Somogyi effect? LOST and confused

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Erin Lewis and Boops

Erin Lewis and Boops

Member Since 2015
So, 2 nights ago, we began to switch my sweet boy over to Levemir, wanting something long-lasting so that he wouldn't be going so high at near-dose times. He had been on 2.5 units of Novolin-N. The vet suggested starting him on 1 unit of Levemir. So, Friday night, after beginning, we monitored his BG all night. It dropped down to 43, and I felt we needed to treat for hypo because we supposedly weren't on the nadir just yet for Levemir. We did and even got up in the middle of the night to check his BG. The next morning, we took him down to .5 units since he had gone hypo on us. This was OK, but we didn't see the numbers we were quite hoping for, so we decided today to split the difference and go .75units. Now, his numbers have been high all day, and I am wondering if it isn't Somogyi effect. I don't want to give him any more insulin in case. Thoughts? We need help, and the vet is a rookie. Le sigh.
 
Nope, not Somogyi (which hasn't been proven to exist in cats). It looks like bouncing: when the glucose drops rapidly and/or drops to an unfamiliar level, this triggers compensatory hormones which release stored glucose (glycogen). This raises the glucose back up, sometimes higher, for up to 3 days.
 
Also, you need to stick with the same dose for 3-5 full days for the effects to stabilize. Levemir works very differently from N insulin. It has carryover effects from shot to shot.

You keep the dose steady unless and until he drops below 50 mg/dL on a human glucometer, then he earns a 0.25 unit reduction
 
When was the last dose of N in relation to the dose that dropped his sugar. N can have residual effects up to 24 hours so it's possible that if the last dose of N was 12 hours prior, there was enough in his system to have an additive effect with the Lev. It's important because of overlap like this to hold doses for a few days (unless they go low - you were right to reduce). I'd stay at 0.75 for 6 cycles then increase.
 
I have seen that type of response when starting insulin/changing insulin type. That you get a very good response on the first does and then little response. As others have said, I would hold the 3/4 for a couple of days and than increase to 1 unit if the BGs show an increae is in order.
 
imho, I think you need to pick a dose and stay with it. If you are more comfortable with 0.5u , that's fine. You can always increase in a few days. Levemir is a depot insulin so it needs time to build that depot.
Try to get data whenever you can. It would be great if you could get something in the +8, +9 or +10 in the pm cycle which means
a early morning bathroom run/sleep test.... ( I know that's hard)

We will learn whether or not it's green numbers that cause him to bounce to blacks..... or maybe even a blue number has the same
effect. It can take up to 6 cycles to recover from a bounce.
He is definitely in a bounce. But I think he will recover sooner than later.

Look how fast he went from High to 135..... that's a sign that 1 u is too much.
The 43 isn't necessarily a hypo.....
most cats can go down to the 30's and not show signs.... but each cat is different so we don't assume.
If he did not show symptoms of a hypo , then basically he just earned that dose reduction.
If you are able to get a +2 after those preshot tests.... it can help indicate whether or not to expect an active cycle where you need
to monitor more frequently.
 
We use 50 mg/dL on a human glucometer as a threshold for intervening with food to keep the cat safe. While a cat not on insulin may go lower, when on insulin, having a bit of a buffer zone for intervening gives you time to help your cat stay alive.
See my signature link Glucometer Notes for more information about home blood glucose monitoring.
 
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