? 7/31 Pearl AMPS 321, bouncing

[Pearl and Emily]

BGs are starting to spike again :-(. I'm thinking her insulin dose is dropping her too low and her body is over compensating? Everything I have read says this is rare with Lantus. Or am I just not being patient enough?

Also, we've been doing just twice daily meals. Should I increase to 3 or 4? She used to free feed but i cant trust her at the moment not to gorge herself.

Switching her to the super low carb food seems to be when the spikes started. Ugh.

 

[Sienne and Gabby (GA)]

I have a couple of thoughts...

First, and admittedly this is a soapbox issue for me, Somogyi is a concept that is outdated, has not been born out in the research, and doesn't apply to cats who are using a long-acting, depot-type of insulin like Lantus. Michael Somogyi, MD first published an article in 1938 in a not very impressive journal documenting the phenomenon in humans. Subsequent research (on humans) has failed to replicate his results. Needless to say, Lantus and Levemir were not in existence in 1938 so the less than stellar results from the original research can't be generalized to the current generation of insulin. Roomp & Rand recently published a paper that debunked Somogyi in cats using Lantus.

I think what you are describing is what we lovingly (not) refer to as a "bounce." When a cat's numbers drop into a range they are no longer used to, drop fast, or drop low, the liver and pancreas release a stored form of glucose along with counterregulatory hormones and the numbers spike back upwards. While incredibly annoying, this is a normal response. Once Pearl gets used to spending time in lower numbers the bounces will begin to diminish.

When you refer to Pearl's numbers dropping "too low," I'm not sure what you mean. For most of us, too low would be in hypoglycemic territory (i.e., below 50 on a human meter or below 68 on an AlphaTrack). When Pearl drops into the 100s, you're seeing a bounce because she's not used to being in closer to normal numbers.

I also think you've nailed it -- you're not being patient enough. You just increased Pearl's dose. Give the depot several days to stabilize. Depending on which dosing strategy you're using, you give the dose 3 days/6 cycles (Tight Regulation) or a week (SLGS) to settle.

Most of us would feed several small meals each cycle. It's easier for your cat's metabolism and pancreas to accommodate several small meals vs one large meal each cycle.

 

[Olive & Paula]

Bouncing happens for most cats. It's all part of it. Lantus doesn't necessarily stop or prevent bouncing. I can attest to 2 cats on lantus and levemir who bounce.

 

[Pearl and Emily]

I have a couple of thoughts...

First, and admittedly this is a soapbox issue for me, Somogyi is a concept that is outdated, has not been born out in the research, and doesn't apply to cats who are using a long-acting, depot-type of insulin like Lantus. Michael Somogyi, MD first published an article in 1938 in a not very impressive journal documenting the phenomenon in humans. Subsequent research (on humans) has failed to replicate his results. Needless to say, Lantus and Levemir were not in existence in 1938 so the less than stellar results from the original research can't be generalized to the current generation of insulin. Roomp & Rand recently published a paper that debunked Somogyi in cats using Lantus.

I think what you are describing is what we lovingly (not) refer to as a "bounce." When a cat's numbers drop into a range they are no longer used to, drop fast, or drop low, the liver and pancreas release a stored form of glucose along with counterregulatory hormones and the numbers spike back upwards. While incredibly annoying, this is a normal response. Once Pearl gets used to spending time in lower numbers the bounces will begin to diminish.

When you refer to Pearl's numbers dropping "too low," I'm not sure what you mean. For most of us, too low would be in hypoglycemic territory (i.e., below 50 on a human meter or below 68 on an AlphaTrack). When Pearl drops into the 100s, you're seeing a bounce because she's not used to being in closer to normal numbers.

I also think you've nailed it -- you're not being patient enough. You just increased Pearl's dose. Give the depot several days to stabilize. Depending on which dosing strategy you're using, you give the dose 3 days/6 cycles (Tight Regulation) or a week (SLGS) to settle.

Most of us would feed several small meals each cycle. It's easier for your cat's metabolism and pancreas to accommodate several small meals vs one large meal each cycle.

The somogyi effect was, maybe unfortunately so, still regarded and considered in my veterinary office. But yes, I agree it doesnt make sense for anyone, cat or human, to experience that with an insulin like Lantus. So it's bouncing then.
What I meant by "too low" was significantly below what has been recently normal for her. We have not experienced clinical hypo as of yet, so really, the more I ramble the more I realize bouncing is exactly what's happening. How long does this typically occur? Obviously ecid, but how long for the depot to establish and calm the bouncing?
I will feed more regularly (4-5 mini meals) to see if that also helps. Would you recommend I stay on the 1u and ride out the bounces, or at the increase to 1.25u (as of this morning?)

Thank you so much for your help

 

[Wendy&Neko]

A vet who posts on here told us how she was trained on Somogyi in school, so it's not surprising that myth still abounds. As Roomp and Rand showed, for cats on long lasting insulin and following protocols with safe increases, it doesn't happen. Having said that, we have seen cats started on ridiculous doses. I remember one cat in Alaska started on 10 units!

I see you have done the increase already, but I have some comments First, you say you are following TR, but there are quite a few cycles with only the preshot test. Following TR, you try to get at least two tests per cycle, the preshot and one other. During the day, an "out the door" or "in the door" test can provide good information. Some people are away 12 hours, in which case this isn't possible. If you just can't get one during the day due to schedule, then you need to get one at night. Many cats go lower at night. Even a before bed test, if it's +2 or later, will help fill in the picture. This is all part of the "safe increases" I mentioned above and knowing how low the dose can take her. You know she got to at least 101 on the AT a couple nights ago.

If you have done the increase, just carry on, but you may need to be more vigilant.

 

[Sienne and Gabby (GA)]

There's a difference between the depot having a chance to be established after a dose change and bouncing. It takes most cats 3 or sometimes more cycles for a bounce to clear. As a cat's body is adjusting back to more normal numbers, the bounces can clear quickly or disappear altogether. That said, there are some cats who insist on bouncing no matter what.

Similarly, it takes 3 days/6 cycles for the depot to stabilize after an increase or decrease in dose.