So Long, Symlin

Ah, Symlin. You were fun. An interesting game of self-experimentation. You kept my post-meal blood sugars so slow, so graded.

But our shared days and nights are over. You changed, and I found myself wistfully wanting the drug I chose originally, not the new version– bigger around the middle, with a lot more packaging all over.

I think my metaphor has escaped from me, so I’ll say it outright: Amylin stopped making the Symlin vial, and the switch to the Symlin pen rendered it useless to me.

I had been mixing Symlin with my insulin (shh, don’t tell!), and that was working capitally. Then the pharmacy informed me that I would have to switch to the pen, as the vial had been discontinued. No sweat, I figured– I would just keep drawing the drug out of the pen with a syringe.

But there was a catch: the pen Symlin is not the same as the vial Symlin. The active drug is the same– pramlintide– but the pen is a more concentrated formulation.

And that’s fine for most people, assuming their doctors adjusts their dosings accordingly (the pen, notably, is dosed in micrograms instead of units as the vial was, I imagine in part to force patients to get the amount re-calculated). But, if, like me, you try mixing the more concentrated solution with Novolog insulin, you will find that the clever mix no longer works– the insulin precipitates out. The smallest bit of Symlin, and my insulin cartridge became a cloud of white powder, suspended in liquid.

At first I thought it was just bubbles or something, but my absorption definitely suffered. It was precipitate. My insulin was stunted, rendered useless by the Symlin mix.

I could fix this– I would just have to add a buffer (sodium acetate, likely) to the Symlin to return it to its original concentration. Then I could mix to my heart’s content.

But then we’re talking mixing insulin, Symlin, and a buffer, which is no longer a quick-and-easy deal. Loading an insulin cartridge takes me 3 minutes; mixing Symlin and insulin and loading a cartridge, ten minutes; three solutions requiring precise titration? Eh. Symlin was nice, but my post-meal spikes aren’t so bad as long as I watch what I eat, which I do regardless.

So convenience wins. Sorry, Symlin. You’re just not the drug for me anymore. This new you is too intense for me. Maybe, if you age a little, return to your old, easy-going self, we can talk again.

In the meantime, I have to re-learn to dose insulin without Symlin, which means more waiting after bolusing and smaller boluses. Adjust, adjust, increment, increment– story of a diabetic’s life.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.