Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.

Insulin isn’t always enough.

Granted, fast-acting insulins have made improvements on their response time to carbs consumed, but they still haven’t met their pharmaceutical match. For the past decade, amylin replacements have been making their way into the diabetes management mix.

What is amylin?

Amylin is secreted alongside insulin by beta cells in the pancreas; this hormone’s functionality, as expected, isn’t working as designed in those living with diabetes.

Amylin naturally has a three-pronged approach to the management of food and appetite in the body: “It inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent,” according to Diabetes Journals. Essentially, amylin decreases blood sugar, slows down digestion and increases fullness.

Amylin enhances insulin’s response, allowing it to do its job more effectively. It’s available in a synthetic medication called Symlin (Pramlintide).

Symlin certainly isn’t a substitute for insulin, but it does give insulin a boost in the body. Along with other select drugs, Symlin can be used for people with both type 1 and type 2 diabetes; with type 1 diabetes there’s no amylin production, and with type 2 diabetes its production is reduced by differing degrees.

How does it work?

Symlin can be a fantastic tool to stimulate weight loss. Diatribe reports that “users of Symlin lose an average of 6.6 pounds over the first six months of use.” With the addition of this missing hormone, appetite has a chance to become better balanced once again.

Gary Scheiner MS, CDE, discovered that patients using Symlin at meal times may have significantly affected blood glucose levels. It may take some finagling to get the dose right. Scheiner explains that “unlike insulin, which works in proportion to the amount given, Symlin is more like an ‘on/off’ switch. The dose either works, or it doesn’t.”

Why aren’t more people using Symlin?

There are a number of reasons why providers may not be prescribing this medication starting with insurance coverage. Prior to beginning taking this drug, be sure it’s covered under your pharmacy benefits.

There is a transition period involved in getting Symlin dialed in; this can be frustrating for both providers and patients—but once it is, the benefits can be outstanding. There’s also side effects of the drug to consider, as well as the extra injections.

Patient tips

Some of the most bothersome complaints with Symlin are nausea, vomiting, headache, and low blood sugar. In order to minimize these side effects, healthcare providers tend to start Symlin dosing conservatively, allowing the body time to adjust to the new medication.

• Symlin is an injectable medication; it’s available in pens and vials.

• This medication is given just prior to eating up to three times a day. Providers may start with once a day dosing to ease patients into it.

• When starting this medication, it’s important to clarify with your provider if you should lower oral or injectable diabetes medications to help prevent low blood sugars.

• Symlin cannot be mixed in the same syringe with insulin, both medications can be taken at the same time, but injected in different areas.

• Some patients inject Symlin prior to eating and insulin after; be sure to know when your provider would like you to take your prescribed medications.

• Contact your healthcare provider if you are experiencing side effects from Symlin; she can help you troubleshoot the problems at hand and make your experience the most successful possible.

• Keeping your lifestyle in mind is vital; exercise, slow-digesting foods and your pre-meals blood sugars may affect your diabetes management approach.

To learn more about amylin and diabetes:

Symlin: Insulin’s Partner in Diabetes Control
Pros and Cons of Symlin, an Insulin Supplement
Beyond Insulin: Other Injectable Medicines to Treat Diabetes