Am I doing something wrong?

Maybe I just need to be more patient, but I'm not understanding Missy's numbers. The first week she was on insulin, her numbers were very good. I was very hopeful that she would not be on the insulin for long. Now her numbers seem to be going up. The past 5 days of evening numbers are very confusing. She goes from 59 to 285 to 332 to 197 to 358. At least the morning numbers are consistent. Again, maybe I just need to calm down and stick with the program and give it time to start working. I just don't understand why the evening numbers vary so much.

 

I suggested in your other post that you could go back down to 1/2 unit. That's when you had the best numbers. Sometimes raising the dose raises the bg levels. I know your vet suggested going to one unit, but I don't really understand the reasoning. If I were you, I would lower the dose and test for ketones for a few days as a trial.

 

I guess that's where my confusion is. I don't quite understand how lowering the insulin dose results in lower glucose levels. I'm completely naive about all of this.

 

Often, too high of a dose causes the rollercoaster numbers. I am not a qualified advice-giver, but when I lowered the dose on Stinky, his numbers flattened nicely.

 

It's called rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound In real basic terms, when the cat gets too much insulin, his body releases glucose so he doesn't crash. That glucose raises the bg levels. It is a hard concept to wrap your head around, but we see it often.

 

That is very interesting. I guess I will start in the morning with a 1/2 unit and go from there. It is difficult to wrap my head around, but y'all are the experts and I trust your advise. Thanks for the help, once again. I am so glad I found this website. I don't know where we would be without it.

 

Just be sure you test for ketones if you reduce the dose. If she stays high on a lower dose, then I am wrong and you will need to look at something else. But it does looks like you had excellent numbers on 1/2 unit. Keeping fingers and paws crossed that you see some lower numbers.

 

I am not advising you here on dosing so i am not saying whether lowering .keeping the same, or raising the dose is what you should do. I do want to answer your question though

When there is too much insulin or if the numbers get too low or even with high numbers if they move down too fast the body has a protective mechanism and releases something called glucogon which will raise the numbers back up. This is called somogyi rebound. So too much insulin can cause the body to protect itself by releasing sugars raising the blood glucose numbers

 

It is a weird concept to get figured out...but like the poster above said, the body will try to protect itself from too much insulin by putting more "counter-regulatory" hormones into the body, release stored sugar, and bing-bang-boom, the numbers are super high.

Our first instinct is to throw more insulin into the mix, because that's what we're told works. And if it's not a chronic rebound situation, it does work. But if it is chronic rebound/Somogyi, it makes the cycle worse. And then we get all frustrated and mad. LOL.

When you reduce the insulin, if it's Somogyi, what you should see is a gradual reduction in numbers, over a few days, until the body stops the whole "PANIC!!!" stuff.

What's almost worse with Somogyi rebound is that you don't even need a hypo event to trigger it. Just a drop of numbers which the body says "that's a bit too fast...we're gonna stop the drop NOW". IOW, if the numbers start at, say, 400, and drop to 200 in whatever time the body deems 'fast', the counter-regulatory hormone release is done. And that drives up the sugars. So you can start at 400, drop to 200, and then get well over 400 at a test a few hours later.

And then we look at the numbers, and say...wow, it's high. The insulin is not working, I should use more. And we do use more. And then, the cycle starts over, but perhaps a tad faster, and spikes higher, and we just run in circles.

The remedy?

Lower the dose, test more frequently, and watch what happens over a three-five day span, and go from there. If it's Somogyi, you should get a flatter cycle after a few days. Not right away, because the body is still expecting to panic, and may slam the counter-regulatory hormones into the system. But over a few days, it should be a fairly different pattern you'll see.

Test a lot, and be sure to log the numbers, and have someone experienced with Somogyi look at your SS with you for a few days, and take it from there.

The sugar dance is hard indeed, and it is made harder because each cat really is different, and so are the beans. And then when something like this happens, it's not only EC(B)ID, but lots of other factors play into it - food, meal timing, type of insulin, and so on.

Hang in there...and pm me if I can help at all.

Best-
Michele