Amylin, explained

A hormone made next to insulin

Insulin is the best-known product of the beta cells in the pancreas, but it does not travel alone. The prescribing information for Symlin® (pramlintide), an amylin-based medicine, explains that amylin sits in the same secretory granules as insulin inside beta cells and is released with it when food arrives ^[1].

In healthy adults, the label adds, amylin and insulin show similar patterns both when fasting and after meals ^[1]. You can think of the two as partners: insulin moves sugar out of the blood, while amylin shapes how quickly sugar from a meal arrives in the first place.

Its other name

The gene record for amylin at the US National Library of Medicine files it as IAPP, islet amyloid polypeptide ^[2]. The islets are the clusters of hormone-making cells in the pancreas, and polypeptide means a chain of amino acids, so the name describes where it comes from and what it is made of.

The record places amylin in the calcitonin family of peptide hormones. It says the hormone is released from beta cells after food to regulate blood sugar and to act as a satiation signal, a message that you have eaten enough ^[2]. It also notes that the protein shows antimicrobial activity ^[2].

Three things amylin does after a meal

• It slows gastric emptying, meaning food passes more slowly from the stomach on to the small intestine, without changing how much of the meal is absorbed overall ^[1].
• It holds back glucagon. Glucagon tells the liver to release stored sugar; by suppressing it after a meal, amylin reduces the sugar the liver adds to the blood. The label points out that insulin alone does not bring this glucagon response back to normal ^[1].
• It acts on the brain. The label says amylin regulates food intake through central control of appetite, and the gene record calls it a satiation signal ^[1][2].
• The label notes that these three effects were worked out in nonclinical studies, meaning in animals or the laboratory ^[1].

Lower amylin in diabetes

Because amylin comes from the same cells as insulin, it is affected when those cells struggle. The Symlin® label says people with type 1 and type 2 diabetes have reduced release of both insulin and amylin in response to food ^[1].

The gene record says something similar: people with type 1 diabetes and with advanced type 2 diabetes have lower amylin levels in the blood and in the pancreas ^[2]. Insulin injections replace one of the two hormones; they do not replace amylin.

What a copy of amylin showed in people

Most of what is known about amylin in humans comes from pramlintide. Its label describes it as a synthetic 37-amino-acid polypeptide that differs from human amylin at three positions, 25, 28 and 29, where proline replaces the original amino acids ^[1].

In human studies, the label says, pramlintide slowed stomach emptying, reduced the rise in glucagon after meals and changed feelings of fullness, which led to fewer calories eaten ^[1]. In a test where people could eat freely from a buffet an hour after a single dose, total calorie intake was about a fifth lower than with placebo, and meals did not get shorter ^[1]. Clinical studies with a controlled low blood sugar challenge found that pramlintide did not alter the body’s hormonal counter-response or the perception of low blood sugar symptoms ^[1].

It is short-lived: the label gives a half-life of about 48 minutes in healthy people, and the medicine was injected before major meals ^[1]. The separate article on pramlintide covers the medicine itself.

The safety point in the label

Symlin® carries a boxed warning, printed at the top of its label, about severe low blood sugar. Used together with insulin it raises that risk, particularly in type 1 diabetes, and severe episodes, when they happen, occur within three hours of an injection ^[1]. The label warns that serious injuries can follow if this happens while driving or operating machinery ^[1].

For that reason the label limits it to people who can follow insulin adjustments and glucose monitoring closely, asks for mealtime insulin to be lowered when it is started, and rules it out for anyone with hypoglycaemia unawareness or confirmed gastroparesis ^[1]. A hormone that slows how fast sugar arrives can push blood sugar too low if the rest of the treatment is not adjusted.

Pramlintide in 2026

The Symlin® label gives an initial US approval in 2005 ^[1]. Two decades on, the official records point to the end of its availability. In FDA’s drug shortage database, AstraZeneca lists SymlinPen® 60 and SymlinPen® 120 as to be discontinued, posted on 27 October 2025, with discontinuation of manufacture as the reason ^[3]. The Orange Book data file of 9 October 2026 places every Symlin® presentation on the discontinued list ^[4].

The Orange Book uses that list for approved products that are no longer marketed, among other categories, so it describes availability rather than a safety finding ^[5]. The prescribing information is still published on DailyMed ^[1]. Anyone who used pramlintide and needs a different plan should discuss it with the prescriber; no other approved amylin medicine was listed in the FDA databases checked for this article ^[4][8].

Amylin, GLP-1 and research compounds

Amylin and GLP-1 are different hormones from different places: amylin comes from the pancreas, GLP-1 from the gut. They overlap in some effects. The Ozempic® label, for example, also says that semaglutide delays stomach emptying and lowers glucagon when blood sugar is high ^[6].

Cagrilintide is described in its phase 2 trial report as a long-acting amylin analogue under investigation for weight management ^[9]. Two phase 3a trials published in 2025 tested it once weekly together with semaglutide for 68 weeks. REDEFINE 1 enrolled 3,417 adults with overweight or obesity and no diabetes; average weight change was -20.4% with the combination and -3.0% with placebo, and gastrointestinal adverse events affected 79.6% and 39.9% ^[10]. REDEFINE 2 enrolled 1,206 adults with type 2 diabetes; the figures were -13.7% and -3.4%, with gastrointestinal events in 72.5% and 34.4% ^[11].

Both trials were funded by the developer, Novo Nordisk, and compared the combination with placebo, so they say nothing about how it would compare with an approved medicine. These are summaries of the published abstracts only. FDA states that cagrilintide cannot be used in compounding under federal law, is not a component of any FDA-approved drug and has not been found safe and effective for any condition ^[7]. Drugs@FDA listed no product containing it in the data checked for this article ^[8].

Keeping notes that make sense later

With any medicine that slows the stomach, the timing of meals, doses and any low blood sugar episodes is detail your clinician will ask about ^[1].

Writing those times down as they happen is more reliable than reconstructing them at an appointment, especially in the first weeks of a new treatment or after a change.

Symlin® and SymlinPen® are registered trademarks of the AstraZeneca group of companies. Ozempic® is a registered trademark of Novo Nordisk A/S. PepLabo is not affiliated with or endorsed by AstraZeneca or Novo Nordisk.