I believe we have Somogyi

The last post described the phenomenom known as somogyi or rebound.
I believe we just experienced this with Kitty last night.

His evening preshot was 26.1 mmol/dl, quite high. I gave him his full dose. Note that when I report a result, I report it as the amount of time after his shot. Therefore, preshot is before he gets his shot. +5 is 5 hours after his shot, etc. At +5 he was at 3.2, which is a HUGE drop from his preshot. At +6, he was at 4.2, so I felt he wasn't going to go any lower and I went to bed.

This morning, his preshot was 21.6, which isn't too bad considering the huge drop he had last night. However, it all went down hill from there, until +7 where I actually got a reading of HI on the glucometer, meaning he was over 33.3 mmol/dl.

This is crazy because it happens inconsistently. I suspect I will need to reduce his dose slightly and start again. I am seriously considering switching insulins at this point as well, to the all beef PZI. I dono't want to waste any more time, it has been five months already and we have seen little improvement.
Not a good day. Hopefully tomorrow will be better.

Somogyi Rebound in Feline Diabetes

Contrary to what common sense would tell us, there are times when the best solution to high blood glucose numbers is to give LESS insulin. This instinctively seems wrong. However, there is very interesting physiology to explain this phenomenon.

In a non-diabetic, there are two hormones that maintain blood glucose levels. These are insulin, and glucogen, both produced by the pancreas. Insulin allows the body to use sugar in the blood or to store it for later use. Glucagon is basically offering a moderating effect to insulin by causing cells to release glucose. Therefore, in a non diabetic, if the blood sugare goes too low, the glucagon will utilize some of the stored glucose. These hormones work together to moderate blood sugar levels.

In a diabetic cat, if the blood sugar drops too low or drops too quickly, the glucagon causes the liver to indiscrimintely dump glucose into the bloodstream. This causes the cat to become hyperglycemic (high blood sugar). It is the body's self defense mechanism to stop hypoglycemia(low boood sugar). This is a simplistic description of the phenomenon as there are other hormones and biochemical processes involved, however this is essentially the mechanism.

This sharp drop followed by unusually high blood glucose levels is known as Somogyi rebound.

Because of all the hormones involved in this process, this rebound may last several cycles,
punctuated by higher blood glucose levels. The blood glucose curves will possibly be flat and high, which normally indicates that more insulin is required. However, this is not the case and the treatment for somogyi is a REDUCTION in insulin, to stave off the precipitious drops that start the whole cycle.

Somygi is difficult to detect but if you are having trouble regulating your cat despite increasing insulin levels, please discuss with your veterinarian the possibility of somogyi rebound.

Types of Insulin Used to Treat Feline Diabetes

There are many different types of insulin used to treat feline diabetes. Part of the trick of feline diabetes is that none of these insulins are exactly like cat insulin. You must find, through trial and error, the best insulin for your cat.

Many vets prescribe human insulins. These are cheap and easy to get and work very well for many cats. Humulin N, L and U are three that are typically prescribed. The N insulin is a short acting insulin and probably does not have enough duration for most cats. It can have sharp steep drops (where the blood sugar drops too low) and then it can wear off quickly causing the blood sugar to increase quickly. L and U (Lente and Ultra lente) are medium and longer lasting insulins. Unfortunately, Eli Lilly, the manufacturer has discountinued these and many people whose cats have been regulated on these are scrambling to find alternatives.

Caninsulin is a pork based insulin which is prescribed by the veterinarian. It is considered a medium acting insulin. This is also knows as Vetsulin in the United States.

Lantus is a newer human insulin that has some promising research done on cats. It is very long lasting insulin.

PZI is another insulin and it can be found in a pork or beef format. The insulin is in a protamine zinc suspension, which makes it a long lasting insulin as well. Many cats do well on the beef derived PZI.