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Pramlintide (trade name --- Symlin)

J

jimmax

Well-Known Member
Messages
49
Type of diabetes
Type 1
Treatment type
Insulin
I'd like to make contact with anyone with T1D who has been treated with Pramlintide in any form. It can be prescribed to T1 and T2 diabetics on insulin in the US by a doctor but not here in NZ. I don't know if it's available in the UK. It claims to allow a reduction in insulin requirement by reducing the sugar spike after meals.
 
Symlin has been around for a while. Initial excitement was followed by mixed reviews. It reduces insulin requirement and post-meal blood glucose spikes by inhibiting supply of liver glucose. Helps with weight loss too. But there are also side effects, with a lot of people getting nausea. Apparently a Kiwi was involved in development of Symlin, but it isn't funded here because of cost.
 
Hi. I hadn't heard of this injectable and have just Google'd it. I wonder what the real advantage of it is? Why not just inject more insulin rather than have two different injectables? It's not for me to query it's use of course and there may be a good medical reason I'm not aware of.
 
Daibell said:
... Why not just inject more insulin rather than have two different injectables? ...
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The issue there is that some of the insulin injected has to cover glucose mobilised by the liver when we eat. Glucagon is secreted, which converts liver glycogen to glucose. In addition to causing post-meal spikes, it means injecting more insulin and this can cause weight gain. Symlin inhibits this liver glucose supply and is particularly useful for people trying to lose weight. Insulin dosage reductions of up to 30% have been reported.
 
MarkMunday said:
The issue there is that some of the insulin injected has to cover glucose mobilised by the liver when we eat. Glucagon is secreted, which converts liver glycogen to glucose. In addition to causing post-meal spikes, it means injecting more insulin and this can cause weight gain. Symlin inhibits this liver glucose supply and is particularly useful for people trying to lose weight. Insulin dosage reductions of up to 30% have been reported.
Click to expand...
Hi. I don't think I agree with some of your post. Insulin itself does not cause weight gain. It enables the body to metabolise all the carbs you throw at it and if that's too many you will gain weight. I guess there may be unusual situations where the body's metabolism is not typical and needs this approach. I gain weight easily if I have too many carbs so I limit myself to around 150gm/day max with insulin to match and maintain a stable weight. If I wanted to lose weight I would just further reduce the carbs (and insulin)
 
Daibell said:
.... Insulin itself does not cause weight gain. It enables the body to metabolise all the carbs you throw at it ....
Click to expand...
Yes, it does, and any carbohydrate that is not immediately used for energy gets pushed into cells where it is converted into fat. This why insulin is known as the anabolic hormone. It facilitates the building of both muscle and fat, both of which show up on the scale.

Insulin messaging is also important. The presence of insulin switches fat burning off and fat storage on. This is especially an issue for people with insulin resistance. They have high insulin levels all the time and have great difficulty losing weight. Insulin tells the body to stop using fat because glucose is available. For people with insulin resistance, this may not be true. Symlin can be useful for them. Weight loss is a key benefit.
 
They have it here in the UK but it is rarely prescribed because of the side effects as mentioned above and the fact that you have to calculate your dose. Every time you eat you would have to calculate both insulin and amylin but also worry about how they would interact with each other as amylin reduces insulin need. Amylin is what your body produces but symlin is the analogue version of amylin.

I was looking at why they don’t make an insulin/amylin mix to better mimic the role of the pancreas but apparently they are stable at different pH so at the moment we just have to overload ourselves with insulin.
 
Thanks TypeZero for the extra information regarding Amylin. I'm intrigued by your name. Do you have long periods requiring zero basal insulin like I do?
 
There are plenty of threads on-forum of T1s also using Metformin too. These days, it doesn't seem uncommon, in my observation.
 
TypeZero. said:
Would this not in theory increase your risk of hypoglycaemia greatly?
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No it only very marginally increases that risk if you also have other tablets. It does not affect insulin output from the pancreas; only the liver and that is background output reduction. I'm one of the many who have Metformin with insulin. My DN suggested I stayed with it as it has other apparent benefits e.g. some cancer risk reduction. I did halve the dose. It reduces my BS by around 1 mmol.
 
Daibell said:
No it only very marginally increases that risk if you also have other tablets. It does not affect insulin output from the pancreas; only the liver and that is background output reduction. I'm one of the many who have Metformin with insulin. My DN suggested I stayed with it as it has other apparent benefits e.g. some cancer risk reduction. I did halve the dose. It reduces my BS by around 1 mmol.
Click to expand...

Wow that’s interesting. I’m newly diagnosed so my medical team are a bit nervous to change anything yet but I will have to do my research as it may be something I can benefit from.

If my basal needs are reduced then the risk of hypoglycaemia would reduce as you would have less background insulin in your body so anything like exercise would be less likely to cause hypoglycaemia
 
TypeZero. said:
... If my basal needs are reduced then the risk of hypoglycaemia would reduce as you would have less background insulin in your body so anything like exercise would be less likely to cause hypoglycaemia
Click to expand...
Yes, I am interested in T1 experience with metformin because it seems like a no-brainer for T1s to me. T1s make too much glucagon because insulin is injected under the skin and doesn't come from the pancreas. In non-diabetics, the liver stops supplying glucose when it sees insulin, which comes through the portal vein from the pancreas next to it. T1 livers never get that message. So something that inhibits liver glucose would seem to make sense. But Metformin is not considered as T1 treatment for some reason. I tried it a while back and it seemed to reduce blood glucose. But the effect also seemed to be inconsistent, so I stopped it. I was eating high-carb back then. I want to try it again now that my control is much better.
 
TypeZero. said:
Wow that’s interesting. I’m newly diagnosed so my medical team are a bit nervous to change anything yet but I will have to do my research as it may be something I can benefit from.

If my basal needs are reduced then the risk of hypoglycaemia would reduce as you would have less background insulin in your body so anything like exercise would be less likely to cause hypoglycaemia
Click to expand...

Hi TZ.

OK? Your in a situation newly diagnosed, & in the "honeymoon" with a semi active pancreas doing the "dying swan."
With exogenous insulin on board picking up the slack. (Let's put bolus aside for a moment.)
You're contemplating adding a drug which potentially increases insulin sensitivity & retards liver dump.
Lantus can be pretty unstable at the best of times in my experience...

MarkMunday said:
Yes, I am interested in T1 experience with metformin because it seems like a no-brainer for T1s to me. T1s make too much glucagon because insulin is injected under the skin and doesn't come from the pancreas. In non-diabetics, the liver stops supplying glucose when it sees insulin, which comes through the portal vein from the pancreas next to it. T1 livers never get that message. So something that inhibits liver glucose would seem to make sense. But Metformin is not considered as T1 treatment for some reason. I tried it a while back and it seemed to reduce blood glucose. But the effect also seemed to be inconsistent, so I stopped it. I was eating high-carb back then. I want to try it again now that my control is much better.
Click to expand...

Mark, a revised insulin delivery system putting it right into that upper intestine location area where the pancreas sits, could be a more viable option? (In therory.) How.? I'm stumped.

The OP is looking for T1s experience of the drug "Pramlintide."

Can we please keep the subject matter within the confines of those with this personal experience. Or pointing in the specific direction of..

Thanx..
 
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