Diabetes and Lipid Clinic of Alaska

 

 


About Amylin, the Hormone, and SYMLIN

People with diabetes do not make any or enough of the natural hormone Amylin

Both insulin and amylin are hormones that the pancreas makes when you eat. Patients with type 1 diabetes and many patients with type 2 diabetes do not make enough insulin. Generally, people who do not produce enough insulin also do not produce enough amylin at mealtimes. Without enough amylin, sugar enters the blood too quickly following meals, producing peaks in blood glucose (sugar) levels after meals.

SYMLIN is an inject able medicine for adults with type 2 and type 1 diabetes to control blood sugar.

Amylin works with insulin


Insulin plays a key role in maintaining proper control of blood sugar after meals. Insulin helps move sugar from the blood into cells, where it is used for energy or it is stored. Amylin works with insulin to control how quickly sugar enters the bloodstream from the stomach and intestines.

Taking SYMLIN at mealtimes replaces the absent or deficient amylin

Insulin is only part of the solution to treating diabetes. Because of its unique properties, adding SYMLIN, a synthetic version of the hormone amylin, to your insulin therapy at mealtimes can help you to maintain better blood sugar control.

Symlin therapy should only be considered in patients with insulin-using type 2 or type 1 diabetes who have failed to achieve adequate glycemic control despite individualized insulin management and are receiving ongoing care under the guidance of a healthcare professional skilled in the use of insulin and supported by the services of diabetes educator(s).

Who Is SYMLIN Right For?

Most patients in clinical trials were able to achieve better control of their blood glucose (sugar) levels by taking SYMLIN along with insulin. You might want to discuss SYMLIN with your healthcare professional if you think that you could benefit from better blood sugar control after meals.

Talking to your healthcare professional about SYMLIN


Now that you know a little bit about SYMLIN, you may have more questions. We've answered some of the more commonly asked questions for you.

When you talk to your healthcare professional, he or she will give you some very important safety information regarding SYMLIN, including possible side effects. These side effects are usually manageable but they require careful consideration, especially in the early stages of SYMLIN treatment. You will also be asked to keep careful records of your blood sugar levels, your insulin use, changes in your weight, and any feelings of nausea that you experience while taking SYMLIN.

Talk to your healthcare professional about all of your medical conditions and any medications you are taking. Tell your healthcare professional if you are pregnant or plan to become pregnant or nurse a baby while on SYMLIN.

There are clear guidelines on who should and should not be on SYMLIN therapy. Talk to your healthcare professional to determine where you fit in.

Who should take SYMLIN?

SYMLIN should only be used by people with type 2 or type 1 diabetes who:

  • already use their insulin as prescribed, but still need better blood sugar control
  • will follow their healthcare professional's instructions exactly
  • will follow up with their healthcare professional regularly
  • will test their blood sugar levels before and after every meal, and at bedtime
  • understand how to adjust SYMLIN and insulin doses

Who should not take SYMLIN?

SYMLIN should NOT be used by people who:

  • do not take their insulin or check their blood sugar regularly as instructed by their healthcare professional
  • have an A1C level of greater than 9%
  • have had frequent low blood sugar (severe hypoglycemia) requiring assistance during the last 6 months
  • cannot tell when their blood sugar is low (hypoglycemia unawareness)
  • have a stomach problem called gastroparesis. This is when the stomach does not empty as fast as it should
  • require the use of drugs that make the stomach empty faster
  • are allergic to SYMLIN or any ingredients in SYMLIN
  • are pediatric patients

Tell your healthcare professional about all of your medical conditions, including if you:

  • are pregnant or planning to become pregnant. It is not known if SYMLIN can harm your unborn baby. You and your healthcare professional will decide how to best control your blood sugar levels during pregnancy.
  • are breastfeeding. It is not known if SYMLIN passes into your milk and if it can harm your baby. You and your healthcare professional will decide the best way to feed your baby if you are using SYMLIN.

Keep a list of all the medicines you take. Tell your healthcare professional about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. SYMLIN can slow down how other medicines pass through your stomach and may affect how much of them get into your body. Therefore, you may have to change the times you take certain medicines.
If your healthcare professional prescribes SYMLIN for you, he or she will give you very specific information about when and how to take SYMLIN

The Benefits of SYMLIN

SYMLIN provides several benefits that can lead to better overall diabetes control.
Less extreme and less frequent blood glucose (sugar) peaks SYMLIN reduces your blood sugar fluctuations by smoothing out the peaks in blood sugar that happen after eating and throughout the day.

Reduces A1C levels

One measure of how well you are managing your diabetes is to look at your A1C level. A1C measures the amount of sugar attached to red blood cells. SYMLIN lowers the A1C levels of most patients beyond what insulin alone can achieve, giving you better overall control of your diabetes.

Potential Weight Loss

Because SYMLIN works like the natural hormone amylin, it can reduce your appetite, which leads to eating less and to possible weight loss.

Less mealtime insulin is needed

Because SYMLIN works with insulin to control blood sugar, you may actually need less insulin to achieve your optimal blood sugar targets after meals.

Nausea is the most common side effect with SYMLIN. Mild nausea is more likely during the first weeks after starting SYMLIN and usually does not last long. It is very important to start SYMLIN at a low dose and increase it as directed by your healthcare professional. If nausea continues or bothers you, call your healthcare professional right away.

Side Effects of SYMLIN

Hypoglycemia

SYMLIN is used with insulin to lower blood glucose (sugar), but in some cases, your blood sugar may drop too low, especially if you have type 1 diabetes. Very low blood sugar, or severe hypoglycemia, makes it hard to think clearly, drive a car, use heavy machinery, or do other risky activities where you could hurt yourself or others. If you develop symptoms of insulin-induced severe hypoglycemia, it will be within the first 3 hours following a SYMLIN injection.

Insulin-induced severe hypoglycemia is a very important side effect to be aware of while taking SYMLIN. While SYMLIN by itself does not cause hypoglycemia, taking SYMLIN without reducing your mealtime insulin dose by 50% can lead to severe hypoglycemia. Talk to your healthcare professional for advice and learn how to manage insulin-induced severe hypoglycemia.

Other Side Effects

Nausea is the most common side effect with SYMLIN. Mild nausea is more likely during the first weeks after starting SYMLIN and usually does not last long. Talk to your healthcare professional for advice and learn how to manage nausea.

Other less common side effects of taking SYMLIN include loss of appetite, vomiting, stomach pain, tiredness, dizziness, indigestion, or headache.

Some patients report redness, minor bruising, or discomfort at the injection site. To reduce the possibility of discomfort, allow SYMLIN to come to room temperature and always use a new syringe and needle for each injection.

These are not all of the side effects with SYMLIN. Ask your healthcare professional or pharmacist for more information.

Knowing when to call for help

Call your healthcare professional if you experience any of the following:

  • excessive swings in your blood sugar levels
  • frequent or severe hypoglycemia
  • inability to eat your usual meals
  • severe nausea
  • illness
  • dosing or injection problems
  • any problems with your diabetes management that put your safety or well-being at risk

Taking SYMLIN

SYMLIN is taken before major meals and snacks that contain at least 250 calories or at least 30 grams of carbohydrate. SYMLIN is taken with insulin for better blood glucose (sugar) control. Check the dosing for type 2 or type 1 diabetes. Your healthcare professional will determine the appropriate starting and maintenance doses for you.

SYMLIN helps control the amount of sugar that appears in the blood after you eat, so less mealtime insulin is needed. When beginning SYMLIN, mealtime insulin doses should be reduced by 50% to minimize the chances for insulin-induced severe hypoglycemia. Insulin dose adjustments should be made only as directed by a healthcare professional.

Do not take SYMLIN if

  • your blood sugar is too low
  • you do not plan to eat. Do NOT inject SYMLIN if you skip a meal
  • you plan to eat a meal with fewer than 250 calories or fewer than 30 grams of carbohydrate
  • you are sick and can't eat your usual meal
  • you are having surgery or a medical test where you cannot eat
  • you are pregnant or breastfeeding

Step-by-Step Administration Instructions

Selecting an injection site


SYMLIN should be injected subcutaneously in your stomach area (abdomen) or in your upper leg (thigh). It is recommended that you use a U-100 insulin syringe (it is best to use the 0.3 mL [0.3 cc] size) to draw up and inject SYMLIN. SYMLIN should not be injected into the arm because this may affect the absorption of SYMLIN into the body. You can inject SYMLIN and insulin into the same area of the body, but the sites for injections given at the same time should be separated by at least 2 inches.

Using the SymlinPen®: Your step-by-step guide


Your healthcare provider has prescribed the SymlinPen®. SYMLIN is an injectable medicine used to control blood sugar after meals in adults with type 1 and type 2 diabetes who take mealtime insulin. In this section, you will get an interactive, step-by-step guide to using your SymlinPen®

What's the difference between the SymlinPen® 60 and the SymlinPen® 120?

The medication in the two pens is the same; the only difference between the two pens is the dose delivered and the amount of medication in each pen.

 

SymlinPen® 60

SymlinPen® 120

Medication
(pre-filled)

SYMLIN

SYMLIN

Dose

15, 30, 45, or 60mcg

60 or 120mcg

Amount of medication

1.5 mL

2.7 mL

Number of pens needed per month, if SYMLIN is used with three major meals per day

4 (type 1 patient at maintenance dose of 60 mcg)

2 (type 1 patient at maintenance dose of 60 mcg)
4 (type 2 patient at maintenance dose of 120 mcg


Quick Facts About the SymlinPen®

  • Pens come packaged two per box, and are available by prescription only
  • New Pen Setup is only required the first time you use a new Pen. However, if you drop your Pen, repeat New Pen Setup to make sure the Pen works
  • The Pen may look empty even when it is filled with medicine because SYMLIN is clear and colorless
  • Small bubbles are normal and will not harm you or affect your dose
  • The SYMLIN in the Pen is a different strength than the SYMLIN in the vial. Never withdraw SYMLIN from the SymlinPen® into a syringe. This could result in a higher dose than intended

Care and Storage

  • All major brands of Pen needles fit the SymlinPen®. Ask your healthcare provider which size needle is best for you. Pen needles are not included with the SymlinPen®
  • Do not store the Pen with the needle attached or with the Knob pulled out
  • Refrigerate your new Pen at 36°F to 46°F (2°C to 8°C) until you start using it. After you use your Pen for the first time, refrigerate it or store it at room temperature (up to 86°F or 30°C) for 30 days
  • Throw away Pen 30 days after first use, even if it still has SYMLIN in it
  • Keep the Pen away from light, and make sure it does not freeze. Do not use the Pen if it has been frozen

Be sure to read the Patient Instructions for Use that came with your SymlinPen®.
This information does not take the place of your healthcare provider's advice. Talk with your healthcare provider if you have questions.
Handling and Storing Symlin

  • Store SYMLIN vials in the refrigerator until you pen them.
  • Opened vials can be refrigerated r kept at room temperature for up t 28 days. Any opened vial should be thrown away after 28 days, even if it still has medicine in it.
  • Vials should not be left at above room temperature (77°F/25°C). Throw away any vial that is:
    • out-of-date
    • has been frozen
    • left at above room temperature (77°F/25°C)
    • left at room temperature for more than 28 days
  • Keep SYMLIN and all medicines out f the reach f children.

Frequently Asked Questions About SYMLIN

What is SYMLIN and how does it work?

SYMLIN is an injectable medicine for adults with type 2 or type 1 diabetes that is used to control blood glucose (sugar). SYMLIN slows down the movement of food through your stomach. This affects how fast sugar enters your blood after eating. SYMLIN also helps you to feel full more quickly during meals, causing you to eat less than you normally would. SYMLIN is always used with insulin to help lower blood sugar during the 3 hours after meals.

Which side effects might I expect with SYMLIN?

There is a risk of insulin-induced severe hypoglycemia (very low blood sugar) when taking SYMLIN. When starting SYMLIN, reduce your doses of insulin before meals by 50% or as recommended by Dr. Tanner. While SYMLIN by itself does not cause hypoglycemia, taking SYMLIN without reducing your insulin dose by 50% can lead to severe hypoglycemia. SYMLIN is used with insulin to lower blood sugar, but your blood sugar may drop too low, especially if you have type 1 diabetes. Your chance for very low blood sugar is higher if you use more SYMLIN or insulin than prescribed by your healthcare professional or if you change your insulin dose without checking your blood sugar. You may also experience symptoms of hypoglycemia if you eat less food than usual or cannot eat for any reason, including when you are nauseous. Your chance for hypoglycemia is higher if your blood sugar is already low before eating. Also, if you are more active than usual or drink alcohol, you may experience hypoglycemia symptoms. Very low blood sugar makes it hard to think clearly, drive a car, use heavy machinery or do other risky activities where you could hurt yourself or others. Discuss with your healthcare professional what activities you should avoid.

Are there other side effects besides hypoglycemia?


Nausea is the most common side effect with SYMLIN. Other side effects may include decreased appetite, vomiting, stomach pain, tiredness, dizziness, or indigestion. Injection site reactions, including redness, minor bruising, or pain, are also possible. These are not all of the side effects that may occur with SYMLIN. If you experience other side effects, report them to your healthcare professional.

How can I reduce the risk of hypoglycemia?


When starting SYMLIN, reduce your doses of insulin before meals by 50% as recommended by your healthcare professional. The use of SYMLIN reduces the amount of insulin that you need before meals. It is important to follow your healthcare professional's instructions for changing your insulin and SYMLIN doses. If you have a low blood sugar level before eating and then inject SYMLIN, your chance of hypoglycemia is higher. If low blood sugar is severe or frequent, call your healthcare professional. You and your healthcare professional should talk about a plan to treat low blood sugar.

How can I reduce nausea when beginning therapy?

Nausea is more likely during the first weeks after starting SYMLIN and usually does not last long. It is usually mild in intensity. It is very important to start SYMLIN at a low dose and increase it as directed by your healthcare professional. This may reduce nausea. If nausea continues or bothers you, contact your healthcare professional.

When should I take SYMLIN?

You should take SYMLIN immediately before major meals and snacks that contain at least 250 calories or at least 30 grams of carbohydrate. Do not take SYMLIN if you do not plan to eat.

How often should I test my blood sugar levels?

When starting SYMLIN, you will need to test and track your blood sugar levels before and after every major meal and at bedtime. This important information will help you and your healthcare professional determine the best SYMLIN and insulin doses for you.

I have type 2 diabetes. How much SYMLIN should I use?

You must use SYMLIN exactly as prescribed by your healthcare professional. A patient with type 2 diabetes should start SYMLIN at 60 micrograms (mcg) just before major meals. Reduce your mealtime insulin doses (rapid-acting, short-acting, or fixed-mix) by 50% as directed by your healthcare professional. Record your blood sugars levels before and after every meal and at bedtime and report this and any symptoms of nausea to your healthcare professional. He or she will tell you to increase your SYMLIN doses to 120 mcg if you do not experience nausea for 3 days or more. Once you have reached your SYMLIN maintenance dose without nausea, your healthcare professional will tell you to change your insulin dose to better control your blood sugar.

I have type 1 diabetes. How much SYMLIN should I use?

You must use SYMLIN exactly as prescribed by your healthcare professional. A patient with type 1 diabetes should start SYMLIN at 15 micrograms (mcg) just before major meals. Reduce your mealtime insulin doses (rapid-acting, short-acting, or fixed-mix) by 50% as directed by Dr. Tanner. Record your blood sugar levels before and after every meal and at bedtime and report this and any symptoms of nausea to your healthcare professional. He or she will tell you to increase your SYMLIN doses in 15-mcg (2½) increments (up to 60 mcg [10 units]) if you do not experience nausea. Once you have reached your SYMLIN maintenance dose without nausea, your healthcare professional will tell you to change your insulin dose to better control your blood sugar.

Who should not use SYMLIN?

SYMLIN should NOT be used by people who:

  • do not take their insulin or check their blood sugar regularly as instructed by their healthcare professional
  • have an A1C level of greater than 9%
  • have had frequent low blood sugar (severe hypoglycemia) requiring assistance during the last 6 months
  • cannot tell when their blood sugar is low (hypoglycemia unawareness)
  • have a stomach problem called gastroparesis. This is when the stomach does not empty as fast as it should
  • require the use of drugs that make the stomach empty faster
  • are allergic to SYMLIN or any ingredients in SYMLIN.

SYMLIN has not been studied in children

What if I miss or forget to take a SYMLIN dose?


Do not make up for a missed dose. Wait until the next meal and take your usual dose of SYMLIN at that meal. Do not take more than your usual dose of SYMLIN.

What if I skip a meal?

Do not use SYMLIN if you do not plan to eat or if you eat only a small meal containing less than 250 calories or 30 grams of carbohydrate. If you are sick or having a medical procedure and cannot eat your meal, do not use SYMLIN. If you miss or forget a dose of SYMLIN, wait until the next meal and take your usual dose of SYMLIN at that meal. Do not take more than your usual dose of SYMLIN.

What if I plan to become pregnant or breastfeed my baby while taking SYMLIN?

It is not known if SYMLIN can harm your unborn baby. You and your healthcare professional will decide how to best control your blood sugar levels during pregnancy.
It is not known if SYMLIN passes into your milk and if it can harm your baby. You and your healthcare professional will decide the best way to feed your baby if you are using SYMLIN.

He or she may suggest that you not use SYMLIN during these times. Also, you and your healthcare professional can decide the best way to feed your baby if you are using SYMLIN.

How does SYMLIN affect other medications I take?

SYMLIN can slow down how other medicines pass through your stomach and may affect how much of them get into your body. Therefore, you may have to change the times you take certain medicines. Keep a list of all the medicines you take. Tell your healthcare professional about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

How should I store SYMLIN?

Store SYMLIN vials in the refrigerator until you open them. Opened vials can be refrigerated or kept at room temperature for up to 28 days. Any opened vial should be thrown away after 28 days, even if it still has medicine in it. Vials should not be left at above room temperature (77°F/25°C). Throw away any vial that is:

  • out-of-date
  • has been frozen
  • left at above room temperature (77°F/25°C)
  • left at room temperature for more than 28 days

Do not use SYMLIN if it appears cloudy or discolored.

What else can I do to better manage my diabetes?


Taking the right medications is important, but exercise and nutrition are also important for good diabetes management. Follow a sensible meal plan and stay active or boost your activity level by adding simple daily routines like taking the stairs instead of the elevator. Always check with your healthcare professionals before beginning any new exercise or meal plan. You may also consider involving your friends and family. The more they learn about your diabetes, the more comfortable they will be in supporting your healthy habits.

For further information please consult with the medical professionals at Diabetes and Lipid Clinic of Alaska.

The information on this Web page is provided for educational purposes. You understand and agree that this information is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. You agree that Diabetes and Lipid Clinic of Alaska is not making a diagnosis of your condition or a recommendation about the course of treatment for your particular circumstances through the use of this Web page. You agree to be solely responsible for your use of information contained on this Web page

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