Sunday, April 22, 2012

Trying Symilin (Part 1)

Yesterday I picked up my Symilin pens and started using it.
Here are a few facts, since I can only minimally report actual results... I'm still on the ramp-up dose.

I received 4 pens that are usable for up to a month each. Depending on the dosage, this set will last me for 2-4 months.  They cost $1159, and my co-pay after insurance was $50. So, it looks like it will cost me about $10/month, and my insurance is paying... A LOT. I don't know what my final dosage will be, I'm guessing I'll go through about a pen a month. This comes out to $279/month. When you add to that my pump supplies and sensors, it's a very expensive monthly routine. Shockingly so... If I didn't have insurance, I wouldn't entertain this experiment at all. So, out of respect for that expenditure, I'm planning to follow through with the trial to see what it has for me.

I guess the million dollar question is whether it will create significant improvements to my blood sugar control, and quality of life.

I will predict some pros and cons to using it.

Potential Pros: 
  • Stopping after meal rises from glucagon
  • Slowing down how meals hit my system so that corrections can be more effective
  • Using less insulin
  • Getting something closer to a normal metabolism
Potential Cons:
  • Taking injections and carrying a pen around again
  • Running higher blood sugars because I have a new variable that makes me nervous about hypos
  • Hypos
  • Another variable
  • One more level of translation: translating protein into equivalent carbs, cutting it roughly in 1/2,  assigning an extended bolus, for a meal which is slowed down by Symilin (kind of complicated, lots of places to miss something). 
The doses:
Since yesterday I have used Symilin three times at the lowest dose, 15 micrograms. I understand it is equivalent to about 2.5 units (although I've also seen it converted into 1.5 units). Because I'm using it directly from a pen with set dosages, it really doesn't matter, it's just a clearly different measurement system. For some diabetics the higher number sounds kind of alarming because it sounds like you are injecting a large amount of material, but you aren't. If I get to the maximum dose for my pen (60 mcg) I'll only be taking 10 units.

Each time, I did notice a sense of satiety post meal, which stayed with me for a long time. I gave my insulin bolus at 50% and spread it across 2 hours. During that time, there was no rise, but later on I did see a subtle rise in the 3-4 hour window. I may need to give the bolus over a broader window of time.

Caveat: It's hard to be absolutely sure what's doing what, because I'm out of my insulin mimetic, Alpha Lipoic Acid Sustained Release, so I'm off my normal routine. I have upped my basal by 30% to compensate for it, but the results are a little squirrelly. It's hard for me to tell if my overnight rise is a really delayed meal rise or just my basal being insufficient. When my next shipment of ALA comes in I'll be able to do these tests on a more comfortable playing field. The thought just crossed my mind, that perhaps it would make sense to phase out my use of ALA. The expense of the supplement is about $1/day.

Conclusions from my 3 small doses of Symilin: 
  • It seems to hold off digestion for a while. 
  • It did not cause nausea for me. 
  • I didn't see the typical glucagon rise that I usually get after a protein/fat meal. 
  • I was gun-shy on meal boluses (3 units for the day), but made up for it in corrections (4 corrections totaling 6 units). My bolus insulin for the day ended up about the same as usual.
Next, I'll move up my dose every three days, unless there is nausea.


  1. Whoa, that's expensive.
    From what I've read Symlin comes in different concentrations.
    I'm assuming that by a "unit" you mean a hundredth of an mL (an mL = a CC) but a unit of insulin isn't really determined by volume either - it's just that almost all insulin sold for human use in the US is sold at the same concentration right now, 100 units to the milliliter.
    You can get insulin that's more or less concentrated, although in the US the only way to get more dilute insulin is to either dilute it (although last I checked the dilutant being sold was only compatible with a small number of insulins) or buy vetsulin, and the only more concentrated insulin is Humulin R 500. But internationally and historically, U 10, U 20, U 30, U 40, U 50, U 80, U 100, U 120, U 400, and U 500 have all been available. The U number means how many units are in 100 mL. A unit is defined as a certain amount of crystaline insulin.

  2. I've only seen Symilin come in 60 mcg and 120 mcg pens. It is no longer sold in vials.

    The intention was that Type 1s would use the lower maximum dose, and the Type 2s would use the 120 mcg pen. However, there are Type 1s trying higher doses too. If I felt the need to go higher, I'd just take more than one injection. I've heard it can sting when injected at larger doses, so there might be an advantage to doing it in one go.

  3. I will be really interested to hear how it works for you. Glad you've been able to evade any nausea so far!

  4. This comment has been removed by a blog administrator.