Symilin: Ale, Potatoes & Pie Experiment

My wife makes beautiful, tasty pies. I love them.

I have had pretty good results calculating my meal boluses with Symilin and avoiding hypos. In fact, I've been rather cautious to a fault and have had some high post meal sugars (but, no lows). I couldn't help but wonder if it might be possible to retain better control when eating a high carb meal if the Symilin slows down digestion. For my birthday dinner I decided to give it a try.

For celebration/experimentation carbs: I had a beer and ate two crispy, roasted, smashed potatoes (awesome!) with dinner, and then for dessert I had a small slice of strawberry-rhubarb galette with vanilla ice cream. All in the name of medical experiments, right?

Admittedly, being a low-carb eater for so long has made me pretty poor at estimating the potency of fast acting carbs, AND I've become more sensitive to them. All that said, I calculated my carb count at about 60 grams, minus 25% for Symilin factor, super conservatively... 45 grams. I bolused for it on the 2 hour square bolus. I was heading to a symphony concert and would rather run high and need a correction, than have a persistent hypo that is difficult to correct while in public.

Well, any worry I had was unfounded... before the concert had even started my glucose was climbing at a rapid rate. I hit 350 mg/dl before all was said and done. However, before I chose to correct, my square bolus insulin was already turning things around, but it was way too late... The amount left "on board" wasn't enough to really finish the job... My corrections ended up being equal to my original bolus I had taken with my meal. I probably could have bolused right after the meal ended with a normal, "fast" bolus.

So, for me, Symilin didn't really allow me to get away with anything new, that day. I would have to practice the timing over and over, to get it right. It's just like any other insulin/food regimen, I guess.

I don't plan on adjusting the way I eat. I already get pretty slow rises from my meals, and Symilin causes them to be even slower. Not a big deal... I consider my real benefit from Symilin to be the reduction in glucagon activity while eating. It allows me to have lower and more effective insulin dosing at mealtimes.

At almost 3 weeks, I'm getting a feel for how things work in my system. I'm starting to be confident with bolus timing and amounts, and I'm getting flatter graphs after meals. I'm starting to believe that the risk of hypos is pretty slim with small 60-90 minute boluses.  I think if I were eating a higher carb diet I would have a more difficult dynamics to sort out, because the variables would be larger and more extreme. But, a lot of that has to do with what I'm already used to.