Somogyi rebound? Wrong Insulin? Can you help me?

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Waldo

Waldo

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Hi! Our dear Firu was diagnosed with diabetes some time ago. We tried first a change of diet (raw and full protein), but did not work, so we started with insulin last week.

Vet told us to start with 1,7 units / 12 hs. And so we did. as we are used to measure glucose at home, we decided to make the curves at home.

When just diagnosed, his numbers were always around 300, 250, 350... No, with insulin and this "bouncing", he is well into 600s! Something is not working...

Below you will find the 1st curve, with 1,5 units.



As here (in Spain) this week is a holiday, we had no access to our vet, and we had to decide by ourselves that this was a bouncing effect of some kind (please, let us know what you think!)

Following Caninsulin web advice, we reduced the dose to 1 unit. Today we are performing the 2nd curve, with 1 unit, will be ready at night, later (but it looks worst than this... :-().

any ideas?
could it be Somogyi?
wrong kind of insulin?
should we continue giving him insulin?
should we reduce even more the dose?

Thanks in advanced!

Waldo.
 

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I LOVE seeing a real graph! Yes, definitely a rebound from the low 4 hours after the AM dose. Whether you call it Somogyi or not (much debated term here) it's an overcompensation reaction caused by either: 1. a very low BG; 2. a lower than usual (but not too low) BG; 3. a rapid drop in BG. We call it "bouncing".

The magnitude of the BG drop from pre shot test to nadir (the low BG) is very good but the slope is likely too steep for your cat's physiology at this point in his diabetes treatment and exposure to exogenous insulin. The increase you saw in the 2 hours after is what we call a "food spike". Very common.

I'm glad you're trying a 1 unit dose today. It's possible the vet prescribed dose was a bit too high for him. Collect data today and tomorrow and post here for advice. You can either show us another lovely graph like the one above or set up this spreadsheet that we all use here:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

It's too early in Firu's insulin treatment to know if Caninsulin is the wrong one for him. Give him more time on a lower dose to see if he settles down.

I hope this helps! :)
 
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I just read your profile and saw that Firu gets dry food as well as wet. If you haven't tried feeding only low carb wet food I'd encourage you to do so. It can have a significant effect on BG numbers.
 
Kris & Teasel said:
I just read your profile and saw that Firu gets dry food as well as wet. If you haven't tried feeding only low carb wet food I'd encourage you to do so. It can have a significant effect on BG numbers.
Click to expand...
Yes! our first option is canned low carb, but looks like Firu is a little picky, and some mornings we wake up to find he hasn't eaten most of his wet food at night, and we think (correct me if I'm wrong!) that it´s important that he eats in order to have a rational picture if this BG numbers, etc... This is some kind of a compromise between the eating and the quality of the food...
 
Waldo said:
Yes! our first option is canned low carb, but looks like Firu is a little picky, and some mornings we wake up to find he hasn't eaten most of his wet food at night, and we think (correct me if I'm wrong!) that it´s important that he eats in order to have a rational picture if this BG numbers, etc... This is some kind of a compromise between the eating and the quality of the food...
Click to expand...
I completely agree. You have to do what works. Maybe @Gill & George have some ideas about the lowest carb dry food available to you in Spain. :)
 
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Waldo said:
Yes! our first option is canned low carb, but looks like Firu is a little picky, and some mornings we wake up to find he hasn't eaten most of his wet food at night, and we think (correct me if I'm wrong!) that it´s important that he eats in order to have a rational picture if this BG numbers, etc... This is some kind of a compromise between the eating and the quality of the food...
Click to expand...
My cat didnt like the diabetic canned food.... But it's not required that it be a perscription food, just that it be low carb. Pate foods without gravy are usually fine. (In the USA most of us feed fancy feast classic or Friskies pate foods.) in sure there are lots carb store available options that your cat may find more enjoyable to eat.
 
Ok! here we go... Today´s curve, with 1 unit every 12 hs... I really don´t know what is going on...

 
Waldo said:
Ok! here we go... Today´s curve, with 1 unit every 12 hs... I really don´t know what is going on...

Click to expand...
Early drop within the first two hours has set off another bounce (rebound). This dose didn't get BG down as low so a slightly higher dose might be better (1.25 u?). Your cat is reacting very strongly to the fast action of Caninsulin. It's the nature of this insulin to act quickly and drop BG quite low (if dose is high enough). I would suggest trying that dose of 1.25 u for the next day or two, gather BG data and see if he'll settle a bit. If this type of pattern persists you might begin a discussion with your vet about trying one of the depot insulins like Lantus. I don't know how easily you can get that in Spain but I'd do some research. You can start by reading the yellow information stickies on the Lantus forum here at FDMB.

I'm reluctant to suggest an immediate change of insulin because they can be erratic in their responses in the first few weeks.
 
We keep the dose (1 u.) for 1 week, and yesterday performed a new curve. In the next graph, you will see curves from April 1 and April 8 (both with 1 unit every 12 hrs). Looks like stabilized, and numbers are lower in general.





Maybe it´s time to go for 1,25?
 
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Waldo said:
We keep the dose (1 u.) for 1 week, and yesterday performed a new curve. In the next graph, you will see curves from April 1 and April 8 (both with 1 unit every 12 hrs). Looks like stabilized, and numbers are lower in general.





Maybe it´s time to go for 1,25?
Click to expand...
I like the April 08 curve. It's a classic Caninsulin curve where nadir is about 50% of AM pre shot BG. The duration was 7-8 hours, not unusual for Caninsulin. Even the April 01 curve would look fairly good if not for that "bump" at 14:35 hours.

What to do next: to try to avoid creating more instability now that he's settled more, why not experiment with what we call a "fat" 1 u. Draw up insulin a little past the 1 u line on the syringe and release a drop or two until the plunger is just barely touching the bottom (relative to the needle) of the 1 u line - ie., just over 1 u. Normally this dosing technique would be something you'd try later to tweak a good dose. However, Caninsulin can create a dramatic response so this might drop his nadir ever so slightly downward without causing undue volatility. Try that dose for a week and do another curve. It might show you that 1.25 u is a better choice afterward.
 
So
Kris & Teasel said:
I completely agree. You have to do what works. Maybe @Gill & George have some ideas about the lowest carb dry food available to you in Spain. :)
Click to expand...
Sorry been away from the board.

The only low carb dry that I know to be available in Europe is ziwi peak

ZiwiPeak 'Daily Cat'
air-dried cuisine Venison
Amazon, and independent
pet stores carb 8.6 (P) 1.72 430.1 14oz pack.

ZiwiPeak 'Daily Cat'
air-dried cuisine Lamb
Amazon, and independent
pet stores carb7.6 (P) 1.38 440.1 14oz pack. 36 33 1.4 7 13

ZiwiPeak 'Daily Cat'
air-dried cuisine Venison & Fish
Amazon, and independent
pet stores carb 8.7 (P) 1.5 425.1 14oz pack. 38 30 1.4 7 13

ZiwiPeak 'Daily Cat'
air-dried cuisine Beef
Amazon, and independent
pet stores carb 4.7 (P) 1.26 451.5 14oz pack. 38 35 1 7 13

This info is taken from the UK food list, https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml iveI been able to buy things on this list on line, found it impossible to buy at local pet stores, even in larger cities.

Of course if you are able to transition to wet food, there is much more choice and I think you will find it more economical, as well as it being preferable for the health of your cat.

The ziwi peak is quite expensive here in spain

https://www.mascotaplanet.com/ziwipeak-gatos/
(If you decide to purchase, make sure that you get the correct varieties, as carb content can vary with different flavours.

We first started on hills diabetic dry, bit that was too high in carbs, so I quickly changed to a wet food.

I use
Granata pet,
Thrive,
Terra faelis,
Ferringa
These varieties are low in carb and low in phosphorus, as George has early kidney problems we also have to keep the phosphorus below 1%.
I buy from zooplus.es.

I'm in Granada, tag me if you need help with anything else,

Espero que hayas pasado una buena semana santa.:bighug::bighug:

 
Kris & Teasel said:
I like the April 08 curve. It's a classic Caninsulin curve where nadir is about 50% of AM pre shot BG. The duration was 7-8 hours, not unusual for Caninsulin. Even the April 01 curve would look fairly good if not for that "bump" at 14:35 hours.

What to do next: to try to avoid creating more instability now that he's settled more, why not experiment with what we call a "fat" 1 u. Draw up insulin a little past the 1 u line on the syringe and release a drop or two until the plunger is just barely touching the bottom (relative to the needle) of the 1 u line - ie., just over 1 u. Normally this dosing technique would be something you'd try later to tweak a good dose. However, Caninsulin can create a dramatic response so this might drop his nadir ever so slightly downward without causing undue volatility. Try that dose for a week and do another curve. It might show you that 1.25 u is a better choice afterward.
Click to expand...

Well, we tried 1 week with the "fat" 1 u. Today's curve (sorry, no graph) looks similar to the last one, but a little higher: nadir at +250 and +5hrs in 400s again... Is it possible that it´s time to try 1,2 or 1,5 again?

Our vet ´s a nice lady but doesn´t seem to be very creative and proactive with this treatment... So, any help will be highly appreciated. Cheers!
 
Waldo said:
Well, we tried 1 week with the "fat" 1 u. Today's curve (sorry, no graph) looks similar to the last one, but a little higher: nadir at +250 and +5hrs in 400s again... Is it possible that it´s time to try 1,2 or 1,5 again?

Our vet ´s a nice lady but doesn´t seem to be very creative and proactive with this treatment... So, any help will be highly appreciated. Cheers!
Click to expand...
I'd try 1.25 u this time around. If you set up a spreadsheet like the one we use here a quick scan of the colours that your BGs generate gives us a lot of visual information on how Firu is doing.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
I love the graphs but they don't convey the BG history in the comprehensive way the spreadsheet does.
 
Hi all... first of all, thanks for your help.

We have arranged the spreadsheet of Firu, here it goes https://docs.google.com/spreadsheets/d/13JOTMz900ybJWbL6AxuTonZJjwSvCPBI7uga1E99yG4/edit#gid=0 (its in the signature also).

We are a little worried because looks like we have lost any stability, numbers are going high again, and we are not sure what to do. We are working now on 1 to 1,2 unit, anything over 1,3 makes the numbers bounce like crazy... Any ideas? We are struggling now to keep him below 500`s... He was quite fine a couple of weeks ago (see the curve in this thread), but looks like we have lost something in the way :-(

Our vet doesn't seem to have a clear idea of what to do next... If go to no insulin and see what´s going on, or give Firu a higher dose. Honestly, this forum is our main source of info. Thanks for that.

He is on wet food, low carbs, and raw & pure protein, mixed with the canned, to make the carbs as low as possible.

Thanks again...
 
Waldo said:
We have arranged the spreadsheet of Firu, here it goes https://docs.google.com/spreadsheets/d/13JOTMz900ybJWbL6AxuTonZJjwSvCPBI7uga1E99yG4/edit#gid=0 (its in the signature also).
Click to expand...
Hi Waldo,
Well done for doing the spreadsheet. However I can't access it, the page I get says, 'You need permission'. Are you able to change your permission settings so that FDMB folks can see the document?

Just been looking at your graphs and am wondering about your feeding schedule.
Are you feeding just twice a day?

Quite a few Caninsulin folks feed a snack an hour or two after the shot, to try to slow down the rate that the blood glucose drops. And I wonder if giving a snack say, an hour after the shot, might slow the rate of drop with your kitty....?

From the first graph it looks like you're leaving a 20 min gap between feeding and shooting. That's great.
Can I just check that you are testing the blood glucose before feeding?

Eliz
 
Elizabeth and Bertie said:
Hi Waldo,
Well done for doing the spreadsheet. However I can't access it, the page I get says, 'You need permission'. Are you able to change your permission settings so that FDMB folks can see the document?

Just been looking at your graphs and am wondering about your feeding schedule.
Are you feeding just twice a day?

Quite a few Caninsulin folks feed a snack an hour or two after the shot, to try to slow down the rate that the blood glucose drops. And I wonder if giving a snack say, an hour after the shot, might slow the rate of drop with your kitty....?

From the first graph it looks like you're leaving a 20 min gap between feeding and shooting. That's great.
Can I just check that you are testing the blood glucose before feeding?

Eliz
Click to expand...

Dear Eliz. Thanks for your reply. I think now the SSheet is visible.

We feed him 3 times a day, but he does not eat all at once, he comes and go. I can say he eats 75 to 80 % of his servings at once and then left the rest for 30-60 minutes later.

We may try the drop-control snacks. But just for a while, we are on vacation now and we are home all day, but when we are working... :-( (we = my wife and I)

90 % of the time, BG is checked BEFORE feeding, and always before the shot. Sometimes, due to organization and schedule, it not possible.
 
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