How do I know if this is Somogyi effect?

[Heather&Dagron]

My vet has been checking out Dagron's spreadsheet and told me yesterday to increase his dose to 5U bid. I started at that dose this morning - AMPS was 205. Since I'm home all day and it's a new dose, I checked BG at +4 and it was 357. Does this look like Somogyi effect? If it is, what do I do?

The needles I have are 30U, so I could probably measure out doses in 0.5U increments, but I think 0.25U increments would not be possible with them. They were prescribed, and I don't know how I can get needles that are smaller to give a more accurate dose (I mean I know I can order them online, but that will take a while).

He's acting totally normal, by the way.

 

[Kris & Teasel]

I checked BG at +4 and it was 357. Does this look like Somogyi effect? If it is, what do I do?

Yes, this could be a high BG in reaction to a very low number that you didn't catch with a test or merely a lower than usual number, like the yellow 205 this AM. We refer to it as "bouncing" here. There's nothing you can do except keep on dosing according to your vet's instructions. If you could make a point of getting extra BG tests scattered at random times over the next several days/evenings, that might yield data that will help us to see what's happening. A full curve is of limited value if it happens on a day when the BGs are high and flat from bouncing.

Re syringes: we recommend syringes that have half unit marks because it's easy to measure half units as well as eyeball 0.25 u fractions with those. Some people successfully eyeball fractions on syringes with only whole unit marks. It's more important that you're consistent when eyeballing, rather than being totally accurate.

 

[MrWorfMen's Mom]

With the testing you have to date, it difficult to say for sure if this is Somogyi or not. Sometimes a rising number happens with dose changes but it appears very likely that the reading at +4 is a bounce from the lower pre-shot and a possibly even lower reading sometime during last night's cycle given the much lower pre-shot this morning.

A diabetic cat gets used to being in higher BG numbers and their defence systems that protect them from low BG go into action prematurely when they detect the BG dropping too fast or to numbers lower than they are used to even if those numbers are not dangerous or still a bit high. This is called bouncing. 5 units is a large dose for a cat this early in the game and from your spreadsheet it looks like 3 units may have been the starting dose which is already higher than usual.

With a bit more testing it will become clearer if bouncing is the problem and decreasing rather than increasing the dose may be in order. I suggest you post on the Lantus forum to get more eyes on your situation. Things may be a bit slow this weekend with holidays in both Canada and the US but the folks there can help you get Dagron sorted out.

I would strongly recommend trying to get some syringes with half unit markings on them for future use. In the meantime, you can take a used syringe and fill it with coloured water to the point where you eyeball whatever half unit dose you want to give and use that syringe as a comparison going forward. It may not be spot on but the dose you give will be consistent and that is more important than a drop or two at current doses.

At the dose you are giving now, 0.5u changes are not as much of a problem. At lower doses 0.25u changes are necessary.

 

[Heather&Dagron]

Thanks for the input. I am planning on checking him at +4 and +8 during the day and right before bed for the next few days, as I have off until Wednesday. I thought about doing another full curve today, but didn't think he would appreciate another one so soon.

I figured out what the deal is with syringes - in NY you need a prescription in order to get them at all. Some websites even require a script, but I'm going to try to order some from diabeticpromotions.com.

I'll post this on the Lantus forum, as well.

 

[MrWorfMen's Mom]

Your vet who prescribed the Lantus should be willing to give you a script so you can get the syringes online or locally.