? AMPS 300, +7 = 59!! Possible Somoji Effect?

Hi, so yesterday I raised Copper up to 4 units of Lantus, twice daily. He's been consistently high. Today's AMPS was 300, and when I just tested 7 hours later, it was 59! He's never been so low. The vet said it's a possible Somoji Effect where it goes from really high to really low and back up again? Any experience with this? The vet said to keep testing. I wonder if we finally found the right dose or is it going to take him too low? And do I give him a PM dose (depending on his pre-shot BG level, of course) and if so, should I continue to give him 4 units?

 

https://felinediabetes.com/FDMB/threads/consistently-high-bg-lantus-insulin-4-units-day.245281/

Previous post for continuity

 

Hi I will tag a few members that can take a look at your spreadsheet

@Wendy&Neko

@Sienne and Gabby (GA)

@Bron and Sheba (GA)

@Bandit's Mom

@Deb & Wink

Thank you ladies





Also could you please add to your signature what you are feeding wet or dry
or both
Also put what insulin you are using to your spreadsheet
We also increase or decrease by 0.25 units, not whole units
I saw on your previous post which I link above that you are using Lantus
Do you have syringes with half unit markings

 

I have been steadily increasing by half units. I don't have syringes with half units, so I eyeball it as best I can. I use the pen for whole units and the syringes for half units.

 

You can still eye ball 0.25 changes with the syringes you have
Let's wait and see if anyone answers my tags
Try and get the syringes with half unit markings it will be easier for you

Here are some with half unit markings for using Lantus

https://www.adwdiabetes.com/product/5739/ulticare-u100-vet-rx-half-unit-syringes-31g-3-10cc-60ct


https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit


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I see you are doing SLGS , can you also add that to your signature please, thanks for adding the other info. Going by the instructions here you should decrease his dose by 0.25 unuts because he dropped below 90

@Deb & Wink

@Bron and Sheba (GA)

@Bandit's Mom

@Wendy&Neko


AM I correct about the decrease?

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

Can you add SLGS to your signature also

 

Hi I will tag a few members that can take a look at your spreadsheet
@@Wendy&Neko

@Sienne and Gabby (GA)

@Bron and Sheba (GA)

@Bandit's Mom

@Deb & Wink

Thank you ladies don't know if you got the tags #3

 

I see you are doing SLGS , can you also add that to your signature please, thanks for adding the other info. Going by the instructions here you should decrease his dose by 0.25 units because he dropped below 90
@@Deb & Wink

@Bron and Sheba (GA)

@Bandit's Mom

@Wendy&Neko

@Sienne and Gabby (GA)


AM I correct about the decrease? #6

 

There is no such thing as Somogyi effect in cats.
What they are doing is bouncing. Bouncing occurs when the cat drops too fast, too low or lower than he is used to.
He could well have dropped lower before you tested for the 59 at+7

I would definitely not increase the dose.
I would try and get some earlier tests in during the am cycle if you can
Also, in the PM cycle where you are seeing the +2 BG lower than the preshot BG, I would be setting the alarm and getting up again to check the BG because cats often drop lower at night and he could very well be dropping lower at night and bouncing.
We recommend increasing the dose in 1/4 unit increments so as not to go past the best dose and to keep Cooper safe.

are you giving snacks during the first half of the cycles as well as the preshot meals?

 

I'm free-feeding. I give him a cheese treat with his thyroid medicine at the time of the shot, because he also has to take that twice a day. Today I am testing every 2 hrs.

 

As Bron noted, Somogyi is a concept that was first described in 1938 in humans and was published in a truly lackluster medical journal. The study was based on a sample of less than 10 people. To say that it is controversial is giving the concept far more credibility than it's due. To be generous, the long-acting, depot typed of insulins were not available in 1938 so the idea of Somogyi is not relevant. Further, it's not relevant to cats. In fact, Roomp and Rand looked at data in cats on Lantus and found no evidence of Somogyi. What your vet is describing is what we've been calling a "bounce." Your vet's description is consistent with what we describe, it's just not Somogyi. For some inexplicable reason, vets have picked up the term and continue to use it despite it not being what was described in 1938.

When a cat's BG numbers drop into a low(ish) range, drop fast, or drop into a range the cat isn't used to, their liver and pancreas react as though it's an emergency. A protective mechanism comes into play whereby a stored form of glucose along with counterregulatory hormones are released that cause the BG to spike upward, hence the return to higher numbers. This is a normal phenomenon although one that the human caregivers find rather annoying.

In looking at Copper's spreadsheet, I have a couple of thoughts.

• The data prior to 3/27 is problematic. There is no way that your cat was going to have a good response to once a day dosing. The feline metabolism is too fast for insulin to last 24 hours. As a result, you had no depot so it was impossible for Lantus to be working the way it should.
• As others have mentioned, the dosing methods we use call for doses to typically be increased by 0.25u. You can't do this with a pen. In fact, the pens are not terribly accurate with smaller doses. Since you have syringes, just use the syringe for all of your dosing. You can eyeball the quarter unit amounts or you can purchase digital calipers which can help you with measuring your doses consistently.
• We use 2 dosing methods -- Start Low Go Slow (SLGS) and Tight Regulation (TR). With TR, if nadirs are over 300, you can increase the dose by 0.5u. If you're using SLGS, you increase by 0.25u regardless of where the nadirs are. If dry food is still in the picture, you can only use SLGS. (If you're no longer feeding Copper dry food, you'll want to remove that from your signature.)
  • With SLGS, if your cat's number drop below 90, a dose reduction is indicated. If the 59 is accurate, you should have reduced your cat's dose by 0.25u.
• If dry food is still a part of Cooper's diet, it may be why you're not seeing lower numbers. The DM is high in carbohydrates. In other words, it's like feeding a diabetic human cookies.

 

Okay, so far today numbers are staying in the 200's after first dose. We'll see. I haven't been able to transition to wet food yet. He has no interest in it at all, and every time I open a can, one of the other cats barges in and eats it all. It's a struggle! Also, I'm afraid to change too many things at once. It's a process...

 

I had to feed Wink in a separate room, door closed, so the other cats would not interrupt him.
He was a dry food addict. I used all of these tips you will find in the following document, to get him off the dry food and eating low carb wet food.

Transitioning your cat from dry to wet food
It's not easy, and it may be 2 steps forward and 1 step back for some time.

 

Reiterating what others have said, since you are feeding dry food, and he went below 90, you should reduce the dose to 3.75 units.

 

Okay, his numbers have stayed in the 200's all day... will give him his pm dose in about 30 minutes. Should I stay at 4 units or reduce? Again, I can't really measure out 1/4 units right now.

 

Reduce the dose. If you are using syringes, you can try counting the number of drops in 1 unit. So, fill up a used syringe with coloured liquid (tea, juice). Squeeze and rotate the plunger to squeeze out a drop. Practice getting consistent size drops. Then try counting the number of drops in 1 unit. Divide that number by 4, you have your 0.25 unit reduction. Load the syringe with 4 units and squeeze out the number of drops that corresponds to that 0.25 units less.

 

You "eyeball" or do your best to be consistent with those 0.25U doses.
See this sticky for pictures of plunger placement, for those "in between the lines" doses.
Sticky Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

 

PMPS was back up to 310, but I reduced the dose to 3.75 units by eyeballing it as best I could.

 

Today's AMPS was 440, and today I am testing every three hours. So far he's staying in the 200's.

 

The 200s are much better numbers! Keep in mind that Copper dropped from your AMPS of 440 to 224 at +6. That's a relatively big drop. Don't be surprised if numbers spike back up. The more time you see Copper in better numbers, the more those numbers will become comfortable for him.

 

BG's stayed in the 300's today, even pre-shot. Not as much bouncing, but I only checked twice between shots, at +4 and +7.