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Symlin

Discussion in 'Parents of Children with Type 1' started by samson, Aug 8, 2016.

  1. samson

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    Do any of your children take Symlin to reduce post-prandial spikes? If so, what is your experience? And how young was your child when he tried it. It's only FDA approved for 15-and-up, but so are some pumps...

    Our toddler is still too young, but down the line I'm wondering if it may have benefits beyond glucose control as beta cells usually also make amylin, which creates the feeling of satiety, stimulates bone growth and inhibits cells that chew up bone.
     
  2. nebby3

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    We havent tried it but I've heard it drops bg to a degree that it makes timing meals very critical and that is why they won't use it in younger than teens.
     
  3. Megnyc

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    I use it with certain meals. I started using it at the age of 19. I would personally never use it in a young child. It is complicated to use and I don't believe it is safe to use without an accurate CGM. You can have very severe lows with it (even when used properly) that require glucagon to treat. There is really no way to treat a low that occurs in the period after taking symlin with oral carbohydrates. I have had great success with it (A1Cs in the mid 5s with minimal effort) but I am continually surprised it is still on the market due to the risk of severe hypoglycemia. Additionally, there are other drugs now such as victoza and byetta that have similar effects with a lower risk of hypoglycemia. I am planning to switch to victoza within the next few months once I use up the supply of symlin I have.
     
  4. samson

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    Thanks Meg! Victoza and the like seem to increase the risk of DKA even in the presence of normal BGs for T1Ds .... that seems pretty scary somehow.
     
  5. Lakeman

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    I have thought about symlin for years now but have never used it for either of my kids. To take an additional shot with some meals does not sound great but if it would result in carb absorbtion that would more closely match the effect of insulin that could be worth it. I'm not so sure my kids would think it was worth it. That being said eating a double quarter pounder with cheese definitely slows down carb absorption. Fat and protein in general slow down carb absorption. I wonder if it might just be better to eat fat and protein with meals while lowering the fast carbs. Not that we get perfect results with this approach...often it works great...but often it does not. I suspect a shot would work great at times...and badly at times.

    Personally I would rather hope for the day when pulses of insulin can be administered intraveneously much the way that our bodies deliver insulin naturally so that the effect could be near instantaneous yet controlled.
     
  6. samson

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    That makes sense Alan. I too don't think additional shots are worth it for my son at this point because he's too young.

    Wish protein and fat worked for us, but it typically increases his TDD of insulin and makes it tougher to bolus for....maybe a smaller initial spike but then hours and hours of corrections. Too bad, it seems to work so well for everyone else. Maybe when he gets older.
     
  7. Sarah Maddie's Mom

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    My DD has experimented with Victoza (she's 18) with some success in reducing TDD. Side effects, upset stomach not concerns about DKA make it a less than ideal tool. Would not even consider adding this to a young child's regimen.
     
  8. mmgirls

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    Yes I have met now 3 adults that ended up in true DKA with normal BG.

    But they did not realize that you can run ketones with normal glycemia, so the simple way to not get into DKA would to be test ketones daily if not more.
     
  9. mmgirls

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    I don't hope for IV but rather into the peritoneal space where it hits the liver first.
     
  10. Lakeman

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    I hate fat spikes and we definitely get them at times. I am still learning how to bolus for fat using extended boluses and it seems to work ok. I don't know what kind of diet your kiddo eats but for us when I first learned about fat spikes we tried to lower the fat in her diet. The more I lowered it the worse the fat spikes were even if she was just eating a few oreos. Later we tried increasing the fat so that every meal included fat and that gave us more level results.
     
  11. Megnyc

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    You know people who ended up in DKA while using victoza? I know DKA can potentially be an issue with SGLT2 inhibitors but I have not heard of it being an issue with victoza. DKA is not listed as a potential side effect for Victoza.
     
  12. samson

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    A recently-published study found an increase in both symptomatic hypoglycemia and hyperglycemia with ketosis, though not DKA. Ketosis is not problematic on its own but it means the tipping point to DKA could be closer at hand.
     
  13. samson

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    Lakeman, interesting. Our kid eats a (fairly) high fat diet. At least 30 percent of each meal is fat. He eats about 30 grams of carbohydrate (subtracting grams of fiber) per meal...about 75 percent of what is suggested for his age. It's when we try to reduce carbs any further that he gets insulin resistant. Very high fat, high-carb, high calorie meals, like mac n' cheese, are a nightmare.
     

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