Since I last posted the saga of the morning blood sugar numbers has continued. My CDE/pump trainer and I continue to tweak all aspects of my pump routine, but those post-prandial bg’s remain Public Enemy #1. I tried going off the Symlin for awhile and doing straight boluses. I still went high. I am not saying that perhaps I might not have been able to work it out. I didn’t change my insulin dose, for instance, and I assume that would need some more insulin without the Symlin. I might have continued to work things out, except for two problems: 1) I am pretty sure that I needed to wait 20 minutes after bolusing to eat to avoid peaking, but that doesn’t work with my autopilot routine and the bathroom usage schedule we have going on at my place and 2) I was hungry all the time. Not just, hmm, I am a little hungry I think I’ll have a snack. I mean, my stomach actually growling by 10 am. Was I really that hungry all the time before the Symlin?
So I went back on, but at 2.5 u, thinking that it would help me avoid those lows at 7:30. It did, but I still had bounded up to 200-250 by 8:30. Thinking it was an issue now of needing more insulin, we made the change from a 1:15 carb ratio in the morning to a 1:10. Surely that should make an impact? Ennngh. My numbers didn’t change one bit. That was almost the last straw: I increased my insulin by 50% in the morning and my numbers didn’t move? Here are the numbers from Tuesday to see what I am dealing with:
6:15 -> 137. Take 6 units in a 40/60 combo bolus, plus 0.75 u for a correction, plus the 2.5 Symlin. Eat my bowl of Kashi with skim milk and a banana.
7:20 -> 112 Check to make sure that I haven’t gone low before I hit the road.
8:30 -> 227 Crap.
As I said, these patterns were beginning to depress me. Yesterday I woke up the same as always, with little hope that this day would be any better bg wise.
6:15 -> 140, take the 0.7 u my pump suggests as a correction. Then take my Symlin and eat my Kashi and banana breakfast. After I have thrown the dishes in the sink I then bolus, maybe 15 minutes after I would normally do so.
7:15 -> 173. A little higher than I want. I am expecting this to rise still further by 8:30, but at this point, I am resigned.
8:30 - duh, duh, duh 114! 114? It couldn’t possibly. I whip out the old Fastake that lives in my desk at work as an emergency backup and test again: 127. Hungh? The number is real, so what happened? Nothing was different except for the timing. I shrug and go about the rest of my days with surprisingly good numbers given I didn’t have to recover from that morning high.
This morning I cautiously tried the same routine of bolusing after I ate. The result at 2 hrs post-prandial? 135! Have I accidentally hit on something that will work? I am too skeptical at this point to believe in complete success until I get some more data under my belt, but this is very, very encouraging. While I am restraining myself from doing so outright, there is a little happy dance going on inside me.
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5 comments:
Emily
When do you take your Symlin? Immediately before you eat, or do you take it and then wait 10-15 minutes before eating?
I've found if I wait 10+ minutes and then eat it's better for my BG control. I only square wave for the meal and I expect to see the values creeping up about 2 hours after eating.
Hi Bernard,
I take it right before I eat. I have found that if I wait eating even 5-10 minutes the nausea starts and my appetite deserts me so I can barely get anything down. Taking it right at the start of the meal gets rid of the nausea and I feel full after a modest meal, and it sticks with me awhile, which is what I would prefer.
Perhaps this wouldn't be much of an issue since I have reduced my doses, so I will keep it in mind in case my current good luck streak comes to an end. (Day 3 didn't look quite as nice, but still better than before!)
I sometimes wonder if Symlin just works a little too quickly for me, and if a smoother action profile might be better. *Shrugs*
Thanks for your input!
Emily
I found the nausea took a long time to go away for me. After several months of using it, I don't get this anymore even when I've not used it for a day or two.
But the nausea is SO BAD that it's a real disincentive against wanting to take the stuff.
The other thing is that I really don't reduce my insulin dose all that much. I just take it as a 90 minute extended bolus.
Overall I think Symlin is a useful tool. But it's a bear to figure it out so you can get good results every time. I'm probably benefiting from it about 60% of the time I use it.
Hi Bernard,
Thanks for your observations. I too have found that my insulin needs didn't change that much with Symlin (I think I just needed more in the morning period). The real difference is, as you say, how you deliver that insulin.
This is why I love the internet for being able to network with other diabetics. I am one of my endo's first patients to use Symlin, and any advice they gave me pretty much came from the little information that the pharmaceutical company put out. My own experience and that of others has been much more valuable.
Emily
This is such an interesting medication. The first real change to diabetes treatment since insulin was refined in 1921.
You might want to go to TuDiabetes .com and see whether anyone there can help with Symlin info.
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