Symolgyi effect help

Nathalie & Boris

Nathalie & Boris

Member Since 2022
I took Boris to the vet this week, and the vet still things he may be heading towards remission,
and is now saying he may be having a symolgyi effect, after I mentioned and asked about this weeks ago.

Anyhow, do any of you have experience with this, and dosing recommendations?

I’ve read multiple clinical trials, and have made dosing charts, which differ a little from the TR sticker listed.

currently I reduced him because he kept going hypo to his current dose of 1u. 3 weeks ago we were at 3u and nothing was happening. 2 seems to be too much, as is 1.5. Yet 1 or lower seems to keep him in high numbers.

according to the studies you continually change the dose, or wait 3 days, within reason.

What has worked for others to stabilize the swings? I’m trying to keep in mind a swing can last 2-3 cycles, but during those curves, how do you work with the dose, and what has been the most beneficial methods?

Is >400mg ok for maybe a day, wait it out and hold the same dose for another day, or bump up the next 12 hours? By charting, Boris seems to typically go biochemical hypo at night, early am. His nadir is never consistent, but as soon as he has a low, he has an extreme high.

so at 1u do I let todays 400+ ride and see what happens the next day or two, or do so attempt to go up .5u in am if pre shot numbers are high? I would say .25, but that is still a mystery to hit on the needle. Can I get a diagram? Lol? This is so complicated!!!
 
Nathalie said:
I took Boris to the vet this week, and the vet still things he may be heading towards remission,
and is now saying he may be having a symolgyi effect, after I mentioned and asked about this weeks ago.

Anyhow, do any of you have experience with this, and dosing recommendations?

I’ve read multiple clinical trials, and have made dosing charts, which differ a little from the TR sticker listed.

currently I reduced him because he kept going hypo to his current dose of 1u. 3 weeks ago we were at 3u and nothing was happening. 2 seems to be too much, as is 1.5. Yet 1 or lower seems to keep him in high numbers.

according to the studies you continually change the dose, or wait 3 days, within reason.

What has worked for others to stabilize the swings? I’m trying to keep in mind a swing can last 2-3 cycles, but during those curves, how do you work with the dose, and what has been the most beneficial methods?

Is >400mg ok for maybe a day, wait it out and hold the same dose for another day, or bump up the next 12 hours? By charting, Boris seems to typically go biochemical hypo at night, early am. His nadir is never consistent, but as soon as he has a low, he has an extreme high.

so at 1u do I let todays 400+ ride and see what happens the next day or two, or do so attempt to go up .5u in am if pre shot numbers are high? I would say .25, but that is still a mystery to hit on the needle. Can I get a diagram? Lol? This is so complicated!!!
Click to expand...

if I was supposed to attach previous threads, my apologies. I haven’t learned how to do that yet. Every day is a new challenge.
 
Hi Nathalie and Boris, I see your spreadsheet and signature still says you're following Tight Regulation is that not the case? To answer your question, TR has been the most beneficial method for many cats.

TR tells you what to do as far as dosing, but not based on pre-shot numbers, it is based on the nadir. I am not familiar with the symolgyi effect.
 
on 4/5 in the evening when Boris' PMPS was 64 you gave no insulin, can I ask why? Lantus works best with consistency and TR calls for dosing changes of .25u usually. Pre-shot BG 50 or higher and you would normally just shoot the dose without adjustment unless you are worried about not being home to monitor or something like that.
 
Hendrick's mom and dad said:
on 4/5 in the evening when Boris' PMPS was 64 you gave no insulin, can I ask why? Lantus works best with consistency and TR calls for dosing changes of .25u usually. Pre-shot BG 50 or higher and you would normally just shoot the dose without adjustment unless you are worried about not being home to monitor or something like that.
Click to expand...

That is the thread we had previous and everyone advised I skip a shot, as well as my vet said if his PS # is 150 or less to delay a shot and adjust, although they have not given any parameters for adjusting.

As you can see from the spreadsheet he was still going down at PS and had not came back up on 4/5. Because he has hit 40's on the Alphatrak previously, I have to be cautious.

I have read all the studies, not just the stickie provided here, and almost all of them recommend using nadir and preshot numbers to adjust the dose.

Here is a link that I have broken down and written into a more easily readable format for me to follow, but the symolgyi affect is throwing me. That is when the cat has biochemical hypoglycemia and the liver goes into overdrive to counteract, causing high numbers. It is not seen in most cats, but has been regular with Boris ever since the vet told me to go up to 3 units. now I'm down to 1, because even 1.5 has caused too low nadir and preshot.

I cross referenced this with newer studies that have been written, and most state that you change the dose as needed, especially with cats that have a biochemical hypo reaction.
Using Glargine In Diabetic Cats - The Cat Clinic
 
oh you're using the AT, my bad. Yes on AT you don't shoot at 60. I am following TR but using a human meter so my mind is locked into that 50 number sorry

this is why I should probably just stop trying to help people tbh. But i hate seeing threads like this with zero replies!
 
Nathalie said:
Here is a link that I have broken down and written into a more easily readable format for me to follow, but the symolgyi affect is throwing me. That is when the cat has biochemical hypoglycemia and the liver goes into overdrive to counteract, causing high numbers. It is not seen in most cats
Click to expand...

Oh. That is just referred to as "bouncing" here at the FDMB and I disagree that it is not seeing in most diabetic cats, because I swear every single cat that comes through here has those liver panic bounces!
 
Nathalie said:
Lol I completely understand. I wake up exhausted these days. Between trying to get Boris stable, reading studies, posts etc and work it’s like 3 full time jobs.
Click to expand...

by the way is there an easy way to find your old threads?

i tried yesterday, but couldn’t remember the date I posted and got lost in the sea. Tried going to my profile but it didn’t show anything unless it was a recent alert.
 
Hendrick's mom and dad said:
oh you're using the AT, my bad. Yes on AT you don't shoot at 60. I am following TR but using a human meter so my mind is locked into that 50 number sorry

this is why I should probably just stop trying to help people tbh. But i hate seeing threads like this with zero replies!
Click to expand...
I’ve almost gotten down the calculation difference. Overall it’s based on 30pts from multiple studies I read. So if someone replies with human meter numbers, I can correlate.
I tested my ReliOn meter against the alphatrak and it was 50-60mg+difference and not consistent, so until I get him stable, it’s easier for me to stick with the Alphatrak. Once he has a semi stable week, I might change over
 
Nathalie said:
by the way is there an easy way to find your old threads?

i tried yesterday, but couldn’t remember the date I posted and got lost in the sea. Tried going to my profile but it didn’t show anything unless it was a recent alert.
Click to expand...

profile page, "Postings" tab, then if you don't see it in that list you can click at the bottom "find all threads started by Nathalie"
 
Nathalie said:
I’ve almost gotten down the calculation difference. Overall it’s based on 30pts from multiple studies I read. So if someone replies with human meter numbers, I can correlate.
I tested my ReliOn meter against the alphatrak and it was 50-60mg+difference and not consistent, so until I get him stable, it’s easier for me to stick with the Alphatrak. Once he has a semi stable week, I might change over
Click to expand...

Nathalie -- look at Tina's Spreadsheet around November 8, 2019 -- I used the AlphaTrac until it looked like she was coming off insulin. By changing to the human meter, it was a lot easier for others to help me, since most use the human meter. Not to mention how much money I saved. And that it became obvious, Tina was ready to come off insulin.
I also liked the idea of the little drop of blood, so I used the Freestyle Lite Meter.
You can learn a lot by looking at other member's spreadsheets.

Very important - the AT and Relion may correlate some of the time, as in 30 pts different, but as numbers get higher, there is a larger difference in the numbers.

Researching is obviously a strong point of yours. I get stuck on it too!

I wish I had found this forum as soon as Tina was diagnosed. Thankfully, I did not hurt her while not testing at the right times. TR is a winner in my eyes. We weren't making much progress going slower.
 
Tina Marie (GA) and Jan said:
Nathalie -- look at Tina's Spreadsheet around November 8, 2019 -- I used the AlphaTrac until it looked like she was coming off insulin. By changing to the human meter, it was a lot easier for others to help me, since most use the human meter. Not to mention how much money I saved. And that it became obvious, Tina was ready to come off insulin.
I also liked the idea of the little drop of blood, so I used the Freestyle Lite Meter.
You can learn a lot by looking at other member's spreadsheets.

Very important - the AT and Relion may correlate some of the time, as in 30 pts different, but as numbers get higher, there is a larger difference in the numbers.

Researching is obviously a strong point of yours. I get stuck on it too!

I wish I had found this forum as soon as Tina was diagnosed. Thankfully, I did not hurt her while not testing at the right times. TR is a winner in my eyes. We weren't making much progress going slower.
Click to expand...

I looked at the spreadsheet, but there was not a lot of numbers to go by. Did they get deleted?

so sorry to see it said your baby went to heaven. Cute video as well!
 
I think you need to go back to 1.25U and hold that dose. The depot is all messed up at the moment, and I suspect the lower numbers you saw were due to the larger depot from the larger doses.

Somogyi effect ..don't get us started lol it has never been proven in cats. It was one study, a long time ago, in humans. What you're seeing is bounces, very normal given the dose inconsistencies, newly diagnosed cat, and the numbers. Hendrick is actually a great example of this if you look at his spreadsheet, he bounced for the first few months and over time it got better and pretty much stopped.

Bounces are when a cat drops lower or faster than they're used to, the liver perceives it as a threat and dumps glycogen and counterregulatory hormones in order to spike BG back up.

As for the meters...in lower numbers yes they read closer, usually within about 20-30 points. But our dosing methods already account for the difference. Now in higher numbers, it's a bigger difference. The pet meters tend to read much higher at higher numbers. But honestly, it's irrelevant. High is high is high, doesn't matter 400 or 500 or 600 because there's nothing you do differently. Just focus on nadir and adjusting the dose to get that close to 68 on a pet meter
 
FrostD said:
I think you need to go back to 1.25U and hold that dose. The depot is all messed up at the moment, and I suspect the lower numbers you saw were due to the larger depot from the larger doses.

Somogyi effect ..don't get us started lol it has never been proven in cats. It was one study, a long time ago, in humans. What you're seeing is bounces, very normal given the dose inconsistencies, newly diagnosed cat, and the numbers. Hendrick is actually a great example of this if you look at his spreadsheet, he bounced for the first few months and over time it got better and pretty much stopped.

Bounces are when a cat drops lower or faster than they're used to, the liver perceives it as a threat and dumps glycogen and counterregulatory hormones in order to spike BG back up.

As for the meters...in lower numbers yes they read closer, usually within about 20-30 points. But our dosing methods already account for the difference. Now in higher numbers, it's a bigger difference. The pet meters tend to read much higher at higher numbers. But honestly, it's irrelevant. High is high is high, doesn't matter 400 or 500 or 600 because there's nothing you do differently. Just focus on nadir and adjusting the dose to get that close to 68 on a pet meter
Click to expand...

Thanks, I'll look at his spreadsheet as well as Tina's 2019 tab.

One question on the nadir, what if the nadir is at preshot? That's where I get worried. When the number continually climbs down until PS like it did on 4/5 and the night before last. I decided to try just reducing the dose yesterday instead of holding because every time I hold the shot he swings super high.
 
Nathalie said:
Thanks, I'll look at his spreadsheet as well as Tina's 2019 tab.

One question on the nadir, what if the nadir is at preshot? That's where I get worried. When the number continually climbs down until PS like it did on 4/5 and the night before last. I decided to try just reducing the dose yesterday instead of holding because every time I hold the shot he swings super high.
Click to expand...
You'll notice that the "bounce breaking cycles" are a long slide down, usually with a much later nadir - like at PS as you've seen. Now based on the data you have, for Boris the next shot onsets at normal time, so you do need to be a bit careful based on numbers (some cats the onset of the next shot is later). For now, we always recommend stalling without feeding and posting and asking for help when you get a low preshot.

Once you get to a good, consistent dose with enough data you'll be able to shoot anything over 68.

He is going to swing high no matter what because of the bounce. So it's actually better to give his normal dose (i.e. more insulin than a reduced dose) to help him from going too high. To be clear - I do not mean raise the dose - I mean keep your normal dose, factoring in any earned reductions. They need insulin and the depot to offset the bounce.
 
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FrostD said:
You'll notice that the "bounce breaking cycles" are a long slide down, usually with a much later nadir - like at PS as you've seen. Now based on the data you have, for Boris the next shot onsets at normal time, so you do need to be a bit careful based on numbers (some cats the onset of the next shot is later). For now, we always recommend stalling without feeding and posting and asking for help when you get a low preshot.

Once you get to a good, consistent dose with enough data you'll be able to shoot anything over 68.

He is going to swing high no matter what because of the bounce. So it's actually better to give his normal dose (i.e. more insulin than a reduced dose) to help him from going too high. To be clear - I do not mean raise the dose - I mean keep your normal dose, factoring in any earned reductions. They need insulin and the depot to offset the bounce.
Click to expand...
FrostD said:
You'll notice that the "bounce breaking cycles" are a long slide down, usually with a much later nadir - like at PS as you've seen. Now based on the data you have, for Boris the next shot onsets at normal time, so you do need to be a bit careful based on numbers (some cats the onset of the next shot is later). For now, we always recommend stalling without feeding and posting and asking for help when you get a low preshot.

Once you get to a good, consistent dose with enough data you'll be able to shoot anything over 68.

He is going to swing high no matter what because of the bounce. So it's actually better to give his normal dose (i.e. more insulin than a reduced dose) to help him from going too high. To be clear - I do not mean raise the dose - I mean keep your normal dose, factoring in any earned reductions. They need insulin and the depot to offset the bounce.
Click to expand...

Thanks for the help and info Frost! I'll be looking for the info you pull from my spreadsheet to help me take this in better. Currently I'm so tired it's not fully computing.

The big question is, I have him on a 530am/pm feeding shot schedule. So if I have to hold the dose and get help, wait to feed and shoot, does that mean the next day the schedule has to change? That is a concern because I set up those times to make sure I could always be here at shot time, around work etc. Even though I really hate the 530am feed and shot. I'll figure it out if I have to and make adjustments.
 
Nathalie said:
Thanks for the help and info Frost! I'll be looking for the info you pull from my spreadsheet to help me take this in better. Currently I'm so tired it's not fully computing.

The big question is, I have him on a 530am/pm feeding shot schedule. So if I have to hold the dose and get help, wait to feed and shoot, does that mean the next day the schedule has to change? That is a concern because I set up those times to make sure I could always be here at shot time, around work etc. Even though I really hate the 530am feed and shot. I'll figure it out if I have to and make adjustments.
Click to expand...

PS my vet said a depot is BS in Lantus and that it is not supported in any of the clinical studies when I asked her about it. I trust you guys more, but need help understanding the depot length time since info on it is not readily available from what I can find. Only thing I have seen is a 2 hour overlap.
 
Nathalie said:
PS my vet said a depot is BS in Lantus and that it is not supported in any of the clinical studies when I asked her about it. I trust you guys more, but need help understanding the depot length time since info on it is not readily available from what I can find. Only thing I have seen is a 2 hour overlap.
Click to expand...

I have been a type one diabetic since 1979. I never knew of any depot, and I've used Lantus almost since it came on the market. What I personally feel, is that the depot may well exist, but at a smaller percentage than possibly thought.
 
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

There are references to papers in there ^ the thing is we never truly know how much is in there, there's no way of knowing. Or how it will last. Anecdotally, we know it can affect things for 4-6 cycles after a reduction. That is where it matters most - if you get some low numbers, usually limes, you sometimes need to consider a skip or one-time reduced dose to help slow down the extra momentum from the depot. We would help you with that.

As for schedule, I would recommend getting a test around 5:10am/pm then? Only on the cycles it seems he's breaking a bounce (your before bed test, or midcycle daytime tests would show you that).
 
If you Google "Lantus depot" you'll get all sorts of scholarly publications explaining it, trying to model it (in humans), etc
 
FrostD said:
If you Google "Lantus depot" you'll get all sorts of scholarly publications explaining it, trying to model it (in humans), etc
Click to expand...

I read through quite a bit. And now, I have to write in a simpler way - whew;)
My understanding: Depot = the sustained release of Lantus in general. The larger the dose, the longer the action may be, taking longer to completely leave the injection site.
Sustained release in me with proper dosage, makes Lantus last 24 hours, as intended (and I add fast acting for carbs); in our cats, we dose twice as often because of a feline's faster metabolism.

Prior to coming to FDMB, I was never aware of a depot (as in lasting past 24 hours in humans or past 12 hours in cats). However, I'm not denying it at all. I have seen it as not every person or cat will have exactly the intended time of action from the insulin. Some people swear Lantus lasts 18 hours, not 24 for example.

Give Mr. Kitty all kinds of love!!! I hope he and your family are well:)
 
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FrostD said:
If you Google "Lantus depot" you'll get all sorts of scholarly publications explaining it, trying to model it (in humans), etc
Click to expand...
That’s what the vet argued, that Depot was in reference to humans but cats have a higher metabolism. I googled some things and read the notes here. Like you said, no real way to know how long. I’ll figure it out with everyone’s help I’m sure.
 
Tina Marie (GA) and Jan said:
I read through quite a bit. And now, I have to write in a simpler way - whew;)
My understanding: Depot = the sustained release of Lantus in general. The larger the dose, the longer the action may be, taking longer to completely leave the injection site.
Sustained release in me with proper dosage, makes Lantus last 24 hours, as intended (and I add fast acting for carbs); in our cats, we dose twice as often because of a feline's faster metabolism.

Prior to coming to FDMB, I was never aware of a depot (as in lasting past 24 hours in humans or past 12 hours in cats). However, I'm not denying it at all. I have seen it as not every person or cat will have exactly the intended time of action from the insulin. Some people swear Lantus lasts 18 hours, not 24 for example.

Give Mr. Kitty all kinds of love!!! I hope he and your family are well:)
Click to expand...
Ah ok that makes more sense when you put it that way. Yes, agree. I'm sure it's different by cat (and human) and dose. I know with Mr Kitty started his acro treatment I was halving doses left and right and it wasn't enough.

He's good, finally got the thyroid meds so need to get those started. Thanks for asking, and same to you!
 
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