? 11/26 Riley Curve shows +314 in 2 hrs - Now what?

Riley bounced a lot so I tried to start low and increase slowly, but ever since going to 3 units his AMPS and PMPS are high numbers. I did a curve and saw a 314 point increase in his glucose within a 2 hour time period. There really isn't much of a curve at all. Since his body seems to be fighting the insulin (he is losing body fat and muscle mass) I was wondering if a lower dose would be better. But at a lower dose his glucose is too high. Where do I go from here?

 

We primairly make dosing decisions on the nadirs or low points, not the preshots. It could be he is going lower than he is used to overnights and bouncing more, hence you are getting higher preshots. The only way to tell for sure is to get some tests at night, maybe before you get to bed.

But his overall numbers are still too high, he needs more insulin. Since you are following SLGS for dosing, the next step is 3.25 units. Good luck with the increase.

 

Should I increase his insulin in spite of the bouncing and even though he went into the 600's? Will the increase bring these spikes into a lower range? Or will he bounce higher with each new increase? My meter just says HI when he goes over 600 so I wouldn't be sure how high he was. When should I consider the high glucose an emergency? Has anyone else experienced high bounces and had success with an increase in insulin? I'm afraid of doing the wrong thing since everything I'm reading on bounces like this indicates that the dose is too high when bouncing is almost constant.

 

Usually a bit more insulin will help to reduce the height of the bounces, once he gets to a dose where he's starting to see normal blood sugar numbers. My Neko's meter used to wave at me, by saying "Hi", when we first started. She wasn't used to normal numbers. At the first she would even bounce at yellow and high blue numbers. The solution for her was to eventually get to a dose where her body could start getting used to lower numbers - in between the bounces of course. It's hard to see the high numbers, but it's a normal reaction in newly diagnosed cats. The only concern if you are seeing high numbers, is to make sure you are testing for ketones regularly.

I have no idea where you are reading this. If you start at a good startiing dose, and increase safely according to the dosng method, it's very unlikely you are at too high a dose.

 

This is from http://petdiabetes.wikia.com/wiki/Somogyi_rebound "A good explanation of Somogyi is that it occurs when too much insulin has been administered, but the amount of overdose is not enough to cause an actual, full-blown hypoglycemia incident. Because the body detects the fall in blood glucose, the counterregulatory hormones are released just as though it was a true hypo emergency. They signal the liver to release its glycogen stores and convert it back to glucose[10]." This makes me think any time he has a drop in glucose that his body thinks is too much and too fast (not necessarily hypo), he will react with a bounce. Another article that I read (unfortunately didn't save it) came from a vet's website and indicated that bounces into high numbers can be harder on the cat's body than a steady but high glucose level. When I look at Riley's spreadsheet I see more high numbers after starting 3 units. If his daily glucose levels are anything like what you see during the 24-hour testing we just completed, his insulin dose is too high. BUT his glucose levels never really reach a low enough point, except one time in September, when at 2 units he reached a low of 110. Maybe I should have stopped increasing the dose then. He vomited back in September as his glucose level rose. And he vomited this weekend as his glucose level rose.

 

OK, I wondered if you were talking about "symogyi". The original study on that was done on a very small group of humans, years ago, when only harsh insulins were available. The article posted in this link, includes research done at a university on cats and Lantus and debunks the myth of Symogyi, especially if the cat was started on a low dose of Lantus and increased systematically. Unfortunately, the myth is still all over the place. The only time we see a true issue is when a cat is started on way too high a dose. Not the case with Riley.

Remember, you aren't looking at the mid cycle nadir or the the nadir, cause you have hardly any tests then. We determine the dose based on how LOW it takes the cat, or the nadir points. You don't need to test throughout the night but so many cats go lower then that we strongly recommend getting a before bed test, to help fill in the picture. If he's getting enough insulin at 3 units to get him lower than he's been before (it could still be very safe numbers, just lower than he's used to), then he will bounce higher for a while until he gets used to it.

Going backwards in dose seldom works. I've been in your shoes. Some cats just need higher doses of insulin to get their blood glucose numbers moving. 3 units is still relatively small.

 

You may want to read this thread discussing that Somogyi h
as been disproved.
http://www.felinediabetes.com/FDMB/threads/11-26-riley-curve-shows-314-in-2-hrs-now-what.187203/

And here is a link to an abstract of a study published in the feline journal of medicine, I've copy and pasted the conclusion of the study below.

CONCLUSIONS AND RELEVANCE:
We conclude that despite the frequent occurrence of biochemical hypoglycaemia, rebound hyperglycaemia is rare in cats treated with glargine on a protocol aimed at tight glycaemic control. For glargine-treated cats, insulin dose should not be reduced when there is hyperglycaemia in the absence of biochemical or clinical evidence of hypoglycaemia.

 

Thank you all for your help. Good study at the nih.gov site. It scares me to think I'm causing him more harm than good when I see the "HI". But if more insulin is better, then we will go ahead.

 

If you can consistently try and get a couple of tests in every cycle it will really help you to see what he is up to.
A good way to build up data is to always get a before bed test in the pm cycle.
And then grab one test in the am cycle, whatever fits best with your schedule.
Run a curve once a week, and grab spot tests as and when you can wherever you are in the cycle.
It is only by doing this that you will be able to figure out how best to dose Riley.