9/26 - AMPS 392 (+24 hrs since last shot) - Adjusting dose

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OrangeTrioMom

OrangeTrioMom

Member Since 2016
Hi all-
I posted on the main forum and need some guidance regarding my cat's insulin dose for tonight.

Joe was diagnosed diabetic on 8/17/2016. At that time, the vet started him on 3U of insulin BID. We started him on Lantus. On 9/1/2016 he did a glucose curve at the hospital where I work (that's also where his doctor is) and it went something like this:
1. Pre-shot AM - 470
2. 4 hours post AM shot - 250
3. Pre-shot PM - 350

At that time, the vet decided to increase his dose to 4U BID. We started him on that and he has been on it since that day. This weekend I chose to do a "curve" at home and here's what I found:

1. Pre-shot AM - 270
2. 4 hours post AM shot - 58
(Gave 1/8 cup Royal Canin Glycobalance and packet of Fancy Feast Broths (1.4 oz) mackerel & vegetables)

At that point, I posted on the boards and have been monitoring him at 15-20 minute intervals since. Here's how it has gone. (I will also note that at one point (measurement #2) I noticed since it was a new glucometer that the code was incorrect. It read "14" and should have read "08." I changed the code & continued the readings):

3. +15 min - 60
4. +15 min - 45 (this is when I changed the code)
(Gave 1 packet of Fancy Feast Broths (1.4 oz.) chicken & vegetables + small amt. of Karo syrup on gums)
5. Immediately following (code change & food) - 71
6. +15 min - 110
7. +15 min - 113
8. +15 min - 103

I am unsure at this point how to proceed with his shot this evening. He is to get it in about 3 hours. Please let me know your thoughts.

(I apologize in advance if I am slow to respond. I am trying to test my cat and study for an exam and respond to posts. Thank you in advance for your patience.)
 
Good for you for home testing! It's the only way to kelt keep a diabetic kitty safe. And good for you for posting, you still have quite a bit of time before the shot. Someone will come along who can help you decide what to do. For sure, you will want to reduce the dose. Do you have plenty of strips? What meter are you using?
Liz
 
Anne & Zener GA said:
Good for you for home testing! It's the only way to kelt keep a diabetic kitty safe. And good for you for posting, you still have quite a bit of time before the shot. Someone will come along who can help you decide what to do. For sure, you will want to reduce the dose. Do you have plenty of strips? What meter are you using?
Liz
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Hi Liz!
I do have plenty of strips (for now...) I may have to run to work to get more. Thankfully we are close by so I can go grab some. We use the AlphaTrak2.
 
Hi Kirsten, how much does Joe weigh? What is his ideal weight? And what are you feeding him? Sorry for all the questions but they factor into our decision.

Good job handling the lows today so far.
 
Wendy will help you decide what to do, she's a very experienced member and will give you excellent advice. Very fortunate that you work in an animal hospital!

What does Joe eat?
Liz
 
I have to go out for a bit to move an outboard motor, but will be back well before your shot time.
 
Wendy&Neko said:
Hi Kirsten, how much does Joe weigh? What is his ideal weight? And what are you feeding him? Sorry for all the questions but they factor into our decision.

Good job handling the lows today so far.
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Thanks for your encouragement! I couldn't have done it without the help of folks on here...

1. Joe currently weighs 17 lbs.
2. Ideal weight 13 lbs., which is what his doctor based his first dosage on.
3. Eats - He was prescribed the Royal Canin Glycobalance dry because he has always been a kibble eater. He gets 1/4 cup of that AM & PM with his shot.

I have been adding in some Primal freeze-dried wet to the dry food for about a week now. He seems to really like it. My goal was to start home testing and use that information to get us on the Primal freeze-dried entirely. Been trying to transition all of my cats to it because I've read such good things about it.
 
Great plan to transition the cats to something other than dry food. If no one has directed you to this site, Lisa Pierson, DVM has wonderful information on her website about feline nutrition and there is also information about transitioning a cat from dry to canned food.

Generally, we use a weight based formula to establish the starting dose for Lantus. The formula is: initial dose = 0.25 x ideal weight in kilograms. So for Joe, his starting dose would have been approx. 1.5u. That amount of insulin does, however, presume a cat is on a canned food diet.

It's entirely possible that the lows you're seeing today are a result of the switch over to more of a low carb diet. Low carb (LC) can make a huge difference in how your cat responds to insulin. We've seen any number of cats go into remission very quickly once their diet eliminated the dry and/or high carb (HC) food.

There are two dosing methods we use -- Tight Regulation (TR) Protocol and Start Low Go Slow (SLGS). Both methods are described in the sticky notes at the top of the board. Because Joe is still eating dry food, your only option is SLGS. Given the low in the 70s, you would want to reduce his dose by 0.25u.

It would also be very helpful if you could put together a spreadsheet. This will allow you to track Joe's progress in a concise way and will give us the information that will allow us to quickly give you a hand if you want input.

 
Sienne and Gabby (GA) said:
Great plan to transition the cats to something other than dry food. If no one has directed you to this site, Lisa Pierson, DVM has wonderful information on her website about feline nutrition and there is also information about transitioning a cat from dry to canned food.

Generally, we use a weight based formula to establish the starting dose for Lantus. The formula is: initial dose = 0.25 x ideal weight in kilograms. So for Joe, his starting dose would have been approx. 1.5u. That amount of insulin does, however, presume a cat is on a canned food diet.

It's entirely possible that the lows you're seeing today are a result of the switch over to more of a low carb diet. Low carb (LC) can make a huge difference in how your cat responds to insulin. We've seen any number of cats go into remission very quickly once their diet eliminated the dry and/or high carb (HC) food.

There are two dosing methods we use -- Tight Regulation (TR) Protocol and Start Low Go Slow (SLGS). Both methods are described in the sticky notes at the top of the board. Because Joe is still eating dry food, your only option is SLGS. Given the low in the 70s, you would want to reduce his dose by 0.25u.

It would also be very helpful if you could put together a spreadsheet. This will allow you to track Joe's progress in a concise way and will give us the information that will allow us to quickly give you a hand if you want input.
Click to expand...

Thank you so much for your response. Joe always ate dry kibble for the most part but has been on grain-free high protein dry food his entire life. We had him on Blue when he was younger and then we moved him to the Nature's Variety Instinct for a while. Then most recently we tried Orijen and Annamaet. Would a change to the Royal Canin Glycobalance make this kind of difference? I don't understand how that food could be better for him and make his numbers switch over any of those other foods.

I am very familiar with Lisa Pierson's website. I have read it for years and have played with my cat's diets, only now after having more trouble with my one cat's hair balls did I try the Primal freeze-dried re-hydrated with Honest Kitchen's Pro-Bloom Dehydrated Goat's Milk. They all seem to love it.

So you're saying to reduce his dosage by .25u. Does that mean I give him his normal shot with his food at 8pm tonight, when he usually gets it? I'm so concerned about his levels!!!!
 
The Glycobalance is approx. 29% carb. Just because a food says it's high protein and grain free doesn't mean it's low in carbs. There can be potatoes, fruit, etc. that drive up the carb count. The Glycobalance ingredients include corn and wheat gluten, tapioca, and barley -- all are high in carbs. So the quick answer to your question is yes, transitioning to the Primal means you are removing a source of VERY high carb food which can cause a sharp drop in BG number. I don't think it's the difference in the dry food that has cause the lower numbers -- it's the introduction of the Primal that is influential (IMHO).

I would suggest you test and post with Joe's +11 number so we can help you assess if it's safe to shoot. I'd suggest that you put something in your subject line (change the subject in the first post in this thread) to reflect that you need help re your PMPS shot.



 
Sienne and Gabby (GA) said:
The Glycobalance is approx. 29% carb. Just because a food says it's high protein and grain free doesn't mean it's low in carbs. There can be potatoes, fruit, etc. that drive up the carb count. The Glycobalance ingredients include corn and wheat gluten, tapioca, and barley -- all are high in carbs. So the quick answer to your question is yes, transitioning to the Primal means you are removing a source of VERY high carb food which can cause a sharp drop in BG number. I don't think it's the difference in the dry food that has cause the lower numbers -- it's the introduction of the Primal that is influential (IMHO).

I would suggest you test and post with Joe's +11 number so we can help you assess if it's safe to shoot. I'd suggest that you put something in your subject line (change the subject in the first post in this thread) to reflect that you need help re your PMPS shot.


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OK, so you're saying I should post a new thread in the Lantus forum saying "Need help with PMPS"? I'm a newbie, forgive me.
 
OrangeTrioMom said:
OK, so you're saying I should post a new thread in the Lantus forum saying "Need help with PMPS"? I'm a newbie, forgive me.
Click to expand...


No just us this thread for your posts. There are people giving advice on both threads and it could get confusing if different advice is given on the different threads.
 
Let me give a little history re: this number, however. I have been giving him small amounts of brothy food consistently (mostly because I'm a newb and don't know what I'm doing)
+9.5 - 103 (Gave 3 crunchy naturals treats & 2 tsp. FF Broths)
+9.75 - 91 (Gave 2 tsp FF Broths)
+10 - 100 (Gave 2 tsp FF Broths)
+10.25 - 105 (Gave 2 tsp FF Broths)
+10.5 - 108 (Gave 1 tsp FF Broths)
+10.75 - 118 (Gave no additional food)
 
OrangeTrioMom said:
Let me give a little history re: this number, however. I have been giving him small amounts of brothy food consistently (mostly because I'm a newb and don't know what I'm doing)
+9.5 - 103 (Gave 3 crunchy naturals treats & 2 tsp. FF Broths)
+9.75 - 91 (Gave 2 tsp FF Broths)
+10 - 100 (Gave 2 tsp FF Broths)
+10.25 - 105 (Gave 2 tsp FF Broths)
+10.5 - 108 (Gave 1 tsp FF Broths)
+10.75 - 118 (Gave no additional food)
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Oh good that 118 looks good.
 
JanetNJ said:
Joe seems nice and safe now so I'm going to head off for a while. These fine folks who are more familiar with your insulin will be really helpful in deciding on the best dose.

You did an awesome job testing today!!! High five!
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You're so awesome, thank you a million times for all of your help. I appreciate it so much. HUGS
 
Will post a +11.75 number but given the above information, how should we approach his PM shot? He's due now to eat and get his shot and I am unfamiliar with how low is too low to shoot. I know there are guidelines and I just haven't read them yet. Please help.
 
Here is your previous thread on Health, for those following along: http://www.felinediabetes.com/FDMB/threads/first-time-bg-curve-at-home-58-mg-dl-just-now.165590/

Sorry, time for more questions. Were there any complications when Joe was diagnosed, such as DKA? (diabetic ketoacidosis). How much of his food is primal vs. the "diabetic" dry food now?

I was suggesting shooting 1/2 hour later today, cause you gave food at +10.5 and we want that food to be cleeared out of the system to see what his non food influenced blood sugar is. You can get back on schedule by moving shot times up (or back) 15 minutes a cycle (2 cycles a day) or 1/2 hour once a day.
 
Wendy&Neko said:
Here is your previous thread on Health, for those following along: http://www.felinediabetes.com/FDMB/threads/first-time-bg-curve-at-home-58-mg-dl-just-now.165590/
http://www.felinediabetes.com/FDMB/threads/first-time-bg-curve-at-home-58-mg-dl-just-now.165590/
Sorry, time for more questions. Were there any complications when Joe was diagnosed, such as DKA? (diabetic ketoacidosis). How much of his food is primal vs. the "diabetic" dry food now?

I was suggesting shooting 1/2 hour later today, cause you gave food at +10.5 and we want that food to be cleeared out of the system to see what his non food influenced blood sugar is. You can get back on schedule by moving shot times up (or back) 15 minutes a cycle (2 cycles a day) or 1/2 hour once a day.
Click to expand...

He had no other complications, no DKA diagnosed. I was only giving him a small amount of the primal (like 0.2 of a total serving) mixed in with his full serving of Glycobalance (1/4 cup) BID.
 
Wendy&Neko said:
When you are stalling like this, you need to also not feed him. Sorry.
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I'm so sorry, I'm unclear about how to move forward right now. As of right now, it's been 1hr. 20min. Since he had any food and he is at 124. Do we give him food now and delay his shot? Also, how much do I give? 3.75u?
 
It will depend on what his BG (blood glucose) is at shot time. You have to delay both feeding and shooting by 1/2 hour. Normally people here will test, feed, then shoot, all within about 15 minutes. If he doesn't come up significantly, you may be skipping the shot tonight. For people who are new to testing and following SLGS, the Sticky Note on the Start Low, Go Slow Method says:

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

Since he seems to be coming up very slowly, I don't know if he'll make it over the 150 mark. On the Health Forum, we suggest to new users that under 200 they skip, until they gather enough data to know it's safe to shoot those numbers. People here will shoot much lower numbers, but only when they've gathered the data to do so. If you skip, you would start your new reduced dose tomorrow morning and can do it on a time frame that suits you.
 
@Wendy&Neko , Kristen is questioning the dose also. I think you suggested for her to reduce the dose to 3.5 but, it just seems like he was started way to high of a dose. What do you think of a restart back to 1 unit or 1.5?
 
Wendy&Neko said:
It will depend on what his BG (blood glucose) is at shot time. You have to delay both feeding and shooting by 1/2 hour. Normally people here will test, feed, then shoot, all within about 15 minutes. If he doesn't come up significantly, you may be skipping the shot tonight. For people who are new to testing and following SLGS, the Sticky Note on the Start Low, Go Slow Method says:

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

Since he seems to be coming up very slowly, I don't know if he'll make it over the 150 mark. On the Health Forum, we suggest to new users that under 200 they skip, until they gather enough data to know it's safe to shoot those numbers. People here will shoot much lower numbers, but only when they've gathered the data to do so. If you skip, you would start your new reduced dose tomorrow morning and can do it on a time frame that suits you.
Click to expand...

Thank you very much for all of your help. I'm sorry I don't have all the information necessary for y'all to help me with the best information, but what you did post here was very helpful. Since he was 124 at +11.75 I think we will feed and not shoot and then measure in the morning before his morning dose. These guidelines are really helpful, thank you.

Again, I'm sorry for my urgent posts but going through this the first time is terribly stressful as I know you all know. Thank you again.
 
Wendy&Neko said:
It will depend on what his BG (blood glucose) is at shot time. You have to delay both feeding and shooting by 1/2 hour. Normally people here will test, feed, then shoot, all within about 15 minutes. If he doesn't come up significantly, you may be skipping the shot tonight. For people who are new to testing and following SLGS, the Sticky Note on the Start Low, Go Slow Method says:

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

Since he seems to be coming up very slowly, I don't know if he'll make it over the 150 mark. On the Health Forum, we suggest to new users that under 200 they skip, until they gather enough data to know it's safe to shoot those numbers. People here will shoot much lower numbers, but only when they've gathered the data to do so. If you skip, you would start your new reduced dose tomorrow morning and can do it on a time frame that suits you.
Click to expand...

After today will be starting a spreadsheet for sure. ;)
 
Bobbie And Bubba said:
What do you think of a restart back to 1 unit or 1.5?
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He's on dry food, just started seeing greens (albeit too low) on 4.0 units. I think cutting back that low is too much of a reduction. As Sienne stated above, for Joe's weight, he would start on 1.5 units if eating an all low carb wet food diet. Dry food makes a big difference.

If you can get that spreadsheet going, that'll be the best tool for us to help you. If you have problems with the spreadsheet, we have people who can help.

We all know how stressful the first time lows are. :bighug: I was "lucky" in that it took months before Neko gave me her first low, so I had plenty of time to read threads from others to see how they handled it.
 
Kirsten, you are doing a SUPER job! We are all very proud of you and what you've done today. Feline diabetes is a tough disease, kudos to you for taking such good care of Joe. You'll figure it out as you go along. It's a marathon, not a sprint.
Liz
 
Since Joe is a kibble addict can I suggest you go to Youngagainpetfood.com and ask them for a free sample of the Young Again Zero carb dry food. I credit this dry food with my cats quick turn around and remission. It is less then 1% carb. I feed my cat 1 1/2 -2 ounces of wet fancy feast classic pate in the morning and evening and let her free graze on Young Again Zero carb any time she wants. It's amazing. An 11 lb bag is $50 but lasts about 3 months with one cat eating it... It's nutrient dense and high calorie so they eat less of it then regular dry food.


If you look at my spreadsheet you can see where I started feeding it and how drastically my numbers changed.
 
Wendy&Neko said:
He's on dry food, just started seeing greens (albeit too low) on 4.0 units. I think cutting back that low is too much of a reduction. As Sienne stated above, for Joe's weight, he would start on 1.5 units if eating an all low carb wet food diet. Dry food makes a big difference.

If you can get that spreadsheet going, that'll be the best tool for us to help you. If you have problems with the spreadsheet, we have people who can help.

We all know how stressful the first time lows are. :bighug: I was "lucky" in that it took months before Neko gave me her first low, so I had plenty of time to read threads from others to see how they handled it.
Click to expand...

Well it sure helps knowing this community is here. We couldn't have gotten through the day otherwise.
At +12.5 he read 142 so we fed him and did not shoot. We will test him in the morning tomorrow and depending on the result will shoot based on the information above. I will also talk to his vet tomorrow to tell her what all went on.

We will most likely dose him at 3.5 tomorrow morning - does that sound reasonable?
 
Anne & Zener GA said:
Kirsten, you are doing a SUPER job! We are all very proud of you and what you've done today. Feline diabetes is a tough disease, kudos to you for taking such good care of Joe. You'll figure it out as you go along. It's a marathon, not a sprint.
Liz
Click to expand...

Thank you so much. I'm sitting here in tears because my husband and I are both facing deadlines and it made today a bit different than I had originally anticipated. But I LOVE my cats and will put anything aside for them... It's just stressful when you have no idea what you're doing. I know you all understand, so thank you for being there.
 
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JanetNJ said:
Since Joe is a kibble addict can I suggest you go to Youngagainpetfood.com and ask them for a free sample of the Young Again Zero carb dry food. I credit this dry food with my cats quick turn around and remission. It is less then 1% carb. I feed my cat 1 1/2 -2 ounces of wet fancy feast classic pate in the morning and evening and let her free graze on Young Again Zero carb any time she wants. It's amazing. An 11 lb bag is $50 but lasts about 3 months with one cat eating it... It's nutrient dense and high calorie so they eat less of it then regular dry food.


If you look at my spreadsheet you can see where I started feeding it and how drastically my numbers changed.
Click to expand...

THANK YOU Janet!!! I have been on a journey these past few months to find a dry food that would be good quality but also super high protein. I don't understand how Young Again can be a dry food with 1% carbs but I will definitely look into it... Joe likes Fancy Feast (as we found out today) so we may try that with the dry food as you suggested. They need that moisture, which is my biggest concern. Working at a vet hospital I see so much feline diabetes, blockages, urinary crystals, you name it... All because (I believe) we feed our cats inappropriate diets. This is also why I've been exploring the Primal freeze dried. It's a very convenient raw diet. Anyway... I should get back to studying... I can't thank you all enough for your help and support today.
 
OrangeTrioMom said:
@JanetNJ, your spreadsheet is awesome. I'm going to start one ASAP because information gives you control and I need that right now. Today was too much of a heart-wrencher for me... Can't say thank you enough to you all for your help.
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Exactly. The spreadsheet is a very powerful tool. Helps you feel more in control to make educated decisions. After a few weeks I could predict with fairly good accuracy what each dose would do and had very few surprises. If I hadn't started monitoring her at home and keeping records there's no way she would be insulin free right now.
 
JanetNJ said:
Exactly. The spreadsheet is a very powerful tool. Helps you feel more in control to make educated decisions. After a few weeks I could predict with fairly good accuracy what each dose would do and had very few surprises. If I hadn't started monitoring her at home and keeping records there's no way she would be insulin free right now.
Click to expand...

I love it... I'm definitely going to look into the YA food. Now to read all the threads about how to make your cat not hate having his glucose checked. :(
 
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