Diabetes and Symlin

Symlin, or pramlintide, is an injectable synthetic version of the hormone amylin and is prescribed to people with either type 1 or type 2 diabetes who use mealtime insulin but who have not achieved adequate blood glucose control.

Amylin, the hormone that Symlin replaces, is normally secreted along with insulin by the beta cells in the pancreas. Diabetes damages or destroys these cells, reducing or eliminating production of both insulin and amylin, which causes blood glucose levels to rise.

Symlin, which is injected at mealtimes either before or along with insulin (but never in the same syringe—it must be injected separately), slows digestion and in turn, delays the release of glucose into the bloodstream. The drug also suppresses secretion of glucagon, a pancreatic hormone that triggers the release of glucose from the liver. All of these actions result in lower and more stable blood glucose.

Symlin can be tricky to use. When it was first introduced, some cases of hypoglycemia (low blood glucose) were reported. Dosing instructions now recommend that Symlin patients take half their mealtime insulin dose to avoid low blood glucose when starting out. Some patients also made the mistake of mixing insulin with Symlin and injecting the two drugs together.