What is a "bounce"?

The following is a quote taken from this website's main informational page. I see a lot of people talking about how their cat keeps "bouncing" and thought the new folks might like to know exactly what it means, how dangerous it is, and how to avoid it....

Somogyi Effect (Rebound)

When a diabetic experiences hypoglycemia, the body tries to compensate. While it generally doesn't have to, the liver is capable of producing glucose. The "signal" is glucagon, produced in the body in response to low blood sugar. Some vets treat hypoglycemia by injecting glucagon, which will keep the liver producing glucose for quite a while. The length of time it keeps putting out glucose is probably tied to the severity and/or duration of the hypoglycemia (or the size of the glucagon injection), but it can last 72 hours. The liver will generally kick in when BG levels get below 60, but in some it may happen at a higher level.

True Somogyi effect is quite rare in cats. Since they are obligate carnivores, their liver enzymes and glucose production ares different than that of humans and dogs.

Any hypoglycemic episode, whether or not you observed it, may be followed by some degree of rebound for some unknown length of time. It will show up as BG spikes happening before the insulin tails off, if you're doing blood tests. If you're using dipsticks, you'll see a high reading at a time when you're not even supposed to see traces. The spikes are almost as bad for the cat's long term health as sustained high BG levels, so they should be stopped. Besides the other things damaged by high blood glucose, the poor old liver gets extra stress, and the long-suffering kidneys are thrown into overdrive again.

Unfortunately, the instinct is to increase insulin when we see high BG levels. If they are caused by rebound, the answer is to decrease insulin.

So how do you know whether to give more insulin or less? First you decide whether or not there is any possibility that hypoglycemia is occurring -- if the cat is unregulated and never has a BG reading below 200, you're probably not seeing rebound.

If hypoglycemia is an unconfirmed possibility, simply decrease the insulin by 20% for three days and see if the spikes disappear. Since food causes blood glucose to rise, it's impossible to differentiate a Somogyi spike from a post-peak food spike -- another argument in favor of restricted feeding.

 

Something worth mentioning about "Somogyi" rebound: They are using the common definition of Somogyi Rebound, which is actually just a "bounce" when a cat goes from low numbers to high as the liver tries to compensate (glycogenolysis). The technical definition of Somogyi Rebound would be if if his numbers spiked over his "normal" high and there was the presence of certain hormones (glucagon, as well as the stress hormones epinephrine, cortisol, and growth hormone). For example, if the cat's range is generally 60 to 300 over the course of the day, then he drops to 39 and bounces back up to 280, that is NOT Somogyi Rebound by definition. If the cat drops to 39 then bounces back up to 330, that might be Somogyi Rebound only if there is the presence of the additional hormones and other factors have been ruled out (i.e. stress, insulin worn off, etc...). Currently, true Somogyi Rebound has yet to be scientifically proven to exist.

 

I don't know how closely you follow the forum but had thought the "Somogyi" effect had not been accepted these days However, I am concerned. As a newbie, I cannot tell if it applies to Elliott. I would greatly appreciate it IF YOU HAVE A SPARE MOMENT to look at his ss...Thanks..Fran

 

I just wanted to add that besides giving you better control over BG levels, this one of the reasons why daily hometesting is recommended. The high numbers from a bounce can last up to 72 hours, so if you're getting tests only once a week or two (either at home or at the vet's office), you don't know whether you missed a hypoglycemic incident or not. Continuing to raise the insulin dose based off infrequent tests can lead to a life threatening hypoglycemic incident. Eventually, either the cat's liver becomes too taxed and/or the dose is too high for the cat to compensate for the low drops.