11/22 - Mugsy has Somogyi Effect

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He definitely has it - I've researched 'till my eyes crossed. He's at 1.25 down from 1.5u. His amps was 443 (after a +600) and his 1:30 was 41. Do I go lower? Hold the dose at 1.25? Skip a dose? Next test in 15 minutes - see chart. I'll be on line until his shot at 8 pm.
 
Normally a reading in the 40s would earn a .25 dose reduction. From my experience, some cats drop down the dosing ladder fairly quickly. If they don't hold the new dose, you could always increase later.

Mugsy might bounce (again) after that 41. Sometimes we'll give the current dose to get thru the bounce and then reduce, but I don't know. Mugsy's been dropping quite a bit on your current dose.

Hopefully one of the experts will drop by. You could edit your subject line to say something like "Dose Advice" to get some attention.
 
Sally, Mugsy earned a dose decrease with the 41 today. You should decrease to 1.0u tonight. He will most likely bounce from the 41 today, so don't be surprised if you see a high number at PMPS, and higher numbers over the next few cycles. The bounce will clear on its own, stay with the 1.0u unless he goes below 50 again.
 
Time's Up - syringe loaded and ready to shoot. Tonight's number was 576. Thanks
 
Sally, you're doing great on the testing. I am proud of you.
Good luck on the dosecrease.

Just one suggestion: When my cat J.D. gets into the 40s, I test about every 15 minutes or so, until he comes up. That's just to make sure he doesn't go into the 30s where I would have to feed him some high carb food to bring him back up to safe numbers.

I hope you have a great night and a nice sleep.
 
Thanks everyone. Thanks Dyana - the lancets made the difference. Hi Celi - hi to Binks. I'm going to collapse now. Goodnight! :-D
 
Somogyi Effect has been a topic of discussion here intermittently. It you have a chance to read the Tilly Protocol, which is more formal version of the dosing protocol we use here, you will find the following information:

Tilly Protocol said:
Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
Click to expand...

Because we raise doses in small increments and allow those doses to settle, there is minimal chance for true Somogyi to occur. Cats do bounce due to the protective functioning of the liver in response to low numbers but over time, these bounces flatten out. To be honest, I have done literature searches in medical databases and can find very little experimental/research studies that document this effect.
 
And heaven only knows what is going on overnight. Most cats go lower overnight than they do in the daytime. I sure wish you would try and get some tests done around midnight or so - diabetes doesn't sleep....
 
Sienne and Perry.....I found tons of info on somogyi-dawn phenom-glyco as well as reading the info on this site. As for testing PMU-AMU, only if absolutely necessary due to lack of light and a need to sleep. I keep a watch on everyone during the night as best I can. No more of your lectures please.
 
Sally and Mugsy said:
Sienne and Perry.....I found tons of info on somogyi-dawn phenom-glyco as well as reading the info on this site. As for testing PMU-AMU, only if absolutely necessary due to lack of light and a need to sleep. I keep a watch on everyone during the night as best I can. No more of your lectures please.
Click to expand...

OK, you know better than all the people on here so you will do what you want, regardless.
You are the only person on here out of hundreds who has a 12 hour spreadsheet and who apparently refuses to accept that a Hypo incident can occur in the middle of the night. I certainly won't lecture you again, you can be quite sure of that.
 
replying to your PM here...
yes, reducing the dose was a good idea. lantus dosing is based on nadirs and that 41 yesterday earned a reduction.

As for testing PMU-AMU, only if absolutely necessary...
Click to expand...
you've been at the "absolutely necessary" stage for awhile now, sally. when a kitty is dropping into the 40s and 50s on any given dose, it becomes necessary to perform spot checks in both AM and PM cycles. perry's suggestion is a good one and is made in the interest of keeping mugsy safe. we've all been suggesting PM spot checks for quite awhile now.

if you take a look at other's spreadsheets, you can't help but notice many, many lantus kitties have more action at night than they do during the day. is mugsy one of these kitties? there's no way to know without spot checks.

please take suggestions in the spirit which they are offered...
 
I worry so much about going low overnite that I get up early some morns to catch a +11 or earlier. It's a bit concern for me and feels like a punch in the stomach to test and catch a low... it would be nice if my cats would give me some sort of sign, but nooooo, the keep it all a secret and act like What? Too low? UGH.

Best of luck with the dosecrease.

Added: See 9/17/10 and 10/28/10 on Oliver's ss for lows in the middle of the nite. NOTE: acros need to be kept above 100 so that's why I call them low.
 
Perry and Jill:

I appreciate what you're saying about PM tests but, (and I'm sick to death of explaining this) they are almost impossible! If you can do tests in the dark with very bad eyesight and a resistant cat - come here and do it. I live in a MOTOR home (30 years old) with less than great lighting when it works properly, little room to work, eyesight that with bi-focals is less than 20-10 AND cataracts. My helper is mentally impaired by strokes and although Mugsy doesn't fight like he did, he is still not willing to endure the pokes without restraint. 2 am pokes are only an act of desperation (mine probably). I set my brain to wake up often and check on him and hubby during the night (they are both snuggled to me) and will hopefully know if something is amiss (I know them very well). I don't get the sleep I need. I am trying the best I can. Information and suggestions from the experienced I can use but, try to understand MY side, please. AND Perry get off your self-righteous high-horse. I need advice NOT lectures. I am NOT doing what I feel like but, what I think is best and if I think NO ONE is looking at the whole picture just bits and pieces I have to do what I think is best. Teach NOT preach. Jill, thanks for responding. Please understand I am not making excuses - just coping the best I can and devouring information about this subject like a starving animal.
 
Sally --

You're correct, there is information about Somogyi all over the place. The problem is that it mostly generates from one study that was conducted many, many years ago and that one study was poorly conducted from a research methodology standpoint. There have been few, if any, attempts to conduct methodologically sound research on Somogyi with a long-acting insulin such Lantus. Instead, what's available on web searches is what amounts to urban legend or whispering-down-the-lane. There really isn't data. I have access to a medical and veterinary library along with all of the research tools available there -- databases like PubMed and Ovid -- as well as medical references. There are very few clinical science oriented, let alone journal articles reflecting experimental studies on this topic especially in felines.

Mugsy is bouncing in response to low numbers. But, all of our cats do this for a period of time until their bodies become once again acclimated to normal BG levels. As it is, you are lowering dose which should, hopefully, mean good things for Mugsy.

From what it sounds like, there are limitations to your getting PM tests. I would only caution you to be very careful and not assume all is fine because Mugsy doesn't look like she's in distress or you're not seeing any outward signs of hypoglycemia. I walked in the door from a trip on Sunday, Gabby's dose had been reduced for my petsitter, and my in the door test was a 34. Gabby was acting fine. I would not want Gabby to be in that range for any length of time. That's our concern. Only getting tests will inform your dosing decisions or let you know if Mugsy is in a BG range that requires you to actively intervene. Because we encourage testing, most of the time we catch those unexpected lows. As long as you are aware of the risks, it's your decision how to proceed. Our only point of presenting information is to make sure you have the facts and can make an informed decision. Our goal is to keep Mugsy safe.
 
(((sally)))
i understand getting those night time spot checks is quite a challenge. i think you've made that clear before today. actually, not being able to get spot checks easily is "why" many of us strongly suggested dropping mugsy's dose from 1u bid three weeks ago (nov. 4th). at that time, your chart shows mugsy had dropped to 53 on that 1u dose. instead, his dose was increased without adequate data a few days later.

my own cat has dropped into the 20s and 30s without any apparent hypo signs what-so-ever. luckily, i just happened to catch the drops by spot checking. things may have taken a turn for the worse had i not intervened. i guess the point i'm making is looks can be deceiving. i just want you to be aware of this.

i'm glad you've reduced the dose. if you're catching low numbers during the day, chances are they're happening at night, too. in that case, as we suggested several weeks ago, the safest thing to do is reduce the dose.

if mugsy is dropping into the 50 - 100 range during the day (given that you are not able to get the night time checks)... how about reducing the dose? remember, lantus dosing is all about nadirs (the lowest kitty drops in the cycle). i have to say, even a plan like this could be risky. mugsy could still drop unexpectedly. you'll have to be prepared for it.

here's the thing... given the circumstances, you don't want to run mugsy as low as some of what you're seeing in this group. practicing tight regulation requires more testing than other methods. in the interest of safety, you don't want to run him so low. make sense?
 
Thank you Sienne, that was very informative.
I found one dissertation on Somogyi effect that referred to the pattern of the curve compared to a normal curve and showed the chart. The test was done on either an alley cat or the cat's name was Alley Cat. Anyway, it was the exact same pattern that Mugsy's curve displays (I made curve charts, too) except he doesn't always go so low. His highs flat line and that too was mentioned. His highs really worry me because they are so damaging and continue for long periods while his lows don't seem to last - he seems to literally bounce to and from them. It has been h... trying just to find his major nadir point because it has occurred at times from 1:30 to 5:00 I finally narrowed it to usually 1:30 - 2:30.
I am very aware that there may be no symptoms for hypo (I have that & hyper posted everywhere) but, you get used to your cat (or hubby or...) and Mugs is also very talkative. In the middle of the night I check his heartbeat and respiration and so forth and he talks to me. If you can't see, you learn what your other senses can tell you. I know it's not infallible but, by 7:30 at night (the PMPS) I can barely make out what I'm doing - everything is black and grey and sometimes I can't even see the blood at all even without my glasses and my nose pressed to it - and this is with two or three lights on in the area.
Everybody, I fear, thinks I'm whining and making excuses but, it really has been hard for Mugsy and me to deal with this. First lack of information (vet simply said "it's terminal"), then he was injured. Between the two of us - it's awful. I am so grateful I was able to get this netbook cheap or I would have buried him by now. It's hard with my limitations, hubby's problems (he's a real 24/7 handful), and Mugsy's problems plus limited funds. I don't think his bg has ever been controlled on either insulin. Right now, information and patience are my best allies and weapons to get Mugs well.

Again - thanks
Sally
 
just a note to say please don't say somogyi does not exist. i saw it with my own cat but ON A DIFFERENT INSULIN. can't we just agree to say that it's not a consideration when we use the tilly protocol on lantus and levemir kitties. we go up and down in small dose increments determined by the cat's nadir/BG range, and are not likely to miss the right dose for long.

the studies i've read seem to be arguing semantics. regardless of what you call it, somogyi or not, let's not refer to something that starts an argument that obscures the task at hand, which is to find the best dose we can for any specific cat. we all have that same goal, so please let's not get sidetracked.

i know i'm late to the discussion, sally, but can you at least add more daytime spot checks on days off or weekends during times when you can see better? of course we all do the best we can.
 
Criscleo - catch up. I'm saying Mugsy has it. And I've been doing a lot of testing.
 
i was posting to support you, and to ask people to stop debating somogyi because it just sidetracks what we're all about.
i have not dealt with you previously, and if you don't need or want support, that's fine. i will not post on any more of your threads.
 
Sally & mugsy are trying hard. You guys need to be a bit more gentle. Not everyone can test multiple times a day.

Maybe with advice we should follow the advice for insulin administration: START LOW & GO SLOW.

Purr more, scratch less.

Hugs,
Rebecca
 
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