5/16 Pumbaa AMPS/267 +2/214 +7/97 +8/117 PMPS/421 +3/381

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Pumbaa

Pumbaa

Member Since 2012
This is only the third time in over a month that Pumbaa has started the morning as low as a yellow number. Yeehaw!

I upped his dose to 1.75U (BID) this morning, and pray that he stays true to form and has his lowest numbers at night, since I disrupted the entire household and changed my work hours to 9 pm to 6 am, to accommodate Pumbaa's lower numbers and so I can test him more at night. I'm so sleep-deprived right now I can barely type. *LOL* The things we do for our furry family members!

Looking at Pumbaa's historical data on his SS, I will bet that today his numbers go up from the AMPS 267, but tomorrow night he takes a dive, maybe into the greens for once! He does seem to dive on his 4th cycle after the dose increase. I so thank Gayle for pointing this out to me!

I so wish Pumbaa was more even in his reaction to insulin, but nothing has ever been easy in my life, so this is no surprise.

Suze
 
Re: 5/16 Pumbaa AMPS/267

Now to make things even more confusing for you here is some food for thought....http://petdiabetes.wikia.com/wiki/Somogyi_rebound

The biggest part that it took me awhile to grasp with Musette, since she still refuses to read the stickies on how to be a good Sugarcat is this part....

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.)

Musette seldom earns a reduction in the classical sense, she doesn't drop extremely low when she needs less insulin she goes high and flat.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: 5/16 Pumbaa AMPS/267

Mel, thank you for the info, but crap! *LOL*

I had read about the Somogyi rebound before, and that is why I was delaying the dose increases and waiting for Pumbaa to settle into a dose. That's why I came back to relaxed...because Pumbaa appeared to be his own entity dealing with insulin. That is why I called a time out on 4/24 and dropped Pumbaa back to .50U.

So, with your expertise with Musette, and seeing Pumbaa's SS, what do you suggest? I just want Pumbaa to have a SS like Autumn's, because for being neglected for all of those months, she is responding tremendously to your care!

For Pumbaa, do you think I should be increasing him in microdoses instead of by .25 units?

I'm still so confused, and just want the best thing for my little guy!

Suze
 
Re: 5/16 Pumbaa AMPS/267

I wish I could tell you....Musette is still an enigma to me as well....just when I think I have her all figured out she throws me a curve ball...lol.

This morning is a good example...beautiful preshot number on what I thought was a fur shot...heck maybe it was...and that is why the preshot was so pretty...lol. So I reduced her dose back down and now she is going the wrong way again at her +3. I'm almost to the point with her to just stop insulin for a couple of days out of conplete frustration and see if any amount of insulin is still too much for her.

Autumn on the other hand is a textbook diabetic, she is responding exactly like she is suppose to, but as we all know ECID...and it seems in Pumbaa and Musette that saying couldn't be more true, we have the most different of the bunch. :lol: :lol: ohmygod_smile

Right now you have two ways to go, keeping raising to see if you can find a break through dose, or start dropping the dose to see if he is in chronic rebound, which is what I suspect with Musette. I really wish there as an instruction manual written in Catanese on how to be a good diabetic for our cats to read as much as we read about how to be a good diabetic cat fur mom...lol

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: 5/16 Pumbaa AMPS/267 +2/214

Mel, before I got Pumbaa on insulin, while I was changing his diet, I was praying he was going to emulate your Maxwell, not your Musette! *LOL*

You are so very lucky that Autumn is responding as well as she is!

What would be the worst thing that could happen if you stopped giving Musette her microdoses? I've seen her chart and she looks like one sugarkitty who doesn't want any more insulin. I say go for it, and let her body decide whether she needs insulin or not. You would catch this need before it becomes dangerous, I know you! Good luck!

Suze
 
Re: 5/16 Pumbaa AMPS/267 +2/214

LOL Don't we wish they would all emulate Maxwell...he spoiled me rotten when it came to caring for a sugarcat!

I have really considered just stopping Musette's insulin and just checking her for Ketones to see if she truly needs insulin at all or if she just needs a teeny tiny bit. I may just do that this weekend when I can stalk her everytime she goes to the litter box..lol. Lord knows it would be much easier on my morning schedule and eyesight if she would decide to give up the shots...lol. I mean the worst that could happen is that she goes back up and stays up, or starts throwing a trace of ketones, in which case all I have to do it pull out the syringes and the insulin again.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Re: 5/16 Pumbaa AMPS/267 +2/214

You will also see high numbers and sudden drops low in cats positive for IAA.
I have not heard of true examples of somogyi, using Lantus, I don't see it.

ETA:
http://www.tillydiabetes.net/en_6_protocol2.htm

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.
 
Re: 5/16 Pumbaa AMPS/267 +2/214

Gayle,

Then what do you want to call it when a cat is being overdosed on insulin and getting higher numbers because of it? We've said it enough times on this board over and over again when a newbie comes on with a cat on too high of a dose and hitting high numbers that too much insulin and too little insulin can look exactly a like...so you explain that phenomenon if it isn't Rebound?

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Gayle and Mel, you both bring up good points and I've read both of the links you've shared, as well as looking up IAA (Insulin Auto Antibodies).

I'm looking forward to reading more discussion on the Somogyi rebound, because I want to understand what Pumbaa is going through. I'm praying this isn't IAA.

Suze

BTW...Pumbaa had his first recorded green number today! Then bounced right back up into the reds.
 
You found us, Helen! :) Yep, I came back to relaxed because I thought Pumbaa needed more time to settle into his doses. I don't know if that is the case...his numbers continue to confuse me, especially when I thought yesterday that I finally identified a pattern of his, then today he totally ignored his previous pattern. *LOL* They are a a handful to try and figure out, aren't they, these diabetic cats? Well, some of them, anyway.

Suze
 
Re: 5/16 Pumbaa AMPS/267 +2/214

MommaOfMuse said:
Gayle,

Then what do you want to call it when a cat is being overdosed on insulin and getting higher numbers because of it? We've said it enough times on this board over and over again when a newbie comes on with a cat on too high of a dose and hitting high numbers that too much insulin and too little insulin can look exactly a like...so you explain that phenomenon if it isn't Rebound?

Mel, Maxwell, Musette, Autumn & The Fur Gang
Click to expand...

It would be good if there was a record that tracked the cats who arrived here at a dose stated as too high, was dropped down to start over, and then where they ended up after ruling out any rebound.

I can speak only of my own cat Oliver who was at 3u when adopted and everyone was screaming rebound when he just needed more insulin, not less. He ended up being acro and IAA positive, and I regret pushing him back to that 1u mark because of pressure from others. He looked dreadful and clearly needed more insulin.
I cannot say more than show me legitimate proof of Somogyi in cats on Lantus or Levemir. If there are some documented cases, I would love to read the data.

Usually when a newbie arrives, they have not been giving a high dose for long and the high numbers are legitimate, not from any prolonged overdosing. Quite often, diet needs adjusting as well, so it's pretty hard to pinpoint the reason for lower BG when an owner changes the diet AND lowers the dose AND begins home testing more often.

That's why I would love to see some formal documented proof of somogyi.

ETA:
I would not worry about IAA so quickly. It could well be that the high numbers just feel like the right numbers still, so when you do see a better BG, the body thinks it's too low and you get your bouncing back up to what feels like the right numbers.
 
I agree in your Oliver's case he did need more insulin but you also have to admit that he is a rarity not the norm that we see....most cats are not acro or IAA.

And I can only speak for what I have seen in my own Musette...I raise her dose, her numbers get worse and become an inverted curve, with a drop at the end when the insulin is wearing off, I drop the dose down her numbers as well as her personality gets better. She is not a newly dxed diabetic, she looks and acts great and her diet was adjusted nearly a year ago when I adopted her. So I have to go with what works if more insulin in her creates higher numbers and a more depressed personality, and less gives me better numbers and a whole cat that feels better...I have to conclude that in her case at least less is more.

Now Autumn is the exact opposite at the moment...she did need more than what she was started on, and an increase gave her better numbers, but she is also just getting use to being on a proper diet as well as receiving insulin since again she isn't newly dxed but she is new to being finally treated.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
I went looking for some more info and found the below on the old board.


What is the Somogyi Effect?

Glucagon and insulin are released by the pancreas. Glucagon and insulin have opposite effects: insulin makes the blood sugar go down and glucagon causes blood sugar to go up. They work together to balance blood glucose levels. Glucagon can increase blood glucose levels by causing the liver to release its stored glucose to the blood stream. Insulin lowers blood glucose by allowing tissues to use or store glucose.

When too much insulin is given the blood glucose drops rapidly and hypoglycemia (low blood sugar) results. This can trigger the body to release glucagon (and other hormones) and the result is that glucose is dumped into the blood. This can lead to hyperglycemia (high blood sugar). So, you have hyperglycemia induced by hypoglycemia, or the Somogyi effect. (Somogyi was a scientist who did research on glucose production by liver during times of stress.)

The method of determining if Somogyi effect is occurring is to do a blood glucose curve. Your cat will have a specific pattern of hyperglycemia if the Somogyi effect is occurring. Although at first it seems odd, the treatment for this type of hyperglycemia is to DEcrease the insulin dose. This prevents the hypoglycemia from occurring and triggering the Somogyi effect.

What caught my eye was the trigger of being low in order to go high. That makes sense to me. It does not look like there were any studies done with cats, only the one on some humans and that study was rejected.

If a cat were getting too much insulin, I would expect to see very quick improvement in numbers when the dose is dropped.
If the numbers remained high, I would think there is no sort of rebound involved at all and would increase the dose again.
If the numbers went even higher, I would be positive that the previous dose and likely a higher dose was needed.
 
Quick improvement is something that I would expect to see as well if we were talking a short lasting insulin like Humulin or a long lasting in and out insulin like ProZinc or PZI...however with both Lantus and Levemir we have the shed to deal with as well. Wouldn't it be safe to say if it can take 3-5 days for a shed to fill it could also take anywhere from 3-5 days for the shed to drain?

Again Musette as an example...at .2 & .3u her numbers were still in the high 200 and 300s out of pure frustration as well as I suspect rebound (if it does exist in cats) I stopped her insulin since last night and with the exception of right after she ate today her numbers have continued to drop, she then took another drop 2 hours after eating. Now granted I may have to put her back on the juice here is a few days once I see her numbers either stablize or start rising again, and I am keeping a close eye on her for ketones...but so far it looks like she was rebounding off a tiny microdose of insulin.

The other side effect so far is she is far more cuddly and has gone back to sleeping with us and waking us up in the mornings purring her brains out...while she might not be ready to be diet controlled she is obviously producing some of her own insulin and if she is rebounding off .2u then I need to find a baseline for her to figure out a correct dose, which at this moment if she goes back on I would have to say isn't going to be much more than a fat zero or .1u

Just because no one has decided to do a scientific study about it in cats doesn't mean that it doesn't exist. It simply means that no one has thought it important enough to seek out a research grant for or to find the test subjects to conduct such a test with...IMHO.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Gayle & Mel:

I'm trying to absorb all that you both are saying, and I thank you for having this discussion.

I tend to agree with Mel on how the shed filling/draining could be an influence on seeing a quick improvement after a dose decrease. That shed certainly throws a wrench in the works if you're looking for immediate cause/effect data from dose changes. :roll:

So, you have hyperglycemia induced by hypoglycemia, or the Somogyi effect.
Click to expand...

The above makes sense, but how is that different than the liver normally dumping sugar into the system when the cat reaches a low BG number that it isn't used to?

Suze
 
The difference at least as I understand is about the same as "How do you tell if its a mock charge by a Bull Elephant?....answer in a mock charge the Elephant stops."

In a bounce the body adjusts to the dose and the higher numbers go away...in rebound they don't until the dose is lower.

While I'm sure there is a better medical definition out there somewhere of why to one the body adjusts and why in the other the numbers stay high...I'm not a vet or a doctor so can't give you the medical reason for why on a bounce their bodies eventually adjust and why in rebound the numbers just keep going up.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
MommaOfMuse said:
The difference at least as I understand is about the same as "How do you tell if its a mock charge by a Bull Elephant?....answer in a mock charge the Elephant stops."
Click to expand...

Hahahahaha! Love the analogy!

In a bounce the body adjusts to the dose and the higher numbers go away...in rebound they don't until the dose is lower.
Click to expand...

As in the highest numbers go away? Like only staying red for a short time and then dropping down into pink and maybe later yellow?

Look at Pumbaa's SS on 5/15...he stayed in the red all morning. The range was from 490 to 401. And this was in his 5th cycle at 1.50U, but later that night he did drop down into blue.

And...if it can take 72 hours to clear a bounce, do you just ignore all data for 72 after a bounce? What if there are subsequent bounces after the first bounce? Like this morning, I don't understand Pumbaa's 428 AMPS. He had an inverse curve yesterday daytime, and I thought he was clearing his bounce. I was really worried that he'd drop back into the greens when I saw his PMPS at 216 last night, but I was ready for it. Instead, he shocked me, and went up. No curve, just a straight diagonal line up.

Where's that manual for our cats to read? *LMAO*

Suze

ps: Every once in a while, I immediately do a second BG test after the first one, with a new ear prick point, fresh blood, new test strip, and only see a couple of points difference, so I don't know that I agree that every test has a +/- 20% accuracy rate from the meter. My meter has been very consistent during these "test the meter accuracy" attempts, and as long as I am comparing apples to apples with Pumbaa's numbers, I'm happy.
 
Every test CAN have UP TO a 20% variance, so if you test and get a bigger difference, it's possible variance.
You could test 10 times in a row, from the same big drop of blood and get 10 diff numbers.... best to retest ONLY if the result is way out of line with a normal curve for your cat. For cats positive for IAA, big drops and rises are common, but not for a normal diabetic cat.
 
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