What is rebound?

I've been seeing this term in a lot of posts and am not sure of the meaning of rebound- can someone explain it to me? I'm scared that I will do something and Sadie will go through it.

Also, I don't know why her numbers are climbing so I'm hoping that its not rebound.

Thanks for your help!

 

Somogyi effect:
It sounds completely illogical, but this is a condition in which the blood glucose level increases if too much insulin is given. It is also called rebounding, rebound hyperglycaemia or insulin-induced hyperglycaemia. If blood glucose levels drop too low or too suddenly, the body panics, thinking it’s being starved. Stored glucose is released to end this “starvation” and the body is flooded with glucose. This causes the blood glucose levels to bounce rapidly from next to zero to really high. This can happen when too much insulin is being injected. Common when first beginning to treat your diabetic cat, the solution is to give less insulin. (Or perhaps try a different sort of insulin).

Source:
http://www.sugarpet.net/glossary.html

 

And for more detail and a blood sugar curve example, see http://petdiabetes.wikia.com/wiki/Somogyi_rebound

 

Just want to second the petdiabetes wiki info - really good stuff there.

I have seen rebound happen from a drop too low (below 50), too fast (250 points in 90 mins), or a great distance (500 to 150). So although a hypo is the expected cause, it can be from just the body perceiving a dangerous situation is happening because the trend, if not stopped, will result in a serious hypo.

It can be very subtle.

ETA: I looked at your SS. What insulin are you using? It could be rebound causing the higher PSs, especially the 400s right now if the insulin is still ok and she isn't getting higher carb food.

I see that when you had her on 1u, there really weren't any spot checks mid cycle to see how low she was going. On Feb 4th you had that really low PS, so I wonder is she was on the way up or down at that point. Often the first few lows, while safe as 49 is, can cause a little rebound "bounce" because they aren't used to the number, but then things settle out if you hold the dose. I still think that the 49 at PS was an indication that a dose reduction might have been a good idea right then. She may need a skinny 1u (something like .8u).

Going from 411 to 79 today may set her up for alittle bounce too. Can you get a before bed spot check in tonight and/or some spot checks over the weekend?

 

I'm going to try to do a curve tomorrow. Her PMPS was 348. We gave her the 1.8 after she ate. Maybe I should've retested after that 79 at +7.

Now I'm getting nervous because I thought I was getting a handle on this but now I'm not so sure.

 

I forgot to add we're using PZI. Today, I don't know if it had anything to do with her drop but she didn't really eat her snacks of wellness between her breakfast at 430am and 12noon. She was acting fine.

 

Not eating her snack could contribute to the lower +7 today.

Don't worry, it takes time and a lot of data to learn how YOUR cat reacts to the insulin you are giving. Change insulins and you start all over again - basically. Rebound is very hard to spot, looks a lot like needing more insulin. You really can only tell if you drop the dose and the numbers get better (lower/flatter).

With PZI I think you are seeing a more immediate response in the numbers to the last dose (PZI folks correct me if that is wrong). The longer acting insulins like levemir and lantus tend to show you a reaction to the the shot/situation a few cycles ago - in most cases.

Maybe do a mini curve this weekend? Test every 3 hours from am PS until you go to bed. That will give you an idea of how fast she drops/climbs back up. You can still do a regular curve at test every 2 hrs, but still get a before bed check in the evening. Some cats have a very different am and pm cycle, dropping lower during one.

 

Thanks so much for the info. Her PMPS was 348 and +3 was 246. Planning to test one more time tonight. I made sure she ate her snacks this evening. After doing her curve, if I see big drops, how much do I cut back to see if too much is causing the drops. She's at 1.8 right now. Do I go to 1.6 or lower?

I know that I must sound like a dummy who can't grasp so I apologize for asking so many questions- so thank you.

 

Just tested at +6 (1040pm) and she was 166. She ate her snacks.

 

Well, for now, her numbers are looking better (last night's cycle). How was she this am?

 

Hello-

This morning her AMPS was 249. Tim was scared to give her a 1.8 so he gave her 1.6. Don't know if we should've done that or kept it at 1.8. I took a read at +4 and it was 271, Then at +7 it was 212. I'm going to test again in 2 hours.

Thoughts?

 

More insulin looks about right. as long as you're adjusting in 0.2 increments I don't think you need to be scared.

Did you see that rebound graph on the petdiabetes wiki? I don't see stuff like that happening to you.

 

Thank you so much. Yes I did read the info on the wikipedia. I didn't think we're going through that but wasn't sure. Thanks for the encouragement. We really need it. I'm thinking we need to stay at the 1.8.

 

I would stay at 1.8 for now and get spot checks when you can. I think doing that you will see if she drops too low and/or too fast. Just remember that you can't rely only on preshot tests to make dose changes. It's that number in the middle that tells you why the PS number is where it is.

Are you posting on the PZI ISG? There are a lot of folks there with a lot of PZI experience.

 

Thank you for the advice! We went to the vet today for a fructosamine test since it's been a couple months. I brought Sadie's journal book with her testing numbers so she could see how she was doing. I feel really good that she thought the numbers were pretty good and was anxious to see how her blood test results come out. She wanted urine as well but Sadie wouldn't give it up.

She said we were doing a really good job and Sadie looks great Find out results tomorrow!