Research Reference
Pramlintide
Synthetic amylin analog used as an adjunct to insulin
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Pramlintide (Symlin) is an FDA-approved synthetic amylin analog used as an adjunct to insulin in type 1 and type 2 diabetes to slow gastric emptying and reduce postprandial glucose spikes.
Dosing Reference
Reconstitution
Add 5 mL bacteriostatic water to the 3 mg vial. Resulting concentration: 0.6 mg/mL.
| Dose | Syringe Units | mL Volume | Schedule |
|---|---|---|---|
| 15 mcg | 2.5 units | 0.03 mL | SubQ, before meals (T2D)FDA start dose (T2D) |
| 60 mcg | 10 units | 0.1 mL | SubQ, before meals (T2D)FDA maintenance (T2D) |
| 120 mcg | 20 units | 0.2 mL | SubQ, before meals (T1D)FDA max (T1D) |
Math assumes U-100 insulin syringes (1 mL = 100 units). Verify your syringe matches before use. Round half-units to the nearest visible mark.
Reconstitution
Pramlintide (Symlin) is FDA-approved as an adjunct to insulin in type 1 and type 2 diabetes. It is supplied as a pre-filled pen at a fixed concentration (0.6 mg/mL = 600 mcg/mL). Compounded research-peptide forms are not FDA-approved.
For a compounded 3 mg vial reconstituted with 5 mL, the concentration is 0.6 mg/mL; a 60 mcg dose draws to 10 units (0.1 mL) on a U-100 syringe. Store per manufacturer directions; compounded forms are not FDA-approved.
Cycling Protocol
FDA-approved pramlintide is titrated before meals: T2D start 15 mcg → 30 → 45 → 60 mcg; T1D start 15 → 30 → 45 → 60 → up to 120 mcg, as tolerated over days/weeks. Used as chronic mealtime therapy; no fixed cycle end.
Routes of Administration
Subcutaneous injection (only established route): Immediately before major meals (≥250 kcal / ≥20 g carbs) into the abdomen or thigh, at a site separate from insulin injection.
No oral, intranasal, or intravenous route is established. Compounded forms are not FDA-approved.
Stacking Protocols
| Stack | Components | Purpose | | --- | --- | --- | | Amylin + Insulin | Pramlintide + mealtime insulin | FDA-approved T1D/T2D protocol |
Pramlintide requires careful insulin dose reduction (especially prandial insulin) to avoid hypoglycemia. Compounded forms are not FDA-approved.
Side Effects & Safety
- Nausea — most common, usually transient with titration
- Hypoglycemia — significant risk, especially with insulin; reduce prandial insulin
- Vomiting, headache, anorexia — common
- Injection-site reactions — common
- Severe hypoglycemia — risk, particularly in T1D; do not mix with insulin in same syringe
Pramlintide (Symlin) is FDA-approved as an adjunct to insulin in T1D/T2D. Compounded research-peptide forms are not FDA-approved.
Research Basis
Pramlintide is a synthetic analog of the hormone amylin, FDA-approved (Symlin).
Mechanism: Amylin receptor agonism — slows gastric emptying, suppresses glucagon, and reduces appetite, complementing insulin in postprandial glucose control.
Clinical evidence: FDA-approved as an adjunct to mealtime insulin in type 1 and type 2 diabetes; demonstrated reductions in postprandial glucose and HbA1c with modest weight loss.
FDA-approved as an adjunct to insulin in T1D/T2D. Compounded research-peptide forms are not FDA-approved.