Somogyi rebound??

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raysofhope

raysofhope

Member Since 2012
I have written to you all before. Now I am quite upset at this time. I cannot get my cat regulated.. It is scaring me to, I am afraid I am going to loose her! She only gets canned food.. She used to be managing quite well. Then about 2 months ago . UP DOWN UP DOWN> I cant get her straight.. My Vet has no clue!! I showed him the numbers and he just said give her more insulin!! She was managing on 1.1 and 1.0 of PZI Now 1.0 is too much she crashes and throws up .80 is too much some times . then she shoots up to 457!! She never used to go over like 345.. I am so frustrated. I dont know where else to turn.. I have lowered her to .50 I am hoping she will level out a little bit. I am at a loss.. here is some of the numbers Ive gotten and the results..


at 8:30 am bg 439 I gave her 1.0 u. 12:00noon bg221 3:00pm bg216 5:45pm bg 187 ( not eating and vomited.) got a little baby food in her.
then at 8:30pm she was 228.. gave her .50u

Next morning she is 347

Here is another set of numbers.

in the morning 377 gave her .95u At noon she vomits.. then 8:30pm shes is 223 gave her .75 she got a UTI ant 11PM that night.

Morning she is 268 gave her .80 then ant night she is 356

Morning 422 gave her 1.2 u then evening she is 405!

8:30 Am bg360 gave 1.0 Noon she got sick and drops to bg90!!

gave her nutrical and baby food that night , bg at 8:30pm is back up to 469!!
thought I might try to lower her dose for a day or so..



Night before last gave her .50U but didnt check her.. ( I know stupid)
the she got sick and and 2:00 am she was 404 then at 8:30am 433 Gave her .80 then at 11:00 am 467!! 12:30 305 then at 3:00 pm 345..SOMOYGYI??

Didnt check and didn't give any insulin..

this morning she was 467 again, gave her .50u.. I am hoping she will come down a little but not too much then I can increase her dose..

I am at a bit of a loss here PLEASE any suggestions??

Sorry I just cant do a spread sheet ,, I dont have time. I have 20 other cats and animals to care for also.. nailbite_smile :sad:
Diana
 
Hard to tell without a spreadsheet. Are these readings taken on consecutive days ? can you add dates to what you said?

i am trying to see trends over time - so it would be more helpful if you did this

11/26
8.30am measured xxxx, gave 1 unit
12.30pm measured xxxx
8.30pm measured xxxx gave 0.75 units

11/27
8.30am measured xxxx, gave 1 unit
12.30pm measured xxxx
8.30pm measured xxxx gave 1 units

Wendy
 
I agree with Wendy it is hard to tell. I would be happy to set up a spreadsheet for you and fill it with the numbers you have so far, if that would be helpful. Check your messages: at the top of the page it will say "1 new message"

And I agree with Larry that the vomiting is troubling and could be contributing to the numbers.Does it seem to be after she eats?
 
Here is some of the info for Diana and Angel's spreadsheet. Angel's SS We'll get it in her signature soon.

Diana, what I see is a lot of dose changes. Some cats react well to those; some don't. It could be that Angel needs to have a dose held for a few cycles. What would you think about giving one unit- as long as she is over 200 at pre shot - and see what happens for a few cycles. I also think you need to have the vomiting checked out. Does it correspond with low numbers? If so, that might be a factor. Also I am wondering what kind of syringes you are using, to measure .95 and .8?
 
Larry and Kitties said:
Have you been to the vet? The vomiting may mean something is wrong and that is causing the BG swings.
Click to expand...
Hi yes We were just to the vets about a week ago , I was worried and did a full blood work up including the thyroid. The vet said she is in good shape for her age..Iam afraid that won't be the case for long if I can't get her bg under control..
 
Hi everyone ,I am not to good at this forum stuff, but anyway,,I have tried to keep Angel on one dose like .80 or 1.0 u after about 3 days she crashes gets sick and then bounces back up.. That's why I am having such a time with her. I know the numbers look a bit confusing . ,most of the readings I gave you were all taken within a couple weeks or so in time. I have tried not to check her 2xs every day. I have tried to adjust the dose down or up a little depending on the levels as the same dose for her never seems to work more than a few days. This morning I tried a new bottle of insulin, just I case.. Her bg was 487!' I gave her .50 and tonight she was 427.. At least she is going down instead of up!
 
Wendy&Tiggy said:
Hard to tell without a spreadsheet. Are these readings taken on consecutive days ? can you add dates to what you said?

i am trying to see trends over time - so it would be more helpful if you did this

11/26
8.30am measured xxxx, gave 1 unit
12.30pm measured xxxx
8.30pm measured xxxx gave 0.75 units

11/27
8.30am measured xxxx, gave 1 unit
12.30pm measured xxxx
8.30pm measured xxxx gave 1 units

Wendy
Click to expand...


Thanks Wendy, I have been trying to find a trend myself! I can't seem to find any, that's why I am having a hard time with this. I will try to post a bit more tomorrow with dates ect.
 
Just in case I didn't do this right , yes I did see the spread sheet and I appreciate you doing that foe me. I will send you some better data with dates ect tomorrow,, thanks again!! Diana
 
raysofhope said:
Larry and Kitties said:
Have you been to the vet? The vomiting may mean something is wrong and that is causing the BG swings.
Click to expand...
Hi yes We were just to the vets about a week ago , I was worried and did a full blood work up including the thyroid. The vet said she is in good shape for her age..Iam afraid that won't be the case for long if I can't get her bg under control..
Click to expand...

lots of things you can consider.... allergies to something in the food being fed, switch to another insulin, and even IBD could be questioned.

Cats don't vomit for no reason.
http://www.2ndchance.info/inflambowelcat.htm
http://pets.webmd.com/cats/guide/cat-vo ... treatments

I would also want to know how your cat's bowel are working?
What sort of stool output are you seeing? Cats will vomit if constipated and/or have a blockage.

Gayle
 
Diana also sent me some more data and I have put it in the spreadsheet. Diana, please review and make any corrections on the url that I sent you via email.

Angel's SS

The insulin does seem to be working. There are some nice numbers sprinkled in there, but there are lots of time when you are missing preshot numbers and there are few midcycle numbers. The only way to figure this out is to start tomorrow, get a preshot number, get a number about 5-7 hours after the shot and a number before the shot at night and see how that dose worked. (If you are unsure about what to shoot, post your preshot number and ask for advice)

Several questions I am still wondering about - what kind of needles are you using? How do you gauge .8 and .9? Is her UTI cleared? Is she still taking antibiotics?
 
I THINK I've figured out how to get here, now I've got to figure out the spread sheet and how to answer you all without just guessing where to click :)
 
She is not on the antibiotics anymore. This is another thing my vet thinks is brought on by her stressing ?? Anyway I am using the insulin syringes with 29g 1/2 inch needles.
 
Hi Gayle

Angel just started vomiting about 2 months ago when she got a bad stomach bug.. She wouldnt eat for 3 days and the vet gave her some injections to calm her stomach, Since then she has a sensitive stomach I think?

I do realize cats are not supposed to vomit all the time. I have 22 cats.. I run a small cat shelter from my home.. Anyway Angel is my special cat. Thats why this is so upsetting..

Diana
 
Hi I have found the spread sheet but how do I edit it?
Click to expand...

If Sue gave you permission/ownership of the spreadsheet she set up for you, you just enter the numbers as you get them. The first set of columns is for the morning cycle (AMPS) and you'd enter the date, your AMPS number, how much insulin you gave (in the U column)....it saves the information as you enter it, so it doesn't have to be "saved" any special way.

Then as you get tests during the cycle, you look at the time..If it's 2 hours after you gave the shot, the number would go in the +2 column...if you test 6 hours after you give the shot, you put that number in the +6 column.....it's that simple.

When you do the PM shot, you start the + system over...so if you shoot at 8am/8pm, at 11pm it would be +3..etc, etc.

If you look at China's spreadsheet, you can see that her AMPS this morning (6am) was 235, her +3 (9am) was 387, +4.5(10:30) was 432 and +8 (2pm) was 304

Her next pre-shot test will be at 6pm and then we're in the new "night" cycle

I hope that helps. If it won't let you enter any numbers, then you should send Sue a private message so she can turn the ownership over to you
 
Sorry, Diana. I sent the spreadsheet again and hope it comes through. That one is the one you save to your favorites; you can edit and add data to it. Let me know if it doesn't arrive in your email.

I attached a copy to your signature so it will come up each time you post, updated. That one is a read only; no one can edit it.
 
I have added some numbers to Angels spread sheet , I hope this helps..
She has been going down some. so maybe I am on the right track??

thanks everyone for the help.

Diana
 
Looks like it might be. The next thing to do is to get a number somewhere in the 5-7 hour after the shot so you know how low the dose takes her. If she goes down in double digits, it's a pretty good dose. If she stays flat through the cycle, you might raise the dose a little.

Does your insulin say U40? Do your needles? Is the insulin ProZinc or PZI? I just want to be sure we are on the same page with the insulin and doses.
 
I was going to give her another day or so then check her about 3:00pm
I have learned that she starts her decent about 3hrs after her shot then drops again in another 3hrs. then she starts to go up again.
 
Hi Everyone.

I have updated Angels chart,, any ideas on what I should do?? About her doses?

she was a bit high both this morning and at 3:00 but she did eat some friskies at 2:00pm .

thanks, Diana
 
Here's some information on Pro Zinc dosage...I don't use it, so other than advising you after reading this, you'll have to wait for more experienced eyes

There is no established protocol for ProZinc. Dose is determined by looking at the history of the kitty – his doses and how he has responded including preshot numbers and midcycle numbers.

Starting Doses
The recommended starting dose for ProZinc or BCP PZI is .5 units or one unit twice daily. It is suggested that if the initial numbers are high, doses can be changed every three cycles, increasing by .5 at a time. If the initial numbers are in the 200-300 range at preshot and midcycle (nadir) numbers are not too low (not 50 and under), increases can be made .25 units at a time. During this early period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers or in a gradual lowering of numbers overall, depending on the cat.

Over time, as data is collected and nadir numbers are available, doses can be adjusted more confidently.
If the cat is in the 250+ range at preshot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible.
If the cat is in the 250+ range at preshot and drops below 50% at nadir, bouncing is a possibility (bouncing occurs when the cat’s body perceives a drop that is below what has been occurring and releases extra glucose, resulting in an “artificial” rise in numbers) Bouncing most often involves a lower midcycle number than the cat has experienced previously. If bouncing is suspected, any increases in doses should be tiny and monitored carefully.
If the cat is high and flat during the entire cycle, the dose could be raised .5 units, as long as monitoring is possible.

ProZinc and PZI are unique in that they can be dosed in two ways, depending on how the car responds. Some cats seem to do best if a specific dose is held for several cycles. It seems to take that long for their numbers to really change. Some cats respond to a sliding scale, getting a different dose for different preshot numbers. Collecting data will help you see which regiment works best for your cat. If you need help with a sliding scale, ask people on the PZI forum to guide you.

Low Preshot Numbers
The general recommendation for new diabetics is not to shoot a preshot under 200, but to wait 20 minutes (without feeding as food raises blood glucose levels) and retest. If the number is rising and above 200, then a shot can be given with perhaps a little less insulin given.

If midcycle (nadir) numbers are in the 40-50 range, the cat should be carefully monitored for the next couple of hours with tests given every 30 minutes as long as the cat stays low. First small amounts of low carb food can be given to raise the blood glucose levels. If that doesn’t raise the levels, higher carb food should be given. If the levels are dropping and below 40, then honey can be put directly on the cat’s gums. If the numbers still aren’t rising, a trip to an emergency vet is probably necessary.

If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal)

If you are using U40 syringes and find yourself trying to eyeball doses under .5, you may want to consider using U100 needles and the conversion chart. (Conversion chart) This will allow you to give mini doses....conversion chart: http://www.felinediabetes.com/insulin-conversions.htm

It is important to test for ketones regularly, at least once weekly even if the cat is eating well and has no infection present. Test daily if any infection is present, the cat is not eating well and/or is in higher ranges. Testing for ketones can catch DKA early. Cats with DKA should be seen immediately by a vet.

Data Collection
Until the bean gets data on their cat’s responses to the insulin, advice on dose changes can be gotten on the forum or from the vet. Using a spreadsheet to record data is the best way to share this data with forum members and the vet.


From this, I'd say you're fine to go up to 1 unit for several cycles and see how it goes

Good luck to you and hopefully others who use Pro Zinc will be along to advise you since it is dosed differently from Lantus or Levemir
 
Can you start getting a before bed test? That would give more data to see what she is doing at night and better be able to evaluate the dose.
 
Depending on your pmps tonight (which I am going to assume will be in the 300'-400s) I would increase the dose IF you can test at least once before you go to bed. (The test a few hours after the evening dose will give you a quick idea of how the cycle is heading - is it going down fast or is she staying in safe numbers and thus probably will be fine overnight.) If you increase, it is good if you can monitor at first to be sure there are no surprises. Maybe up it to .75 if you can measure that easily?

This scenerio assumes she won't continue down in numbers through pmps. If that happens, completely different scenerio.

The way I read your ss, even though there are a lot of holes :mrgreen: , is that she has never dropped dangerously low. The only green was the one time she vomited. So it seems like you have room to increase. Then I would hold that dose for a few cycles to see how it works UNLESS you see a midcyle number in the 40-50 range or you get a pre shot near 200.

How is her tummy doing?
 
I am not sure if PZI works similar to Lantus, but with Lantus, you should keep at the same dose for at least a week. It can take that long before a cat's body adjusts to it and the BG readings level out.
 
Pzi doesn't work the same as Lantus, Lisa. It is not a depot insulin - it is basically in and out of the body in 12 hours so the advice is to hold for about 3 cycles before adjusting the dose up or down.
 
Hi everyone , thanks for the suggestions. I wasn't going to test her tonight as I am sure she is up there. Prob high 300's or low 400's. No since poking her for nothing. I know I haven had any dangerously low numbers , that's because I usually catch her on the way down, 90 is low for her ..anyway. Was going to try for .60 if I can guess that one.. Wish they had more lines on these syringes. And I think I should TRY to keep this dose for a few days if I can.the bad thing is she got a couple pieces of dry food tonight!! :roll: caught her Sneaking!! I have several cats in the house. We keep the bowl covered . But every now and then she manages to sneak a piece or 2. And yes I know this is not good. But I haven't figured how to completely eliminate this. I can't switch all the cats to canned food as I have one that refuses to eat any of it, I've tried..Anyway I will try a reading about 11:00 pm and see what I get. Will keep you posted. I do appreciate all the help.
 
If I were you, I wouldn't skip preshots. You never know when she can throw out something unusual. On the PZI forum tonight, Terriy's kitty was about in the same numbers as Angel but she unexpectedly continued down for the pmps. That probably means her dose was a little high as the insulin lasted more than 12 hours. You just can't be sure what will happen for any given preshot.
 
I think I may have figured out whats going on with Angel.. I read somewhere that cats can go down in the first hr. then bounce up again and have high readings.
Last night At 11:00 pm Angel was 389 and she was a bit nauseous and didn't eat all night., this morning at 9:00 404 and Now at 10:20 she is 214!! gave her some more food and a dab of Nutrical.. I guess I need to reduce her dose to .25??

What do you All think??.

thanks so much,

Diana
 
raysofhope said:
I think I may have figured out whats going on with Angel.. I read somewhere that cats can go down in the first hr. then bounce up again and have high readings.
Last night At 11:00 pm Angel was 389 and she was a bit nauseous and didn't eat all night., this morning at 9:00 404 and Now at 10:20 she is 214!! gave her some more food and a dab of Nutrical.. I guess I need to reduce her dose to .25??

What do you All think??.

thanks so much,

Diana
Click to expand...

I am wondering about the nutrical you are giving..... you know there are sweeteners in it, with the first ingredient being corn syrup?

Caloric content: 338 calories/100 g (20 calories/6 g).

Ingredients: Corn Syrup, Soybean Oil, Malt Syrup, Cod Liver Oil, Cane Molasses, Methylcellulose, Water, Gelatin By-products, dl-Alpha Tocopheryl Acetate (Vitamin E), Sodium Benzoate (Preservative), Manganese Sulfate, Ferric Ammonium Citrate, Thiamine HCl, Niacin, Calcium Pantothenate (Source of Calcium and Pantothenic Acid), Magnesium Sulfate, Pyridoxine HCl, Potassium Iodine (Source of Iodine and Potassium), Riboflavin 5- Phosphate Sodium (Source of Vitamin B2 and Phosphorus) Vitamin A Palmitate & D Supplement, Folic Acid, and Cyancobalamin (Vitamin B12).

Gayle
 
Let's see how today plays out - get a few more readings. The sudden drop is interesting. Usually they rise after food unless their pancreas is working. The data guides you with the doses. The more data, the better the dose choice.
 
I know the nutriical has sweeteners that's why I gave it to her . Because she usually drops at noon then again at 3:00pm she can't afford to drop too much with a reading of of 214.trying to avoid a hypo.
 
Hi Diana!

A number in the 200's isn't anywhere close to a hypo....If they drop below 50, we reduce the insulin. Now a drop like that is noteworthy, just because it IS a fairly significant drop, but doesn't warrant a dose change.

I read somewhere that cats can go down in the first hr. then bounce up again and have high readings.
Click to expand...

I think you might be talking about "bouncing". Bounces happen when the blood glucose drops lower than the cat's liver is used to, or there's a big drop. The liver has gotten used to those higher numbers, so when the numbers go into unfamiliar territory, it "panics" and releases hormones and sugars to bring it back up. If you look at China's spreadsheet, look at 6/11/13 (this was when we were first starting). In the AM cycle, she dropped to 143...See where she was at PMPS? 541...that's a "bounce"! A bounce can take up to 72 hours to clear, but as our cats get more time in "normal" numbers, their livers re-learn what normal is, and don't react quite so much.

Nutracal can be used if Angel's blood glucose goes below 50 I suppose, but most of us use the gravy out of a "gravy lovers" kind of food, or Karo, honey or syrup. Giving those simple sugars will bring their numbers up, but also wear off just as quickly, so aren't always the best choice.

Due to the drop you saw this morning, it's good you're going to be home to test. If you can get a +4 that'd be great and we'll see where Angel is...she just MIGHT earn that reduction!!
 
Thank you very much for the information, yes I know 214 isn't anywhere near hypo , but I know her cycle some what and dropping some 190 PTs in a little over an hour is not good either. If I don't catch her and bring her up a little she will continue to fall until 4:00 pm or so . Then she will be hypo..

SHE WORKS BEST ABOUT 150 or so a bit high but any lower she starts vomiting gets chills ect.

I need to get her down gradually to a more reasonable number, so I think I may have to reduce her to.25 for a while and see what happens..Not sure just questing at this point
Thanks!
 
I put a few more figures into Angels sp sheet. Anyone have any thoughts?? I didnt check her before I went to bed.. I forgot ,,
Then I think she dipped again as she vomited sometime after 11:00pm. And didnt want food again untill this morning.. She still isnt eating that great.. I am at a loss.. thanks :?
 
You could need to increase or decrease. There is really no way to know without some more midcycle numbers, Diana. If she went low overnight, this morning is most likely a bounce. If she stayed steady, then last night's dose was too low.

I think it is very important that you figure out the vomiting. Does she eat all one flavor? Maybe switch. My cats have all have trouble with beef flavors. Does she eat too fast? Add warm water to make a gravy or smear it around a dish so she will eat slower. Does her tummy seem sensitive to the touch? (one of the signs of pancreatits)

Please try to get a few numbers during the cycle today.
 
Thanks Sue,,

I just checked her a few mins ago and she was 417. I guess I should have checked her an hr.after she ate again to see..But I was hoping she might do better and not dip so far on only .25.. :YMSIGH:
Her stomach seems ok. She gets Friskies Country platter, and Mixed grill,and the beef and chicken special diet I used to feed her the turkey and giblets. and thought MAYBE it was that so I started her on the other 3 flavors last week. I give her FF classic when she wont eat. and Baby food by syringe sometimes. Oh and Halo liv a littles dried chicken meat as a small meal or a treat.
Usually when she is having a good day she eats about 1-2 TBl. every 2-4hrs.

You do have some good suggestions though. My gut feeling is bouncing around . But then I really dont have a LOT of data to back it up.
 
If she is dropping too fast and you are intervening with high carb, I would try reducing the dose. You may find that it works better to give a lower dose 3 times a day, rather than a higher dose twice a day. Each cat is different (ECID)

******************************************************​

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- 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 (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, 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.
 
Also, if it seems her stomach/GI tract is continually upset, one thing you might try is 1/4 tablet of Pepcid AC, the regular 10 mg tablet, about 20-30 minutes before feeding. You might check with your vet to see if there are any objections to trying that.
 
Checked out the ss, Diana. It looks like a flat high cycle. If you can monitor tonight, I'd raise the dose to .5? If you can't monitor, then maybe in the am? I do think her infection may be raising her numbers as could be the medicine (it looks like she is on meds and still has an upset stomach), but I don't think you want her staying in those high numbers.
 
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