Somogyi effect and reducing insulin ??

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MyTitan (GA)

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Hello all, this is Titan's dad, mom has handled the FDMB to date but she is getting a little anxiety ridden dealing with Titans venture into diabetes so I get to post the question. We are fairly certain we have crossed over into the Somogyi effect based on BG readings. Titan started out at 2 units 2x a day (Lantus) and based on urine strips and vet advice moved up to 4 units 2x a day with no improvement. We started doing BG tests and he is in the high 300's 6 hours after his morning shot. We have not done a glucose curve yet at home but intend to soon. My question is if we drop his insulin down to 1/2 unit twice a day how fast can we drop it down? We essentially would like to start over to find the sweet spot feeling that the start at 2 units 2x a day put him right into the Somogyi effect. Has any one else had to do this? I am currently plan on dropping each shot .5 units alternately every third day so in essence it takes 6 days to drop a unit, he's getting 8 units a day now. Too fast or to slow? Any advice would be welcome.
Many thanks and kudos for the help given so far this is a wonderful support group.
 
Hi Titan Dad - welcome!

I am so very glad to hear that you are going to reduce that huge 8 units dose!

But in terms of giving you a practical advice as to how to reduce - sorry, not enough experience. There are people who are able to help you on this Board but they will be asking you the same question - can you post all of the tests results you have for Titan? For each day since he was on Lantus?

I do hope someone with experience in such matters will stop by to help you out.
@Wendy&Neko
@Kris & Teasel

Titan is such a handsome boy!
 
Titan started out at 2 units 2x a day (Lantus)
The usual starting dose for Lantus is 1 u twice a day.

moved up to 4 units 2x a day with no improvement.
Was this one increase or two 1 u increases? Either way, you could have zoomed right past a good dose. We recommend increases of 0.25 u at lower doses.

We started doing BG tests and he is in the high 300's 6 hours after
Excellent! The high numbers might be due to an overreaction we call bouncing. We'll need to see data to assess.

We have not done a glucose curve yet at home but intend to soon.
A curve is of limited usefulness if his numbers are high and flat. What's more revealing is a scattering of tests at random times over several days. We recommend:
  • testing every AM/PM before feeding and giving insulin (no food at least 2 hours before) to see if a planned dose is safe
  • at least one other test between AM/PM doses and one before bed in the +4 to +7 range to see how low he's going
  • extra tests on days off to fill in the data gaps.
What does Titan eat? If there's any dry food in the picture you have to be very careful phasing it out because BG could drop quite a bit. Home testing is the way to do it safely. Why not set up a testing routine first to set the hang of it. Grab some data at his current dose and set up the spreadsheet we use here so we can look at it to offer advice.
 
The usual starting dose for Lantus is 1 u twice a day.


Was this one increase or two 1 u increases? Either way, you could have zoomed right past a good dose. We recommend increases of 0.25 u at lower doses.


Excellent! The high numbers might be due to an overreaction we call bouncing. We'll need to see data to assess.


A curve is of limited usefulness if his numbers are high and flat. What's more revealing is a scattering of tests at random times over several days. We recommend:
  • testing every AM/PM before feeding and giving insulin (no food at least 2 hours before) to see if a planned dose is safe
  • at least one other test between AM/PM doses and one before bed in the +4 to +7 range to see how low he's going
  • extra tests on days off to fill in the data gaps.
What does Titan eat? If there's any dry food in the picture you have to be very careful phasing it out because BG could drop quite a bit. Home testing is the way to do it safely. Why not set up a testing routine first to set the hang of it. Grab some data at his current dose and set up the spreadsheet we use here so we can look at it to offer advice.

Bear with me on this message board posting and replays. We only have two BG readings so far and just finished the signature page. He is on all wet food, Hills CD for his urinary tract issues and Wellness CORE. We alternate cans plus Fancy Feast "Purely" strictly as a treat after shot and BG test. He lovvvvves chicken. Still working on figuring out how to set up the spreadsheet. I guess I'm wondering if I test tomorrow am before morning meal and he is 300+ can I give only 1/2 unit or back down slowly form the 4 units ?
 
Bear with me on this message board posting and replays. We only have two BG readings so far and just finished the signature page. He is on all wet food, Hills CD for his urinary tract issues and Wellness CORE. We alternate cans plus Fancy Feast "Purely" strictly as a treat after shot and BG test. He lovvvvves chicken. Still working on figuring out how to set up the spreadsheet. I guess I'm wondering if I test tomorrow am before morning meal and he is 300+ can I give only 1/2 unit or back down slowly form the 4 units ?

He's at 8 u twice a day, right? Very high dose for a kitty on insulin less than a month! I wouldn't go back to only a half unit. I think you'd be better off asking the Lantus folks for advice on this. What I can say is that he has a large depot from the 8 u dose still working. It'll be a few days before the effect of any reduction is seen.

I see your signature - oh, my, Titan has been through a lot, hasn't he? If you need help with the spreadsheet there are people here to do that. :)
 
Hi Titan's Mom and Dad. What a lucky guy Titan is to have two such dedicated pet parents!

I know you just started testing and got a successful test yesterday 6 hours after his shot. Congratulations on your success and kudos for testing as that is the best tool you have to get Titan onto a better path. Kris has given you great information on testing.

Titan (quite the cutie and I love his ears!) looks like a small kitty in the picture! How much does he weigh and is he at his ideal weight? With his history of urinary problems, and the C/D cat food, his insulin needs are likely to be a little higher than a cat on a low carb diet (under 10% carbs). One of the C/D wet flavours is 34% carbs (so I assume the others are also high carb) which is considerably higher than we would normally recommend, however, Titan's history of urinary issues has to be taken into consideration when deciding on diet and if he needs to stay on that diet that means he will likely need a slightly higher dose of insulin to compensate.

I thought you reduced the dose to 3.5u last night. Have you continued with 3.5u today or did you give 4 units again this morning? As Kris said, Lantus creates a depot of insulin so the effects of any dose changes are not immediately apparent and doses are generally held for at least 6 cycles (barring any low BG readings) to see the true effect of dose changes.
 
Hello and welcome. Congrats on getting your first couple of blood tests in. At this point it's really hard to say what is a good dose for Titan. Some cats have secondary conditions that mean they need larger doses of insulin. Neko got up to 8.75 units and Linda's Menace also got into higher dose territory. With the high carb wet food in the picture, that will also mean a need for larger doses of insulin. 4 units twice a day is not a really large dose, though your vet did increase in larger increments than we do here.

On a side note, there are other options than high carb C/D wet for urinary issues. Giving low carb, low phosphorus wet or raw food with plenty of water added is also an option. When my Neko was diagnosed with FD, she started stealing my other cat's CD. I had to find a food they both could eat, so I went the raw route on her vets recommendation. More about appropriate diets for urinary issues on Dr. Pierson's website here. Just don't change the diet until you are able to test more. Changing from high carb to wet food diets can make a HUGE change in insulin requirements. If you look at Dr. Lisa's food chart, you'll see that even some of the Wellness Core options are medium carb, not low cart. We consider foods under 10% carbs to be low carb.
My question is if we drop his insulin down to 1/2 unit twice a day how fast can we drop it down?
You can drop a dose down right away to 0.5 units if you wanted, though the depot from Lantus will impact 4-6 cycles after you drop the insulin dose so you won't see what the lower dose is doing until after those 4-6 cycles. However, and this is a big one, I would not reduce the dose unless you are testing regularly for ketones. It's possible that Titan needs 4 units and even more, and dropping the dose too low will set him back. How is Titan's appetite? Another option might be to get some more mid cycle test when you can, and see if those 300's you are seeing is because the dose is too low, or if he's bouncing.
"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Note, bouncing is not Symogyi. The high numbers you are seeing could mean either (1) the dose is too low or (2) the dose is fine and he's bouncing or (3) the dose is too high. Only blood sugar test values will tell you which of these scenarios is at play.
 
Good morning all, what a wonderful response to our query. I'll try to elaborate and answers all questions. Titans dose this morning was 3.5 units and last nites 7/24 pm was 2.5 which was a drop from 3. He had been on 3 units for 6 cycles in the pm. His weight has dropped, he had been a 15-16 lb cat but is hovering around 11 1/2 now. We did not know Hills CD was such a high carb diet and will look into lowering it. We topped out at 4 units twice a day which would be 8 units total for a 24 hr. His appetite is very good so getting food into him is no problem.
 
Thank you Tanya and Ducia for asking. Things are pretty rough here. We are trying to get back to 1u twice a day
and start the whole regulation process over. We went to 8u (4 x 2) very quickly. Blood draws are going better. We
will do first curve when he gets to 1u morning and evening. He was a huge 510 twelve hours after his 2u of Lantus
this AM. Vet thinks he may have some disease process going on so we've asked if she'll do more extensive blood
testing. First blood panel didn't give us any info. I seem to be on a continuous crying jag which does my beloved
boy absolutely no good. I'm just so scared and frustrated.
 
Thank you Tanya and Ducia for asking. Things are pretty rough here. We are trying to get back to 1u twice a day
and start the whole regulation process over. We went to 8u (4 x 2) very quickly. Blood draws are going better. We
will do first curve when he gets to 1u morning and evening. He was a huge 510 twelve hours after his 2u of Lantus
this AM. Vet thinks he may have some disease process going on so we've asked if she'll do more extensive blood
testing. First blood panel didn't give us any info. I seem to be on a continuous crying jag which does my beloved
boy absolutely no good. I'm just so scared and frustrated.
I like the idea of a restart. He might still be feeling the effects of being overdosed. How many days has he been at 1 u BID? Would you consider setting up the spreadsheet we use here so it's easier for us to help you?
 
I seem to be on a continuous crying jag which does my beloved
boy absolutely no good. I'm just so scared and frustrated.
I am sorry for what you are going thru. I was just like that when my girl was diagnosed and had DKA but please believe me when I say it will get better. I promise, just give it some time.

I agree with Kris's that Titan might still be under the overdose influence. I also strongly urge you to consider setting up a spread sheet. I had no clue what spread sheets were neither I am into the electronics so someone on this forum set it up for me and show me how to use it. Turned out to be easiest thing, after a little a practice. The way the SS stores the data - tests results, etc is very useful and telling about kitties typical responses to doses and helps immensely to hunt down the proper dose. Let us know if you'd like help with setting up SS.

Blood work might be a good idea as infection/inflammation drives the BG numbers up.

Hang on in there. People on this forum have extensive practical experience and willing to share and to help. Keep posting here or on the Lantus & Levemir forum. It's wonderful chance for Titan that you found your way on to here!
 
Are you testing Titan before you give insulin without any food influence and again mid cycle?
Normal routine would be to remove any food 2 hours before planned shot time. Test after food has been withheld for at least 2 hours, then feed and shoot. Test again at least once mid cycle between +3 and +8 post shot randomly to see how low the dose is taking Titan. With Lantus, a test at +3 will often tell you what to expect for the cycle i.e. whether it's going to be an active cycle or not. Nadir will usually be sometime between +5 and +8 so getting another test in that time frame will help you determine how low Titan is going.

As Wendy mentioned earlier, there are conditions that can cause our kitties to need high doses of insulin but it's more likely that Titan's dose has just been increased too quickly and is still too high.

I agree with the others re: the spreadsheet. It is a wonderful tool that allows you to visually see how Titan is doing and we are very reliant on being able to see the data in a familiar format here in order to give you the best assistance possible. :)
 
On 7/20 he was still on 8 units a day. We are decreasing .5u every three days. Going slowly so we don't shock
his system. The last two days he has been on 2u AM and PM. His numbers are climbing and I worry about
doing irreparable damage. Ed will set up spreadsheet with the data we have so far.
 
On 7/20 he was still on 8 units a day. We are decreasing .5u every three days. Going slowly so we don't shock
his system. The last two days he has been on 2u AM and PM. His numbers are climbing and I worry about
doing irreparable damage. Ed will set up spreadsheet with the data we have so far.
Yes, you want to get his BG down but cats can tolerate hyperglycemia better than humans and dogs do. It's much more dangerous to have a kitty drop too low into hypoglycemia. That's the reason we advocate a good testing routine here along with logging data on the spreadsheet. Over time you can see how your kitty responds to doses, dose changes, etc.
 
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