I have a question for the all-knowing blogosphere.

Symlin/Amylin. (no, that’s not the question. Be patient…I’ll get to it…)

Symlin is the brand name of the man-made drug now available that resembles amylin. Amylin is a natural hormone that is created by the pancreas and released into the blood after meals. It’s job is to slow the rate at which food is digested and absorbed, to reduce the production of glucose by the liver, and also to reduce appetite. Many of us have heard about it, and know people using it.

I know that I probably would benefit from symlin, and will give it a shot (ha!) soon. I have pretty dramatic post meal BG spikes, but then come back down to target within a few hours. I can’t add more insulin because I would be dropping too low shortly after. I think I could do better by making smarter food choices (lower GI items), bolusing 15-20 minutes before eating (I try, but it’s pretty damn hard most of the time), and by limiting the amount of carbs I eat in a meal. I have also tried John Walsh’s “Super Bolus” with promising results, but it’s a complicated bolus and takes a little bit longer to program.

That list of stuff exhausts me just thinking about it. So, I’ll try symlin and see how that goes. I’m waiting for it to come out in pen form (recently FDA approved) and to get on a CGM. Both are (relatively) right around the corner.

My question is this; We know that amylin/symlin slows the digestion of food (therefore slowing the rise in BG). We know that people without diabetes naturally produce amylin. I know that I don’t produce amylin. Does that mean that my food digests (and raises my BG) faster than a person without diabetes (because they produce amylin)?

Shit. That hardly seems fair. I’m already pancreatically challenged, and the timing of today’s insulins are not fast enough as it is. Don’t tell me my food is raising my blood sugar even faster than the next guy and his perfectly working pancreas!

If my carbs are like Road Runner then I’m like Wile E. Coyote getting all effed up trying to chase them down (using all sorts of questionable contraptions).

I hope that C-Peptide (another hormone produced by the pancreas that is not in the man-made insulin I use) doesn’t do anything terribly important!

Maybe it is responsible for boosting IQ. That would explain a lot

 
  • Allison

    Scott,

    I am going to send this to my uncle. He works for Amylin. I will let you know when I hear back from him.

    -Allison

  • in search of balance

    You may be right about the C-peptide IQ thing. That would certainly explain my day.

  • Sara

    gosh – I hope not!

    real helpful right? :D

  • travis

    Unfortunately I don’t have an answer to your question. But my question–in addition to yours–is: Does Symlin really reduce our appetite? Does that mean type 1s don’t feel full the way ‘normal’ people do, and will just eat and eat and eat without filling up? That’s how I usually feel. Now THAT isn’t fair.

  • George

    I am going to watch these comments for an answer. I was thinking about trying Symlin but I dunno.

  • Heidi

    Hi Scott,

    I don’t know about the Symlin question, but as for the C-peptide question, I may have some answers/information for you.

    Insulin is produced as a prohormone. The prohormone is not functional and such it is a practical way to “stock” hormones for a quick activation when needed. To activate insulin, the prohormone is cleaved by proteases, removing part of the protein. The part that is removed from pro-insulin to make insulin is C-peptide, where C could be for “connecting peptide”, or just a continuation of the terminology of insulin consisting of an A and a B chain of amino acids….. I don’t know, and that is really not important either, is it? :-)

    When it comes to the functions of C-peptide, it does have some that can only make diabetics envy even more those people with fully functioning pancreases (you’ll know what I mean when you read on).

    C-peptide is involved in repair of damages to the muscular layers of arteries, it may be involved in the regulation of blood flow through the heart, and seems to prevent diabetic nephropathy. With these effects one can only wonder why C-peptide is not a part of the treatment for diabetes…..

    You can find more information about it amd links to other sites describing this on Wikipedia (http://en.wikipedia.org/wiki/C-peptide) – I still haven’t learned how to include hyperlinks in comments so you will have to copy-paste the address :-)

  • Kathleen Weaver

    To start with, I’m a Type 2.

    But my biggest problem when I started taking insulin was that I was hungry all the time. Never felt full.

    Symlin hasn’t completely fixed that, but it’s helped a lot. So you are probably right about the food digesting thing.

    I agree that you should wait for pen form, the vial and needle is a pain. In fact, I’m not refilling until new form comes out. I may have to buy needles, and if I run out, I’ll beg endo for vials.

    I posted a lot about Symlin when I first got on it, and have a separate archive category. but remember, I’m a Type 2 on it, and YMMV.

  • Kendra

    Travis – I’ll take a stab and say that yes, amylin has a role in appetite. I noticed almost immediately after my Type I diagnosis that I could wolf down as much food as my teenage brother – and actually eat him the under table. And STILL be hungry an hour later.

    I still feel that way, but I’ve learned to recognize the overeating and deal with it. It’s a bummer.

  • Scott K. Johnson

    Wow – these are some FANTASTIC comments! Thank you!

  • Allison

    Scott,

    I wrote to my uncle and copied this quest: “Does that mean that my food digests (and raises my BG) faster than a person without diabetes (because they produce amylin)?”

    My uncle wrote back: “Basically, your colleague is correct. However, there are a lot of redundant mechanisms controlling gastric emptying and GI transit time, so it is subtle.”

    –Allison

  • Scott

    Regarding C-Peptide, the reality is that we have only begun to discover its utility in human physiology, so it could have an impact on glycemic control, but no studies have yet proven that. What we do know about C-Peptide, however, is that it keeps the blood vessels more pliable, thus playing a critical role in preventing cardiovascular disease. We also know that a lack of C-Peptide has an impact on keeping the nerves healthy, meaning that a lack of C-Peptide contributes to neuropathy.

    My personal belief is that there is no element of the human body that is “useless”, we may not know what these things do, but they all serve some function. Just recently, U.K. learned that the appendix served to sort of “reboot” the digestive system (less of an issue in today’s modern society where cleanliness means we encounter fewer bacteria, but it served a vital purpose at one time). Today, there is news that German scientists have discovered that small RNA molecules that were previously regarded as “junk” by the medical establishment without special function actually help regulate important cellular processes.

    The only thing we know is that we have much more to discover.

  • Jan Chait

    I use both Symlin and a CGMS, so I can visibly see the results. I blogged about the pros and cons of Symlin once and it’s probably easiest (for me) to just point you to http://tinyurl.com/3bl5mb. The differences between eating an using Symlin (or not) were amazing. Pens should be out next month. I can’t wait!

    JanC
    http://www.diabetesselfmanagement.com/blog/Jan_Chait/

  • Amylia

    Great comments. I don’t have anything to add other than I have noticed that I seem to digest my food fast. None of my friends believe that it’s possible, but I think so.

    thanks for the visit to my blog, btw. I wondered what happened to you! My updates don’t show on Diabetes Daily, even though I’m a member b/c it says there is some error on my blog and it won’t authenticate it. I don’t know how to fix it. Grrr…

    Glad all seems well in your world!

  • Bad Decision Maker

    hey Scott,
    My understanding is what Allison (her uncle) said – yes, our food digests faster and raises our blood sugar faster than someone without diabetes, even if you fix the insulin difference. That explains so much – I never got why even when I give my humalog far ahead of time (which non-diabetics aren’t doing) and start low/normal, I still get spikes that are way outside of what non-diabetics have.

    When I first read articles explaining amylin, I was surprised and annoyed it hadn’t come up more earlier. They missed a whole freaking hormone?!?! My bitter self thought, maybe if they weren’t so focused on a complete miraculous cure, they would have found out this helpful info for us folks living with diabetes now.

    My take on it is that it’s probably pretty important, but I also would not underestimate the role of pharmaceutical companies and $$ in hyping the importance. They are so powerful and underwrite a lot of the education even doctors get (and articles in medical journals, and studies the FDA uses). So the fact that there is now a shiny new profitable drug, Symlin, might be making it into a bigger/better deal than it is.

    That said, I am thinking about starting it. My post-meal blood sugars have been insanely high lately if I eat anything besides greens and meat/cheese.

    I had no idea about C-peptide being useful, I was about to comment that it’s just a byproduct used as a marker. Thanks Heidi & other-Scott for that new info!

  • Jim

    Now you got me thinking about Amlym. But as far as the C-peptide, well everyone knows that controls your Mojo. Are you having problems with your Mojo? :-)

  • Andrea

    I completely agree about being angry that the pharma industry went so long without discovering/producing another ENTIRE HORMONE made by the pancreas. I mean, if we all know that the Type 1′s pancreas is useless, why wouldn’t they have looked sooner to see if it is producing anything else that diabetics might find useful?

    It’s tempting to think that now that it has been produced that big pharma might try to over-emphasize its importance, as someone here said, but I have to disagree based on my own experience.

    I feel like I have been given A MISSING PIECE since I started injecting Symlin 4 years ago (I got in at the end of the clinical trials). I lost 25 lbs in those first 3 years, with way less exercise than the 45 min/5days/week I had done all those years pre-Symlin in a futile attempt to battle my weight. It’s not all about the weight — I don’t want to portray it as a weight-loss drug, but the fact was that I was barely trying and I felt totally ‘normal’ after meals. No more wondering if I was really full and feeling a need to eat more just to make sure. Finally, I am at a normal weight and my gain/loss has to do with what I am actually doing or not doing — punishment for eating poorly and not exercising, and reward for eating healthy and going to the gym. It’s an amazing feeling.

    I know it’s 3 shots a day, but it just went back to being a part of my normal routine. This disease sucks, right? So I trade the suckiness of going back to shots while feeling way more normal after eating.

    I guess I had a lot to say this afternoon! Hope it helps.

  • Bernard

    Scott

    That’s something I forgot to mention in my recent post about Symlin.

    Once I got a little used to Symlin (so less nausea) I noticed that it made me feel full for the first time in I don’t know how long. That’s a big blessing.

  • Fda Pharmaceutical

    Useful post! Thanks a lot.

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