Somogyi Rebound? or not Enough?

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Abbey Erwin

Abbey Erwin

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Hello!

We have been using Prozinc for our cat Cosmos with 4 units in the morning and 3 at night. He isn't doing worse but he isn't doing better. This has been increased a few times since he was diagnosed in January to the 4 and 3. We feel this may be too much and are trying out 3.75 and 3 starting today and see how he does.

We also thought about just starting at 1 unit/morning and evening... and just doing glucose checks daily as well (2 - 3 checks a day - one before shots and one in the middle of the day if possible). We just didn't want to jump from 4 units and 3 units to 1, not knowing how that would effect him.

We just need to figure out the best way to find that sweet spot. Yesterday Cosmos displayed some sitting on his front wrists more than we would like too - so we are thinking his blood sugar is still way to high (just started him on B12 last week - helped a little bit but I think until we get his blood sugar under control he's going to struggle with it more). He had a reading of 453 before we fed him this morning and a 312 about 4 hours or so after the first reading.

Sigh guys.... I just want him better!

We do know that he doesn't have pancreatitis - he was checked for that a bit ago - and we do make sure to get him grain free food or wet food so that he gets the least amount of carbs possible. So... all is well in that department atm!

Thanks for taking any time to just read! :) I will try to post this in the general section too - in case someone might catch it there!!

Take care,
Abbey
 
Welcome! :) We can help.

Re food: Wet food is best but grain free doesn't always mean low carb. Have a look at this great food list put together by a very knowledgeable vet: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Re insulin dose: We generally recommend keeping the same dose AM and PM unless you have a large body of testing data that indicates otherwise. Increasing in full units is too much but many vets want to do that. It's difficult to know whether the 3 u dose range is too much or too little. You need to starting gathering more BG data. Congratulations on home testing! It's the best way to keep Cosmos safe. Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
Re neuropathy: B12 can help but it takes quite a long time to get there. You need to give a high enough dose, preferably of the methylcobalamin form. Many people order a supplement called Zobaline online. It also helps greatly to get BG under better control.

Re going forward:
  • check the carb content of the food you feed him
  • set up that testing routine at a 3 u dose both AM and PM to get data at that dose with what he eats now. Do this for 3 or 4 days to get enough data to assess.
  • if the wet food is too high in carbs phase in lower carb food (below 10% carbs as fed) slowly while monitoring because it can have a significant effect on BG levels. Wait until the initial testing period (described above) is over.
  • check in here often for help if anything is unclear or you have other concerns.
I hope this helps! :)
 
The food information is on point! Finally had a chance to check it out today (someone else also recommended it)! Cool! Weruva isn't bad at all... I just know which to avoid and to definitely not the pouches!

The B12 supplement we have is 5000mg and we give him one in the morning and one at night. He's been taking it for about a week so far. We plan to keep testing him before he eats in the morning and gets his insulin, one time during the day, and once just before we feed him at night (and he gets his 2nd insulin dose).

You noted above that 3u in am and 3pm.... What if 3 is already to high? Is that possible? I have no way to know if it is. Would it be better to restart way low and go up every 3 to 4 days depending on that OR is there actual danger in too large of jumps that low to start? I guess what I do not know is, what's too low to start or what's a good mid point just to be the most efficient (maybe 3 and 3 IS the good starting point)? :)

THANK you. This has already been very very helpful! :)

~ Abbey <3
 
You'll know if it's too much insulin or too little as you gather more data. The mid-cycle tests (anywhere from +4 to +7 is usually the most helpful) are the most important to figuring out the dose, but you need the PS because it's the change between the two that gives us the information we need. If Cosmos is really in the numbers we see on your SS, and not because of a bounce, then lowering the dose could put him at risk of ketones. So I would go with Kris' suggestion to lower to 3u AM and PM, but only for 3-4 cycles, keep collecting data, and then let's see what happens and figure out next steps from there.

Also, I would strongly suggest getting him off of the dry food completely. Dry food, even the prescription diabetic dry foods, are too high in carbs for our sugar cats. Even a tiny bit is enough to push them up into high numbers. If you're feeding the dry because you like to leave food out, we have a number of simple tricks you can use to leave wet food out during the day. I leave both canned and raw food out with no problems at all.
 
Abbey Erwin said:
The B12 supplement we have is 5000mg and we give him one in the morning and one at night.
Click to expand...
To clarify: do you mean 5000 micrograms? That equals 5 milligrams and if you're giving it twice a day that's a daily dose of 10 milligrams. The Zobaline tablets are 3 milligrams each to be given only once a day. B12 is supposed to be water soluble so the excess is excreted but I suggest you lower the daily dose to one 5 mg (=5000 mcg) a day.
 
Kris & Teasel said:
To clarify: do you mean 5000 micrograms? That equals 5 milligrams and if you're giving it twice a day that's a daily dose of 10 milligrams. The Zobaline tablets are 3 milligrams each to be given only once a day. B12 is supposed to be water soluble so the excess is excreted but I suggest you lower the daily dose to one 5 mg (=5000 mcg) a day.
Click to expand...
OH geez! MCG. Yes! Haha! Sorry! Ok, we give him two doses of 5mg a day!
 
Kris & Teasel said:
Welcome! :) We can help.

Re food: Wet food is best but grain free doesn't always mean low carb. Have a look at this great food list put together by a very knowledgeable vet: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Re insulin dose: We generally recommend keeping the same dose AM and PM unless you have a large body of testing data that indicates otherwise. Increasing in full units is too much but many vets want to do that. It's difficult to know whether the 3 u dose range is too much or too little. You need to starting gathering more BG data. Congratulations on home testing! It's the best way to keep Cosmos safe. Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
Re neuropathy: B12 can help but it takes quite a long time to get there. You need to give a high enough dose, preferably of the methylcobalamin form. Many people order a supplement called Zobaline online. It also helps greatly to get BG under better control.

Re going forward:
  • check the carb content of the food you feed him
  • set up that testing routine at a 3 u dose both AM and PM to get data at that dose with what he eats now. Do this for 3 or 4 days to get enough data to assess.
  • if the wet food is too high in carbs phase in lower carb food (below 10% carbs as fed) slowly while monitoring because it can have a significant effect on BG levels. Wait until the initial testing period (described above) is over.
  • check in here often for help if anything is unclear or you have other concerns.
I hope this helps! :)
Click to expand...

Just to update! We are working hard at A) making sure he just gets wet food only/protein only. B) He is geting Methyl B12 and Folic acid daily. C) We have been checking his glucose 3 times a day and will keep doing so until we have a nice range to stabilize Cosmos and finally, D) I have been updating his chart/spreadsheet so that people can throw in their two cents that's linked under my posts now! As his glucose is still much higher than we'd like it to be, we have went down to 2.75 units starting tonight and will chart that for a few days. We didn't want to restart him down to 1 unit or so right away thinking that it would mess with his system - and wanted to be gradual about it! That being said, the going down seemed to lower things from what it was before... ie... the first glucose curve we ever did in a whole day he was in the 600's (was probably in late February or so wen we did that). But, the fact that it's steadily creeping down as a trend is a good thing. We will keep watching it though to see if this is where he needs to be/direction we need to take him!

Thank you so much again for all the help so far! It's been very helpful! And of course, please let me know if there's anything another pair of eyes might catch in the info we are taking in! Your notes have been invaluable so far in helping his life be better! (and by proxy... ours too!) :)
 
I would just add to that the importance of getting test during the PM cycle as well. Most cats run a bit lower at night than they do during the day, so collecting data during both cycles is important. It is, of course, harder to test at night, but if you are ever out late and can get a test when you come home, or if you get up during the night to use the bathroom, or if you can set an alarm occasionally and grab a quick test...or even just get a +3ish before you go to bed...You may not have as much data at night, but it's important to collect whatever you can.

And do keep posting. I'm a little nervous about that reduction given the numbers on your spreadsheet.
 
Djamila said:
I would just add to that the importance of getting test during the PM cycle as well. Most cats run a bit lower at night than they do during the day, so collecting data during both cycles is important. It is, of course, harder to test at night, but if you are ever out late and can get a test when you come home, or if you get up during the night to use the bathroom, or if you can set an alarm occasionally and grab a quick test...or even just get a +3ish before you go to bed...You may not have as much data at night, but it's important to collect whatever you can.

And do keep posting. I'm a little nervous about that reduction given the numbers on your spreadsheet.
Click to expand...

Hmmm... if we feed him at 11pm though... a few hours after he eats for late PM test is a bit rough! :( Maybe an alarm would be ideal or we could at least get those on days before I have to be up early in the AM!

We'll keep paying attention to things! The good news, going down from 4 was a good idea.... a solid 3 was good too! Thank you Djamila!
 
If you shoot right before bed, the other option is to get a +6/7ish when you wake up. Or even a +8 if you're one of those people lucky enough to get a full night's sleep o_O:)
 
I did manage to get one in this morning mega early at 4am because I just happened to be up - and thought - I'm up - let's just do it! In more slow but steady good news... he's acting more like himself and doesn't sleep as much as he did a week or two ago. Definitely because his glucose levels are going down from lowering the insulin amount (so far - and we keep watching - staying at 2.75 presently) and from getting ONLY non crazy carby wet food! I hope this trend will continue to level him out to regulation - not simply lower than what it's been but higher than what we want. Need to take the little victories and keep paying attention. (When I checked his glucose this afternoon, I was even able to do it with no help from another person - I think I prefer having another person just because it makes it all smoother - but... it's doable to do it on your own! (Also minorly empowering! :P but something! :) )
 
Small victories are always to be celebrated! And hey, testing by yourself is a huge accomplishment! Even if it's easier with someone else, being ABLE to do it alone if needed is awesome!
 
He had a real weird spike tonight out of nowhere though - This morning it was the lowest it's been with the 229 before the morning shot and tonight before the night shot and before bed he was at 462! Needless to say, I did this : o_O

My roomie was saying sometimes weird spikes happen, we'll just keep paying attention but... that was weird. He didn't get anything but normal wet food. He did get a little less in terms the amount - if that can create a higher reading. We found no evidence that he got into anything/our other cat's food that's WAY high up and away from Cosmos....

Anyhoo, I wanted to note it here. :/ And just get thoughts out of my head. (which I've had a hard time doing anyway)

(Thank you for the encouragement above!)

EDIT: My roomie also mentioned that since he was a little more ravenous - the stress could have had an effect on his reading too (for about an hour or so - he was READY for 11pm noms!)!
 
Congrats on the solo test!!! Nice work! And yes, it is empowering. And also re-assuring knowing that you can do it when you need to.

I think Cosmos is ready for your next increase whenever there is a cycle you can monitor. :)
 
Ok.. so maybe back to 3 is where we need to be. He was fairly high last night. Lower this morning, but this after noon he was 10 higher than the AM (before insulin check). This is the first day since regularly checking like this that he's actually went up any amount in the MIDDLE of the day. We will watch it... if it keeps doing this - we will likely bring it back to 3. Our concern is that 4 was too high when we were initially starting to test - even if that was just really 1 more unit a day (at the time it was that 4 in the AM, 3 in the PM thing... 3 and 3 seems about right. However, he did have is best reads just before this weird spike last night and today just before and that's with the 2.75 dosing. It's sometimes hard to tell where to go. I suppose just keeping it solid for a few days to watch what happens is smart and go from there!
 
I would like to just stop in on this thread and see what anyone thinks about Cosmos' numbers! I posted in Prozinc recently just check in there also. He seems to be sticking around 300 or so no matter what we do - and feel kind of like we are floundering - I should say - it's probably noticeable on the chart. It was suggested to me to just go back to 2. The reason we kept going down from 2 was because he had that big giant spike and thought - the spike was indicative of going down more - so now we are trying to work our way back up. This might not be the best policy. Maybe we should just go back to the 2 and go up from there. - just want to make sure it's right!

Please check out his numbers and put your 2 cents in if you have them! :)
 
You see signs of decent numbers periodically with a dose of 2 u. I suggest you stick to that dose both AM and PM for a couple of days. If that doesn't produce some blues then try 2.2 u both AM and PM. I'd avoid using different doses AM and PM for now as well as avoid changing dose too frequently. Tweaking the dosing plan with doses in response to PS is best used once you have him at/near a good dose range that produces a lot of blue and some dark greens.

Try to ignore spikes in BG that can be the result of bouncing or volatility caused by too frequent dose changes.
 
Kris & Teasel said:
You see signs of decent numbers periodically with a dose of 2 u. I suggest you stick to that dose both AM and PM for a couple of days. If that doesn't produce some blues then try 2.2 u both AM and PM. I'd avoid using different doses AM and PM for now as well as avoid changing dose too frequently. Tweaking the dosing plan with doses in response to PS is best used once you have him at/near a good dose range that produces a lot of blue and some dark greens.

Try to ignore spikes in BG that can be the result of bouncing or volatility caused by too frequent dose changes.
Click to expand...

THANK you. :) We've been sticking to the 2.... we will plan on altering it as we go here and not change him up too much as we go. :)
 
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