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? Somogyi and bounces

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Sue484, May 25, 2015.

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  1. Sue484

    Sue484 Well-Known Member

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    Are bounces and Somogyi rebound the same thing? If not, what are the differences?
     
  2. Tina & Sammy

    Tina & Sammy Well-Known Member

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    I am not completely fluent with either, but here is what I know. Both are caused by the liver dumping sugar into the blood due to lower numbers. I think when my vet talks about Somogyi they think the cat goes too low which is what makes them bounce back up to the high numbers due to the liver dumping sugar into the blood. Bounces work the same way but it isn't because the cat is too low, it is because they have lower BG then they have been use to and the liver panics. So basically I think they are the same.
     
  3. Sue484

    Sue484 Well-Known Member

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    Thanks. That makes sense.
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Simply put, no.

    This is a soapbox issue for me. I'll try to be succinct. The term first appeared in 1938 and was named after Michael Somogyi. It was based on a very small sample of humans and urine glucose was being measured. The "research" (if you can call it that) appeared in a local St. Louis medical publication - not a major medical journal. The results have never been replicated and have been contested in recent years. Consequently, the entire idea of Somogyi in humans is controversial. There's an article in Wiki that is a decent summary as it relates to humans.

    With cats, there hasn't been any research let alone research with new insulin such as Lantus and Lev that are pharmacologically very different from what was available in 1938. I haven't a clue why vets continue to contend that a cat is in "chronic Somogyi rebound" when a cat may be bouncing off of a low number or fast drop. With humans, the recommendation is typically to decrease the dose in order to alleviate the problem What we've seen repeatedly is that when a caregiver does this, the cat stays in high numbers (because you're not giving enough insulin) and you end up wasting a good deal of time as a result of working the dose back up.

    As long as you are systematically increasing the dose according to the protocol, you won't be giving too much insulin.

     
  5. Meya14

    Meya14 Well-Known Member

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    Great explanation Sienne. If somogyi is in fact real, theoretically, systematic increases will eventually overwhelm the compensatory mechanisms and lower blood sugar. So the treatment should still be more insulin and not less. The doctors I worked with didn't believe this was a cause of hyperglycemia, I'm inclined to agree. Also, much of what we call "bouncing" may be more related to normal insulin curve, duration, and food spikes rather than compensatory mechanisms. I'm somewhat confused that R&R study would comment on insulin induced hyperglycemia without providing some supporting evidence.
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    You've summarized the issue beautifully.
     
  7. Jem813

    Jem813 Member

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    Aug 5, 2015
    Until now!!

    J Feline Med Surg. 2015 Jun 4. pii: 1098612X15588967. [Epub ahead of print]
    Rebound hyperglycaemia in diabetic cats.
    Roomp K1, Rand J2.
    Author information

    Abstract
    OBJECTIVES:
    Rebound hyperglycaemia (also termed Somogyi effect) is defined as hyperglycaemia caused by the release of counter-regulatory hormones in response to insulin-induced hypoglycaemia, and is widely believed to be common in diabetic cats. However, studies in human diabetic patients over the last quarter century have rejected the common occurrence of this phenomenon. Therefore, we evaluated the occurrence and prevalence of rebound hyperglycaemia in diabetic cats.

    METHODS:
    In a retrospective study, 10,767 blood glucose curves of 55 cats treated with glargine using an intensive blood glucose regulation protocol with a median of five blood glucose measurements per day were evaluated for evidence of rebound hyperglycaemic events, defined in two different ways (with and without an insulin resistance component).

    RESULTS:
    While biochemical hypoglycaemia occurred frequently, blood glucose curves consistent with rebound hyperglycaemia with insulin resistance was confined to four single events in four different cats. In 14/55 of cats (25%), a median of 1.5% (range 0.32-7.7%) of blood glucose curves were consistent with rebound hyperglycaemia without an insulin resistance component; this represented 0.42% of blood glucose curves in both affected and unaffected cats.

    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.
     
    Meya14 likes this.
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Jem813 : Just as an FYI, this isn't empirical research. It's a review (summary of retrospective data vs data that were collected in a controlled study). I'll track down the article, though. Let me know if you want a copy. It's good to know that Roomp & Rand are saying what we've been saying for a while now!!
     
  9. Sue484

    Sue484 Well-Known Member

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    I'll have a copy please. I look forward to the look on my vets face when I show her!! I don't like doing it as she is lovely and accepting of how I am treating Frankie and has saved him numerous times, she just knows nothing about diabetes. Actually, I'd rather do it to the oncologist (!!!) who was treating Frankie for diabetes at the RVC and knew even less!!!
     
  10. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    @Sienne and Gabby I too would be very interested in seeing the whole article on this. Thank you.
     
  11. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    In the US, vet students get exactly 5 hours of study on diabetes - that includes both cats and dogs - and based on what one student told me, Somogyi is included in that 5 hours!! :rolleyes: No wonder they seem to know so little.

    I, too, would love to see that whole article. I would like to have it in my hand when next I take Cinco to UCD for "diabetes management".
     
    Amanda & Shmee likes this.
  12. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    How annoying. I can't download the pdf until the article is actually published. My university has a subscription to the journal but because it's not yet published, I can't access the pdf and there's no indication of the actual publication date.

    I've contacted Kirsten Roomp and we'll see if she'll send a reprint or at least let me know when the article is due to be published.

     
    Last edited: Aug 20, 2015
  13. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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  14. Jem813

    Jem813 Member

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    Attached.
     
    Wendy&Neko likes this.
  15. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Jem813 - thank you!!

    BTW, this actually is a research article and not a review.
     
    Last edited: Aug 20, 2015
  16. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Thank you! I notice Dr. Nelson at UCD has a couple of papers in their references. Makes me feel good about having access to him!
     
  17. Jem813

    Jem813 Member

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    Your welcome.

    "This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors."

    They probably published this to (hopefully) get funding for the prospective study. Have to start somewhere.

    Julie
     
  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Jem813 - The sentence you quoted is a standard disclaimer. If the study was funded, even by an organization similar to NIH in the US, that information is included. It's a way to make sure that people know that if, for example, a drug manufacturer funded the research that the authors are making that information known. It is a way to deal with what could be conflict of interest.

     
  19. Tina & Sammy

    Tina & Sammy Well-Known Member

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    Could you post the link?
     
  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Tina & Sammy = see Julie's post above. She was able to attach a pdf of the article.

    The only link I have is to the abstract. If you mean the "like" to Kirsten Roomp, I googled her and found her university e-mail address.
     
  21. Jem813

    Jem813 Member

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    I don't think they had any funding for this study...if that's standard things sure have changed!
     
  22. MaineLove

    MaineLove Member

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    Jun 26, 2015
    I gave my vet a curve on 8/6/15 and she wanted me to reduce her dose from 1.25 U to .75 U around 8/11/15 stating Somogyi. I compromised to 1.0 U and have gone back to the 1.25 U (probably on the skinny size) haven't seen the numbers go into the high 100's since. Coral had surgery so that has probably had some effect. No definite confirmation of what the lump is waiting until next week, but they did get all the tendrils so the excision was clean. Hope the girl has a positive outcome. Very difficult to know what is going on, but would like to see her start her day in the high 200's or low 300's so her numbers go lower. The graph given in our reference material shows a curve that follows a 24 hour period with a curve going from the high 200's to low 200's dipping into the mid 100's at about the +6 hour, a flat curve, sounds like heaven to me! Of course, ECID! Would be interested in more information on this subject.
     
  23. Jem813

    Jem813 Member

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    I'd like to share it with my vet (proponent of Somogyi effect in cats) but I will tell her up front the data's from a forum not unlike FDMB, unlike data generated in (much more) controlled studies. Since my vet is already familiar with the original study done in 6 cats, she will also be interested in the updated commentary on that earlier study, and the discussion section is well worth reading.

    I tend to believe it might not have been published if not in agreement with the human studies refuting the Somogyi effect (I wonder if she's read those?), but it's an important article if only to warn cat owners and to start a discussion with the vet. Also I think it's a nice testament to forums and home glucose testing, if your vet is not into that kind of thing.

    (I might wait until after I break the news that I'm no longer using the preinjection BG Lantus dosing charts for Natasha that she provided.)
     
  24. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    @Jem813 - The original study was NOT done with cats. Michael Somogyi's "study" was with 6 humans. If you look at the article, they note that the data was extrapolated to cats. While chronic Somogyi rebound is at best controversial in humans, veterinarians seem to cling tenaciously to the concept despite any convincing research.

    If your vet wants a double blind, randomized, controlled study, unless people are willing to put their cats in a vet hospital for an extended period of time and be paid to have their companion participate in a research study,a board such as the German Lantus board, is probably the best way to get subjects. In addition, even at a large veterinary school, I doubt there are a sufficient number of diabetic cats at any one point in time to get a large enough sample size to be meaningful. To have a group of caregivers, like those on a board such as this, is a huge resource for research or other data.

    I'm not sure how familiar you are with the scientific publishing process. Manuscripts that are submitted for publication undergo a peer review process -- usually 2 or 3 people who have familiarity with the area you're researching review the article to insure that the paper has scientific merit. Reviewers may recommend the authors look at any literature they may have missed or that they revisit their statistical analysis. Better journals are very rigorous and it can take several rounds of review and re-review to get published. If an author thinks a reviewer is biased, they can discuss this with the journal editor as well as in their written response to the reviewers when they are editing the manuscript. Articles are not dismissed because the results are not consistent with a popular point of view -- especially if the article can pointedly demonstrate that a point of view does not have data to support it. Editors LOVE getting an article that is well done and shakes things up because the article gets cited a lot and it improves the journal's rating.
     
  25. Kirsten

    Kirsten New Member

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    To clarify: the paper contains detailed information on the only other study in cats (from 1986). Plus information on the various relevant studies in humans.

    The reason we included so much information on the 1986 study is because it was the only study and thus forms the basis for what you read in text books, etc and is extremely difficult to access (not available electronically). See in particular Tables 2 & 3.

    I'd be very happy if the new study has an impact on the general thinking of lots of vets regarding this issue.
     
  26. Jem813

    Jem813 Member

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    Please see the author's comment above.



    Like I said before, the discussion is great: the authors I think clearly and carefully indicate the caveats in the dataset, and the concept of collecting the data from a forum is I think a fantastic start for answering this question. As a scientist who has had to handle and habituate diabetic mice so that I can collect BG for glucose curves in an unstressed animal, I also appreciate that the animal subjects "participating" in a forum study are probably relatively unstressed which adds to the validity of the data in my mind at least. (Anecdotally of course, my kitty purrs through all her BG checks and I'm not sure this always happens in the lab setting!!) However, it seems that diabetic cat models do exist, so one might one day aspire to run a controlled randomized study with those subjects instead of diabetic pets.

    I am a PhD-level scientist with publications on the subject of obesity and diabetes in peer-reviewed journals and I have participated myself in the peer-review process, authored grants etc. I was thinking more that the authors might have hesitated to submit the MS if it was not in keeping with the more recent human data refuting the Somogyi effect, since we still lack the insulin duration/growth hormone data in cats.


    Julie
     
  27. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just fyi, @Jem813 - Kirsten Roomp who posted just above you is one of the authors in the study, along with Dr. Jacquie Rand of the University of Queensland. They are the two that developed the Tight Regulation Protocol that we use on this site. Kirsten has the link to the Tilly's Diabetes site (same protocol) in her signature.
     
  28. Jem813

    Jem813 Member

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    Yes I know...you can see in my response above to Sienne and Gabby that I put that together! :)
     
  29. Jem813

    Jem813 Member

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    Yes I realize that, and in posting the article here I expected that the study might be of interest since many on the forum are familiar with Roomp and Rand. I must say that I was a little surprised then that some took issue with the fact that it's a retrospective study, when you consider the source!

    Julie
     
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