work the best for me. Maybe just changing my insulin will result in some biological variable that works better.

      You are right. On the glucagon, I was simplifying the process. The literature that describes Symilin never mentions glucagon, but only glucose and the liver... so I added the glucagon release to the mix because of Bernsteins theory about the full stomach triggering a glucagon release (from the pancreas).

  2. As far as I'm concerned, this is the most convincing article on Humalog out there:

    1. I read a bunch about Humalog and Novolog comparisons, and the thing that helped me decide against Humalog was the amount of people who had trouble with clogs in their pumps. I've not had any issues with that, and I don't want to add that into the mix.

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