Somogyi effect?

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Cara and Wynken (GA)

Cara and Wynken (GA)

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I have been reading a lot online this morning to try to educate myself more about what might be happening with Wynk's blood sugar. The Somogyi effect was something that I had heard about but not completely understood. Now that I'm more knowledgeable I'm starting to become convinced that this is what is responsible for all these high values for Wynken. Maybe he has a lot of green nadirs, but I'm not testing then?

I'm posting a link to an article that suggests that bouncing can last for three days… Maybe most of you who give dosing advice already knew this, but I didn't.

http://petdiabetes.wikia.com/wiki/Somogyi_rebound

Right after I had him checked to make sure that the urinary tract infection was gone (which it is!) I sent an email with a link to his spreadsheet to his primary Vet (who had always checked his blood curves when I sent them to her in excel) and I also copied the vet who treated him for the urinary tract infection.

She didn't have any dosing advice for me other than to say that the high blood sugars after the shot might indicate Somagyi effect. She said she knew of an endocrine specialist at Ohio State who specialized in feline diabetes, and told me if I would get glucose values every hour after the shot she would consult with him about what he thought best. She agreed that these high values are BAD, but didn't offer any dosing advice, herself. She said it could be too little insulin or too much insulin. :confused: How's that? :banghead:

I am starting to get incredibly anxious, because I leave on a business trip February 8 and will not be back until the following weekend… Basically seven days gone. Although my sitter is comfortable giving insulin shots she has never tried to home test. Not sure Wynk would let her... We've gotten by for years with her blindly shooting whatever dose he's on, when she puts the plate down... which was also true for me, prior to late November. She's going to have to learn quite a bit about weighing his food, and feeding him separately from his sister. I hate to ask her to learn to test, as well.

It's probably too much to hope for that we would find the right dose for him in the next week… But I need to be able to tell her what dose to inject twice a day while I'm gone and keep him safe.

Thoughts on what to do over the coming week while I AM still at home?
TIA!!
 
Hi Cara - well, I think today, if you get a lot of testing in, will tell you alot about whether it could be too much or too little insulin and that will help you get a good travel dose - the people here will help you determine a safe dose
I hear you about the pet sitter - I have to go away in May and I'm already starting to panic -
I know you hate to see the reds, but look at all the blacks in Murphy's SS, and maybe you will feel better
 
I think your curve today is a great idea. It will be interesting to see if he gradually goes down and then when he starts back up. If there is something low to bounce from, then I think bouncing is your answer. If he is pretty high and flat, then unfortunately I am with the vet. It can be too much insulin or too little. You have raised slowly and carefully so too little doesn't seem logical, but neither do his high numbers. If he remains high and flat, then I'd use my week to try one approach first (maybe going back down to 1.6 or so, doing ketone tests and only staying there a few cycles to see if he drops) and then the other (raise by .5 and then again after three cycles if no movement.)

I agree that bounces can last for several cycles; we just need to see if there is anything low enough for him to bounce from.

BTW, that article pretty much describes what we call bouncing. Somogyi is the name we used to use for it. Now we just call it bouncing.
 
Carol & Murphy said:
I know you hate to see the reds, but look at all the blacks in Murphy's SS, and maybe you will feel better
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It does NOT make me feel any better... Just bad for Murphy, too!:(
We are all trying to fight the good fight… And we are doing our best, so I suppose we should give ourselves credit. It's just so hard when there doesn't seem to be anything to try to make the situation get better.

I'm up against the same sort of problems with one of my kitties that has elevated liver enzyme's and another kitty who has chronic kidney disease and also heart problems. I used to say that I ran a geriatric home for cats. But now I feel like I am running an elderly intensive care unit with multiple patients.

My sugar boy is actually doing pretty good... He always seems to feel fine, no matter what his blood glucose reading is. And he's not drinking or pee-ing too much. He does sleep a lot more than he used to. I just want him to do better.
 
Sue and Oliver (GA) said:
I think your curve today is a great idea. It will be interesting to see if he gradually goes down and then when he starts back up. If there is something low to bounce from, then I think bouncing is your answer. If he is pretty high and flat, then unfortunately I am with the vet. It can be too much insulin or too little. You have raised slowly and carefully so too little doesn't seem logical, but neither do his high numbers. If he remains high and flat, then I'd use my week to try one approach first (maybe going back down to 1.6 or so, doing ketone tests and only staying there a few cycles to see if he drops) and then the other (raise by .5 and then again after three cycles if no movement.)

I agree that bounces can last for several cycles; we just need to see if there is anything low enough for him to bounce from.

BTW, that article pretty much describes what we call bouncing. Somogyi is the name we used to use for it. Now we just call it bouncing.
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Thanks, as always, Sue! I wasn't entirely sure that bouncing was the same thing, so thanks for confirming that. Sometimes I feel like I don't know what I'm doing...but I actually have started to have a very strong "gut feeling" that his insulin dose is too high.

Either he's become insulin-resistant or that. I wish I could tell.

So far today he has stayed very high & flat. I am trying very hard to not touch anywhere near the injection site after I inject, after Cindi recommended I not rub the site. I had always rubbed pretty vigorously both because it seemed to make him feel good and I was checking to see if my hand would get wet or smelled like insulin. Now I feel like I can't tell.... So I suppose he could be high because this morning's dose was a fur shot ....?

Aaaaaargh.:facepalm: No way to know.

Couple hours later: So...I just shaved him with the clippers I use for summer. He has little spots on each side where I can see his skin under the white fuzz left by the clipper. NO. MORE.FURSHOTS! :woot:
 
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Well, apparently it was a blankety-blank fur shot... :mad: And my poor baby....
His ears are toast... :blackeye:

And I need more data on a day he actually has a response to the insulin...TOMORROW, hopefully. Not sure there will be any non-tender spots left on the edge of his poor ears.

@Sue and Oliver (GA) - Is it possible this wasn't a fur shot and he just stayed flat like this WITH insulin?
 
That's what I think too, Sue. With the shaved spots, that shouldn't happen again. Well, if his liver HAD been panicking from some previous "low" I didn't measure... maybe I've made it less panicky with hyperglycemia (I'm trying to joke/find a bright side). :facepalm:

My gut tells me to lower the dose. I think I will shoot 1.6 tonight and for all pinks. If he's red or black for a PS value in the next few days, only 1.8. Sound ok? I think of this as safe, although I know he may stay high for awhile. I've checked his blood for ketones a couple times when he's been high and it was 0.1 and 0.2.... Besides high BG, and the acetone breath smell, is there any thing else to watch for to trigger a ketone check?
 
Cara I have been reading your thread and Oh it sounds just like me back in December. I too was convinced that Bubba was getting too much insulin and started taking him down. As it turns out he was not getting enough insulin and he developed ketones. So, please keep checking him on that. Wyn's SS is as confusing as Bubba's was. Sometimes it looks like Wyn has a normal nadir and sometimes it looks like he has a late nadir like Bubba. It's enough to have you pull out your hair. Wishing you lots of luck with him when you see the specialist to see if you can get resolution.
 
Bobbie And Bubba said:
Cara I have been reading your thread and Oh it sounds just like me back in December. I too was convinced that Bubba was getting too much insulin and started taking him down. As it turns out he was not getting enough insulin and he developed ketones. So, please keep checking him on that. Wyn's SS is as confusing as Bubba's was. Sometimes it looks like Wyn has a normal nadir and sometimes it looks like he has a late nadir like Bubba. It's enough to have you pull out your hair. Wishing you lots of luck with him when you see the specialist to see if you can get resolution.
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Bobbi that is VERY helpful to hear your experience. Thanks! :bighug:

His vet told me that if he didn't come down it could be too much or too little… I guess I'm jumping the gun by wanting to lower it right away.

Instead of lowering to 1.6 tonight, I'll stay at 1.8 which is almost his normal dose. I will shoot two units if he's over 500 or in the high 400s, but otherwise 1.8 for the rest of the weekend. I will wait to hear from the endocrinologist after he looks at the sheet early next week.

Actually, he is not going to be *seen* by the specialist doctor, since he's down in Columbus. However, my veterinarian will consult with him about Wynken's spreadsheet and hopefully have some good advice about the direction we need to go.
Thanks again!!!!!
 
If he has any trace of ketones, Cara, then I would definitely try the higher dose rather than the lower. (I don't know what the numbers on your meter mean)Ketones make me nervous, and lowering may not be a good idea right now.
 
Just a few random observations/comments.

"Somogyii" and "bouncing" are not the same thing. We might exchange one term for another, but "somogyii" should never had been mentioned on the board, ever. Back in the '30s. there was a doctor named Michael Somogyii who did an experiment on six human patients. Back in the day when nobody knew much about diabetes. And his "conclusions" resulted in what is called the "somogyii effect" as an explanation for consistently high urine glucose readings, which he theorized were caused by excess insulin. The "theory" was never proved, and in today's medical community it is largely discounted. The effect has never been studied on cats in a laboratory environment. It has never been duplicated in humans, actually, because most in the diabetic medical community don't believe it exists. There's a really good discussion about it found here:
http://www.felinediabetes.com/FDMB/threads/somogyi-and-bounces.138412/

IMO, this is the best comment in the thread:
"If somogyi is in fact real, theoretically, systematic increases will eventually overwhelm the compensatory mechanisms and lower blood sugar. So the treatment should still be more insulin and not less. The doctors I worked with didn't believe this was a cause of hyperglycemia, I'm inclined to agree. Also, much of what we call "bouncing" may be more related to normal insulin curve, duration, and food spikes rather than compensatory mechanisms."

I'm glad that Bobbie chimed in. I remember very well when she believed that "less was best" only to find it wasn't. Take a good look at Bubba's SS. She kept increasing, and eventually Bubba reached a dose that worked. Granted, she's using a completely different insulin (otherwise she sure wouldn't be giving 5u on a green preshot. But I think that had Bubba stayed on Prozinc, he would have continued to need increased doses until it finally "broke through". Given the large dose Bubba needs, he is better off on Lantus. He wouldn't get the beautiful flat cycles he gets now using Prozinc because that isn't how it works.

In general, I believe that unless you see a number below 90 on your AT meter, you either hold the dose or increase it. You're basically following the SLGS approach (as opposed to tight regulation) and 90 is the magic number for reducing the dose no matter what insulin or type of meter you are using.

Sliding Scales - I think that they are the best way to use Prozinc/PZI. BUT, only if your goal is to see a nadir within the normal BG range. Sliding scales qualify as an aggressive treatment method, and the goal with a sliding scale is to keep the numbers in the normal or close to normal range for as many hours per cycle as possible. Over time, the intent is to lower the PS numbers, while seeing normal range nadirs. However, that isn't the way most people use them. So they end up using an "aggressive tool" in a "conservative" way, which is not logical (IMHO). And not very effective. In additon, when you are shooting a dose of 1.8, "tweaking" it to 2.0 is only a 10% difference in total insulin. Given that a meter can vary by up to 20%, I don't think it's likely that a 10% change in insulin is going to give someone a positive indication that the .2u adjustment works or doesn't work. I just thought differently about the whole thing I guess. I adjusted in .5u or 1.0u increments, and my ranges were far larger (100 points) apart. Not saying that it the perfect scale, but it at least let me expect to see definite differences between one dose and another. As Bob improved, my ranges remained the same (still 100 points between them) but his dose adjustments were sometimes .25u which didn't happen very often.

Definitely show the vet your SS and see what they say. My unprofessional opinion is that Wynk just needs more insulin rather than less.
 
Sue and Oliver (GA) said:
If he has any trace of ketones, Cara, then I would definitely try the higher dose rather than the lower. (I don't know what the numbers on your meter mean)Ketones make me nervous, and lowering may not be a good idea right now.
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Thanks for that input, Sue. I probably do need to increase now that I've read what you and Bobbi and Carl have written. I think the 2 measurements I made with my Precision blood ketone meter are basically "not detectable" and the blood shows ketones before the urine, so I think I'm ok. Would love to hear if that's not the case, but that's what I've pieced together.
 
Cara and Wynken said:
Thanks for that input, Sue. I probably do need to increase now that I've read what you and Bobbi and Carl have written. I think the 2 measurements I made with my Precision blood ketone meter are basically "not detectable" and the blood shows ketones before the urine, so I think I'm ok. Would love to hear if that's not the case, but that's what I've pieced together.
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Yes, blood ketone meters show you "now". Urine ketone sticks lag behind current conditions. Not sure how many hours behind.
 
Carl & Polly & Bob (GA) said:
Yes, blood ketone meters show you "now". Urine ketone sticks lag behind current conditions. Not sure how many hours behind.
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. I got out the manual and although it is written for humans… It says that values less than .6 are considered normal. Values from .6 to 1.5 indicate an issue...and values over 1.5 indicate a serious issue with blood ketones.

My results were .1 and .2. So I interpreted this as being all right. Now I am questioning whether the value that may be a problem (0.6 and higher) would be the same in a cat.
 
@Bobbie And Bubba
Bobbie might be able to tell us, if she uses a meter with Bubba. I know I've seen the "cat ranges" listed on the board someplace. Let me see if I can find them. I think you're ok though.
 
Wait... We had lowered his max dose to 2.2 after Jan 1st.

I am pretty sure (exactly) a month ago, 2.4 units was too much. And look at what happened with two units just a few days ago on January 24th.

So confused. Although I am becoming more convinced that today's morning shot was a fur shot.
 
Cara and Wynken said:
Wait... We had lowered his max dose to 2.2 after Jan 1st.

I am pretty sure (exactly) a month ago, 2.4 units was too much. And look at what happened with two units just a few days ago on January 24th.

So confused. Although I am becoming more convinced that today's morning shot was a fur shot.
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Think I've said this before ;) but maybe not to you...

Don't assume that what worked yesterday will work again tomorrow.
Don't assume that what failed yesterday will fail again tomorrow.
Wynk is not the same kitty he was a month ago, or on Jan 24th. for that matter.
"ECID" to me means Every Cycle Is Different.

And if this morning was a fur shot, it was just a fur shot, no biggie.
 
Carl & Polly & Bob (GA) said:
Don't assume that what worked yesterday will work again tomorrow.
Don't assume that what failed yesterday will fail again tomorrow.
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Boy is this true. If you look on Bubba's SS on 1/15, he was on 5 units and he started to creep back up. We hiked him up to 5.25 and in a short amount of time it proved to be too much. When we took him back to 5 units on 1/18 BINGO the perfect dose for right then! Since then he has had a few reductions.
 
Okay! Okay! Love you guys for reminding me..lol :bighug:
So *now* maybe he needs more insulin. I understand.

However, for about 3 years, I shot blind 2 units (with slight variation based on curves that were done months apart). He was eating more then...

Scary thought...I'll never know what close calls we may have had (hypo) or if he was high for weeks during that time.
 
Cara,
I know exactly how you feel. It is so frustrating, I'm going through the same very stormy waters of FD and I'm worried about my sanity but somehow, recently I found inner strength to fight against the waves and stay strong - I have no choice.
It looks like we don't really know much about how cats react to insulin and what these numbers really mean in a particular cat. I also read about Somogyi effect, like you tried to educate myself. There are a lot of theories in medicine which are just that - subsequent attempts to prove them yield completely different result, different things happen in different biological beings so it might as well be that Somogyi effect is a myth which I'm inclined to view as just that.
Carl wrote a lot about bounces here and what I particularly find helpful is that if the bounce doesn't come from green number we should ignore it (correct me Carl if I'm wrong).
Now, with my Rocky a low dose of insulin (o.5) kept him in pink numbers all day long for days. His insulin was lowered because on a slightly fatter dose he was dropping too fast too low and I suspected Somogyi because he was jumping up. After days of pink numbers we are trying to give him a slightly higher dose of 0.75 but he bounced again this morning - I don't know if he went down too low at night or because I kept feeding him during the night trying to slow the going down. It looks to me that he got used to be in high numbers for such a long time that when a right dose of insulin send his BG to lower number his body sees it as danger and throws out more glucose hence the bounce. But I might be wrong, only time and trying various approaches will tell.
Cara, as most of us here sail through the very difficult process of trying to regulate our cats without harming them we feel the frustration and stress you going through, it is really difficult but you are NOT on your own.
Sending best wishes to you and Wynken and keeping our paws crossed for better regulation,
Marlena and Rocky XXX
 
Yes, Marlena, there are two types of bounces (sometimes called "rebound")

Warranted bounce - a bounce caused by an actual low number. It usually merits a dose decrease.

Unwarranted bounce - a bounce caused by a number that is not really low, but lower than what a diabetic cat is used to. These are the bounces that I am talking about when I say I would ignore them.

Dr. Lisa explained it well in this post:
http://www.felinediabetes.com/FDMB/threads/new-day-after-yesterdays-hypo.58953/#post-642503
 
WOW, @Carl & Polly & Bob (GA) -
That link to Dr Lisa's post was great.

I read it once this morning… But will read it a couple more times today. There is so much information there and what she says resonates with me. I realize that what has been making me crazy is thinking about the glucose toxicity.

Even though she was writing to someone else about their cat, much of what she said can be directly applied to Wynken.

Thanks again.
 
Hey there Cara ~ I can't help with the dosing advice but I would say to start a new thread and preface it with a ? mark and title it Dosing Advice ASAP. That way peeps will know it is something that needs an answer ASAP and not just a continuation of last night's conversation. Nice AM number.
 
Bobbie, I appreciate it... I actually just deleted my post because I felt crazy asking for such prompt advice when I basically know what to do (1.8 or 2). And I wanted to shoot right at 7 so my hourly checks were easy to remember today. I shot 1.8.
 
Bobbie And Bubba said:
PS, I would not let the food get to ahead of the dose, you want to get it in him soon. Go with your gut if no response and be around to monitor.
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Thanks for confirming that vague feeling that I had.... I knew I didn't want to wait. I always shoot him right when I put the plate down, because he consumes his three and a half ounces at approximately the speed of a large shop-vac. :rolleyes:
 

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Cara and Wynken said:
Thanks for confirming that vague feeling that I had.... I knew I didn't want to wait. I always shoot him right when I put the plate down, because he consumes his three and a half ounces at approximately the speed of a large shop-vac. :rolleyes:
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Shop vac! Funny stuff, and I can so relate to that as Bubba is a chow hound and sucks up his food so fast your head can spin! My civvie on the other hand is a grazer which causes a problem making me the food police, picking up Forrest's food when he's done for the moment and having to give it back to him again in 30 minutes when he begs for it again. Cute pic of Wyn. He is so lucky to have him as his bean.

Cara, you are doing a great job trying to get a handle on his numbers. You will find that magic number when he starts responding better to the insulin. Those highs must make you so upset, I know they would me. Remember, an increase doesn't mean you are going in the wrong direction. It means you are getting closer to getting Wyn in better numbers. ;)

Glad you got the insulin in him Fingers and paws crossed :cat:
 
Marlena said:
Cara,
I know exactly how you feel. It is so frustrating........

Cara, as most of us here sail through the very difficult process of trying to regulate our cats without harming them we feel the frustration and stress you going through, it is really difficult but you are NOT on your own.
Sending best wishes to you and Wynken and keeping our paws crossed for better regulation,
Marlena and Rocky XXX
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Marlena,
Thank you so much for sharing your experience with Rocky, and what's going on with his dosage right now. You're right! It seems like it's the same thing. We all have similar woes and we love them so much we want to do what is exactly right.
It really helped me this morning to read through with Dr. Lisa wrote, that @Carl & Polly & Bob (GA) posted. There are many different philosophies about this apparently… And more than one "right road" to get to the goal of regulation (or if we are very lucky.... perhaps remission).

Every once in a while, when I mention that I have a diabetic cat someone will share with me that they are diabetic or that they have a friend that's diabetic. It astonishes me when I hear from these human beings that they seem to check blood sugar much less then I check Wynken. Some human diabetics are in such denial that they don't actually take their oral medication or in some cases don't do what they're supposed to do with their diet or their insulin. What are they thinking? !!

A LONG time ago, when I had no personal experience with diabetes, I worked with a man whose diabetic condition was under such poor control that he had to have a system installed on his body that continually monitored his glucose and supplied insulin. Even though that was 1999, I think about that man now, and how he got to that place where he needed that. I also think about the technology being available, and what it would be like to be able to monitor our kitty cats' glucose continuously. And then this morning, I read about Dr. Lisa imagining the same thing! Maybe someday with all the microtechnology there will be something very small that can be strapped on or even surgically added to the kitty that will make all of this testing and worrying a thing of the past.

Until then, we keep up the good fight!! Thanks again for your message of solidarity! :bighug:
 
Dear Cara, you're very welcome.
We need to support each other here on this forum - it is helping me so much and as I got help from others I would like to give back and hopefully offer a platform for releasing the frustration which goes with trying to regulate a diabetic cat.
Let's have our hopes raised as so many people struggled with sick cats for months and in the end it was worth the effort.
Let's encourage each other to do our best and educate ourselves, we will get there. Let's be brave and positive.
Your partner in FD dance
Marlena XXX
 
Well, he certainly confuses me. The 1.8 last night seems to have given you a lovely lower amps. So what is with the immediate jump to reds? If his patterns hold (such as they are) he will gradually drop, but the early high rise makes no sense to me. I know you have thought about this, and am assuming you see nothing early on in the cycles that could account for this?
 
Sue and Oliver (GA) said:
Well, he certainly confuses me. The 1.8 last night seems to have given you a lovely lower amps. So what is with the immediate jump to reds? If his patterns hold (such as they are) he will gradually drop, but the early high rise makes no sense to me. I know you have thought about this, and am assuming you see nothing early on in the cycles that could account for this?
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Yes, Sue... Very confusing. I was pretty sure he would drop at some point today and the reading I just took IS slightly lower. However he's been so high and flat so far today that I wonder if yesterday really was a fur shot? I am 100% convinced that today I got the insulin in, this morning. That's because I injected it right where I shaved him yesterday and I could see very clearly that the insulin went in subcutaneously.

As far as his blood glucose going up after injection… That has been happening very consistently for a while. If you look back you'll see it over and over. That's why my vet asked me to get readings every hour especially right after injection so that she could have the endocrinologist look at the data.

I'm like you… Completely flabbergasted…
 
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I know he normally goes up right after the injection but these cycles of high levels for 6 hours seem unusual. Glad to see some yellows later...
 
Jill & Alex (GA) said:
It's certainly possible. He does have a lot of late nadirs!
However, since I've never used any of the P insulins, I hesitate to draw conclusions. I think that part is best left to those who are more familiar with the action of the Ps than I am.
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I was thinking you and Libby had experience in both P and L Man, he reminds me of Bubba except Bubba's numbers weren't as high.
 
If the strings of high and flat numbers are actually bounces, then some of these low numbers could just be evidence the "the bounce has cleared". You can't control or predict when the effects of a bounce are going to go away. But the sign that a bounce is over would be lower numbers that follow.
 
He let me poke his ears about 35 times this weekend. His poor ears. :(
Hopefully this is enough info for the endocrinologist. Goodnight! Thanks EVERYONE for hanging in there with us during this testing extravaganza. :eek:

:bighug:
 
Hi Cara - I just wanted to lend my support to you - so glad an endocrinologist will be looking at Wynken I know the saying here is that ECID - but unfortunately I have come to the conclusion that - for some kitties - my Murphy being one - EDID - every day is different
lots of :bighug::bighug: to you
 
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