[type1rachelle]

Hi guys,

I'm a 31yo F - DMT1 for almost 14 years, 5'2", 114lbs. I am on a pump (Animas) and CGM (Dexcom). My A1c is consistently in the low to mid 7s, but lots of variability and would like tighter control (might want a baby 3 years down the road or so). Just started seeing a new Endo and he wrote me a Rx for the SymlinPen 60 today - his only advice was to "experiment with it" and see him again in 5 weeks for an update. I'm a student nurse and have done plenty of research on it, but would love to hear any tips or tricks from other T1s.

I personally have decided not to take it with dinner since I have hypoglycemic unawareness in my sleep - no issues at all during the day, I just am a very deep sleeper and have a history of seizures in my sleep (or non responsive in the middle of the night and my husband injecting me with glucagon - yay!). So I've decided to try Symlin with a larger breakfast and lunch, and keep dinner on the smaller side. I will start with 15mcg 2x a day for 3 days, then 30mcg 2x a day for 3 days, then 45mcg and then 60mcg. I'm hesitant to actually go above 30mcg because I don't want to really lose any weight. (a few pounds would be fine, but not looking to drop down below 110lbs - I'm also very active, so keeping weight on is important). Does that make sense? Everything I read says higher doses will aid in weight loss and lower doses will aid in tighter postprandial control.

From things I've read, I know to watch out for nausea and diarrhea (hence trying each dose for 3 days before increasing), I know to take it 15-30mins before a meal (at least 250 kcal and 30g of carbs), and to give myself a combo bolus for my insulin intake for that meal - maybe space it out over 2 hours (since Symlin slows gastric emptying). I also read things about reducing the overall boluses up to 50% while on Symlin which I might try. I'm nervous about going high OR low on Symlin since it can take longer for correction boluses to bring me down, and longer for glucose intake to bring me back up. Has anyone found this to be absolutely true or is it more like a warning to keep in mind, but doesn't make a huge difference?

Any thing I missed? Any other tips/tricks?

Thanks in advance!