? Bizarre Blood Sugar Numbers - Bouncing or Somogyi or something else?

Hi,

Butters, it seems, is extremely difficult to regulate. I need help, please. We are now two months since diagnosis, and her numbers are all over the place. I think I'm starting to see a pattern where she drops super low and then goes high for a few days.

We have gone from a starting dose of 1.5 U BID down to .25 U BID, and now we are back up at .5 U BID. I have been following Tight Regulation. What happens is, she drops below 50, then the next day she goes high, occasionally over 500 but mostly over 300 or 200, and stays that high for several days even though she continues to get insulin (I am doing the .25 decreases per TR). But all of her blood glucose drops are surrounded by high numbers that last for days. Lately she just does not seem herself, either. When she feels good, she likes a five minute play session after she eats. But that hasn't happened in a couple of weeks.

The vet looked at Butters' spreadsheet and thought it looked like the somogyi effect. She also said that Butters is difficult to regulate and recommended I take her to an internal medicine specialist. I think she broke up with me, lol. I have been spending a lot of time doing research, but I'm at a loss. I have been doing all of these dose decreases all based on a cycle of a single low day followed by several high days, and now we are doing dose increases.

I was wondering if anyone out there who has experience with a kitty with numbers that are all over the place.

Thanks so much.

 

I think you're missing the insulin in your signature. What is she on?

 

Lantus. I must have accidentally removed it when the recent sticky came out about organizing one's signature. I'm putting it back in now! Thanks Ale!

 

From Wiki: Although this hypothesis is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[6] A study published in 2007 using continuous glucose monitoring showed that a low glucose during the night (nocturnal hypoglycemia) can be highly prevalent in type 1 diabetic treatments, but is associated rather with morning hypoglycemia, not hyperglycemia.[7] Furthermore, many individuals with hypoglycemic episodes during the night don't wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[8] Thus, Somogyi's hypothesis is not assured and may be refuted.

I suggest you post in the Lantus forum where there are more experienced Lantus users to look at your spreadsheet.

 

I read that, and a number of other sites that talk about Somogyi. I'm really at a loss with trying to dose when I spend one 12 hour period trying to ward off a possible hypo, followed by three or more cycles of high to very high numbers. I would love for someone to be able to tell me that I'm not killing my cat with too much insulin.

Sure, I can also post about it in the Lantus forum.

 

I feel like you haven’t had super high numbers since 7/06, which is good. Why did you increase up to .5? You may not have given .25 enough of a chance to work. You have to wait out the bounces to really see what the new dose is doing. My two cents but let’s see what others say

 

I thought I was supposed to do an increase after three cycles of numbers mainly in the 200-300 range when doing tight regulation. That said, you have highlighted my biggest concern: that I didn't stick with .25 long enough. On the one hand, I fear I'm hurting her with too much insulin. On the other hand, what if she needs more insulin? Why don't I know what is happening when I look at her numbers. Sigh.

She is definitely not acting herself today and yesterday. When I try to play with her, she runs away from any toy I toss at her. Normally she'd just stare at me with contempt. She also seems much lower energy and looks a bit stiff. She also has not been drinking water which she normally does when she goes over 300. But most important, she still has her extremely hearty appetite.

 

This is not as bad as you think but I know how you feel. Her numbers are not horrible and 2 months is not that long. Remember that diabetes is a marathon not a sprint and every cat is different so it’s a puzzle until you get her pattern. Eating is important and not drinking as much is a good sign. She’ll feel better soon.

okay you’re following TR it makes more sense now. I’ll defer to what the folks in the Lantus forum say.

 

Hi Lyla

Sorry you are having such a hard time. It does take time for a cat to get regulated and the bouncing can get frustrating. I am dealing with a really bouncy baby myself.

Let me tag some senior members who can help you with dosing. @Bron and Sheba (GA) @Wendy&Neko

Hang in there!
Bhooma

 

Hi Lyla and Butters,
I do understand your frustration as Sheba was a very bouncy cat.
However looking at Butters SS, she is doing really well for a cat who has only been a diabetic for a short time. And she is responding to the Lantus very well.
Just a few comments first.
I can't see anywhere where you swapped to Lantus. Can you put that in the SS please with a line inbetween the Lantus and the caninsulin so it is plain to see, and also in your signature. Thanks. When helping we always look at the signature and the SS.

Also using two different meters (pet and human) in the SS is very confusing when we are trying to see trends.
Would you be able to just use the human meter in the SS and if you need to use the pet meter for the vet, just keep it on a separate sheet?

I can see you are using fat and skinny doses. We don't really use those until the cat is very close to the best dose and we are tweaking the amount given. It is best to go up and down in 1/4 unit increments for now.

The BGs you are seeing that shoot up high after low numbers are from bouncing which can happen when cats drop too low, too fast or drop lower than they are used to, and it a is very common in newly diagnosed cats. The way to overcome bouncing is to have the cat in normal numbers as much as possible. Bouncing can go on for some time in some cats so don't be discouraged by it.

If I were you I would start posting over on the Lantus forum daily..
That way we can see what is happening and can help you. We start a new threat every day on the Lantus forum and we put the date, cats name and AMPS and the add the BGs as they happen ...like this. If you have a question you can add it..
7/24 Butters AMPS 200 please help with explaining xxx.

How many times a day and night are you feeding Butters?
With Lantus you test, feed and shoot within 10 minutes. You don't wait an hour which it looks like you may be doing when looking at the SS?
If you are following TR you hold the dose for at least 6 cycles unless Butters drops too low. For now I would encourages you to ask if you need to hold the dose or increase until you get the hang of it. If you are posting each day we will get to know Butters.
Bron

 

Thanks everyone who responded for your help and encouragement. I am beyond grateful.

Bron, to answer your questions:
I've been having spreadsheet problems, lately. I just re-entered the line I had from when she started Lantus, which was June 12th, 2020. It had become a blank line.

I'm not waiting an hour to feed. I did once when she had super low numbers at shot time. I'd correct that in the spreadsheet but I'm not sure what makes it look that way. I test her then while she eats I shoot. I think I've been holding doses for six cycles, which equals three- 24 hour periods, right? I'm confusing everyone and myself by not using the terms correctly, though. Apologies. I'm two months in and even though I'm constantly reading the dosing sticky for Lantus, I'm still getting things mixed up.

I'll set up a different sheet for the Alphatrak. I don't have a vet right now anyways, it seems, so won't be using it for the time being.

I'm feeding Butters her main meal plus two snacks each day and each night. Generally, snacks at night are at +2 and +4. During the day, +3 and +6. If she goes very low I'll feed more until she comes up again.

If this is just regular old bouncing and not Somogyi like my vet suggests, should I even have been lowering her dose when she bounces? We somehow got down to .25 U and then she earned an increase back to .5 U I believe.

I'll start posting her numbers daily in the Lantus forum.

 

For a newly diagnosed cat, which Butters is, you reduce when she goes below 50. Try to ignore the bouncing. It is perfectly normal in newly diagnosed cats. It is not Symogyi, which has been disproven in cats on Lantus and TR, paper here.

It is also not uncommon to have to go up and down in dose a bit. Look forward to seeing you over on the Lantus forum.

 

Thanks for the link, Wendy. I’ll give it a read.

I will do my best to ignore the bouncing now. I know I screwed up by not reducing when she dropped below 50, and I put Butters in danger. I feel awful about it and won’t be making that mistake again.

 

Everyone makes mistakes Your beautiful Butters will forgive you.

 

Thank you Jeanne.

I am glad to have it pointed out to me. My number one concern is to do right by Butters and keep her safe. She and I have landed in a wonderful spot with amazing people.