Could my cat have Somogyi rebound?

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Jennifer and Spot (GA)

Jennifer and Spot (GA)

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Someone just sent me a link on this because of Spot's bouncing numbers.

http://petdiabetes.wikia.com/wiki/Somogyi_rebound

We went from giving him 1 unit a day to 1 unit twice a day, in AM and PM, because I got on this forum and many posters said once a day was not the correct treatment. No one said how much to give him, so we gave him 1u in the morning and one approx 12 hrs later. But since doing that, his numbers are all over the place. So, can anyone recommend what now? Should we try .5 in the AM and PM, or .75? We gave him .75 this AM. I feel like I don't know what I'm doing, and what I'm doing isn't helping him. Please help.

We are giving him Lantus.
 
Hi,

What you need to do is start doing "spot checks" between cycles. Just preshots is not a lot of information to go by. Please try to get at least one test between +4-6 during the cycle (4-6 hours after the shot). More if you can, and a full curve (testing every 2 hrs for one cycle) once a week would really help.

Lantus is dosed based on the nadir (lowest point of a cycle) and no one will feel comfortable giving you dose advice when we do not know anything other than preshot numbers. It is also risky for your cat, especially on days like 4/13 when you shot him a full dose at 78 without knowing how the insulin is working for him.
 
Ditto everything Ry just said. By testing only before giving shots there is no way to know how the insulin is working throughout a cycle. That info is vital for determining dose, otherwise you are shooting in the dark, so to speak. With more info you will feel more in control and members here can help you better.

Hang in there.
 
Use caution with insulin - once it is in, you can't get it out. If you are thinking you've got too much, sometimes re-starting at 0.5 units is a safe strategy while you get more information and blood tests.

If you start with a conservative dose AND get tests before every shot and as possible, 1 or more between shots, plus some curves when a dose has been stable for 5-7 days (test every 2 hours over 12 hours), you will build your knowledge of how your cat responds to the insulin. This will help guide you in the best way to use it for your cat, following established protocols.
 
.5u twice a day sounds like a good dose reduction, but again, it's really hard to tell based only on preshots.

Remember that the mid-cycle tests don't have to be during the day if you're not home--it can be in the PM cycle instead, and then get the curve when you're home on the weekend. I work two jobs and go to grad school, so there was no way I could get mid cycle tests during weekdays. I used to either stay up a little late or set an alarm to get the test 6 hrs after the shot and then go right back to bed. It seems like a pain at first, but it's really worth it because the sooner you know what's going and and can dose accordingly, the sooner you can get your cat off insulin and not have to worry about it anymore.
 
BJM said:
but it's really worth it because the sooner you know what's going and and can dose accordingly, the sooner you can get your cat off insulin and not have to worry about it anymore.
Click to expand...

It is also important to remember while a high precentage of newly diagnoised cats that are started on Lantus do go into remission and go off insulin altogether, not all of them do, some will be insulin dependent for life, but can still have a great quality of life even if they do require those two tiny shots everyday. Just like human diabetics, some can be diet controlled and not need insulin, and some can't be. But with testing and adjusting doses as needed they will lead a long and happy life as diabetics.

Plus even if you are one of the lucky ones that get to be diet controlled, once a diabetic always a diabetic and he will never be able to go back to eating high carb dry or gravy laden foods. Of course we all hope and pray that every cat that comes on this board will one day no longer need to take insulin but there is also nothing wrong with just getting them well regulated and keeping them healthy and happy on insulin.

Mel, Maxwell, Musette & The Fur Gang
 
ammonzon said:
We went from giving him 1 unit a day to 1 unit twice a day, in AM and PM, because I got on this forum and many posters said once a day was not the correct treatment.
Click to expand...

Glad to see you are giving shots twice/day now. That is a great start! I was looking at your ss this a.m. to see how things were going. To help get things working in both yours and Spots favor, you will want to make sure you are giving the SAME dose both a.m./p.m. This needs to be held for 6-10 cycles, with a full curve done before making changes to the dose (unless a BG under 50 is caught...then the dose gets reduced the next shot). Also, giving shots 12hrs apart is ideal. It looks like the shot time in the evening is anywhere between 30-60 minutes early. It is said that giving an early shot is similar to increasing the dose, and giving a late shot is like decreasing the dose. How much this time difference in your shots, with the combination of changing the dose around is affecting Spot's BG's...we don't know.

Is there a way for you to either give the a.m. shot earlier or the p.m. shot a bit later, so you are on a 12/12 schedule?

I know all of this sounds really picky, but like I said...we want things to work in your favor.


ammonzon said:
No one said how much to give him, so we gave him 1u in the morning and one approx 12 hrs later. But since doing that, his numbers are all over the place. So, can anyone recommend what now? Should we try .5 in the AM and PM, or .75? We gave him .75 this AM. I feel like I don't know what I'm doing, and what I'm doing isn't helping him. Please help.
Click to expand...

I think a few people suggested splitting the one unit in half and giving twice/daily (ie/ .5u in a.m. and .5u in p.m.) in this thread:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=68343


In order to answer your question about Somogyi rebound (which is a debate in itself ;-) ), there needs to be more information about blood glucose values during a 12-24hr period. There are two ways to go about gathering this information.
1. Bring your cat to the vet for 12+ hours to do a full glucose curve. (expensive, more stressful for cat, less accurate, less time consuming for human)
2. Do a glucose curve on your cat at home. (cheaper, less stressful for cat, more accurate, more time consuming for human)

imho, I think without a curve of some type, changing the dose of insulin can be a very dangerous game. For those who are not home testing, a vet will recommend the full glucose curve at their clinic every few weeks or month until the cat is regulated. They do not do this to collect more money from us. They do it because they need information to base their decisions off of, in order to keep the cat safe. For vets who want to save us humans money, the cat stress, and have more accurate results ...they will encourage or recommend full glucose curves done at home by the owner.

If Spot were my cat, with the information I have gained over the years, I would:
1. Try to make my shot times on a 12/12 schedule.
2. Choose a dose I felt was safe, in case I was not home to test (.5, .75, 1u) and give the same amount at each shot.
3. I would try to get a test when I leave for work in the a.m., and one right before I go to bed.
4. After 3-6 days of following the above routine I would do 1-2 curves:
AMPS, +2, +4, +6, +8, +10 OR AMPS +3, +6, +9
PLUS
PMPS, +2, +4 (if I was still awake!) OR PMPS, +3, +6
5. After the curves I would know for sure if my cat needed an increase or decrease, and/or if Somogyi was a concern. :mrgreen:

*If I could not commit the time due to work, family, or other obligations/barriers (that happens, we are only human!)...I would bring my cat to the vet for a full glucose curve, listen to both my vet and the boards recommendations, then make the best decision I could for my cat on what to do with the dose. I would repeat this process as necessary, while always testing preshots.

I hope all this makes sense, and you find the other responses you received helpful in your care for Spot.

ETA: I chose to test and do curves at home due to finances, and I felt it was more accurate. My cat had to go to the vet enough for other issues, so it was not the kind of stress I wanted to inflict on her. I shared the first handful of curves with my vet and discussed what to do, along with posting on the board. Beyond that, the vet and I had an agreement that I would call if the curves were showing something strange or out of the ordinary. If not, he trusted I would change the dose appropriately. He had full access to my ss on a daily basis, so he could always check up on us. :mrgreen:
 
Thanks all.

Carolyn, we can test at home. I meant to run a curve today, but we woke up late and he did not get his shot until 9:30 AM. I can do it, but not sure at what times now. Also, he will definitely need to eat before 9:30 pm. If we feed him at 6:30 and test him at 9:30 would that be ok?
 
We usually suuggest no food in the two hours leading up to a shot test, and you're doing three hours so it should be ok. Does he pretty much clean the bowl quick at meal time?
Carl
 
ammonzon said:
Thanks all.

Carolyn, we can test at home. I meant to run a curve today, but we woke up late and he did not get his shot until 9:30 AM. I can do it, but not sure at what times now. Also, he will definitely need to eat before 9:30 pm. If we feed him at 6:30 and test him at 9:30 would that be ok?
Click to expand...

Ok....so you are 2hrs late on the shot, which means you will want to slowly adjust it back to your regular shot time. Two of the most common ways to do this are as follows:
1. Give shot 30 minutes early ONCE each day or 24hr cycle.
ie/ Saturday night shot time would be 9pm
Sunday a.m. shot time 9am
Sunday p.m. shot time 8:30
Monday a.m. shot time 8:30
Monday p.m. shot time 8:00
Tuesday p.m. shot time 7:30
Wednesday a.m. shot time 7:30 (and now you are back on track, right?)
*hopefully, I did my math right with all of those!

2. Shoot 15 minutes early each shot time until back to regular schedule.
ie/ Saturday p.m. 9:15
Sunday a.m. 9:00
Sunday p.m. 8:45
Monday a.m. 8:30
Monday p.m. 8:15
Tuesday a.m. 8:00
Tuesday p.m. 7:45
Wednesday a.m. 7:30 (and back on schedule)

If either of these options are extremely inconvenient, some people have been known to skip a shot and start over at their regularly scheduled time, or pretend it was a fur shot (accidentally missed getting it in). It happens.

If you want to do a full curve you could test every 2-3hrs after injecting the insulin. So....
9:30 AMPS
10:30 (+1)
11:30 (+2)
12:30 (+3)
1:30 (+4)
2:30 (+5)
3:30 (+6)
4:30 (+7)
5:30 (+8)
6:30 (+9)
7:30 (+10) *try not to feed past 7pm, which would be approximately 2 hrs before your shot time*
8:30 (+11)
9:30 PMPS (or 9 if shooting 30 minutes early, 9:15 if shooting 15 minutes early)
*bold = test for curve*

Keep in mind, because the shot time was late, he may have higher numbers. A late shot acts as if a dose was decreased.
It would be great to do a curve and get a general idea. I am not sure if I would change his dose quite yet, based on the numbers you get (unless they go below 50) because they may not be accurate due to the late shot.

Btw...we have ALL woken up late at one point or another. It happens.
 
Carl, yes he eats everything up right away. Isn't that what you call a "hoover"? He is now, and has always been, a hungry cat that eats everything right away.

Still think I should give the shot at 7:30 tonight, then 7:30 tomorrow. etc. Very hard to be on such a restricted 12/12 shot plan -- if you sleep in or something's going on...
 
Giving his shot 2hrs early is potentially like giving more insulin.
I don't know many people who would recommend that route.

If you choose to do that, be prepared to possibly have to test a lot tonight.

I was really challenged with the 12/12 schedule, too. I had multiple part time jobs. Some at night, some during the day. The only way I could do it was to shoot a 6am/6pm schedule. Well, I am NOT a morning person. Especially when some nights I would work until 2am. I can't say I enjoyed it, but I managed. And I would do it again in a heartbeat if my cat was still here.

It takes some adjustment (emotionally/physically). But if you are willing, it does get easier.
 
OK then, let's just look at this one day at a time. You've gotten all sorts of good advice about testing and getting curves and all that, but for now, let's just worry about the next 24 hours.

Spot got his shot at 9:30 AM today, and you need to give him shots over the weekend to allow you to shoot his morning shot by 7:30 am on Monday, right?
And his regular dose right now is .5u am and pm, correct?

I understand that Lantus works best on a 12/12 schedule, but I also understand that you can work around that in situations when you have to do that. I also understand that when you have to shoot early, it acts like an "increase" in dosage, so you should adjust the shot to a little bit less insulin.

How comfortable are you with eyeballing an amount less than .5 units on your syringe?

Throwing this out to people who use Lantus.....
Can't Jennifer just shoot at 7:30 PM tonight, shoot a reduced dose, and stay at 7:30 am and pm moving forward? I know it isn't the "best way" to get from here to there, but it can be done, can't it?
She needs to know the number is rising since she's shooting early, correct?
Can she test at 6 PM, hold off feeding until 7:30 PM, test him just before feeding to make sure he is rising, and then shoot something like a .3 or .4 at 7:30 while Spot is munching dinner?

Jennifer, it is "hard" at the beginning, but please believe that it does get easier. Everyone here has been through the tough times at the start, so we understand how you are feeling. That's why it helps to look at this in 12 or 24 hour periods instead of the "big picture" sometimes. You'll arrive at a point in a week or two where you will realize that it isn't as big a deal as it seems like it is today.

Carl
 
Thank you, Carl. I hope someone will respond. I just did a 12:30 test and it was 268. Yes, we give him .5 Lantus AM and PM lately. I could try for a little less than .5 at 7:30.

What do I need to worry about, if he goes too high? He does not seem to be going low at all, though I'm sure that could happen.
 
Carl & Bob in SC said:
Throwing this out to people who use Lantus.....
Can't Jennifer just shoot at 7:30 PM tonight, shoot a reduced dose, and stay at 7:30 am and pm moving forward? I know it isn't the "best way" to get from here to there, but it can be done, can't it?
She needs to know the number is rising since she's shooting early, correct?
Can she test at 6 PM, hold off feeding until 7:30 PM, test him just before feeding to make sure he is rising, and then shoot something like a .3 or .4 at 7:30 while Spot is munching dinner?
Click to expand...

I'm not personally comfortable with making that suggestion. Maybe someone else would be.

Some people, including myself, have been known to shoot their cat 1hr early IF they were in very high numbers, or obviously starting a bounce. ETA: You will also need to make sure you are around to monitor BG levels the entire cycle. I don't see enough data in Spot's ss to encourage that either. Again, maybe someone else would offer that as a suggestion once pm shot gets closer.

The most important thing is to keep Spot safe. The best way, imho, is to follow the schedule I listed above OR give an accidental fur shot tonight and start fresh tomorrow. I am not trying to be difficult or lack creativity. Suggesting anything other than that would rest heavy on my heart if something happened.

You can (and probably should) be testing for ketones once/day. You can pick up a box of ketostix at most pharmacies for about $10.

Keep us posted on the numbers. I have to run out and get some more supplies to heal my cold. Then I am back to the couch resting for the day.
 
Btw...here is some information on the 'shed', which is likely to play a factor for Spot in the next day or two due to the late shot (and potential early shot).
There's a storage shed/insulin depot under your cat's skin. It has first dibs on the insulin. Once it is filled, the insulin that you shoot doesn't have to go into the shed. It can be used. The shed HAS to be filled before the Lantus or Levemir gets to use the extra on cat's BGs. So by skipping shot, or waiting too long to shoot, or giving a fur shot... the cat starts dipping into it's shed and the next shot or shots have to partially go to refilling shed before they can work on BGs.

When you get impatient and overfill the storage shed by upping the dose too fast, you get into a situation where at first it looks like nothing is happening because the shed is still filling up. Then you reach the point where it is totally full and yet you are still giving a dose that's too high. Now suddenly none is going into shed, because that is full. It is all working on the cat... and the numbers drop out on you.

Worse case scenario is when you over fill the shed/insulin depot... get very low numbers... then empty out shed by dropping dose too much... or having to skip the shot. Then you'll see high numbers from the combo of the effects of rebound and an empty storage shed/insulin depot. Most react by bumping the dose back up which overfills the shed/depot again resulting in a roller coaster ride to nowhere. Not the way to work this insulin.

~ written by jojo and bunny(GA) and Y
Click to expand...
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
 
The most important thing is to keep Spot safe. The best way, imho, is to follow the schedule I listed above OR give an accidental fur shot tonight and start fresh tomorrow. I am not trying to be difficult or lack creativity. Suggesting anything other than that would rest heavy on my heart if something happened.
Click to expand...

Carolyn,
I totally understand and definitely respect that you feel this way. I have, unfortunately, made a suggestion or two that "went bad" (not critically bad, but bad enough), and the resulting guilt tore me up for quite a while. Not a good feeling at all, and thankfully no dire consequences.
That's why I try to qualify my comments at some point with "I've never used this insulin before" and ask for input from people who have lots of experience with it.

But I also try to be creative while keeping the safety of kitty in mind, and I am hoping someone can either verify this idea could work, or come up with a different idea that works a little easier than the "15-30 minute backup of shot times" schedule, especially because Jennifer needs to get to 7:30 by Monday morning at the latest.

Carl
 
hi jennifer. someone asked me to take a look at your thread to see if i could help you get back on schedule easily.

at this point, i don't think we have enough data to safely suggest shooting early without requirements/conditions. i say that because at the current dose, we really don't know when spot's onset is (the length of time before insulin reaches the bloodstream & begins lowering blood glucose), when he reaches nadir (the lowest point in the cycle), and we don't know how much duration (the length of time insulin continues to lower blood glucose before the insulin peters out) he's getting from 0.5u BID. the words in blue are clickable links which will take you to more information.

in other words, we don't know yet (but will eventually) how spot responds to insulin.

i want to add a little to suggestions already offered:

1). skip tonight's shot. this will allow you to get back on your 7:30/7:30 schedule easily.

2). continue spot checking often today (every 2 hours). post your results as you get them. "IF" it appears spot drops lower than his body has become accustomed to and he begins to bounce, you might be able to shoot an hour or two early tonight. however, please do not shoot early without guidance from experienced board members.

shooting early would require a commitment from you to monitor carefully tonight since we do not have much data to go on. shooting early tonight also requires having karo, some high carb canned food (15% - 18%), and an ample supply of testing strips on hand in case you would have to steer spot's numbers (managing the curve with food to prevent kitty from dropping too low). you'll also want to post numbers tonight as you get them. experienced members will provide assistance.

3). follow carolyn's suggestions for moving shot times gradually.
gradually moving shot times creates the least impact on BG numbers, but it's tedious and requires patience... something i don't always have enough of. :-D


considering you're new to feline diabetes, option number 1 is the easiest, safest, and least stressful way to go. skipping will give you a break, allow you to get a good night's sleep, and allow you to regroup and start over fresh in the morning.


carl, you mentioned the the possibility of shooting a reduced dose early tonight...
imho, we just don't have enough data at this point in time to unconditionally make that suggestion without seeing what spot does today by spot checking every 2 hours so we know what is happening prior to the suggestion. see option #2. imho, those same conditions would apply.



about running full curves (BG testing every 2 hours)...
if you really want to shoot an hour or two early tonight, testing every couple of hours IS necessary TODAY... only because we're currently dealing with limited data. as you compile more data, this won't always be the case. i can now shoot my cat early or late (and do) because i have the data to support my decisions. eventually, you'll know spot's response as well as i know alex.

however, under normal circumstances i think doing curves is highly over-rated and in most cases unnecessary. random spot checks spread out over days/nights will yield much more information than a single curve. for example, say i happen to run a curve on a day my kitty is bouncing from low numbers. that curve will not tell me how low that dose is taking my cat (nadir) nor will it show me when the insulin begins to work (onset), nor will it show me how much duration she's getting from that particular dose. in other words, that particular curve will not give me the information i need to make educated decisions about her dose. random spot checks will fill out the big picture. think of spot checks as collecting data... like pieces to a puzzle. the more puzzle pieces you have... the easier it is to see the whole picture.

many, if not most of our caregivers have full-time jobs outside the home. they successfully manage their kitty's diabetes by getting BG tests before every shot, in the door or out the door spot checks, as well as before bed spot checks every night. in the beginning stages of this dance you'll want to do more spot checks to learn how spot is responding to insulin. as you learn, you'll have a better idea of how often you'll need to test.


jennifer, hang in there, ok? i remember how overwhelming this all was in the beginning for me. i'm sure you're experiencing a lot of those same feelings we all had in the beginning. trust me, treating feline diabetes DOES get easier! alex was diagnosed in 2006. we have enjoyed two periods of remission, but other illnesses have put her back on insulin for the last 2 years. her diabetes has become a simple part of our daily routine... just as brushing teeth, eating, sleeping, and playing. :-D

just my thoughts... hope they help a little.
 
OMG. How could I NOT be OVERWHELMED? I'm sorry but I do NOT want to NOT give him a shot tonight. You guys were ALL OVER ME when I did not give him a shot twice a day. I am going to give him .5u at 8:00 pm. I will test him again at 11:00. Then start tomorrow at 7:30. I guess I can no longer sleep in on the weekend. Or do anything but worry about Spot's BGs!
 
ammonzon said:
OMG. How could I NOT be OVERWHELMED? I'm sorry but I do NOT want to NOT give him a shot tonight. You guys were ALL OVER ME when I did not give him a shot twice a day. I am going to give him .5u at 8:00 pm. I will test him again at 11:00. Then start tomorrow at 7:30. I guess I can no longer sleep in on the weekend. Or do anything but worry about Spot's BGs!
Click to expand...

Hi Jennifer,
There is a difference between regularly dosing 1x/day, and fixing an 'oops' on occasion. The later is what you would be doing tonight.

Please take Jill's advice if you choose to shoot early both tonight and tomorrow:
shooting early would require a commitment from you to monitor carefully tonight since we do not have much data to go on. shooting early tonight also requires having karo, some high carb canned food (15% - 18%), and an ample supply of testing strips on hand in case you would have to steer spot's numbers (managing the curve with food to prevent kitty from dropping too low). you'll also want to post numbers tonight as you get them. experienced members will provide assistance.
Click to expand...

If I opted the route you are choosing, I would test 30-60 minutes before I shoot and make sure the PMPS number is one that is rising. You would NOT want to shoot a dropping number. I would maybe get a +1, but definitely a +2 and keep testing /posting numbers every hour, at least through the typical nadir (+6). If you post, other members could help you figure out if you can be more lax on the testing or if you need to test/feed more frequently.

You will want to follow the same plan tomorrow, since the shed may start overfilling.

None of these suggestions are to stress you out more. We just want to make sure Spot stays safe and get both of you back on track so you can be LESS stressed. That is one of the reasons skipping the shot would be less stressful....no monitoring...go to bed early/sleep....start fresh in the a.m.! :mrgreen: :YMHUG:

As myself and many others have said to you thus far...it is VERY challenging and stressful at first. We all understand this! But once you get in the swing of things and have a routine, it will be a breeze.

Oh....a lot of times I would test/feed/shoot (I fed first because I had an unreliable eater), then go back to bed on the weekends or my day off.

Hang in there, Jennifer!!!
 
Hi Jennifer
if you want to shoot tonight, at 8, then that's okay. Always remember, you hold the syringe. All we try to do is help when help is needed and asked for.

My suggestion would be to shoot a little less than. 5 if you can eyeball it. I'll be on after work at 10 if you need help.
Carl
 
While I can appreciate Carl's support in this situation, he is not a veteran Lantus user. Jill is. She has enormous experience in using Lantus. IMHO, her point about having insufficient data to shoot early is worth listening closely to. IF you opt to give an early shot tonight, a strategy I am not personally comfortable suggesting, you will absolutely need to monitor closely. It is the only way to insure that your cat will be safe.

Lantus works in a cumulative fashion. Each dose builds on the previous dose. And, as others have pointed out, it is a depot-type of medication. Fundamentally, this means that Lantus likes consistency. Dosing needs to be consistent as do shot times. If you dose hop or change shot times by more than 30 min., you will not get the best results and it's quite likely you will see wonky numbers.

As for Somogyi, at best, this concept is controversial. This is a post of mine from some time ago:
Sienne and Gabby said:
The topic of Somogyi came up some time before you joined the Board. Both Jill and I did a lot of lit searching. I have access to both a medical and veterinary library system. For a theory that has so many people convinced that it is a factor in human as well as in feline diabetes, there is an amazingly small amount of research on the topic. The earliest paper by Michael Somogyi, is from the 1930s and was not published in a widely recognized medical journal (i.e., it was in the Weekly Bulletin of the St. Louis Medical Society). Note that this was a report based on 5 human subjects and urine glucose, not blood glucose was measured. More recent reports note that Somogyi's observations have not been reliably reproduced under controlled conditions.

Gale said:
Although some patients had a very rapid fluctuation from hypoglycaemia to hyperglycaemia, we found no evidence that changes in counterregulatory hormone levels were responsible.The preceding interval of hypoglycemia was often prolonged, which implied defective homeostasis, and the difference between the patients with apparent rebound and those without could not be explained in terms of circulating levels of cortisol, growth hormone, or glucagon. Other workers have noted very variable changes in growth-hormone and cortisol levels after acute hypoglycsemia in unstable diabetics. We did not measure catecholamines and cannot rule out the possibility that they were partly responsible for the difference between our groups. However, the evidence presented here suggests that free insulin is the major factor involved.
Click to expand...
The bold is mine. It points out that there is no evidence for what the vet is suggesting about "stress" hormones (i.e., cortisol).

In addition to the dearth of empirical research, there is even less that pertains to cats and none that addresses Somogyi phenomenon in the use of Lantus. Given that the presence of Somogyi is believed to be associated with doses that are raised in too large of an increment, it is surprising that this IM vet would not be an enthusiastic supporter of the Queensland/Rand tight regulation protocol. (FYI - there is another TR protocol and the vet may have assumed this was the one you were referring to.)

This is a link to info on Chronic Somogyi Rebound on Wiki. I would draw your attention to the section on Controversy:
Although this theory 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.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night fail to wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.
Click to expand...
This information pertains to humans, not cats. However, the phenomenon was based on humans and extrapolated to felines so I'm going to presume the issues with the paucity as well as quality of the research are the same.
Click to expand...
 
Thanks everyone! I just did a test at 7:02 before I give him his shot at 8:00. He was at 363. Seems the usual. He's not been going lower. At 8:00 pm I will give him .5, doubt we can figure out how to give a little less. Hard enough to get to .5u as it is. I will feed him a full meal when we give him the shot. He is hungry now, and I fed him 1/2 can at 4:10. That is Spotty. I will test him again at 11:00.

Thanks for all your help, I do appreciate everyone's thoughtful answers and please don't think I'm snipping at you. I'm sorry if I came off that way. I re-read some of my responses and was like, WHAT A BRAT!!!! I am lucky to have you guys here helping me!

Jennifer
 
Hi Jen,
Did you test at 8 when you gave the shot? If not, can you test at 9?

Carl
 
nailbite_smile
So what's the 11 o'clock news look like?

:smile:
 
That is good. The way I understand it, if he's going to go really low, you would see that by +3, or at least see a clue. That's why a couple people advised you check at +1 or +2. Now at +3 It doesn't look like that is happening.

Like I said before, Jennifer, this does get easier and less stressful for you and for Spot. Just try to take it a day or a cycle at a time for now.

Carl
 
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