How do I know if this is Somogyi effect?

Status
Not open for further replies.
Heather&Dagron

Heather&Dagron

Member
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?

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.

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). ((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.))

He's acting totally normal, by the way.
 
FWIW, the concept of Somogyi, especially with long-acting insulin, has been refuted. The original research was done in 1938 when long acting insulin wasn't available. The original paper, which was based on a very small sample of humans, has never been replicated. For who knows what reason, Somogyi seems to have become an urban myth. A recent paper by Roomp & Rand (the people who did the research on Tight Regulation for Lantus in cats), disputed the existence of chronic Somogyi rebound.

That said, cats' numbers can bounce. It looks like what you are seeing in Dagron's AM cycle is that his numbers may have dropped lower than the 237 you tested at +4 last night. If a cat's system isn't used to being in lower numbers or if there's a relatively big drop in numbers, the liver and pancreas release a stored form of glucose and counterregulatory hormones which cause the numbers to spike upward. Once the hormones and glucagon clear out, the numbers come back down -- it can, however, take up to 3 days.

Syringes only come in half unit increments. You can either eyeball a 0.25u amount or use digital calipers to help keep your dosing consistent. If you want to do the latter, I got my 4" digital calipers from Harbor Freight. There are instructions on the board on how to use them. Most states require a prescription for syringes. Wherever you're ordering from will probably ask you to have your vet fax them the prescription or if you have the hard copy, you can fax it. It doesn't matter where the outlet for supplies is. They go by what the regulations are in your state.

 
Sienne, I did read the abstract of the paper refuting Somogyi and suggesting that Lantus should just be given at the same dose in the event of the bounce. Didn't read the full paper. However, from what I have read about Somogyi, it sounds exactly like what you are describing as a bounce - liver releasing glycogen into the bloodstream as a sort of buffer. How is a bounce different from Somogyi?

BTW, I just tested him again, and he's 313 at +8. This cat's BG is really just all over the place all the time, and I don't know what to make of it. What I really want to do is take him off of all insulin for two weeks and then do a curve, see how he does with just low carb/high protein food. Then maybe start really low and test each increase if he still needs some help. I feel like the high units of insulin are just screwing him up worse.
 
Heather&Dagron said:
What I really want to do is take him off of all insulin for two weeks and then do a curve, see how he does with just low carb/high protein food. Then maybe start really low and test each increase if he still needs some help. I feel like the high units of insulin are just screwing him up worse.
Click to expand...
It's quite possible that he was started on too high a dose. I wouldn't, however, take him off insulin for 2 weeks. If the experts here think that a dose restart is a good idea, I'd go to whatever lower dose seems to be reasonable at the next shot, recognizing that it'll take a few days for the depot to stabilize at its new level.
 
Last edited:
Lantus is dosed based on how low they go not how high. They only way you know that is by getting mid cycle tests in during both the AM and PM cycles. They can be at different times each day which will help fill in the "puzzle" as we call it. Have you read the Start Low Go Slow sticky at the top of the page? Start Low Go Slow would be used if he's eating any dry food. The other is Tight Regulation (TR)

We also only increase doses in .25 increments...not full units this way you don't pass up a potential good dose. It's possible Dagron is on too much insulin. Too much could look like not enough but we can't tell without mid cycle tests. It's not uncommon for cats to dive from high numbers at preshot and shoot back up to high numbers by next preshot. I wouldn't stop insulin either but can you confirm they started Dagron's dose at 3u?

I'm not picking on you but have been where you are today. Good job home testing! I didn't home test for the first 3 months and dosed Lantus wrong following my vets advise for another 3 months. Almost killed my cat more then once. Once we finally found this board it saved my Doodles life.
 
I
Doodles & Karen said:
Lantus is dosed based on how low they go not how high. They only way you know that is by getting mid cycle tests in during both the AM and PM cycles. They can be at different times each day which will help fill in the "puzzle" as we call it. Have you read the Start Low Go Slow sticky at the top of the page? Start Low Go Slow would be used if he's eating any dry food. The other is Tight Regulation (TR)

We also only increase doses in .25 increments...not full units this way you don't pass up a potential good dose. It's possible Dagron is on too much insulin. Too much could look like not enough but we can't tell without mid cycle tests. It's not uncommon for cats to dive from high numbers at preshot and shoot back up to high numbers by next preshot. I wouldn't stop insulin either but can you confirm they started Dagron's dose at 3u?

I'm not picking on you but have been where you are today. Good job home testing! I didn't home test for the first 3 months and dosed Lantus wrong following my vets advise for another 3 months. Almost killed my cat more then once. Once we finally found this board it saved my Doodles life.
Click to expand...
I was also a slow learner wrt not having a good testing routine in Teasel's first 6 months of treatment. I did pointless BG curves for my vet that got me nowhere.
 
Heather&Dagron said:
However, from what I have read about Somogyi, it sounds exactly like what you are describing as a bounce - liver releasing glycogen into the bloodstream as a sort of buffer. How is a bounce different from Somogyi?
Click to expand...

From what I understand, the Somogyi effect happens in response to hypoglycemia. Many cats bounce from blood sugars that are still well above where they should be, but lower than the cat is used to.
 
PMPS is at 340. I went ahead and shot the full 5U. Verified on the scrip literature that it did start at 3U BID, which my vet called a low dose and said it would likely not do anything.

As soon as we started injections, I stopped giving the boys dry food. They get low carb, high protein wet all day (and a ton of it, sheesh!), and only get one piece of kibble after having to be poked. I'm hoping this tiny amount of kibble isn't affecting him too much. I guess I liken it to a human having one Hershey's kiss instead of two slices of pie? His brother gets a piece of kibble whenever I have to poke Dagron too, because he gets very food-jealous.

I did read over the TR protocol, and I'm nervous about it because my hours are very strict. I leave the house at 7:15 M-Th, and don't get home until about 6-6:30. Have to be in bed by 9:30/10 because I have a handful of my own problems to deal with, and I think getting up at 2 in the morning or whenever would compound those (though maybe if I'm getting up to pee anyway I could test him?). I know it sounds like I might be "yes but"-ing, but I'm really just trying to figure out a solution. Any suggestions are helpful.

I'll go read TR again and maybe I can think of a way to do it?
 
Hello and welcome. Another item for your reading list is the concept of New Dose Wonkiness or NDW. It can mean a temporary increase in numbers after you first increase the dose.

There is a Stcky Note at the top of this forum on following TR while doing a full time job. There are lots of useful ideas in there, no matter what dosing method you decide to follow.
 
I'm starting to think SLGS would be better. I get up at 6, test and dose him at 7, leave at 7:15. In the evening, I get home with just enough time to warm up the Lantus before testing/dosing. I can easily do +1, +2, maybe +3 in evening. I'll try to test him when I get up in the middle of the night.

At the risk of TMI, I'll tell yall a little about myself. I have autism, and I am not intellectually disabled, but I am easily confused when too much information is thrown at me too quickly. I need some handholding when I start something new. So, I just went back and read the thread on TR, and it looks like a great resource for once I have a handle on this, but for now if someone could tell me exactly what I need to do (like just my next step, or 2, or 3, no more than that), I would appreciate it so much. I think what I need to do at this point is try to get at least a few days worth of +11, +12, +1, +2. Does that sound right?

If it's helpful for whoever wants to try and break this down for me, this is my typical schedule: Mon-Thurs home & awake 6am-7:15am, 6:30pm-9:30pm. Fri home & awake 7-9:30am, 12:45-11pm. Sat/Sun home & awake 7am-11pm except for when I go to the grocery store (usually Sat night after PM shoot so I can avoid crowds).
 
Heather&Dagron said:
I'm starting to think SLGS would be better. I get up at 6, test and dose him at 7, leave at 7:15. In the evening, I get home with just enough time to warm up the Lantus before testing/dosing. I can easily do +1, +2, maybe +3 in evening. I'll try to test him when I get up in the middle of the night.

At the risk of TMI, I'll tell yall a little about myself. I have autism, and I am not intellectually disabled, but I am easily confused when too much information is thrown at me too quickly. I need some handholding when I start something new. So, I just went back and read the thread on TR, and it looks like a great resource for once I have a handle on this, but for now if someone could tell me exactly what I need to do (like just my next step, or 2, or 3, no more than that), I would appreciate it so much. I think what I need to do at this point is try to get at least a few days worth of +11, +12, +1, +2. Does that sound right?

If it's helpful for whoever wants to try and break this down for me, this is my typical schedule: Mon-Thurs home & awake 6am-7:15am, 6:30pm-9:30pm. Fri home & awake 7-9:30am, 12:45-11pm. Sat/Sun home & awake 7am-11pm except for when I go to the grocery store (usually Sat night after PM shoot so I can avoid crowds).
Click to expand...

Here are my thoughts:

  • I suggest you start with SLGS to get used to a routine that's a bit more relaxed. You can stick with it or switch to TR later if you want.
  • Lantus works best when doses are as close to 12 hours apart as you can get. Mon-Thurs you can dose at 7 AM/7 PM. Can you shift your schedule just a little so you can also do 7 AM/7 PM on Fri/Sat/Sun?
  • Work days: aim for a +2 or +3 test every evening because you can't be there during the day.
  • Fri/Sat/Sun: aim for at least one afternoon and one evening test each day. Do your weekly SLGS curve either Sat or Sun.
You have two days off ahead of you, correct? Why not get a good number of tests each day to start building your spreadsheet data base.

Does this help? Please ask if you need something here broken down further. :)
 
Hey there, grab a test when you get up in the middle of the night and pee, that's what I did. :rolleyes:

I think that the term Somogyi and bouncing are being confused and causing confusion. Cats do bounce up into higher numbers when they go lower than they are use to or drop to fast. FACT.

If you are able to get a +2 before you leave for work to know how active the cycle could be and give some higher carb food to steer if needed and get a nadir test, somewhere around +4 - +7 then you can do TR. Otherwise, maybe SLGS is a better fit.

You can only do what you can do. :cat:
 
Kris, thank you, that's perfect. I can wake up 15 min earlier on the weekends to get him his dose at 7. And I should be able to get a lot of testing done before Wednesday when I go back to work. How often do you think I should test him over the next few days?

Other pertinent information: I live alone, and I try to make sure they have food available at all times. Obviously, sometimes they run out during the night or while I am at work.

Also, if I am going to do SLGS, would I start him at 0.5U BID? Or something higher since he's on such a high dose right now? A lot of what I have been reading here contradicts what my vet said, so I'm really just... losing faith in him and baffled at what is right and concerned about the idea of finding a new vet. I don't even know what questions to ask a new vet.
 
Heather&Dagron said:
Kris, thank you, that's perfect. I can wake up 15 min earlier on the weekends to get him his dose at 7. And I should be able to get a lot of testing done before Wednesday when I go back to work. How often do you think I should test him over the next few days?

Other pertinent information: I live alone, and I try to make sure they have food available at all times. Obviously, sometimes they run out during the night or while I am at work.

Also, if I am going to do SLGS, would I start him at 0.5U BID? Or something higher since he's on such a high dose right now? A lot of what I have been reading here contradicts what my vet said, so I'm really just... losing faith in him and baffled at what is right and concerned about the idea of finding a new vet. I don't even know what questions to ask a new vet.
Click to expand...
Heather&Dagron said:
How often do you think I should test him over the next few days?
Click to expand...
This is a prime opportunity to fill in the missing middle of the cycle data. Why not aim to get a scattering of tests between +2 and +10 in the daytime plus at least one before bed on your upcoming days off? Maybe aim for +2 and +6 one day (plus before bed), +4 and +8 another day (plus bedtime), and +5 and +9 (plus bedtime) or similar? Do more if you want and your kitty will tolerate it.
Heather&Dagron said:
I try to make sure they have food available at all times. Obviously, sometimes they run out during the night or while I am at work.
Click to expand...
There's no problem letting a diabetic kitty graze. However, you should remove the food 2 hours before each pre shot test so the result isn't food influenced. Timed feeders can help with that.

Heather&Dagron said:
Also, if I am going to do SLGS, would I start him at 0.5U BID?
Click to expand...
That's what a kitty just starting on insulin would get. Your kitty has been getting a high dose for a while now. Two things:
  • in post #6 above Karen asked whether your kitty was started at 3 u then the dose raised from there
  • we need that all important mid cycle data to judge his current dose of 5 u BID. You have recent curve data that *might* suggest that the dose is too low but, as was said before, too high a dose can look like too low a dose.
Heather&Dagron said:
Or something higher since he's on such a high dose right now? A lot of what I have been reading here contradicts what my vet said, so I'm really just... losing faith in him and baffled at what is right and concerned about the idea of finding a new vet. I don't even know what questions to ask a new vet.
Click to expand...
I honestly don't know what to say about his dose. If he was started at 3 u, that's too high. It could have set the scene for all this dose escalation that's confounding us right now. I suggest you stick to it for the next few days and get those random tests done.

If you like your vet for other things and you think he might be willing to work with you to treat your kitty's FD there's no need to change. Many vets aren't very knowledgeable about FD.

Action plan:
  • stay with current dose for now
  • get those extra tests done
  • try to read the yellow Lantus stickies a little at a time
  • ask any question that comes to mind.
 
Last edited:
Status
Not open for further replies.
Back
Top