Somogyi or rapid metabolism?

Re: Somogyi or rapid metabolism?

Glenn Hodgson — Wed, 12 Feb 2014 22:41:35 GMT

Fair point Andrew, thanks, will probably give this a go for the next two weeks prior to re testing. Feed then jag is usually my normal. He is a lab though.... Eating should not be an issue.

I have already briefed client for possible insulin type change. had it in my mind that this sort action was mainly a thing of kitty cats.

Re: Somogyi or rapid metabolism?

Andrew Kent — Wed, 12 Feb 2014 11:40:57 GMT

Hi Glenn,

What time is the dog being fed with respect to insulin administration? One of the things that can cause a curve like yours is that the maximum effect of the insulin is occurring a while after absorption of food, so you may get a better curve by feeding the dog 30-60 minutes after the administration of the insulin to try to get the post-prandial surge the the insulin a bit more in sync.

Andy

Re: Somogyi or rapid metabolism?

Martin Atkinson — Wed, 12 Feb 2014 09:20:30 GMT

[quote user="Glenn Hodgson"]I felt too late a a glucose spike after injection to be somogyi but your opinion supports my ponderings. [/quote] It is true that it is not a classical over-swing curve with a nadir after 4-6 hrs then a sudden rise but they don't always (often) fit this pattern. What makes me think it is a chronic rather than acute over-swing is: a) a relatively high peak with a near hypoglycaemic nadir, b) the wobble after 4-6 hrs when the glucose goes back up which could be the attempt to compensate which then fails and the level falls again, c) the sudden rise after its nadir when you'd expect a much slower rise given the preceding relative plateau, d) the high fructosamine when most of the curve looks controlled. If you're going to fiddle with the dose then you can't confidently increase it given the small margin for error - with that nadir you'd almost certainly be heading for a hypoglycaemic crisis so the only way is to reduce and see if it improves. Maybe a case for Lantus glargine which would give you a much flatter curve.

Re: Somogyi or rapid metabolism?

Glenn Hodgson — Tue, 11 Feb 2014 22:41:58 GMT

your assumption is correct re insulin timing Martin. thanks for yoir thoughts.

I felt too late a a glucose spike after injection to be somogyi but your opinion supports my ponderings.

Will find out soon enough when i tamper with the insulin.

Re: Somogyi or rapid metabolism?

Martin Atkinson — Tue, 11 Feb 2014 17:16:42 GMT

Basic information missing from here is the time of injections, No conclusions can be drawn until we know that. But If we assume the morning injection was given at or around the same time as the first test and the second 12 hrs later I would say there is a chronic over-swing going on here. On first site the figures are nice, but that fructosamine doesn't reflect this, the nadir of 4.1 is too low for comfort and far to long after the injection then there is a very rapid rise. I would reduce the dose by 25% and repeat the curve in a week.

Re: Somogyi or rapid metabolism?

Glenn Hodgson — Tue, 11 Feb 2014 16:35:43 GMT

Update:

He is otherwise well other than cataracts is developing and v sl pu/pd. I have reproduced these results twice over 2 weeks.

Going to re-check his pee for UTI and check curve again 2 weeks if still symptomatic.

No harm potentially teaching to suck eggs. Is what I asked!

Re: Somogyi or rapid metabolism?

Virginia Campbell — Fri, 07 Feb 2014 16:19:47 GMT

OK, I'm sure somebody more knowledgeable will be along in a minute but I'll give it a go.

I don't think this curve shows Somogyi overswing. For that I would expect a much earlier nadir - within a couple of hours- with a fairly quick "escape" to higher bg values and the dog to be hyper for most of the day. Prob also not that likely at 2/3 unit per kg - that's not a massive dose.

I think that's a nice curve actually, perhaps going a little low for comfort in the afternoon but if the dog has shown no signs of hypos I might be in no rush to change things. If the dog is clinically well as you say, weight, appetite stable and body condition decent (maintaining topline muscling,not skinny on top w slack belly), not PUPD I'd leave well alone.

But. If your dog's blood glucose was doing that every day twice in 24 hours, I don't think its fructosamine could be rising. So I would look for reasons for the bg curve to be all nice on the day you did it but possibly not the rest of the time. The next thing I would do is

- check that the person who gave the insulin on the day of the curve is the same person who usually does it

- ask them to indicate the sites they use for injection - did they usually inject in the scruff but use the ribs on that morning as is was their nice fresh bit of injection site for Sunday best? check skin for thickening

- check that there's nobody else at home who could be undermining their good care- parents or children sneakily feeding handfuls of choccy bikkies when they're not looking

- check for perio dz and send some urine off in case has quiet UTI

- since it's a male, urine glucose dipsticking should be easy for Os to do in the mornings- should be trace glucose sometimes

All of the above is probably egg-sucking teaching though, sorry! If morning urine glucose consistently + or ++ or a repeat fructosamine in another month or so gives the same result or higher, I probably would consider changing the type of insulin given. Otherwise I would do nothing

Re: Somogyi or rapid metabolism?

Robin Grimmer — Fri, 07 Feb 2014 16:03:24 GMT

I agree, not much convincing evidence of either really. Maybe repeat the curve in a week or two.

Re: Somogyi or rapid metabolism?

Nicola Lawlor — Fri, 07 Feb 2014 15:40:21 GMT

I don't think that looks like a Somogyi overswing. Is the dog having any symptoms or problems or are you concerned based on numbers?

Personally I would be very pleased with that glucose curve and I would change nothing at the current time, but perhaps recheck fructosamine/possibly another curve in a couple of months if there is a concern, esp if increased thirst etc.

It is possible that the dog was unwell or had temporarily altered insulin requirements prior to that last fructosamine that was run and this is now more settled? Hopefully the next one you do will be back to the usual level.