newly diagnosed..suspecting somogyi rebound. need advice

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Michele M

Michele M

Member Since 2013
Hi

My cat Crushy was diagnosed Aug 1 with blood sugars in the low 400s. The vet put him on 2 units of Lantus Insulin twice a day.

I JUST found this site on thurs (aug 8) and began checking his blood glucose that day. His numbers were still in the 300s.

On friday (Aug 9) the vet tested his blood, confirming my blood findings, and decided to put him on 3 units of insulin twice a day and lower his food intake a little (he had gained weight since the previous week)

I tested him today (Saturday) 6 hours after his shot, which is supposed to be the insulin peak, and it was 426!! yikes! what the heck happened?

He's acting completely fine. I never would have known if I hadnt checked his blood. He's not even drinking a lot of water.

After doing a little reading on this website I suspect a somogyi rebound and Im leaning towards lowering his insulin to 1 unit for a couple days and monitoring him closely.

he's 11 years old and he's been raw fed for the last 10 years (very low carb diet) The vet suggested not to change what he is eating. He's a big cat. He normally weighs 19 lbs and had dropped down to 17 lbs (that may sound really fat but he has a very large frame)

of course its the weekend and I cant get a hold of my vet. Any thoughts would be welcome

Michele
 
It takes a few cycles with Lantus before the new dose "shows" itself and there is also the factor of New Dose Wonkiness (yes, it's totally a scientific term :lol: ). I would perhaps hold it a little longer, however, I still think it might be too high a dose because we generally don't like to increase more than .25 to .5u at a time. It might be warranted in Crushy's case, but we won't know that without a few more tests. ;-)
 
Hi Michele
Just as I was signing in I saw that someone did respond to your post. I never give out dosing advice. It's just not my comfort zone. There are a few insulin support forums on this page. You may want to start checking them out and start your own spread sheet. I think it is great that you started testing. Hopefully more people will see your post tonight and you'll get some more replies. People are very helpful here.
 
thanks Kpassa & Sandy and Brie for your responses.

I just tested his BG again and it 312 (so it went from 426 to 312 in 3 hours) (does that fit with the new dose wonkiness you mentioned Kpassa?)

he didnt have any food in that time, just lots of cuddles and pets and a kajillion ear pokes as Im still getting the hang of getting blood from his ear. He is so patient with me.....

now Im even more unsure what to do though
 
Let's start with some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
When starting out, we suggest you not give insulin with a pre-shot test below 200. That no shot number may be lowered as you obtain test results showing it would be safe.

From pre-shot test to lowest point - nadir - between shots, can swing 200-300 points, depending on the cat.

You want the nadir to stay above 50 mg/dL.

Diet may make a substantial impact on glucose level. Feeding a low carb, canned or raw may lower the glucose 100 mg/dL or more. Cat Info has a terrific pdf file with numerous US foods and the percent of calories from carbohydrates, protein, and fat. Select those with under 10% calories from carbohydrates. It isn't necessary to feed a prescription diet for diabetes.
 
thanks for the info BJM

I have yet to figure out how long after his shot he reaches the nadir but I think it might be around the 7 or 8 hour mark. Im trying to take his BG every 2 hours but I am still new to getting blood from his ear and have given up in frustration more than once. That said I have yet to see a number under 300.

you said: "From pre-shot test to lowest point - nadir - between shots, can swing 200-300 points, depending on the cat."

Can you clarify this statement? (Im new to all this and trying to learn while pretty stressed out) Does that mean that BG could go up and down 200-300 pts from pre shot to nadir and that would be normal?

Im checking for ketones but this cat has a huge bladder...I swear he only pees once a day..and is super stealthy about it. So far so good though.
 
Usually, it'll be a drop, and yes, between the shots, the glucose level may drop as much as 300 mg/dL and rise back up.

If the cat has been diabetic for a while, the body may have become accustomed to higher glucose levels. A large and/or fast drop may trigger counter-regulatory hormones which release stored sugar in the form of glycogen. This gets broken down into gluocse and raises the glucose levels back up, often more than you started. We call it bouncing.

Check my signature link Secondary Monitoring Tools for some tips on urine testing and other assessments you may wish to track.
 
right... the somogyi rebound is the same as "bouncing"
that is what I was worried about in the first place

what do you do when you suspect bouncing? lower the insulin dose?
 
The curve patterns (serial blood glucose patterns) look different and the causes are different.

You'll see bouncing with a sudden fast/large drop followed by return to pre-shot levels and higher. They gradually calm down.

With Somogyi, my understanding is the numbers stay high until whatever reserves there are to compensate for excess insulin are exhausted and then the glucose bombs out, sometimes to hypo territory.
 
Michele M said:
Hi

My cat Crushy was diagnosed Aug 1 with blood sugars in the low 400s. The vet put him on 2 units of Lantus Insulin twice a day.

I JUST found this site on thurs (aug 8) and began checking his blood glucose that day. His numbers were still in the 300s.

On friday (Aug 9) the vet tested his blood, confirming my blood findings, and decided to put him on 3 units of insulin twice a day and lower his food intake a little (he had gained weight since the previous week)

I tested him today (Saturday) 6 hours after his shot, which is supposed to be the insulin peak, and it was 426!! yikes! what the heck happened?

He's acting completely fine. I never would have known if I hadnt checked his blood. He's not even drinking a lot of water.

After doing a little reading on this website I suspect a somogyi rebound and Im leaning towards lowering his insulin to 1 unit for a couple days and monitoring him closely.

he's 11 years old and he's been raw fed for the last 10 years (very low carb diet) The vet suggested not to change what he is eating. He's a big cat. He normally weighs 19 lbs and had dropped down to 17 lbs (that may sound really fat but he has a very large frame)

of course its the weekend and I cant get a hold of my vet. Any thoughts would be welcome

Michele
Click to expand...

yes, everyone is going to scream I am wrong, but I had 2 thoughts reading your post.

1. nobody has ever been able to prove somogyi on Lantus with actual data from frequent tests.
I don't believe it, but others will say I am wrong. My reply is prove it with data.

2. he's eating the best diet, raw, and "he's always been a big cat". To my brain, I think acromegaly.
Now the screaming can begin.

Wendy is correct. You are already home testing... what meter are you using - human or pet .... and can you give us your test numbers....

Test before am shot, post time, BG blood glucose number, and dose given.
See if you can get some other tests in... a curve is best where you test every 2 hrs between am shot and pm shot. The curve will let you know what is going on with the insulin all through the cycle.... you need to know is he staying high all across the 12hrs or is there a bit of a dip lower at some point, OR is he high at shot time then dropping really low at some point along the cycle and then bouncing high by the next shot time.

I know you say you started at a 2u dose BID, and it may be high for some cats but not others.
Some may for you to start over at 1u dose, but I would not. Sure you can try it for a day but if you immediately start to see much higher numbers, and your cat acts worse, jump on up again to the 2u dose, and follow the protocol most others are using for Lantus.

Be sure you are testing for ketones. Get KETOSTIX from the pharmacy and test his urine to be sure he has no ketones. If you test and get even just a trace, post here. Ketones can turn ugly fast.
Some cats are more prone to them than others, and ketones can occur even at lower BG, so it's good to know if you have a cat who is prone to them or not.

Gayle
 
Welcome Michele and Crushy to the FDMB!

what do you do when you suspect bouncing? lower the insulin dose?
Click to expand...
Ride it out. Your cat will bounce until he doesn't bounce anymore. His body has to get used to what it considers "too low" and that simply takes time. We do not lower the dose when the cat bounces.

Im leaning towards lowering his insulin to 1 unit for a couple days and monitoring him closely.
Click to expand...
The protocol we use, does base the starting dose on ideal weight or current weight if underweight. At 17 pounds, that would mean
17/2.2 kilos per pound = 7.72 kilos
7.72 * 0.25 Units per kilo = 1.93 Units
1.93 units rounded down to nearest quarter unit = 1.75U

The starting dose your vet suggested is pretty close to what the protocol we use would have suggested also. I would not recommend dropping down to 1U on the dose. We recommend only making increases in the dose in 0.25U or 0.5U increments, depending on what the nadirs were. Vets are often not used to making dose changes in less than 1U increments, be we have found that smaller changes prevent bypassing a good dose for your cat.

A bounce can take up to 72 hours to clear. You might want to wait out the bounce and then see where Crushy's BG levels are. If you feel you really need to decrease the dose, I would recommend not less than 1.75U at this point. My recommendation is that you ride out the bounce, wait the full 72 hours and see what happens. It's your choice though.

The best syringes for a cat are the 3/10 cc, 5/16" or 1/2" needle length (your preference), 29-31 gauge, with 1/2 unit markings on the syringe barrel. Wal-Mart Relion, some BD, some Terumo syringes and other brands have those important 1/2 unit markings. Do you have those syringes with 1/2 unit markings?

he's 11 years old and he's been raw fed for the last 10 years (very low carb diet) The vet suggested not to change what he is eating.
Click to expand...
Agree with your vet on the diet. A raw diet is a very good diet for any cat, and a good low carb diet for a diabetic cat. I certainly would keep up with that diet.

I tested him today (Saturday) 6 hours after his shot, which is supposed to be the insulin peak, and it was 426!! yikes! what the heck happened?
Click to expand...
Not all cats peak at +6. My Wink peaked early at +4. Some cats peak later at +8. You need to test to find Crushy's nadir. It can take a while to find that normal nadir for him and the tricky part is that the nadir can shift around to different times.

Are you warming the ear or massaging to get the blood flowing?
Are you using larger gauge lancets, 25-28 gauge, "For Alternate Test Site" is often on the box, for testing?
Are you always giving Crushy a treat for being good with the test?
Testing tips here.

Did the vet think that Crushy needed to lose weight? I ask, because you said he had gained weight and the vet told you to lower his food intake a little.

That spreadsheet (SS) setup that Wendy recommended would be really useful. You can share it with your vet, as many of us here do, and we can look and see what is going on with Crushy's BG numbers. If you need help with the setup, just ask.
 
Blue said:
Michele M said:
...He's a big cat. He normally weighs 19 lbs and had dropped down to 17 lbs (that may sound really fat but he has a very large frame)...
Click to expand...
...2. he's eating the best diet, raw, and "he's always been a big cat". To my brain, I think acromegaly.
...
Click to expand...

When higher doses come in conjunction with big cat and low carb diet, acromegaly is a very reasonable thing to rule out after checking that the basics are done.


Just a spot check on the raw diet - what all are you using as ingredients?
 
Cat isn't on a high dose yet. We don't think high dose until a cat gets up around 5-6 units per cycle or more.
 
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