Amylin: The Forgotten Hormone

Most diabetes talk is dominated by the hormone insulin, which is secreted by the pancreas. People with type 1 diabetes have lost the ability to produce insulin; those with type 2 diabetes cannot produce enough of it.

What isn’t so well-known is that diabetes causes a deficiency in another hormone: amylin.

If you have diabetes, your ability to secrete amylin is likely compromised. What does that mean for you? This article will explore amylin and its importance for people with diabetes.

What Is Amylin?

Amylin is a hormone that is released by the pancreas at the same time as insulin. Amylin was first identified in 1987.

Amylin acts as a sidekick to insulin. It mostly kicks into gear during and after meals. The hormone instructs the liver to release less glucagon (a stored sugar), which helps prevent postprandial glucose spikes. It also slows gastrointestinal emptying, which helps to curb the appetite.

So what happens when your body isn’t making enough amylin? Bigger glucose spikes and increased hunger, driving weight gain.

Should You Be Taking Symlin, the Synthetic Amylin?

If the healthy body secretes amylin with every meal, should you be putting synthetic amylin back into your body? It certainly seems to make sense.

There is one brand of synthetic amylin available in the United States. The drug is pramlintide (Symlin). It is indicated for “patients with type 1 or type 2 diabetes who use mealtime insulin and have failed to achieve desired glycemic control despite optimal insulin therapy.”

A review of major studies found that Symlin reduces both A1C and postprandial blood glucose levels in patients with both type 1 and type 2. Symlin also causes modest but significant weight loss.

Some people with diabetes absolutely love Symlin. For one perspective, check out this blog post from advocate Kelly Close of diaTribe. Close lost weight and enjoyed some of the steadiest blood sugars of her life after meals. Symlin also reportedly triggers a mild euphoric feeling when it’s used.

Why isn’t Symlin more popular? There are some significant downsides…

The Downsides of Symlin

There are at least three major reasons that Symlin hasn’t caught on:

Cost. Symlin is a very expensive drug; as of this writing, it costs about $1,000 per month off the shelf, and insurers may be reluctant to cover the cost of it.
Inconvenience. Symlin acts quickly, and must be injected with every meal.
Side effects. A substantial number of Symlin users end up discontinuing the drug because they experience gastrointestinal distress, including nausea and vomiting. Some get over this unfortunate side effect after a few weeks, and others never experience it at all.

Symlin can also increase the risk of hypoglycemia, and may require complex adjustments to your insulin dosing practices. We have an article with concrete suggestions on how to adjust your diabetes management habits when you start using Symlin: Pramlintide Applied: Practical Tips for Getting Symlin to Work Right.

The Bottom Line

Amylin is a rarely-discussed hormone that is dysfunctional or absent in diabetes. It’s possible to bring your amylin levels back up with the use of pramlintide (Symlin), a synthetic exogenous amylin. Symlin has great effects for some people, including steadier blood sugar levels and weight loss, but it never became popular due to its significant downsides: cost, inconvenience, and side effects.

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