Experience with Somogyi effect?

[tphilly]

Hi, All! I am new to this forum and am excited to be here. My 8 year old Shih-tzu, Mercedes, was diagnosed with diabetes in September. In the beginning, her glucose levels were very high, over 500. The vet put her on Humulin N starting with 3 units twice a day. It didn't seem to do much, so he doubled it to 6 units twice a day. Again, it didn't really seem to do much, so he increased it by 1 unit twice a day for a total of 7 twice a day. At first her symptoms persisted; however, after I took her to the opthamologist for an unrelated eye condition (she has dry eyes) and got her on eye drops, she responded to the insulin almost right away. I sometimes wonder whether the pain from the dry eyes was upsetting her immune system, which caused her to not respond to the insulin. In any event, within a week of helping her eyes, her diabetic symptoms disappeared. She was no longer urinating glucose and her water intake went back to normal. This was about 1.5 months ago, and she has been on 7 units twice a day since. Even though she seemed controlled, I decided to buy an Alpha Trak 2 and do a glucose curve. I did it today, and I am wondering whether she is experiencing the Somogyi effect. First thing in the morning, about 14 hours after her last shot and before her first for the day, her glucose was at 106. Two hours later, after eating and getting her first shot, her reading was 181. I attributed that to the food. Two hours later, 4 hours after her shot and meals, her reading decreased to 104. Two hours later, it increased to 142 and then to 177 another two hours later. This was her first glucose curve that I did; however, I checked the meter for accuracy before beginning with the control solution. But, if I'm not mistaken, it seems as though her glucose is decreasing rapidly and reaching nadir and then rising rapidly within 2 hours. Doing some research online, I found information on the Somogyi effect, and it seems to match what is happening to her. Has anyone had any experience with this or know much about it? Any other possibilities to explain this issue? I plan on calling her vet, but he is sometimes hard to get hold of. Other than the above, she acts completely normal. Thanks!

[jesse girl]

Re: Experience with Somogyi effect?

hi and welcome the numbers you have posted are very good for a diabetic dog the fluctuations you are seeing are not to worry about many would be happy to see blood sugar like that we must remember also hand held meters aren't exact and can be off a bit even from back to back tests but still gives a close enough range to know where your pup is at

if you start seeing much higher numbers well into the 200s or higher then yes that affect could be happening but not at the levels you have posted

it hard to say if the insulin might be a tad to much you could slowly reduce the dose by a quarter unit give it a week and reevaluate if still in the same range you can try the process again till you see an elevation in numbers then hold and again reevaluate

[k9diabetes]

Re: Experience with Somogyi effect?

With blood sugar all in the 100s and 200s, I wouldn't be looking at Somogyi rebound. More likely there's just some bouncing around as the insulin and food digestion jockey for position in her blood.

All of those levels are actually lovely. I know a lot of folks who would give anything for a curve as beautiful as this one.

Ultimately it really doesn't matter whether the curve follows a standard bowl shape or not. Dogs refuse to read the book and pretty much do what they want!

Premeal at 14+ after last injection: 106.
+ 2 hours 181
+ 4 hours 104
+ 6 hours 142
+ 8 hours 177

So you had a turn upward from her meal during the first two hours - which tells you that the insulin wasn't in full swing yet but she had digested quite a bit of her breakfast and turned into blood sugar. That's a post-prandial rise - common in human diabetics, somewhat less common in dogs.

Then it looks like the breakfast sugar was about used up and the insulin wasn't overwhelming things so she stayed in a good range and started turning upward again as the insulin started to run out.

Given the 14-hour stretch from dinner to breakfast and the low morning reading, I suggest doing a curve at night to see what's happening then and also to see how much higher the blood sugar goes toward dinner time.

If all of the readings are similar to these, I wouldn't change a thing.

Does she usually wait 14 hours for breakfast?

Not a problem as her blood sugar is not going high. Just curious.

Natalie

[jim maceri]

Re: Experience with Somogyi effect?

tphilly,

If I didn't look at your heading I would swear that is my dog Spirit's readings.

For some reason he does a mountain curve in the evening and overnight "usually" giving us a morning reading between 110-150....spike up a bit after breakfast then 3-4 hours in the insulin seems to kick in so it's back to the low 100's and then a gradual rise till dinner time.

I throw in a couple of walks during the day if it seems to be going high, he loves them.....

Anyway, those are just GREAT numbers and anytime you can keep them between 100-200 life is good!! Congratulations, nice job.

[farrwf]

Re: Experience with Somogyi effect?

Hi & welcome.

Those numbers are absolutely great! Many here would sell their souls for their pups to have B/G's like that.

[tphilly]

Re: Experience with Somogyi effect?

Thanks, everyone! I appreciate your help with looking at these numbers. This is my first experience with diabetes, and it is all still new to me. I guess I was looking for that traditional bowl curve.

@k9diabetes: no she doesn't normally go 14 hours, but I had to run out for a little bit and didn't want to give her the insulin too early. So I opted to give it to her a little late as she was sleeping and looked comfortable. Normally, I give it to her every 12 hours. I was, however, surprised to see how low it was after 14 hours.