Aloha! You're speaking to Dr. Michael SalkinYes, when increasing doses of insulin are needed, rebound (the Somogyi effect) needs to be considered. This is evidenced when the blood sugar drops below 65 mg/dL (3.6 mmol/L) only to rebound over 400 mg/dL (22 mmol/L). Here's more on this effect: http://www.vetsulin.com/vet/Monitoring_Somogyi.aspxThis is why it's important not to judge how much insulin is required by looking at just one blood sugar daily; instead, a glucose curve - blood sugar levels taken every 2-4 hours for 12-24 hours is necessary and gives a more accurate assessment of how well the current insulin dose is working.In general, a 15 kg (33 lb) dog is going to need more insulin than 5 units. I believe that Poppy is considerably underdosed at this time rather than the Somogyi effect being present. I would have initiated insulin dosing at 0.5 units/kg twice daily or 7-8 units twice daily.Please respond with further questions or concerns if you wish.
Thank you. I don't know why I saw 15 kg instead of 7.5 kg. Mea culpa. I would have initiated insulin at 4-5 units. That curve simply indicates underdosing. She's a severe diabetic with those numbers. There's no evidence of rebound (Somogyi effect). I wouldn't investigate causes of insulin resistance or problems with administrating the insulin until she didn't respond to up to 12 units of insulin twice daily.Please continue our conversation if you wish.