Is My Diabetic Dog in Rebound (Somogyi)?
Today we are going to talk about Somogyi Effect also known as Rebound (too much insulin). Remember when we were discussing curves a few posts ago and I mentioned that a high numbered flat curve could be indicative of something? This is what I was talking about.
Appropriate insulin dose changes are made after a 12 hour curve is done (for a refresher, you may want to go back and read the post on curves) and studied to determine if an adjustment needs to be made. This is a subject close to my heart as my pup was put into rebound, not once but TWICE and I paid close to $6,000.00 for the privilege! So you see, sadly, I have a bit of experience with this phenomenon.
How is it possible that my dog is getting too much insulin?! My best guess is that it goes something like this… You take your pup in to “have his/her glucose checked”, the vet or the vet tech does a spot check and based on this one reading, they make an insulin adjustment. No full 12 hour curve, no taking into account that your pup was stressed because he/she was at the vet and it’s not their favorite place to be (white coat syndrome), the stress of being there makes their BG (Blood Glucose) number go up and it is determined that your pup needs more insulin. You think to yourself, OK, they went to vet school and I didn’t so you do as instructed. The following week the same thing happens and the cycle continues…. You get the picture.
What’s wrong with the above picture? Let’s start at the beginning. If you test at home, you can do your own 12 hour curve in the comfort of your own home where stress doesn’t factor into the equation and oh by the way, you save a bunch of money. Your home based curve is far more accurate than one done at the vet clinic for the majority of pups. Next, you have a full picture of your pup’s fluctuations during the day and will find out when your insulin dose is at its peak which is called a nadir. If you took your pup in shortly after breakfast for the spot check, it could be that on top of the stress of being at the vet which will affect numbers, you may also have gotten the spot check during a food spike (post prandial spike)! Now you are basing an insulin dose change on a completely inflated number… Yikes! So that’s one scenario for how it could have happened. There are others, but this is likely the most common. That begs the question… How do I know if my dog is in rebound?
There are some telltale signs that your pup is in rebound. The first is when you look at a curve that you’ve done, and there is a wild swing within the 12 hour period. If you draw a line through your readings, it looks like a check mark. By that I mean that there is a lower reading and then the numbers climb to a high reading. Another sign is that your curve is flat and all high numbers (this can also mean that you are early in the process and that you just aren’t giving enough insulin yet). The third indicator is that with an increase in insulin, your numbers go up. If you have seen better numbers on a lower dose of insulin and all other factors have remained the same (food, exercise, etc.), chances are good that your pup is in rebound.
How do you fix it? You decrease your insulin dose. In most cases a decrease of 25% of the dose will break the rebound cycle. You may have to increase slowly in small increments from there, but the cycle will be broken and you can carefully increase to find your perfect dose. You MUST let a dose settle for up to a week so that you can see the full effect of the adjustment before doing another curve to determine where to go from there. Increasing insulin too fast without giving a new dose a chance to settle can result in rebound. I could give you the scientific and physiological reasons that Somogyi occurs, but suffice it to say that it isn’t good and all you need to know is how to recognize it and how to fix it. There are several good resources online if you want to know the science behind the condition, just Google Somogyi Effect in Dogs.
If you suspect that your pup is in rebound, please talk to your vet about a dose decrease. I will warn you now that many vets don’t believe that Somogyi is a real thing. I can tell you first hand that it is real and there is nothing good about it.
As always, your thoughts and comments are welcomed in the comments below.
If you’re shy and don’t want to post in the comments, please feel free to email with questions or topics for upcoming posts at: NancyForPetTest@pharmasupply.com
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