Explain 'rebound' please?

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Anyname

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Really really simple for me please. give example is possible. really don't get it at all.

As far as I understand it: Kitty numbers too high, so increase dose after a period of high numbers. Put dose up but then numbers go higher from rebound.

How can we help bring kittys numbers down if increasing dose causes higher numbers? Does rebound settle in time - just put up with high numbers until kitty gets used to higher dose?

marilyn :roll:
 
Here is what is on the board about rebound. Simply, the liver releases Glucagon, which raises blood sugar, to protect the body when blood sugar goes too low. This can result in high blood sugar. To fix it you need to lower the amount of insulin.


http://felinediabetes.com/concurrent-somogyi.htm

What is the Somogyi Effect (rebound)?

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.
 
ok I need to do a curve! As things are pointing towards rebound with my kitty. thank you for answering.

marilyn
 
Marilyn,
Unfortunately, like every other step of this "dance", it isn't always "simple". What Debby posted could be what is going on, but there's no way to tell for certain.

It really depends on how often it happens. Some cats will see a cycle of wonky numbers, and then things settle down. The terms "rebound", "somogyii effect", "bounce", and "liver panic" are mentioned very often on the board. But while some people use them interchangeably, to other people they aren't the "same thing".

The way I understand it, the "somogyii effect" is something that happens repeatedly, not "once in a while". It doesn't clear quickly, and it doesn't happen from just one high dose.

The liver action in that quoted text is a good explanation of how it happens inside kitty's body.

Often, people will see that during a cycle after they increase dosage, but often, if you keep with the dose, it will go away after a day or so. I've seen it called "liver training" on the board. The first time or two the liver reacts in a self-preservation manner, to keep the BG at a "safe" level. It doesn't mean the cat is hypoglycemic, just that its body "thinks" it is. When a cat is used to living in the 200s and 300s, and all of a sudden drops to 150, the liver can dump "sugar" and try to get the numbers back into the "normal" (high) range that kitty is used to. That is commonly referred to as a "bounce", and it eventually will go away.

Usually, if a dose of insulin is too high, you'll see a curve that isn't really curve-shaped. More of a flat line. Sometimes you'll see an "inverse" curve, where the numbers climb a little during the cycle, then return to just about the same level the cycle started at. The problem is that the same shapes can happen when the dose is too low. That's why this "dance" is so confusing. There aren't any definite rules that say "if this, then that".

The only way to figure out what a dose is doing for sure is to run a curve. You need to see what happens in between one shot and the next.

Carl
 
The best explanation is in the pet Diabetes wiki: http://petdiabetes.wikia.com/wiki/Rebound

Carl also explained it very well. Rebound is possible on any insulin and he is right, it does not always mean the dose is too high. However, if using one of the longer acting insulins (Lantus or Levemir) and you have lows coupled with 500s, that is a pretty sure sign of rebound. And as some people cannot test often enough to determine lows, if you see 500s, it's wise to try to get a curve after a couple days (so the rebound has some time to clear).
 
It's no big deal for me to do a curve - I'm not convinced I have bounce but just wondered why LBs number when up after morning dose of lantus today. Increased insulin last night but been struggling with high numbers for over 3 weeks since LB returned from 4 weeks in cattery. This group is helpful but these kitties can be very complicated. @-) LB thanks you for your help.
 
Somogyi is, ostensibly, a chronic state of numbers dropping lower then higher. This is different than a bounce/rebound. Also, with the longer acting types of insulin, a "flat" curve is more typical of their action -- and may be desirable.

I would also point out that the entire Somogyi phenomenon is considered controversial:
[url=http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound:gblg8xui][b:gblg8xui]Wiki - Chronic Somogyi[/b][/url] said:
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.
I would encourage you to look at the source materials that are noted. There have been no replications of the original 1938 research and the quality of that research is questionable.

I would also not want to draw a conclusion off of one number. A blue pre-shot followed by flat yellows doesn't tell you a great deal especially in light of no PM tests.
 
SIenne,
I am glad you posted as I have always been confused by the frequent use of these terminologies (rebound, Somogyl, etc) especially in light of what I read on the German's Group protocol a while back (Dilly's page , see sticky on Lantus)

WHile you were posting I was literally copying the quote to post here to ask about this:

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.

Thanks

Elaine and Pinky
 
Please bear with me, I'm not a medical person so have to 'translate' everything into something that makes sense to me.

I too have found myself confused by the different names for what I now decided to call a 'bounce'. KT does this every time that his BG's go low usually into the double digits but first, it was in the 100's. If you look at his spreadsheet, you'll see this happening right after the greens. Sometimes we even go back up to 300's for a short time. It's a natural body defense against those low numbers that their bodies aren't accustomed to. When this first started, it would take 2-3 days for the numbers to come back down. It's now taking about a day. It becomes easier to predict as more information is gathered. The more often and longer his numbers fall into the 'normal' range, the more his body will adapt to it.

Just my 2 cents worth...
 
Now that I've read the information I don't think my kitty has rebound. He's got high numbers full stop. :!:
 
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