What is Pramlintide?:
Pramlintide (brand name Symlin) is a new class of diabetes drug to manage both type 1 and type 2 diabetes. It was approved by the FDA in March of 2005. It is a synthetic form of amylin, a hormone usually produced in the pancreas. Amylin works with the body's insulin to control the release of sugar into the blood after you eat.
In type 1 diabetes, amylin and insulin production are stopped altogether. In type 2 diabetes, amylin production can be impaired, so that not enough is released. Symlin can boost the performance of amylin which can help control postprandial blood sugar, when combined with insulin therapy.
Who Can Use Pramlintide?:
It is effective for type 1 and type 2 adult diabetics who are on insulin. It is for people who need better control of their blood glucose levels and whose blood sugars still spike after eating, even when covered by insulin.
How It Works:
Pramlintide slows the rate of digestion which means that the food you eat takes longer to empty from your stomach, which makes you feel full longer. This slows the release of sugar into the blood. Pramlintide is intended to be used with insulin to help keep blood glucose levels in control.
Severe hypoglycemia can occur as a side effect, especially in people with type 1 diabetes. Pramlintide alone rarely causes hypoglycemia, but when it is used with insulin, severe hypoglycemia can result. To prevent this from happening, your usual insulin dosage will be decreased by your doctor when you first start pramlintide and your pramlintide doses will be increased gradually over the course of the first few weeks to decrease the chance of a severe hypoglycemic reaction.
Reducing the Risk of Hypoglycemia:
Because hypoglycemia is a concern, pramlintide, is always administered at the start of a meal at the same time as the pre-meal insulin dose. Pramlintide should not be used unless the meal is a substantial one (over 250 calories or more than 30 grams of carbohydrates). Don't take your pramlintide dose if you are going to be skipping a meal.
It's important to be able to recognize when your blood glucose is dropping, because hypoglycemia can impair your judgement. Driving a car or using dangerous machinery is not recommended until you know how pramlintide affects you.
Other Side Effects:
Nausea may also occur. Pramlintide is started gradually to minimize this side effect. When your stomach is not used to emptying more slowly, mild nausea can result. According to pramlintide studies, the nausea shouldn't last long and gradually subsides as your body adjusts to pramlintide.
Pramlintide may make you feel full longer after eating, due to the effects of delayed gastric emptying. This sometimes results in some weight loss, which may be a beneficial side effect, if you are trying to lose weight.
When to Take Pramlintide:
Pramlintide is injected just before mealtime, along with the pre-meal insulin dose. Although pramlintide is injected like insulin, it cannot be mixed with insulin for injecting. Two separate syringes must be used. The Pramlintide injection site should be about two inches away from the insulin injection site and is best given in the abdominal or thigh area.When first starting pramlintide, you should check your blood glucose levels often, especially before meals and 2 hours after meals, to see how the pramlintide dose works for you. You should also test whenever you feel like your blood glucose may be low.
Who Should Not Use Pramlintide?:
If you have hypoglycemic unawareness then pramlintide may not be for you. Being unable to tell if your blood sugar is dropping could be dangerous because of the increased chance of hypoglycemia with pramlintide.
If you've been diagnosed with gastroparesis, you also may not be a candidate for pramlintide, due to the delayed gastric emptying that occurs with pramlintide.
Pramlintide has not been approved as safe for unborn babies or nursing moms, so if you are pregnant or nursing, then pramlintide may not be prescribed for you.
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