1/4 Henry AMPS 141 PMPS 115 could use some help with fine dosing.

Hi everyone,

Was told to post here from the welcome forum. My boy Henry is 13, and was diagnosed on 12/30/20. Vet believes diabetes may be steroid induced, he's no longer taking them.

Vet told me to start at 2 units of Lantus BID; did that for about a day until I started doing my own testing. I've lowered the insulin dose according to his preshot numbers, he last shot I gave was morning on 01/02/20, 0.25 units. I haven't given anything since then as everything I've read says not to shoot lower than 8.3 (150) if unsure how kitty will react and I'm terrified of him going hypo.

I've managed to keep him somewhat green and mostly blue with a diet transition to mainly canned food - people in the welcome forum told me I should come here to get some insight on fine dosing. I'd like to get him in the green as much as I safely can to encourage a possible remission.

He tends to go green after mealtimes for a few hours, then reverts back to blue around the 5+ mark. Hoping any of you would be so kind as to look at his chart and let me know if I should be giving 0.25 units BID, or giving a finer dose.

I had quite some difficulty with the 0.25 dose- found it next to impossible to pull up in the syringe, so I'd really appreciate any insight on how to draw up finer doses (if you all think his numbers warrant them.) I have U100 3/10 0.3ml syringes.

Thank you for reading my novel! I'm a concerned cat mom and feel overwhelmed with all the information out there. Unfortunately I had to go back to work today so I won't be able to get readings after his AMPS shot for about 9 hours, which makes me now even more hesitant to shoot in the mornings.

https://docs.google.com/spreadsheet...itnqaaiZOn2OhwhBBwKsv5XSsSE/edit?usp=drivesdk

Angela & Henry

 

Hi Angela and welcome to the Lantus forum.
As you know dosing is based on the nadir, not the preshot for Lantus.
Yes, Henry does still need some insulin but it is good his BGs are going down after food. That shows that the pancreas is kicking in a bit.
The next dose for you to try is 0.1unit. You might find a magnifying glass helpful. Some people use calipers to get the tiny doses as well.
I will attach a photo for you to see what it looks like. The 0.1 unit is the middle picture.
Are you giving snacks during the cycles as well as preshot? If you are having to work, a timed feeder would help with dispensing the food for Henry.
I would make sure you get tests in during the early part of each cycle as well as mid cycle as his BG is dropping from the food..

If Henry is under 150 at shot time, stall, don’t feed and test again in 20 minutes to see if the BG is rising and post and ask for advice

 

Hi there!

Thanks for your response. I have started with the 0.1 dose as you suggested. That photo was extremely helpful, thank you for posting.

He's not much of a day eater (sleeps all day) but when he asks he gets snacks from my mom who is home with him. I will look into an auto feeder for when I'm at work, that's a great suggestion.

I can get tests early and mid cycle tests done in the evening after his shot without issue. It's impossible for me to do it after his AM dose though, because I'm at work. Weekends I'd be able to do it for both cycles. That's why it makes me so nervous to be giving him any insulin in the morning. Do you think I should just skip the morning shot until I can fully monitor him on the weekend? My mom is home with him during the day so she can keep a watchful eye on him; however she can't do testing as she had a stroke last year and can't use her right arm.

His spreadsheet is updated with my 0.1 dose last night if you'd like to have a look.
Thank you for all your help!

 

Hi Angela,
Henry is certainly wanting to come off insulin, but he's not quite there yet. We want a strong remission for him so that means having him in mostly or all green numbers before stopping the insulin.

What food are you feeding him at the moment?
I see you have some dry food in your signature. Do you know how many carbs are in the dry?
How much dry does he get and when does he get it? Just trying to work out why he is in green sometimes and blue other times and wondering if it is the food, or just Henry bouncing a bit from the greens. Some of the blue numbers are from skips.
Maybe if you could get rid of the dry he might go down into geeen numbers. But only try that when you are home to monitor the numbers.

Do you know how many carbs are in the wet food?

He has earned another reduction down to a drop of insulin with the BGs dropping under 90 yesterday.
There is a photo of a ‘drop’ in the photo I attached in the first post...it is the “some”insulin picture.
Another way to draw up a drop is to draw up 0.25 units then gently squeeze out a drop at a time until there is none....do it a few times with an old syringe and water to practise. Count the number of drops. Then when you are ready to draw up the insulin squeeze out all the drops except the last one. And give that last drop. Does that make sense?

I would also make sure he eats during the day cycle while you are at work. I would wake him up if he sleeps all day and give him a +1 and a +3 and +5 snack. We want to stop him from dropping too low early in the cycle and food is a way of stopping that happening. Do you think your Mom could manage that? You could do the same with the pm cycle.
What we are trying to do is stop him earning another reduction and keep him on the insulin for a bit longer.
Can you write in the remarks column of the SS what and when you feed Henry please.

Its better if you don’t skip the am dose, but in saying that I do understand your anxiety about him dropping low and you not there. You hold the syringe and you have to be comfortable and happy with whether you shoot or not when you have to work. Henry is still very early in the FD journey and you don’t have a lot of data. Most people have a lot more time to prepare for shooting low numbers, but Henry is on a mission, so if you are uncomfortable about shooting then going to work, skip the shot until we see how he goes with the extra feedings and hopefully removing the dry food.

Does you Mom know about rubbing honey or Karo onto his gums if he shows any signs of a hypo? Could she manage to do that?
Here is a link to how to recognise and treat a hypo. Print it off and put it on your frig
https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

He’s a gorgeous boy!

 

Thank you so much for responding.

Noted that we are not quite there yet and wanting to have him in mostly in green numbers.

I'm feeding him Tiki After Dark canned, there is 0 carbs in his canned food. The dry food is Petcurean Go Grain Free Chicken, Turkey & Duck. Dry is Protein 46%/Fat 18%/Carbs 15.5%. He eats very little dry, maybe 1/8 a cup daily split between am & pm feedings after he eats his canned food.

I've been gradually cutting down the dry, which may be why he's more green now? Some blues are definitely from skips. I'm going to attempt getting rid of the dry completely this weekend when I'm home to monitor. I'm trying to get more sound in my feeding routine as I have two other kitties (so three total with Henry) and feeding them separately is a disorganized fiasco, my place isn't big. One kitty will only eat dry, second kitty will only eat canned pate, then we have diabetic Henry who will inhale anything in I put in front of him in 60 seconds.

The dropping explanation definitely makes sense, I'll be doing a lot of practicing tonight until I feel confident.

My mom could definitely handle the +1/+3/+5 snack. Is dry or canned they way to go here for the snacks? Seeing as his canned has 0 carbs and we want to keep him from dropping too low- but giving dry snacks seems counterintuitive. Maybe I should switch canned food.
I will add his food to my spreadsheet. What should I put in the insulin dosing column? I guess "drop" would suffice?

Henry sure is on a mission! I'm still somewhat shocked his Vet told me to give 2 units BID and that there was no need to monitor at home.

I have a hypo kit ready, mom can help with that if he exhibits signs while I'm at work. Thank you for linking the sheet, I'll definitely tape it to the fridge. I'm still not sure if I feel comfortable shooting in the morning. I shot this morning and he did well, tested at 85 half an hour ago for his PMPS.

Thank you again for all your help.

 

Maybe looking for some low carb canned food that is higher than 0 carbs but lower than 10% to feed instead of the 0 carbs to see if that helps with keeping the BG up a bit.

 

Hi Angela. It looks like you decided to skip insulin tonight. I hope you can get some canned 10% . If you are stalling he will likely drop with out food. Please confirm whether you are stalling or skipping.

There have been steroid induced cats that quickly went OTJ. One is Kyle’s Simon. Henry might not need insulin just as fast. Here’s his spreadsheet.
https://felinediabetes.com/FDMB/thr...al-day-3-ambg-64-pmbg-84.233781/#post-2614005

 

Hi there!

I apologize for the delay, yes I skipped tonight. I rechecked at PMPS +1 and he hit 4 (72.) I got scared and decided to skip. He ate some 8% carb canned after that reading and is now at 6.2 (112) PMPS +3. Back in blue... I don't even know if I did the right thing here. Did I do the right thing? If I get a lower AMPS/PMPS in the future, should I feed him to get him up and then shoot 0.10 to ensure a good remission?

I have no idea what to shoot tomorrow morning now. This is so completely stressful for me, I have no idea how you guys do this daily and even take time out of your day to help others. I'm so appreciative and thankful for this community. I feel like pulling my hair out.

 

It is stressful, no getting around it. With the great response you are gettingI think your stay here will be short. (Anti-jinx). You were right to skip. Were you feeding a high carb food before diagnosis? I would not feed him to bring him up. If you did the bg would be food influenced and he could then drop too low. We pick up food 2 hours before insulin for that reason. What we do is stall, don’t feed, and test again in 20-30 minutes to see if the bg comes up on its own. If it dies you can shoot. If not you need to skip. He’s only been on insulin for a week and already in normal numbers. How long was he on steroids or was he given a shot. How long has he been off? It was for the URIs?

 

I hope my stay here will be short too! Okay I think I gotcha. Don't feed to raise levels because he could drop too low if I shoot. No food 2 hours prior to insulin. If he's low, stall, don't feed and test again in 20-30. If bg comes up, shoot. If not, skip. I'm going to print this and put it on the fridge.

Am I correct in only shooting if his preshot numbers are blue?

He was on steroids for about 14 days. They were stopped on 12/29/2020, the day before he was diagnosed with diabetes as I noticed he was drinking a lot. So off for a week. He was on dexamethasone, but it was not an injection. It was a solution he was taking intranasally. It was something my Vet thought he should try to help the URI's, yes. He has some kind of growth/polyp in his sinuses so he has ongoing secondary URI's due to that. Vet doesn't want to give him more antibiotics fearing he'll become resistant. Next step for this is a CT scan and possible endoscopy if they think they can get the mass out in chunks. Was planning on doing it in the spring, $4k+ here to get all that done. He also has arthritis and panniculitis, although I don't think that's relevant to the diabetes. Poor boy has so many issues and I feel so awful he's diabetic now.

Yes he was on a high carb dry prior to his DX, Hills Metabolic as recommended by my Vet to lose lbs because he's overweight. Low in cals but high in carbs.

 

Poor boy. I had to look up panniculitis. It sounds like it can be cured by surgery? Feeding a canned or raw diet will help him lose weight. It needs to be done slowly though. Lisa Pierson has a section on her site on it and I helped my friend’s cat lose weight following her guidelines.

I would not shoot if green. If that happens again I would go to a drop dose at the next cycle.

 

Has the vomiting settled during the pm cycle.?

 

Yes, no vomiting this morning after feeding, although I had to leave for work. I told my mom to call me if he throws up again. AMPS was 7.1 (128) but I didn't feel comfortable shooting with the vomiting yesterday. Will see where he's at tonight.

In the past when he's eaten too quickly he's regurgitated his food an hours later, I think that may be what happened here. Although he had 3 separate episodes of throw up last night which is rare for him. He was feeling so crappy once he hit 15.7 (283) I just let him sleep.

I didn't realize vomiting could raise BG. I hope this isn't DKA or pancreas related.

 

Does she have a history of pancreatitis?

 

No history of pancreatitis. No vomiting today so far. Do you think this episode last night warrants a Vet visit?

 

No. Cats vomit sometimes for no apparent reason or eating too fast. I never run to the vet unless my cats act sick after vomiting r repeatedly vomit a few days in a row.

 

Angela, are you checking the urine for ketones?
With all the skipping of doses I think it would be a good idea.
You can buy Ketostix from Walmart or a pharmacy. You just collect a urine sample and test the urine strip after dipping it in the urine exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention.

 

Hi!

I'll pick some up at the pharmacy tomorrow. Any advice on how to collect the urine? Could I stick the test stick in a stream of urine as he's going?

I use clumping cat litter so I don't know how else to collect one.

I intended to start shooting again tonight but his PMPS was green at 4.8 (86) so I skipped again. I even tested twice to make sure it wasn't an error. Should I have given a drop with an 86 reading? I truly do not understand what is going on. He hasn't had insulin since yesterday morning.

Thank you for your help.

 

Yes you can put the test strip into the stream of urine or collect some as he’s peeing in a small container. Make sure you read it exactly 15 seconds later.

Can you start a new thread for today please Angela as we start new threads each day on the Lantus forum otherwise the threads get too long.thanks
In the subject line write the date, then Henry AMPS (or PMPS) xx and a question if needed