I recently worked with a young woman with Type 2 diabetes who had started on Symlin (pramlintide) in the past month. I was really interested in what she had to say because this is a new medication, and I hadn't heard much feedback from the patient's perspective.
Symlin is an injectable medication to be taken before each meal by people with type 1 or type 2 diabetes who are on multiple daily injections of insulin. Symlin slows down the movement of food through your stomach, which helps control blood sugar levels.
The biggest issue my client had after starting Symlin was low blood glucose levels after meals. Symlin by itself doesn't cause hypoglycemia. What she found most challenging, however, was figuring out how much rapid-acting insulin to take before each meal.
The general recommendation is to take half your regular bolus of insulin, but this wasn't working for her. Another option is to take Symlin before the meal, then take your bolus of insulin after the meal based on how much was eaten. If you're thinking about starting Symlin, make sure that treating low blood sugar is part of your game plan.
My client also told me that starting Symlin led her to change many foods she was used to eating. She had purchased mainly low-carb products. But, you need to eat at least 30 grams of carbohydrates at a meal when taking Symlin.
She found this tough to do with low-carb products because she felt full more quickly (Symlin slows down digestion, causing an earlier feeling of fullness called satiety). Now that she was eating less, she started purchasing regular food products again.
Here are a few general pointers about Symlin:
- Even though Symlin is used before each meal, when you're first starting out, try taking it before just one or two meals each day at first to determine your tolerance and to help control possible hypoglycemia.
- Always carry something to treat hypoglycemia such as glucose tablets or 5-6 pieces of hard sugared candy.
- Plan on starting your meal within 10 minutes after taking Symlin to decrease the possibility of nausea.
- Don't plan meals with just low-carb foods. Eat your carbs first just to make sure you do consume those 30 grams of carb.
- Stay in close contact with your diabetes doctor because you'll likely need to make adjustments to your insulin after starting Symlin.
