Somogyi Overswing

Re: Somogyi Overswing

Martin Atkinson — Thu, 01 Nov 2012 17:27:19 GMT

[quote user="Rajat"]Is the owner calibrating her alphatrak regularly or is asking her that question going to give more grief than its worth ?[/quote] The owner is diabetic and uses her own glucometer so we allow a unit or 2 error on the high side.

Re: Somogyi Overswing

Rajat — Wed, 31 Oct 2012 20:18:01 GMT

[quote user="Martin Atkinson"]

[quote user="Rajat"]The fructosamine will be interesting.[/quote] Fructosamine 439umol/l (Axiom reference limits <450 fair recent control). I've already advised the client to reduce the dose by 25%. I'm getting less and less happy with fructosamine as a monitoring tool, its useful for differentiating diabetic and non-diabetic cats with a high stress hyperglycaemia but I think it adds nothing to this case as someone has already said.

[/quote]

I largely agree, but like I said interesting, not conclusive by any means. I rarely never use the fructosamine to solely make judgements on these ones. And to catch a somogyi you need a curve anyways. I just thought it'd be interesting as there were no other numbers provided in your initial curve and if it was low it'd fit our suspicions (though I obv understand the upswings in BG following the drops can mask the readings hence fructosamine can be wnl..)

Anyways I agree with y'all that it is not helpful in this situation, and the curve nails the diagnosis.

Is the owner calibrating her alphatrak regularly or is asking her that question going to give more grief than its worth ?

Re: Somogyi Overswing

Rajat — Wed, 31 Oct 2012 20:14:26 GMT

[quote user="Martin Atkinson"]The curve is as good as it gets, the owner refuses to bring the dog in for us to perform on cost grounds and does it 2 hourly at home, heck its difficult enough to get her to come in every 3 months for a check and fructosamine. [/quote]

That's annoying.

[quote user="Martin Atkinson"]That said there is little to add to the figures given. The rise from 8.9 at the time of dosing to 6 hours later then the fall to 6 at 12 hours are steady, no big jumps, no plateaus,[/quote]

So the insulin was given at the time BG was 8.9 and BG contd to rise for 6 hours?

Weird. Caninsulin should be bringing BG down 2 hours in not raising it. Somogyi smelling curve already

[quote user="Martin Atkinson"]That said a spot test taken on an Alphatrak here one hour before the evening dose was 39.1! [/quote][quote user="Martin Atkinson"]This stinks of a Somoygi overbound to me with the nadir at the time of dosing and the peak where the nadir [/quote]

Exactomundo totally agree

[quote user="Martin Atkinson"]so I'm going to reduce the twice daily dose by 25%, I'm not going to take the risk as this dog has gone hypo before, it is overweight and the owner is (in theory) going to put it on a diet![/quote]

Mate I'm with ya on this one!

Re: Somogyi Overswing

katie mountford — Wed, 31 Oct 2012 19:58:19 GMT

I've had a couple of cats present in a hypo crisis that had been managed with fructosamines rather than glucose curve. As far as I understand it the fructo gives an 'average' of the overall glucose control and so a normal or 'good control' can mask both lows and highs-therefore to me it seems a pretty useless management tool really- as martin said, only really useful to confirm the intial diagnosis.

Re: Somogyi Overswing

Martin Atkinson — Wed, 31 Oct 2012 17:19:52 GMT

Re: Somogyi Overswing

Martin Atkinson — Tue, 30 Oct 2012 08:50:07 GMT

[quote user="Rajat"]

Definitely twice daily for Caninsulin mate

8.9mmol is low for a 12 hour post injection dose. Do you have the rest of the measurements (were they done 2 hourly)? The fructosamine will be interesting.

DM is always an interesting disease as so many other things can affect it and it is never the same twice (at least not for me, yet)

[/quote] You're right the more I learn about DM the less I realise I know and the more I test the more unstable they become!!

The curve is as good as it gets, the owner refuses to bring the dog in for us to perform on cost grounds and does it 2 hourly at home, heck its difficult enough to get her to come in every 3 months for a check and fructosamine. That said there is little to add to the figures given. The rise from 8.9 at the time of dosing to 6 hours later then the fall to 6 at 12 hours are steady, no big jumps, no plateaus, and the same for the second 6 hours before the curve was terminated. That said a spot test taken on an Alphatrak here one hour before the evening dose was 39.1! This stinks of a Somoygi overbound to me with the nadir at the time of dosing and the peak where the nadir should be so I'm going to reduce the twice daily dose by 25%, I'm not going to take the risk as this dog has gone hypo before, it is overweight and the owner is (in theory) going to put it on a diet!

Re: Somogyi Overswing

Michael Woodhouse — Mon, 29 Oct 2012 23:43:24 GMT

TBH with glucose in the high twenties at times in the day not sure the fructosamine adds much? It is going to be high.

Suppose a more detailed curve is needed.

Re: Somogyi Overswing

Robin Grimmer — Mon, 29 Oct 2012 22:46:47 GMT

You might need to do hourly measurements to 'catch' a Somogyi. Having said that, the insulin doses are not that high.

Re: Somogyi Overswing

Rajat — Mon, 29 Oct 2012 19:48:19 GMT

Definitely twice daily for Caninsulin mate

8.9mmol is low for a 12 hour post injection dose. Do you have the rest of the measurements (were they done 2 hourly)? The fructosamine will be interesting.

DM is always an interesting disease as so many other things can affect it and it is never the same twice (at least not for me, yet)

Re: Somogyi Overswing

James Laidlaw — Mon, 29 Oct 2012 19:07:11 GMT

Twice daily is always meant to give better control, no? The can insulin people are pretty awesome if you send them all the info to discuss a case in more detail. Quick replies too, which is always a bonus. We used to have feedback forms, but you can probably just call them.