Much has been written about insulin, but there is another important hormone secreted from the beta cells of the pancreas that is also important in the regulation of blood sugars. That hormone is called Amylin.
Amylin works synergistically with insulin. This relationship is very important when it comes to mealtime. As people with diabetes know, control of blood sugars is a balancing act, and post-meal blood glucose spikes can cause A1C’s to jump, sometimes unexpectedly.
Just to review the roles: Insulin helps glucose get into the cells to use for energy, and insulin unlocks the cell door. Amylin “helps” insulin work more efficiently by slowing digestion, blocking glucagon secretion and keeping hunger at bay. This can blunt post-meal blood glucose spikes.
A synthetic equivalent to amylin is Symlin® (pramlinitide). It works well to help control mealtime spikes in many patients. It is approved for use in both type 1 and type 2 patients with diabetes who have not achieved optimal blood glucose control with insulin or current medications and have difficulty with mealtime control especially. It is not for any and all patients, and as with all medications there are warnings and precautions.
Symlin is given only by injection, so it may be a drawback for some who want to avoid extra injections. Given the way Symlin works to slow gastric emptying and control hunger, the risk exists for hypoglycemia and needs to be discussed before you start this drug. This means closely monitoring blood sugars pre- and post- meal possibly to help avoid sudden bouts of hypoglycemia. Treating hypoglycemia can also pose a challenge because Symlin blocks glucagon production. Because Symlin affects gastric emptying, patients who have pre-existing gastroparesis would not be candidates for this drug.
Symlin is not recommended if a patient has an A1C over nine. As I have discussed in previous articles, an A1C over nine most often points to a higher fasting blood glucose. Symlin is used to help control mealtime blood glucose excursions. Once you begin taking Symlin, keep in mind that insulin doses will generally have to be decreased as well as oral medications in the case of type 2 patients. Mealtime insulin can decrease by 10-20 percent, although this will vary patient to patient.
Because Symlin is acidic, it may sting upon injection and cannot be mixed with insulin in the same syringe. It may also cause some nausea when you start taking it. Some patients find this goes away after being on the drug for a while.
If your doctor prescribes Symlin, just be patient as some adjustments are needed to get to the correct dose. Make sure you test blood glucose pre- and post- meal as instructed. Not all medications work the same in everyone, but there are many options and more to come in the world of diabetes treatment. The company that makes Symlin has a free patient support line by phone and email where you can talk with a health care professional to answer any questions you may have. To enroll, call 1-8888-796-5461.
Stay informed and healthy!