Sick of It
Wednesday, March 31, 2010 at 10:06AM This morning I got up the nerve to up my dose of Symlin to 45. I have been taking it for quite some time but have had terrible nausea. Because of that I started off at 15 and tried sticking with that until the nausea was completely gone before bumping it up to 30.
From looking at all of the people I know taking Symlin, I seem to be on the very sensitive side. Most have been able to adjust rather quickly and I am worried why it is taking me so long.
After many weeks I bumped up my afternoon and evening doses to 30 and finally went to 45 when I was nausea free. My morning dose stayed at 15 for a while and when I moved 30, I had a very rough time. The nausea was awful and almost unbearable but I pushed through it and stuck with it until the nausea was gone.
That was some time last week. I wanted to move to the 45 mark but was very scared after how horrible the jump from 15 to 30 was. I didn’t know if I could handle it.
So this morning I decided to try it. I clicked my pen to 45 and pulled back the plunger. As soon as I stuck it in my gut and pressed down, I was sure I would get nauseous.
Sure enough, I got terribly ill.
I went into the bathroom and started dry heaving. My stomach was cramping up on me and finally all the heaving caused me to start actually throwing up. It was worse then before because I could not stop myself. Over and over my body clenched up and heaved. Throwing up is not usually a big deal for me so this was weird. At one point I thought I would have to go to a hospital to stop my body from continuing to vomit.
When it stopped I sat on the floor and tried to catch my breath. I wanted more than anything to lie down and rest for a while but a tug on the door handle told me someone was waiting to use the facilities so I figured I would get up and head back to my desk.
I feel better now or I should say, the way I usually do after taking Symlin. Not sick to my stomach but it feels like I have heart burn or something stuck in my esophagus. It’s a weird feeling but not nausea.
I sometimes wonder if it’s worth it. My blood sugars are pretty darn good with the Symlin but is it worth the few hours of awful nausea? I am not sure.
I would love your opinion because I am on the verge of just giving up on it.
Reader Comments (11)
That sounds miserable dude. Absolutely miserable.
Maybe you are more sensitive to it than others? Who knows? You should not feel bad or worried about it though. Another thing to think of, is that maybe a lower dose is all you need? Maybe you need to stay on the lower dose for much longer? What's the rush in moving up?
I seem to tolerate symlin pretty well, when I use it. But I also know that usually, getting a bite or two of food down shortly after I've taken it, makes the nausea go away. I know I've shared that before, so I imagine you've tried it already.
We're all so different. That makes it hard sometimes. Maybe just stick with the lower dose, if that seems to be helping the BG's. ??
G-Im so sorry you have to go through this crap!!!
Have you considered taking Metformin. It really helped me with spikes and I lost 7 lbs on it.
I started taking two pills, one in before bed and one after breakfast. I felt nausea for the first 2 weeks and had bathroom bouts. It was to rough on my system and my Dr said to start with the bedtime pill, which made it easier. After two weeks I felt better and started with 2 pills. My problem was that it cut my hunger so much I forgot to eat. My Dr. told me to cut back and stick to 1.
I was on it for two years and I felt great. Finally took a break in August but am considering going back on it.
Another benefit of Metformin is that it really protects the vascular system - and with my family history, I need all the help I can get!
Feel better my friend- and big HUGS your way!
Kelly K
George, Symlin dosage titration (which essentially means slowly increasing the dosage until you reach the recommended dosage amount) should not be rushed, even if the doctor is pushing to do so sooner. diaTribe http://bit.ly/atciuL actually covered a Symlin in an early issue, but noted that nausea was usually a more serious issue for patients with type 1 and that titrating the dosage often takes longer than it does for patients with type 2 diabetes (aren't you glad to be type 1 NOW?). Diabetes Health http://bit.ly/azbnK5 offered the following advice from Dr. Steven Edelman on titating the dosage:
Symlin can cause nausea, anorexia and vomiting, especially in people with type 1 diabetes. It is extremely important not to rush the dose titration. In patients with type 1 diabetes, start with a mealtime dose of 15 micrograms, which is equivalent to 2.5 units on a traditional insulin syringe. If after one week there are no side effects, then it is safe to advance by 15 micrograms. If, on the other hand, the patient is experiencing nausea or other gastrointestinal side effects, do not increase the dose of Symlin, and wait until the side effects dissipate altogether. Patients with type 2 diabetes experience significantly fewer side effects, so the titration can start at 30 micrograms and you can titrate more quickly if the patient is asymptomatic.
Just to summarize: there should be no rush to increase the dosage to the maximum recommended dosage, especially if it causes nausea. In fact, you could try to bring it up more slowly, perhaps increasing it only by 0.5 units at a time, and don't be afraid to go back to a smaller dosage until the nausea is less of an issue.
Hope any of this helps!!
Oh, George, I'm so sorry. As one of those people who has managed titrate fairly quickly, I hate to see you struggling.
Let me ask you something. What kinds of food are you eating? I have noticed a correlation between high-fat foods and increased nausea.
The first time I tried Symlin, I never made it past 30mcg. This time, I was determined to push through. I've come pretty closing to vomiting a few times, but I've managed to avoid it (so far). I'm at 105mcg (on my way to 120mcg), and the nausea is brutal. I keep thinking that maybe I should just stick with the 60mcg dose; I'm a type 1 after all. But then I read this: http://www.tudiabetes.org/profiles/blogs/a-practical-symlin-guide-for and felt like I needed to push it to get the best benefits.
I hope that you're able to stick with it because it does help. After my post yesterday, I weighed myself this morning. I've lost four pounds. Not a lot, but a step in the right direction. I've decreased my basals by 10% and my I:C ratio has been decreased by almost half.
Feel better, my friend!
Hey George
I had similar issues, but they passed... sorry to hear you're haven't. What are your 2 hour numbers like? If you can get them down with a different carb ration, you may not need to increase it. If you are getting benefit at the maximum you can tolerate, then leave it right there. There's nothing that says you have go to the max...
Another thing I found was that as I lost weight, I had to cut my dosage. When I first started, I got up to 120mcg, now I take 30 with most meals and 45 if it is esp carb heavy
Good luck
This does sound miserable, and I'm sorry to hear about it George. Honestly, I don't know what to tell you. I've never used Symlin or thought much about it, up until reading from so many DOC members that they've tried or gone to it for more stable BGs. But from those I've read, all seem to say that it causes nausea, at the very least. Even with more stable BGs, I don't think I would want to tolerate this regular sickness to any extent... doesn't seem worth it for me. But I wish you well in the new dosage, and will send thoughts your way. Hope it evens out soon!
I am with Kelly - maybe try Metformin? My experiences are very similar to hers, though I have not yet forgotten to eat. I also take the extended release pills, so I take two after dinner, not twice a day. It has definitely helped with hunger, but I still get hungry right now. Hoping the side effects go away soon. I blogged about it the other day if you're interested in reading more.
I haven't actually thrown up yet, but geewilikers this medicine can do a number on your system, can't it?
I'm glad you got back to "normal" so quickly though. I'm pretty much sick for a full 3 hours after taking it. I am back on the 45mcg dosage, thinking of even going back to 30, but I'm going to give it a few more tries to see if I can handle it before I do.
Stick with it and keep us up to date, G. :-)
I'm so sorry about this George. It shouldn't have to hurt to take care of oneself.
Firstly, Hi! I have read an odd post of yours here and there but this is my first time commenting (I think).
I have been on Symlin for 4(?) years and I have been taking 30 mcg for most of that time. Anything more than that and I had horrible lows ~60 minutes after a meal, and that is with playing with extended boluses. In my humble never-been-to-medical-school opinion, I think you should find the level that makes your blood sugar good. Everyone is on different insulin doses, so why would everyone take the same symlin dose? With the severe lows that I had with higher doses I would end up rebounding later, giving me worse control than I had on lower doses.
I took symlin for a few months back in the fall of 2008.
From my very first dose, I knew it would not be an easy road. My stomach would knot up about five minutes after I started eating. I lost weight, because I couldn't eat anything without dry heaving or at least feeling extremely ill (and sometimes actually vomiting), and my insulin dosage went way down for what I was eating. I had a lot of lows, though, because I could never eat all of the carbs I had meant to eat at the beginning of the meal. I stopped taking it after about three months of feeling miserable. Using less insulin is awesome, and so is having tighter control-- but it isn't worth feeling like crap everytime I want a sandwich.