Why aren’t we talking about amylin? 

Sure, insulin is something we truly cannot live without, but those of us with type 1 diabetes aren’t producing amylin either and it’s also extremely important!

Well, more accurately: you’re likely producing as little amylin as you are producing insulin. Some people with type 1 diabetes may still produce some insulin, which means they probably still produce some amylin, too.

Let’s take a deep dive into yet another obnoxious thing our hijacked immune-system is messing with.

What is Amylin?

Amylin is a “37-amino acid peptide hormone” that wasn’t discovered until 1987 — which could explain why compensating for its absence is so far behind our options to replace insulin.

Amylin is actually “co-secreted” with insulin, produced by the same beta-cells that produce insulin, stimulated by the presence of food, like insulin. 

In people with type 1 diabetes, the beta-cells are being destroyed which means — as you already know — they are no longer producing insulin. But they are also no longer producing amylin.

(In people with type 2 diabetes, there can be significant “amylin intolerance” much like insulin resistance and a lack of amylin produced.)

When it comes to managing post-meal blood sugar levels, amylin is pretty crucial.

How amylin works

Amylin works in two ways to help manage your blood sugar levels after you eat or drink calories. 

#1 — Amylin slows down the rate at which your stomach empties the food you eat into your small intestine. 

• When food enters the small intestine, the glucose is absorbed into your bloodstream. 
• By delaying this entire process, it slows down the rate at which your blood sugar rises after eating or drinking.   
• Without adequate amylin present, the glucose produced from the food you eat is hitting your bloodstream much sooner than compared to a non-diabetic.

#2 — Amylin helps manage your blood sugar after eating is by suppressing your pancreas’s production of glucagon.

• Glucagon is a hormone that signals your liver to release glycogen. 
• Glycogen is glucose that’s been stored in your liver and your muscle tissue. 
• Your body depends on this glucagon/glycogen/glucose relationship in order to get the fuel it needs between meals and while you’re sleeping. 

Amylin’s Role in Glucagon (Dys)Regulation

Glucagon also triggers your appetite, which means that by suppressing your body’s glucagon production, amylin is suppressing your appetite. 

Thus, people with diabetes who don’t have sufficient amylin present, tend to experience a delay in feeling satisfied or full after eating.  

Your lack of sufficient Amylin is why you are hungry all the time.

Your brain, in particular, depends upon that second-by-second delivery of glucose in order to function, and your body’s glycogen stores provide that essential fuel.

For those of us with type 1 diabetes, we live with “glucagon dysregulation,” and the reason is that we do not produce amylin properly.

The overall result of a shortage of amylin is both higher post-meal blood sugar levels and higher insulin needs overall.

No wonder it is hard to achieve non-diabetic blood sugar levels even you follow all the rules since we’re only given one of the two hormones essential to blood sugar regulation. 

And yet, while “insulin replacement therapy” is vital to staying alive, “amylin replacement therapy” has been neglected because it is not vital to staying alive.

What about Synthetic Amylin?

One of the biggest obstacles in creating synthetic amylin is that it contains “physicochemical properties” that can form “amyloid fibers” which are known as a potential threat to beta-cells in people with type 2 diabetes.

For this reason, pharmacology developed a more stable form of amylin, known as “pramlintide” that is sold under the brand name, Symlin.  It became available in 2005 and is an injectable medication taken daily designed to mimic natural amylin.

The most common side-effect is nausea and a reduced appetite which leads to another common side-effect of weight-loss. While weight-loss isn’t drastic, most patients report an average weight-loss of about 6 pounds within the first few months on the drug.

Should you take Symlin?

“It took more than 80 years after the discovery in insulin for another medical treatment for type 1 diabetes to finally come along,” Gary Scheiner, MS, CDE, and author of Think Like a Pancreas told Diatribe in 2010. 

You would think that everyone with type 1 would have jumped on the Symlin bandwagon, but that just hasn’t happened. Fewer than 5% of all type 1s in the US are using Symlin.”

Scheiner says one of the biggest reasons most people with type 1 diabetes don’t even know about amylin is because health insurance providers are reluctant to provide coverage — in fact, most won’t.

Nausea that comes with taking Symlin is mild and short-term, said Scheiner, but he feels it also deters patients from trying it or sticking to it. 

And of course, it’s yet another medication to keep track of, another injection, another expense — and it’s not vital to staying alive. 

Lastly, Scheiner theorized that many physicians aren’t comfortable prescribing Symlin — likely due to a lack of experience and a fear of patients experiencing severe hypoglycemia after starting the drug. There is certainly a period of adjustment that comes with taking any new hormone — and that includes Symlin. You would need to work closely with your diabetes healthcare team and keep a close eye on your blood sugars. 

If you’re struggling to improve your A1c and with overall blood sugar management despite making efforts in your lifestyle habits and taking insulin properly with meals, synthetic amylin might be a worthwhile option — particularly if you can get your healthcare team to advocate for you and get health insurance to cover it.