It's hard to say with any certainty, but here's what I think happened starting with the PM cycle on 2/1: some nice low greens that PM cycle, then the AMPS the morning of 2/2 is a little higher (325). That might be a small bounce. He does go down pretty nicely from there. I think he actually had a late nadir the AM cycle of 2/2. The last reading I got that morning cycle was 135 at +7. I'm guessing he went a bit lower than that. Then the PM cycle of 2/2 he has a good pre-shot of 245, but sits flat in the yellows that whole cycle. After studying him for a while, that PM cycle of 2/2 is where the bounce pops through (I think). A flat cycle like that can be a bounce.
Eddie will sometimes have a higher pre-shot after some lower numbers the previous cycle, but clear those and have another good cycle. A cycle or two later, however, the counter-regulatory hormones that are floating around just are too much for the insulin to break through, so he has a flat cycle. At least that's what I think Eddie's doing. Sometimes, he'll bounce for a full cycle (flat cycle) after one good cycle, or sometimes he'll have even three good cycles in a row, then one flat cycle. That's the hard part. Just like the insulin is a hormone, bounces are thought to be caused by hormones too, so throw two (or more) hormones into the mix, and it's hard to predict when a bounce will pop up. Sometimes it's within the same cycle, like when you see a sharp rise at the end of a cycle, sometimes it's reflected in a high-preshot number that clears, or sometimes those bouncy hormones overcome the effect of the insulin and you have a high flat cycle.
From what I've seen the bounces that last a full cycle seem to be a bit more common in the L insulins because they have the depot working, but for whatever reason, Eddie seems to do that too. The thought with trying to do a reducie is to see if we can get him out of those flat cycles, or reduce how frequently they happen. As you can see tonight, though, looks like the reduced amount just isn't quite enough.
The Somogyi stuff is definitely interesting. It makes a lot of logical sense, and bounces really are just based on the same concept - lower number causes a release of glucose and counter-regulatory hormones. I think the only real difference between Somogyi and "bouncing" as we understand it and see it on our spreadsheets is a matter of degree. Somogyi is dangerous because it involves dangerously low hypo numbers that cause subsequent huge spike up. Check out Xuxu's situation:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=85129&p=912704#p912704.
The key is that low number. Bouncing is pretty much the same thing, but generally doesn't involve the type of dramatic lows and highs that Somogyi is thought to involve. There's a lot of disagreement on this board frankly, as to whether Somogyi even technically exists. The phenomenon was documented in 1938 and really hasn't been replicated since then. Personally, I think it does in fact exist, but it's really not important what you call it....the important thing is what number caused the bounce? A dangerous hypo low? Or a number that kitty is just not used to?
The concern with Somogyi - and this is just my opinion - is moreso in cases where someone is just starting to test and not catching a lot of numbers. Maybe just the pre-shots which are higher and higher. It's entirely possible that there is a super low number happening in the middle of the cycle that is not being seen. That can look like not enough insulin to someone who isn't catching mid-cycle numbers.
I think what you're referring to on the wikia page with regard to the "short-acting" insulins is the novolin/humulin insulins that only last for 6-8 hours. I'm sure you've seen threads from newbies that are using these types of insulin that are having really high preshot numbers, and then catching something in the 30's around peak. That would be Somogyi.
Check out this thread, which demonstrates this pretty clearly:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=113808.
Frankly, the concern with P
was early on that there were lows that may not have been documented, and that's why there was generally a consensus that a trial of a significant reduction was appropriate, and you did that, and got lots of tests in, without catching any lows that would be causing any kind of "chronic" rebound. You're also doing enough testing at this point, that even if he was having a drop early in the cycle and rocketing back up, you'd catch some evidence of that. Hopefully that helps! :smile:
Edited when I saw that Carl and Bob popped in! Carl helped point me in the direction of a lot of the information that I'm passing on to you, Melissa!
When using shorter-acting insulins, repeated Somogyi rebound may manifest instead as rapidly alternating high and low blood sugar[11] numbers with no apparent logic. The highs and lows will both be exaggerated compared to what you'd see on a smaller dose.