We tend to use words like "somogyi", "rebound" and "bounce" interchangeably here, but I think one person's definition of "bounce" and another person's are not the same in most cases.
When many people say "bounce" it is a short term increase in BG caused by low numbers in the prior cycle. It isn't a long-term high-numbers chronic rebound. The numbers don't even have to be "low" like less than 100. Some cats react to a drop of a couple of hundred points no matter what "color" the numbers are. A drop from 400 to 200, if the cat is used to being in the 300-400 range can cause that to happen. A rapid drop in BG, regardless of the number range, can also cause that to happen.
The best way I have seen this described is by Dr. Lisa, in reference to a kitty last year in PZI. (although she uses the terms "rebound" in this case rather than "bounce"....)
She makes a distinction between a high number being "warranted" or "unwarranted", and I believe the distinction is extremely important:
I am going to break my rule here and comment on dosage. I would be raising it. I understand the issue of possible rebound but, generally speaking, I see it worried about far too much.
I often see more worrying about rebound than ongoing glucose toxicity.
Yes, we have to be patient but not so patient that we keep watching the patient drown in sugar.
I also do not see rebound as a failure or a mis-step.
Also, we need to consider the issue of warranted or unwarranted rebound. If warranted? ( a number truly too low or the drop too fast)..... Lower the dose. If unwarranted? (a cat over-reacting to a safe number) Stay the course and push through it. Don't just look at a high number and assume warranted rebound.
I think what you are describing with Martha's numbers would fall into the "unwarranted" category. I would, however, call it a "bounce". The blue numbers you saw in Martha's cycle were not too low - as Dr. Lisa describes it, it was a "cat over-reacting to a safe number". This happens very frequently and regularly especially early on in the treatment period. Martha's system "thinks" that a safe blue number is "too low" right now, and reacted to it by causing her BG to "bounce" back up. While this happens a lot, the advice from Dr. Lisa, and from most people who are following the TR protocol (or even the SLGS protocol) is to "Stay the course and push through it". Eventually it will stop happening as her body gets more used to lower numbers. As many people say "kitties bounce until they don't".
As far as "somogyi" goes, it gets mentioned often, but the prevailing opinion on the board seems to be that it doesn't really exist. Apparently, from threads I've read, there's a disagreement in the scientific community because (at least what I've read here anyway) the study has never been duplicated, it was done nearly 100 years ago, and it's never been proven to exist in cats?
Here's the wiki-link to it:
http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound
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 don't wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.
It's also something, if it exists, that is usually associated with the term "chronic". What's going on with Martha can't be evaluated as "chronic" at this point. I think it's just her body reacting to what it feels are "lower" numbers. In FDMB-speak, this would be called a "bounce", and it'll stop happening or happen less frequently as her body gets used to numbers that are closer to "normal" than she's been experiencing since she became a diabetic.
Hope that helps!
Carl
