Page 215 - WSAVA2017
P. 215

monitoring documenting hypoglycemia followed by hyperglycemia still does not indicate if the hyperglycemia is due to inadequate insulin concentrations to prevent hyperglycemia. This requires concurrent measurement of circulating insulin concentrations.
In summary, in humans, the frequent occurrence of
the Somogyi effect has been refuted, and in a study of glargine-treated diabetic cats, blood glucose curves consistent with insulin-induced rebound hyperglycemia were very rare, despite the frequent occurrence of biochemical hypoglycemia. It is important to recognize that the fluctuations of blood glucose concentration occur commonly in the first weeks, and more rarely months, following the initiation of treatment with glargine, and can be mistaken for the Somogyi effect. However these fluctuations generally resolve with time using consistent dosing.
As a rule of thumb for clinicians, the dose of glargine
or detemir should be reduced if the cat develops asymptomatic or clinical hypoglycemia, but not
when blood glucose concentration is high and poorly responsive to insulin. In cats with intermediate acting insulin and experiencing hyperglycemia, with or without preceding hypoglycaemia, it is strongly recommend that the cat be switched to a longer acting insulin. When this is not possible, consider increasing the frequency of dosing. Insulin dose should be reduced if hypoglycaemia occurs, especially if it results in clinical signs.
1 Somogyi M. Exacerbation of diabetes by excess insulin action. Am J Med. 1959; 26: 169-91.
2 Gale EA, Kurtz AB and Tattersall RB. In search of the Somogyi effect. Lancet. 1980; 2: 279-82.
3 Tordjman KM, Havlin CE, Levandoski LA, et al. Failure of nocturnal hypoglycemia to cause fasting hyperglycemia in patients with insulin-dependent diabetes mellitus. N Engl J Med. 1987; 317: 1552-9.
4. Hoi-Hansen T, Pedersen-Bjergaard U and Thorsteinsson B. The Somogyi phenomenon revisited using continuous glucose monitoring in daily life. Diabetologia. 2005; 48: 2437-8.
5. Hirsch IB, Smith LJ, Havlin CE, et al. Failure of nocturnal hypoglycemia to cause daytime hyperglycemia in patients with IDDM. Diabetes Care. 1990; 13: 133-42.
6. McMillan FD and Feldman EC. Rebound hyperglycemia following overdosing of insulin in cats with diabetes mellitus. J Am Vet Med Assoc. 1986; 188: 1426-31.
7. Havlin CE and Cryer PE. Nocturnal hypoglycemia does not commonly result in major morning hyperglycemia in patients with diabetes mellitus. Diabetes Care. 1987; 10: 141-7.
8 Pramming S, Thorsteinsson B, Bendtson I, et al. Nocturnal hypoglycaemia in patients receiving conventional treatment with insulin. Br Med J (Clin Res Ed). 1985; 291: 376-9.
9 Raskin P. The Somogyi phenomenon. Sacred cow or bull? Arch Intern Med. 1984; 144: 781-7.
10 Choudhary P, Davies C, Emery CJ, et al. Do high fasting glucose levels suggest nocturnal hypoglycaemia? The Somogyi effect-more fiction than fact? Diabet Med. 2013; 30: 914-7.
11 Bolli GB and Gerich JE. The dawn phenomenon - a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus. N Engl J Med. 1984; 310: 746-50.
12 Carroll MF and Schade DS. The dawn phenomenon revisited: implications for diabetes therapy. Endocr Pract. 2005; 11: 55-64.
13. Roomp K, Rand J. Rebound Hyperglycemia In Diabetic Cats J Feline Med Surg. 2016 Aug;18(8):587-96. doi: 10.1177/1098612X15588967
An Urban Experience

   213   214   215   216   217