"Richard Evans" wrote in message
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Ripley, our grand old man, is 17 and has been diabetic for a number of
years. He's on Glargine insulin, 1.5 units in the morning and another
1.5 at night. He's been stable for quite some time. The last couple of
weeks, though, he has been having wild swings in sugar levels: 30 to
400 in the same day.

When he drops into the 30s, he can't walk, vomits, loses bowel and
bladder control. We force feed him Karo syrup or other high-sugar
foods and he comes out of it. Other times, he's over 300, even into
the low 400s. We give him the usual 1.5 units of insulin, because
increasing the dose is a crap shoot and likely to push him into hypo
territory again.

Actually, its the hypOglycemia that's causing the hypERglycemia. Upping the
insulin dose will only make matters worse- much worse.

You've described an almost textbook description of glucose
counterregulation- better known as the infamous "Somogyi Phenomenon" a/k/a
"Insulin-induced Hyperglycemia", a/k/a "Rebound Hyperglycemia".

Here's what happens when a cat's blood glucose drops below 65 mg/dL:

1. Diabetogenic hormones, epinephrine and glucagon, are released. These
hormones promote gluconeogenesis and glycogenolysis in the liver and
decrease the utilization of glucose by peripheral tissue (which is why he
can't walk).
2. The blood glucose level rises rapidly.

3. Cortisol and growth hormone are released, which further increase the
production of and release of glucose.

4. The blood glucose level increases even more rapidly

5. Because the cat is diabetic, levels of insulin adequate to respond to the
glucose rise are unavailable.

6. Therefore, the blood glucose rises to uncontrollable levels, as high as
600 mg/dL.




For the most part, he gets a protein diet (chicken is his favorite)
with carbs added as necessary to counteract hypos. Unfortunately, he
has stopped eating on his own and we are force feeding him whenever he
does eat.

Last night, for instance, his sugar level was 33. We gave him a small
dose of Karo but no insulin. This morning, he was 335.


At 33 mg/dL the Somogyi probably had already begun.




I'm putting off taking him to the vet because that's a minimum $500
and we've already spent thousands on him.

Does this new fluctuation in sugars plus his refusal to eat mean he's
nearing the end?


Hell no! It probably means he needs less- if any insulin. A lot of diabetic
cats go into remission after beginning glargine insulin therapy and no
longer need any insulin. If he's not in complete remission, his insulin
requirements may have decreased.


He sleeps a lot, and doesn't seem to be in pain,
except when his sugars go really low.

Do you check his blood glucose before you give him insulin? You need to do
a glucose curve to plot his blood glucose levels throughout the day.


Best of luck,

Phil