Help Very High Glucose - Diabetes In Dogs: The K9diabetes.com Forum
Diabetes Discussion: Your Dog Anything related to your diabetic dog. Miss Mollie is a 12 year old Malti-Poo, weighs 11 pounds she was rescued from an apartment where the tenants had been evicted and weighed 12 ounces. I fostered her and ultimately adopted her. She was diagnosed 5 weeks ago. She is on her second increased dosage of insulin, Humulin N NPH is now at 4 units 2X a day. She is currently eating Hills w/d 2X a day. Today was the first time that her glucose level was less than 450, her fasting number was at 215 so it looks like we may be making progress. I had been advised that WalMart was the least expensive place for insulin, however today I was shocked at the $162 price being new to this I did not realize until I got home that the bottle was much larger, 10 ml than the first one that was 3ml so it was actually less expensive by volume I have two questions regarding food and insulin. Will it be possible to change her food after she is regulated and what is the difference between the WalMart Relion brand of insulin and the Humulin N? A pharmacist that I trust told me that the Relion was a good substitute for the Humulin but the vet wants me to use the Humulin. If anyone can explain this to me in laymans terms I would greatly appreciate it. Hi and welcome! Sounds like you are making progress. Humulin N and Novolin N are the two brands of NPH insulin used. Wal Mart contracts currently with the manufacturer of Novolin to simply put Relion on the box. It is essentially the same insulin like comparing folgers and maxwell house coffee. The differences would be subtle and likely only due to a different preservative. Many vets say they favor Humulin but I also have heard Eli Lilly works the vets offices like a doctors office so they may be the reason they recommend it Continue reading >>
Hyperlipid: Insulin, The Un-dead And Coffin Nails
You need to get calories from somewhere, should it be from carbohydrate or fat? Things keep getting in the way of the next post, which is roughed out but needs tidying. I've also been meaning to post on the Somogyi overswing effect in diabetes treatment for some time, so here is a minor diversion down that route, mostly because it's very illuminating. The Somogyi effect is quite common in those unstable diabetic dogs which tend to get shunted in my direction at work. Any clinician will recognise the effect. A dog is given 8iu of lente insulin at 7am with a meal of utter crap (ultra low fat Chappie usually). Blood glucose spikes to 22mmol/l by 9am from the carb load then falls progressively until about mid day, as the slow onset insulin struggles with the hyperglycaemia. It looks like there is a nadir at about 6mmol/l around mid day. The 1pm reading is unexpectedly high at 30mmol/l. No food, no behavioural signs. Just sudden hyperglycaemia. The Somogyi overswing. This fades slowly to around 15mmol/l by the next meal time at 7pm. The cycle repeats. Management (if you can't change anything else) is to reduce the dose rate of insulin, which stops that sudden surge in blood glucose at 1pm. Somogyi attributed the effect to a reflex release of glucose from the liver to prevent catastrophic hypoglycaemia in response to insulin overdose. Most clinicians seem to still think in these terms. Logical but incorrect. The advent of continuous glucose meters has pretty well disposed of the "hidden hypo" explanation and people are now looking at the effects of hyperinsulinaemia per se. The sudden rise in blood glucose appears to be associated with progressively rising or even peak levels of insulin in the blood. Let's have a think about what is happening. Under insulin deficiency condit Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
- Only 2 Ingredients and You Can Say Goodbye to Diabetes Forever! No More Medications and Insulin!!!
It’s Difficult To Regulate Diabetics
I recently euthanized a sweetheart of a diabetic cat. I’ll call him “Hans.” Hans had been diagnosed about three years ago, very early in the course of his disease, and his owner and primary care veterinarian were able to put him into remission with dietary changes and a short course of insulin injections. Unfortunately, he recently relapsed and this time around his caregivers were unable to manage the disease, primarily because Hans fought his insulin injections with every ounce of his being. His owner decided, rightfully so in my opinion, that Hans’s quality of life was so degraded by having to put up with twice daily injections that euthanasia was in his best interest. This case got me thinking about the reasons (other than behavior) why diabetic cats can become difficult to regulate. These patients end up on unusually high doses of insulin (greater than one unit per pound) but still suffer from the typical symptoms of diabetes mellitus, including: increased thirst and urination weight loss despite a good appetite weakness The first step in figuring out what is going on with a difficult to regulate diabetic is to examine the care the animal receives at home. Is the cat eating an appropriate amount of a low carbohydrate diet? Canned foods are best. Is the owner using good injection technique? Oftentimes it is best to avoid injecting around the nape of the neck and use the flank areas instead. Are appropriate insulin and insulin syringes being used? A mismatch can lead to under or overdosing. Is the insulin handled appropriately (refrigerated, replaced every three months or so)? Are any other medications being given? Some (e.g., corticosteroids) interfere with glucose regulation. Once home care has been validated, it’s time to look at the cat itself. Concurren Continue reading >>
Diabetes Mellitus: Complications Of Treatment
Investigation of unstable diabetes mellitus Full review of management issues such as diet, feeding schedules, exercise and handling and administration of insulin: If the dog is receiving significantly <1.5 IU/kg/injection then absolute under dosage of insulin is possible: Increasing the dose of insulin in this situation may provide better control. If the dog is receiving intermediate acting insulin once daily, then short duration of activity is likely: Dividing the dose and administering in two equal doses 12 hours apart may provide better control. Problems with owner administration can be eliminated by reviewing owner technique. Problems with insulin may be investigated by injection with a new bottle of insulin. This should aim to confirm those signs caused by diabetes mellitus and identifying features indicative of a concurrent disease process. In many cases the cause of the problem is diagnosed at this stage. When blood glucose concentrations decrease to approximately 3.5 mmol/L or below, the hypoglycemia induces release of diabetogenic hormones, in particular epinephrine and glucagon. These hormones act to increase blood glucose concentrations and the result is a hyperglycemia that develops rapidly after the glucose nadir. Diagnosis requires the demonstration of hypoglycemia followed by a severe and precipitous hyperglycemia within a 24 h period. The insulin dose should susequently be reduced by at least 25% and the animal re-evaluated. The Somogyi overswing can result in significant hyperglycemia for several days. In some animals the duration of insulin action may differ from that predicted. Short duration of action is almost predictable in animals administered once daily intermediate-acting insulin such as lente preparations. This can be resolved by giving twice Continue reading >>
The Somogyi Effect
Go to site For Pet Owners An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual—it is a life-saving response. The body attempts to counteract the decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly, or approaches hypoglycemia (blood glucose concentrations of less than 65 mg/dL [2.8 mmol/L]) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the central nervous system, adrenaline and subsequently cortisol, glucagon, and growth hormone are released. These hormones bring about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen and increased peripheral resistance to insulin). The resultant hyperglycemia produces polyuria and polydipsia. This can easily be misinterpreted as caused by an inadequate insulin dose. If the morning polyuria is thought to be the result of an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms may become exhausted resulting in severe hypoglycemia. Hyperglycemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycemic episode. As a result, blood glucose concentrations do not always normalize within a few days after lowering the insulin dose. When to suspect a Somogyi overswing Minimal glycemia: <65 mg/dL or 3.6 mmol/L Maximum glycemia: 400–800 mg/dL or 22–44 mmol/L Persiste Continue reading >>
Diabetic Crises: Recognition And Management (proceedings)
123Next Diabetes mellitus occurs in both dogs and cats and is the most common endocrine disorder in the emergency setting. Three types of diabetic emergencies may occur: (1) Insulin overdose, (2) Diabetic ketoacidosis, and (3) Non-ketotic hyperosmolar diabetes. Historical findings may be similar in all 3 cases, and may include polyuria, polydypsea, weight loss, anorexia, weakness, ataxia, severe depression, stupor, coma, or seizures. Diabetes most commonly occurs in middle-aged female dogs and in older male cats. The initial approach to an animal with suspected diabetic crisis is aimed toward differentiating between the 3 types of diabetic emergencies and determining how "sick" the patient is. An intravenous catheter is placed and 4 capillary tubes of blood are collected to run the hematocrit and total protein, blood glucose (using a Dextrometer, Ames Laboratories, Ames IA), blood urea nitrogen (using a reagent stick), and serum electrolytes. Blood for serum electrolytes must be collected in a lithium heparin capillary tube rather than in a sodium heparin tube. Evaluation of the laboratory work will reveal whether the animal is hypoglycemic or hyperglycemic, and whether or not ketones and glucose are present in the urine, and whether the animal is dehydrated, anemic, azotemic, or has a serious electrolyte imbalance. Other tests which can be run rapidly in an emergency setting include serum osmolality and venous or arterial blood gases. Within a few minutes after the animal is presented to the hospital, the clinician should be able to determine which type of diabetic crisis is occurring and to manage it accordingly. I. Insulin Overdose Insulin overdose can occur through owner error (for example, switching from low dose insulin syringes to tuberculin syringes) or through Continue reading >>
Canine Diabetes Mellitus: The Somogyi Effect
Canine diabetes mellitus: The Somogyi effect An important reason for conducting a blood glucose curve, ie, evaluating blood glucose levels every 2 hours following the morning Vetsulin (porcine insulin zinc suspension) treatment is the possibility of Somogyi effect or rebound hyperglycemia. In cats, the Somogyi overswing occurs when the insulin dose is too high and the patients blood glucose plummets below 60 mg/dL. The Somogyi effect occurs when the body attempts to counteract the life-threatening decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly or approaches hypoglycemia (blood glucose concentrations of less than 60 mg/dL [3.3 mmol/L]) following the injection of insulin. The cat becomes hungry and restless or lethargic. In response to a declining blood glucose concentration in the central nervous system, adrenaline and subsequently cortisol, glucagons, and growth hormone are released. These hormones increase blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen, and increased peripheral resistance to insulin). The resulting hyperglycemia produces polyuria and polydipsia. This can be mistakenly attributed to an inadequate insulin dose. If the morning polyuria is thought to result from an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms may become exhausted, resulting in severe hypoglycemia. The Somogyi effect can occur in both cats and dogs, but cats are particularly prone to develop this rebound hyperglycemia. The appropriate corrective action is to decrease the patients insulin dose to prevent insulin-induced hypoglycemia. Min Continue reading >>
The Hard To Regulate Dog - Mar Vista Animal Medical Center
The goal in long-term management of diabetes mellitus is the alleviation of unpleasant clinical signs (constant thirst, weight loss etc.) and prevention of dangerous secondary conditions (infections, ketoacidosis etc.). To accomplish this, blood sugar levels should be regulated between 250 mg/dl and 80 mg/dl. This is not as good as the bodys natural regulation but is a fair and achievable goal in most cases. Some patients just seem completely unaffected by even high doses of insulin and it is important to have a step-by-step plan to rule out causes of insulin resistance so that regulation can be achieved. Persistent high blood sugar levels throughout the day when 3 units of insulin per 4 pounds of patient body weight are used. A unit or more of insulin per pound of patient body weight (or more) is needed to achieve regulation. Typically glucose curves show glucose levels that are consistently too high with virtually no drop in sugar level when insulin activity is peaking. So what is going on here? The possibilities may seem surprising. (pic in middle of dog receiving injection) Owner error is actually the most common cause of insulin resistence. This may seem very basic but it is important not to skip the basics. Confirm that the amount of insulin being drawn into the insulin syringe is correct, that the injection technique is correct and that the patient is actually receiving the injection. Rule out any snacking or changes in the patients feeding schedule. Be sure the bottle of insulin is not expired and that it has been properly stored. Ideally, the veterinary staff will observe insulin administration and will check the bottle while the pet is being checked in the hospital. To review insulin storage and handling click here . Step Two: Determine for sure that the Pati Continue reading >>
Canine Diabetes Mellitus - Wsava2011 - Vin
World Small Animal Veterinary Association World Congress Proceedings, 2011 Johan P. Schoeman, BVSc, MMedVet(Med), PhD, DSAM, DECVIM-CA Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa Diabetes mellitus (DM) is a common endocrine disorder, with an incidence of between 1 in 100 to 1 in 500 dogs. The majority of dogs with diabetes mellitus will be successfully stabilised and will remain stable for long periods of time. However a significant minority will either become unstable again or will be difficult to stabilize from the outset. The most common cause for instability is failures in the daily management of the patient. Problems associated with insulin resistance and Somogyi effects are quite rare. When investigating instability always start by checking the daily routine and equipment supplied to the owner, before embarking on a search for complex causes of instability. This paper will focus on diabetic management and the causes of insulin resistance. The main goal is the elimination of owner-observed clinical signs by limiting blood glucose fluctuations and maintaining near-normal blood glucose levels. These are achieved through: Avoidance or management of concurrent inflammatory, infectious, neoplastic or hormonal diseases Insulin is classified according to its promptness, duration and intensity of action. Short acting insulin: This is represented by the crystalline insulin Actrapid. It is used chiefly in the management of DKA. It may be given by any route. It has a rapid onset of action (minutes) and a short duration of effect (hours) and is very potent. Intermediate acting insulin: These are represented by Protophane. They are used mainly in the management of canine DM on a twice daily Continue reading >>
Somygi Phenomenon
in Pets with Diabetes Mellitus. There was a very good article that was found at this link which seems to not be working at this time so here is the page that was originally found there. Somogyi Below is a blood glucose curve depicting the Somogyi phenomenon. In this scenario, the positive urine glucoses prompted continued escalation in the insulin dose administered. The subsequent insulin toxicity (and concomitant hypoglycemia –or low blood glucose) resulted in initiation of protective compensatory mechanisms which caused massive transient rises in blood sugar. In this case, urine dipsticks for glucose were checked twice daily and were always positive, prompting the owners to incrementally increase the insulin dose. This graph depicts in days what usually happens over weeks when well-meaning concerned pet owners try to use urine dipsticks to determine insulin dosing. Fortunately, the body is able to release several hormones which increase the amount of circulating glucose and which “shield” the tissues from the effects of insulin. Over time, even as the body is experiencing dramatic fluctuations in blood sugar levels, the tissues develop a resistance to insulin which may require weeks of insulin withdrawal to resolve. The best way to avoid Somogyi is to base insulin dose adjustments on blood, not urine glucose levels. Your veterinarian can do this by using a glucometer with just a drop of blood acquired every 2-3 hours for 12-24 hours, depending on how often insulin is administered. From the Pet Diabetes Dictionary Somogyi effect: A condition in which the blood glucose level increases if too much insulin is given. It occurs when insulin causes the blood glucose level to go so low it stimulates the production of other hormones in the body such as epinephrine which Continue reading >>
Somogyi Rebound
Somogyi rebound aka "Somogyi's phenomenon" is a common phenomenon in pet diabetes: When blood sugar levels drop too far or too fast, the animal will defensively dump stored glucose from the liver into their bloodstream, resulting in high blood sugar. It happens more often with pets than with humans, since humans check their own blood sugar more often and have a better idea of the right insulin dose. Because of the variability in a cat's response to insulin and that an individual cat's insulin needs can change greatly when not on a low-carb diet, they are more prone to having Somogyi episodes[1]. It's confusing but true: Too little insulin means pre-shot blood tests are too high; too much insulin often also means pre-shots are too high. This effect is often noted by those who test their pets' blood glucose at home. It means that even when blood glucose levels are too high, simply raising insulin dosage can make things worse instead of better. The blood sugar readings may go from a lowish number very suddenly to a high number, with a 'checkmark' shaped curve (see graph below). If overdose goes on for a few days, you may see few or no low readings, and just lots of very high and unpredictable readings that don't seem to correlate with feeding. Once in a while, a very low reading or even a symptomatic hypo may ensue. The reason: Anytime the glucose level drops too far or too fast, the cat or dog may defensively dump glucose into the blood by breaking down glycogen from the liver. Hormones epinephrine and cortisol, as well as growth hormone and glucagon,[2] causing temporary insulin-resistance, will also be released into the bloodstream[3]. (If these are insufficient, hypoglycemia ensues!)( See the nice tutorial on the insulin/glucagon equilibrium at the link below.)[4] Even Continue reading >>
Chronic Somogyi Rebound
The rebounding blood sugar following undetected diabetic hypoglycemia can easily become chronic when the high morning blood sugar data is misjudged to be due to insufficient nighttime insulin delivery. Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar.[1] When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night. This theoretical phenomenon was named after Michael Somogyi, a Hungarian-born professor of biochemistry at the Washington University and Jewish Hospital of St. Louis, who prepared the first insulin treatment given to a child with diabetes in the USA in October 1922.[2] Somogyi showed that excessive insulin makes diabetes unstable and first published his findings in 1938.[3] Compare with the dawn phenomenon, which is a morning rise in blood sugar in response to waning insulin and a growth hormone surge (that further antagonizes insulin). Background[edit] A person with type 1 diabetes should balance insulin delivery to manage their blood glucose level. Occasionally, insufficient insulin can result in hyperglycemia. The appropriate response is to take a correction dose of insulin to reduce the blood sugar level and to consider adjusting the insulin regimen to deliver additional insulin in the future to prevent hyperglycemia. Conversely, excessive insulin delivery may result in hypoglycemia. The appropriate response is to treat the hypoglycemia and to consider adjusting the regimen to reduce insulin in the future. Somogyi Continue reading >>
Canine And Feline Diabetes - The Somogyi Effect
Canine and feline diabetes is a disease that results in an abnormal increase in blood glucose levels. When treated with insulin, the blood glucose levels are decreased and, hopefully, kept within the normal range. Insulin overdose, however, is possible and can lead to a phenomenon known as the Somogyi effect. What Is the Somogyi Effect and How Does It Affect a Diabetic Dog or Cat? The Somogyi effect occurs when an overdose of insulin occurs. The insulin acts to lower the blood glucose (blood sugar) level. However, because of the fact that too much insulin was given, the blood glucose level may fall lower than the normal range. When the blood glucose becomes too low (a condition known as hypoglycemia), the body has defense mechanisms that go into effect to force the glucose to increase again. However, the dog or cat may not be able to control how high the blood glucose goes and it may rebound to an abnormally high level. This is known as the Somogyi effect. This effect may actually become circular in its effect if the insulin overdosage is ongoing. When the insulin dose is given, the blood glucose level first falls to below normal then rebounds to an abnormally high level. The insulin dose is repeated, which again leads to first an abnormally low glucose level and then a rebound to an abnormally high level. And the circle goes on and on. How Is the Somogyi Effect Diagnosed in Dogs and Cats with Diabetes? A blood glucose curve will be necessary to diagnose this phenomenon. The blood glucose curve is a series of blood glucose measurements taken at regular intervals after the administration of insulin. When evaluating a blood glucose curve for a dog or cat that is experiencing the Somogyi effect, it will be possible to see the blood glucose value drop first to an abnormally Continue reading >>
Somogyi Effect (rebound Hyperglycaemia)
An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycaemia. This can also be produced if blood glucose concentrations fall too rapidly. The body attempts to counteract the decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly or approaches hypoglycaemia (blood glucose concentrations of less than 5 mmol/l (90 mg/dl)) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the CNS, adrenaline and subsequently cortisol, glucagon and growth hormone are released. These hormones bring about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen and increased peripheral resistance to insulin). The resultant hyperglycaemia produces polyuria and polydipsia. This can easily be misinterpreted as a result of an inadequate insulin dose. If the morning polyuria is thought to be the result of an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms become exhausted resulting in severe hypoglycaemia. Hyperglycaemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycaemic episode. As a result blood glucose concentrations do not always normalise within a few days of lowering the insulin dose. If the Somogyi effect is suspected, an alternative approach is to decrease the dose by 20% and closely observe the clinical signs. If signs of polyuria or polydipsia worsen a few days following the dose adjustment, it is unlikely that the Somogyi effect was the cause of the regulat Continue reading >>
Somogyi Rebound
What it is Sample Somogyi bg curve When can Somogyi happen Suspected Somogyi Diagnosed Somogyi Treatment for Somogyi Occurrence Other terms Definition Somogyi rebound is one of the body's natural defense mechanisms to protect itself against hypoglycemia. It can occur when the blood glucose is too low, or if the blood glucose is above "normal" but drops too quickly. A non-diabetic maintains normal sugar metabolism using two major hormones. The first is insulin, which lowers the blood glucose by allowing cells to remove glucose from the blood and either use or store the glucose. The second hormone used to regulate sugar metabolism is glucagon. Like insulin, glucagon is produced by the pancreas. Glucagon has the opposite effect of insulin. Glucagon causes cells to release glucose, thus causing the blood glucose to increase. When the blood glucose becomes too low, the body's natural defense mechanism is to release glucagon and several other hormones into the blood. The overall effect of these hormones is to increase the blood glucose. Glucagon causes the liver to rapidly release large amounts of stored glucose into the blood stream. After all this glucose is released into the blood, the animal can become hyperglycemic (high blood glucose). The other hormones involved in this protective mechanism act to keep the blood glucose elevated for a longer period of time. Because Somogyi involves several other hormones that have a longer duration of action than glucagon, the hyperglycemia caused by a Somogyi may last for several days and you may see insulin resistance. This can make diagnosing somogyi difficult. Somogyi bg curve Figure 1 shows a hypothetical Somogyi rebound. The green line show the bg curve when an appropriate insulin dose is given and the red line shows the Somogyi Continue reading >>
