Short answer: The Symlin label cuts mealtime insulin by 50% at the start. In type 2 diabetes it starts at 60 mcg right before each major meal and goes to 120 mcg after 3 days without significant nausea. In type 1 diabetes it starts at 15 mcg and steps to 30, 45 or 60 mcg, each step after 3 nausea-free days.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Symlin is approved for: Symlin is approved as an add-on treatment for people with type 1 or type 2 diabetes who use mealtime insulin and have not reached their glucose goals despite optimal insulin therapy (section 1).
Source
SYMLINPEN (pramlintide acetate) injection, prescribing information and Medication Guide. AstraZeneca. DailyMed, version published August 20, 2024. DailyMed setid 4aea30ff-eb0d-45c1-b114-3127966328ff
Symlin is injected under the skin of the stomach area or thigh immediately before each major meal (250 kcal or more, or at least 30 grams of carbohydrate). The arm is not recommended because absorption varies (section 2.4).
It should be at room temperature before injecting, sites are rotated, and the site is kept separate from the insulin injection site. Symlin and insulin are never mixed (section 2.4).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Who | Insulin change at start | Starting dose | Steps | If nausea persists |
|---|---|---|---|---|
| Type 2 diabetes using mealtime insulin | Reduce mealtime insulin (including premixed) by 50% | 60 mcg immediately before each major meal | 120 mcg when no clinically significant nausea for at least 3 days | Decrease to 60 mcg if significant nausea persists at 120 mcg |
| Type 1 diabetes | Reduce mealtime insulin by 50% | 15 mcg immediately before each major meal | Next increment (30, 45 or 60 mcg) when no clinically significant nausea for at least 3 days | Decrease to 30 mcg if nausea persists at 45 or 60 mcg; consider stopping if 30 mcg is not tolerated |
Symlin is used only by people who can follow insulin adjustments and glucose monitoring, and dose changes are made only as directed by a professional skilled in insulin use.
Wait at least 3 days before moving to the next dose step, to reduce the risk of nausea.
Blood glucose is checked often, before and after meals and at bedtime, especially when starting or raising the dose. More frequent mild or moderate lows are a warning sign of severe lows.
If Symlin is stopped for any reason, such as surgery or illness, the same starting steps are followed when it is restarted.
The label says to stop Symlin with repeated unexplained lows needing medical help, persistent significant nausea, or not keeping up with glucose testing, insulin adjustments or scheduled visits.
Pills that need to act quickly are taken at least 1 hour before or 2 hours after the Symlin injection.
If a Symlin dose is missed, wait until the next scheduled dose and give the usual amount.
More on this: missed a dose of Symlin.
In Dose Track you set up Symlin as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.