Handling lows caused by Symlin
I've been using Symlin since late 2006 to reduce the blood glucose peaks that I get after eating.Symlin works by slowing down food processing so that your sugar levels rise more slowly after you've eaten. Typically you need to reduce your insulin dosage and, if you're using an insulin pump, take the bolus over an extended duration so that you don't have a low. It takes time to get used to Symlin and figure out how much Symlin to take and how to properly take whatever insulin you need to cover the meal.
When I started using Symlin I had a lot more lows. They were hard to fix because the Symlin slowed down the absorption of the juice or Gatorade that I took to get my blood glucose levels up.
I finally figured out this tip for fixing low blood sugars that are caused by Symlin. I chew one dex tablet at a time, holding the chewed up mess in my mouth for as long as I can. That way some of the dextrose is absorbed through my mouth What does get into my stomach is easier for my digestive system to work on. After 2-3 tablets I wait for 15 minutes and see how things are going.
This works much better than drinking a lot of juice and then having to deal with the super highs later. The juice absorption is slowed enough by the Symlin that it takes more time than usual to work.
If you're using a pump, don't forget to cancel any bolus in progress otherwise you may have a recurring low shortly after fixing the first one.
posted by Bernard @ 5:10 PM
7 Comments:
Bernard - so smart! I think it sounds really spooky not being able to fix a hypo quickly! So you are brave too! Bernard, my dam insulin needs have bounced up AGAIN! I cannot believe it! Yes I can - duh. I have changed my cartridge and it now containes insulin that cannot possibly be the same as I have been using before. Unfortunately, I do not think this is going to solve my problems. I think the root of my problems is hidden somewhere in the chemistry of my body. Boy, Lili's post really opened my eyes. Can't we even strust the insulin. I don't think I can deal with another possible culprit. I WANT to believe in the insulin..... I have been known to try different bottles of sugared coke, maybe they were misslabeled, when my hypos cannot be fixed. And Per wonders why I trust NO ONE or anything.....
Yup, yup, yup. When I was first taking Symlin and would go low I would drink some juice, wait 15 minutes, test again, still be low, take some more juice... and repeat. I usually had to dose 2-3 times before I felt safe to drive, as the lows always happened right when I was supposed to be driving off to work. Glucose tablets only need 1-2 doses with me. I haven't tried cancelling the bolus with the pump (Until two months ago I was messing around with Novolog and Regular), mostly because I haven't had a really bad low since starting.
I mentioned the hard to recover from lows to my CDE and she said "Really, I never heard that, but I guess that would make sense!" She gave me some of the gel to try, as it is supposed to absorb through your mouth more. I haven't had a chance to try it yet.
I've tried similar tactics with sports gels but it didn't work. I don't think I kept it in my mouth long enough. Plus, they probably don't have the right type of sugar.
I just started using Symlin again since my ironman training is over. So far, my BGs seem to have improved, and I haven't had those nasty lows yet. I expect that I will at some point, though. So thanks for a good suggestion.
Liquids, such as orange juice, will bypass the symlin action and correct a low quickly. Melting a glucose tablet in the mouth as Bernard suggests also work.
I have not tried the gel.
Thank you so much for the suggestions! I started on symlin and would drop quickly to extreme lows (23-37). With my emergency kit in hand, I would drink approx. 1/2 gallon of juice praying. I fortunately did not pass out in my first 3 weeks of trying symlin but, I am scared to give it another try. My endo suggested lowering my basals and if needed, trying to hold the sport gel in my mouth.
Can you please suggest a min. level to be at before injecting symlin? My thought is around 115. I wait until my cgm gives me the ok to bolus (I see a slight increase approx. 2 hrs. post symlin injection and then it really shoots up). I also started using the combo bolus. Do you have any suggestions on what ratio and for how long I should try? I am using 40/60 for 1 1/2 hrs. if I wait 2 hours to bolus. My thought is that if I bolus at approx 1 hr. after symlin injection and lower the setting to 25/75 for 2 hrs I might get less extremes at the 3 hrs. mark.
If I am at approx 115-130 and inject symlin, get the feeling not to eat, monitor my BS with my cgm , do not see much of a change in my BS, can I just not eat/not bolus? At the 3-4 hrs. mark would I do this again, inject symlin and bolus per my plan, or eat less than 250 cal/30 g carbs? My endo suggested experimenting. Will a constant amount of symlin be helpful even if I am not eating and bolusing?
What if I have a high pre-symlin injection? Do I treat the high and wait approx 2 hrs before injecting symlin? Or, do I still inject symlin and then correct at my 50% reduced dose?
I am sorry for so many questions. However, I am new to symlin and want to give it another try without my fright of extreme lows. I appreciate your expertise and would be grateful for any additional advice and/or tips.
I know there will be other lows and am looking forward how your new approach to treating them will help.
Do any of you other symlin users have any input on how this has worked for you?
I plan to start using symlin again tomorrow.
Thanks so much. I want the best control as possible but, need as much help as possible with this "tool"!
Anonymous
I don't think this will answer all your questions, but I put a long blog post up about Symlin. I hope it helps you some.
My advice is to start slowly and take it very carefully. And definitely monitor your blood sugars carefully until you get used to it.
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