Symogy?

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Tillie & Bookends

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It has been difficult to get in a good groove with my cat, Swirl. His BGs have tended to run high or low for years and he doesn't stay "right on" for very long. His dosages of PZI vet have ranged from .5u to 4u at different times of his life. His current dose is 2.25 PZI vet bid. He eats FF canned. He's 16 yrs. old. The last two curves( including today) have me wondering about Symogy effect.

April: Pre-shot 261
219
54
50
165
310
332

Today: Pre-shot 336
327
221
22
318
472
one more test to go at 8:30

Swirl is always symptomless for hypo at low numbers. His symptom at high numbers is copious urination. Years ago his diabetes was only found when he had blood work for a dental procedure. He continued to have trouble with gum disease until all his teeth were removed last year.
I consider today's numbers dramatic for him with that range from 22 to 472 though he shows no sign of feeling uncomfortable.
What I'm wondering is: Does he have this sharp dipping pattern because it is just the way he functions or am I inducing a rebound with insulin he doesn't need? Without insulin his BG levels stay up over 400. (His brother is also diabetic and has been on HM for years. His curves were always very nice at low doses of insulin. If he dipped low or spiked the symptoms were very obvious very quickly.)
I don't want to increase Swirl's insulin because of the dips, but at both ends of the day the meter is flashing ketones signs at me. I'm puzzled. Is this what Symogy looks like?
 
I think he can definitely be bouncing from those low mid cycle numbers to the higher ps numbers. If I were you, I would reduce the dose. How about going down to 2 units and see if he levels out?

You should check out the PZI forum and look at the spreadsheets of people using PRoZinc.
 
You have lots more experience than me, but those drops sure would scare me to death. I know Maisey had BIG bounces up after lows like those, so I would be lowering dose, because the lows are so low they are scarry. And everyone told me, better a little high than that low.
Maisey was on PZI also, now Off the Juice for a month. Low carb wet food made a big difference for her.
 
Looks like classic Somogyi to me.

Here's an article with a good graph showing the dive in BG when Sogomyi is the result of too much insulin. http://petdiabetes.wikia.com/wiki/Rebound

On the longer acting insulins Lantus and Levemir, we recommend lowering the dose when there's a low or nadir below 40. I would think on PZI that threshold might be raised to lowering the dose when nadir goes below 60, because PZI acts faster. In other words, you should definitely lower his dose.

The main problem I have seen with PZI is that sometimes this effect continues even if the dose is lowered or different doses tried. It can be difficult to level out the BGs to acceptable levels (under renal threshold, usually under 250mg/dl) for some cats on PZI. Especially if they have been on PZI for "years." You did not say how many years he's been diabetic.

We have a comparison graph in the Levemir ISG http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=682between his PZI curve and 2 separate Levemir curves after we began using it. The difference is remarkable. He was on PZI for 2 1/2 years and just tired. I attributed it to the constant swings he endured from the faster acting PZI. He has done amazingly well on Levemir for a cat with several other health issues and will be 18 in a week and a half!

Lowering the PZI dose would be the first thing you should try, but you may also speak with your vet about switching insulins. Many people here have done it and most cats do better on either Lantus or Levemir.
 
This looks like Somogyi to me too - I have had lots of experience with that with Jake before he went into remission just over a year ago. He initially was on PZI where my now former vet was prescribing too much insulin and did not want me to home test. I did not listen to her, Jake would be dead if I did, and I took up hometesting on a very stringent basis. I also got a new vet and changed insulin to Lantus. The Somogyi effect was not as pronounced when Jake was on Lantus. Maybe because Lantus is supposed to be longer lasting; but it is more likely the latter because I was testing so often to see if a high number was really a high number or a rebound from a low number and was able to give very small doses when it appeared to be a rebound situation.

Judy & Jake
 
I think my previous post was a little confusing. I meant to indicate that it was probably the fact that I was testing and giving less insulin that resulted in less rebounds (Somogyi effects) rather than the type of insulin. Sorry for the confusion.

Judy & Jake
 
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