03/26/2018 Thomas PMPS 475

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Sara & Cats

Member Since 2018
Today's been a rough day. Thomas has just been laying around.

I can't understand why his blood sugar is so high. Is this a somogyi rebound for the yellows I saw a couple days ago? Or have I been overdosing him for weeks and that's why I'm seeing a relatively high flat curve?
 
Hi! I feel your pain on the high numbers. Sometimes it takes a while to get the numbers to budge - as you may see from my spreadsheet.

I’m curious as to why you reduced the dose from 4 to 2 on 3/10. I am by no means an expert, but it seems to me that he might need a higher dose. Are you trying to follow the TR protocol? I would stick to the protocol guidelines to see if you could get to a dose where you saw more of a curved curve. Hope one of the senior members can advise further.
 
We got up to the 4 units twice a day based upon one blood sugar a week. It made sense to me until I found this group. Then I realized, it was based upon very little data. Plus he was still eating dry food. I felt like we had missed the dose, I really wanted to start back at the beginning of possible.

I was just reading this:
http://petdiabetes.wikia.com/wiki/Somogyi_rebound
Which refers to high flat curves and I got stressed out.
 
I've copied this right from the link above. I don't like seeing really high numbers, I'm more comfortable when they are closer to 300. I wonder if I'm doing something wrong. His diet has been very consistent since March 9, 2018. Except he didn't want to eat much tonight.

" Repeated overdose with long-acting insulins can even cause high, flat numbers all day long."

"A good explanation of Somogyi is that it occurs when too much insulin has been administered, but the amount of overdose is not enough to cause an actual, full-blownhypoglycemia incident. Because the body detects the fall in blood glucose, the counterregulatory hormones are released just as though it was a true hypo emergency. They signal the liver to release its glycogenstores and convert it back to glucose[10]."

"It's unusual to be monitoring glucose right when this happens, and typical to just continue the overdose, leading to a repeated rebound situation. So it's good to learn to recognize the patterns of repeated rebound.

  • A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin, but it doesn't always happen.)"
 
If you’re following TR you can raise the dose by 0.25 u after 6 cycles (3 days) if you aren’t seeing better numbers. You’ve held the last two doses longer than that.
 
Or because I saw the yellows, 0.25 would make more sense?
At your current dose level you’d increase by 0.25 u. I suggest you print out the yellow info sticky for TR dosing of Lantus. That would give you a ready reference you can jot notes on, underline or note things you want to ask about.
 
I'm having trouble determining if my nadirs are above or below 300. I feel like I need more info. I'm comfortable with a .25 increase
You need to get test data in the range when nadir is most likely to happen - on average between +5 and +7 for Lantus. The nadir can move around though.
 
I've copied this right from the link above. I don't like seeing really high numbers, I'm more comfortable when they are closer to 300. I wonder if I'm doing something wrong. His diet has been very consistent since March 9, 2018. Except he didn't want to eat much tonight.

" Repeated overdose with long-acting insulins can even cause high, flat numbers all day long."

"A good explanation of Somogyi is that it occurs when too much insulin has been administered, but the amount of overdose is not enough to cause an actual, full-blownhypoglycemia incident. Because the body detects the fall in blood glucose, the counterregulatory hormones are released just as though it was a true hypo emergency. They signal the liver to release its glycogenstores and convert it back to glucose[10]."

"It's unusual to be monitoring glucose right when this happens, and typical to just continue the overdose, leading to a repeated rebound situation. So it's good to learn to recognize the patterns of repeated rebound.

  • A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin, but it doesn't always happen.)"
Interesting. I haven’t heard much discussion about that on here. I hope one of the more senior members will comment. To me, it seems as though the dose is not high enough.

I agree that increasing by 0.25 given than you saw some yellows is a good idea. As you can see from my spreadsheet, control takes time. And sometimes it’s easier to achieve than others, for unknown reasons. At first my cat was super easy to control, and after we went away on vacation in Feb everything suddenly changed and now his sugars are high and he needs more insulin.

Good luck!! Keep posting your progress, will try to help as much as I can
 
The numbers at the beginning of your spreadsheet are wonderful. I can't wait to see some more yellows and blue which I have never seen. Thomas and I will celebrate that day. We had a great day when those yellows happened
 
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