Very high NADIR - Somogyi effect?

[Justyn]

Hello all, i've posted about this recently but am confused at what to do next for my diabetic fur ball.. I'm running low on tester strips so hadn't done a curve since last weekend, but just today was going to test him at his +6, +8 and +10 to see how low he was going - but I only got his +6 reading today of 393... His true NADIR seems to be more around the +8 mark but should be much, much lower around then.
The only thing that I think can explain this erratic number out of nowhere, would be a recent crash that is causing him to bounce... I've read to help determine Somogyi effect, we should reduce the insulin in 1/2, but I'm worried his BG is just going to be in a too high range to cause issues, such as Ketones.

Does anyone have any recommendation on what to do? I can test him more today but feel that it's just very fluctuated from something as it's never anywhere near this BG at this time of the day..

I've just tested him for his PMPS, and it is 322 - so also backs up my idea of bouncing as it is now lower than it was at his 6+ in. I've reduced his insulin from 2 to 1.5 and will be trying to test him for his PS BG readings to see how it's effecting him - but as I work the next 5 days, I won't be home or awake to check his NADIR at 8+ in...

Please review my spreadsheet and let me know of any other ideas that may be causing these crazy levels..

 

[Sue and Oliver (GA)]

I just don't know. Without more data, it isn't possible to tell what is happening. There are several options - too much insulin, a bounce that has lasted several cycles, too little insulin. Without knowing which one, it's hard to know what to advise about the dose. Even if you can't get nadirs, could you get preshots daily? That'd be some help. Then you can get nadirs on the weekend. Nadirs would help you see how low the insulin takes him, and then you know whether to raise/lower the dose. Is there any chance you could set an alarm and wake up at night a few times during this week?Once you have some numbers, we can try to help you figure out what is going on and what to do to help.

 

[Squeaky and KT (GA)]

Hi Justyn! Things like this are confusing aren't they. There's a difference between a 'bounce' and what is referred to as the 'Somogyi effect'. What you're seeing is likely a 'bounce' - technically it's the liver releasing glycogen, another type of sugar, as a safety measure. This happens for several reasons
* Steep or rapid dive from high to lower numbers - this doesn't mean 'low', just lower than what they've been running
* Also a run of lower numbers

We would normally advise you to not change the dose of insulin due to this, just continue what you've been doing but we need more info...

The 'Somogyi effect' has no repeatable research behind it....

 

[Justyn]

Sue- I will be trying to get his PS BG readings for the next few days. I don't really think he's on too little insulin as his readings have all been consistently low since I've lowered from 3u, until just random high BG readings that don't correlate with the other readings. It is unfortunately impossible for me to fall back asleep after getting most of my night's rest, so I know I couldn't survive my 50 hour work week running on only a few solid hours of sleep - and by the time I get home, it's almost exactly ready for his PM shot/food at 12+.. I also work 7 days/week at times so this last weekend and next may not be possible to get a NADIR. I wish I could take off work but it's impossible for me to do so for the next 14 days.

It's just pointing to 'too low' as a lot of his bg readings around the NADIR that I've gotten lately, has been low, almost too low, but during the same week, I'd get a PS BG reading of CRAZY HIGH numbers - and couldn't lower because his NADIRs were too low.

Squeaky and KT - I have only lowered it due to my horrible schedule these next few weeks and the inability to check his NADIR. We have only seen better numbers since lowering his dose (none in the red or black), and even last weekend on 9/17, I had a PM PS reading of only 179 and still gave the normal dose - as I could see he was on his way back up but I think it definitely may not have been high enough for the normal 2u dose because I've had fairly high numbers since but these today have thrown the consistency off. If his +6 reading and his PMPS reading was more normal today, I would have definitely kept the dose the same - but as the +6 was higher than the PMPS, something is just definitely off.

He has definitely been very chill and sleepy lately, so I am really thinking he's been getting too low... I'll definitely keep an eye on it as much as i can over the next week and if it the numbers don't start improving, I'll definitely have to raise the dose (slowly).. He surely has been doing better as gaining weight, not drinking/urinating much more than my other cat, and has been gaining muscle mass back beautifully, especially since even just lowering his dose.. so raising it doesn't seem very clear at the moment..

 

[Sue and Oliver (GA)]

You do the best you can. But understand that it is scary for us to advise you on dose with so little data, and when you can't be there to monitor. On 9/17, the 2.5 looked pretty good. But it is good you got the pmps and knew to reduce. 2 seems like a safe dose - he doesn't seem to be bouncing. If you can be around to get a nadir, you could see what 2.25 would do on those 300s.

 

[Justyn]

Well, the last 2 mid-cycle numbers I've gotten have been far off from what they should be in comparison to the 9/17 curve. But even with the 9/17 curve, the dose of 2u must have been too much as he's had a very high mid cycle number (9/18 @ 5+).

I had reduced the insulin on 9/25 from 2u to 1.5u BID as his PMPS reading during his curve on 9/17 was lower than 200 - which I've been advised to not even shoot under - so the only thing sensible to keep him from crashing was to reduce his dose.. I have tested his PMPS now and it's lower than it had been a few times on 2u, and I will be checking his PMPS numbers every day for the next few days.. I know it's going to take some time to adjust, but feel that if he needed a higher dose, his PMPS reading would have been much higher.

And as I can't check his nadir for the next 6 days, I'd rather see him higher over the next few days in his PMPS to confirm my theory is wrong before raising it - as ever since lowering, his numbers have been much more consistent.