2/5 Sandy AMPS 163, 120@+2, 47@+4

Gave food and .25 Glargine at PMPS. BG was 124. Have been scanning and BG dropped to 43@+7. He was able to eat a little bit waited 1/2 hour and is now at 70@7.5.
Drops similar to this keep happening if I give shot if he’s under 200. Should I be trying to lower dose?
If so the amount is so tiny already how to I guess less than .25 units?

 

Here’s the sticky on fine dosing which shows the dose less than .25 which is .10. With DKA I think you need to feed higher carbs when you see bg under 100 to avoid a drop under 50. See with others with lots of experience say about decreasing or feeding higher carbs though.

https://felinediabetes.com/FDMB/thr...info-proper-handling-drawing-fine-dosing.151/​

 

Hi Liza, have you had a look at the link tiffmaxee sent you and found the 0.1unit dosing part?
I am going to talk to @Marje and Gracie about the dose moving forward. I will be back.
In the meantime can you tell me what you have been feeding (what carb food) Sandy during the last couple of cycles.

 

Liza I have spoken to Marje and she thinks we should try the 0.1 Unit dose

Do you think you can get that dose in the syringe OK? It is a fat zero barely touching the line.



So moving forward you will need to test for the ketones in the urine at least once a day as we need to make sure there are no ketones appearing now that we are dropping the dose.
Try and get him to eat lots of snacks during the cycles (except for the 2 hours preshot) as food helps keep those ketones away.
Keep feeding the higher low carb around 8 to 10% to try and keep Sandy above 90. If he starts to drop give him some higher carb food but we don’t want him up too high. The last three cycles have been great.
We want to keep him on this dose for a while if we can.

It looks like he is most likely going into remission so you will need to get rid of that dry food out of the house because when a cat is in remIssion he is still a diabetic but just a diet controlled one. If you start feeding him higher carb food again, his BGs will go up and he will all out of remission.
Let me know how you go.

 

He’s only had some FF chicken and gravy 12% carbs. Biggest issue is he’s not eating much. I had to give him some Rachel Ray grain free ocean fish & flaked Tuna because he wouldn’t eat anything else. Not sure carb content on it. When he dropped to 43 I put some corn syrup on his gums because I was worried he’d drop lower.
He is now at BG 75, and has 2 hours to go for shot. What is a safe number to shoot at with the .10? If he remains above 80 is it ok to give? And what if he won’t eat again?

 

Are you giving cerenia?
I have to go out to a meeting and I have asked @tiffmaxee to look in on you.
Sorry I can’t stay atm

 

A lot can happen in two hours. If he will eat only the lc food we can add corn syrup to it. Do you think he will eat the higher carbs if it’s mixed with the Rachel Ray? Just a couple teaspoons each time will be enough.

 

Yes still on Cerenia, hasn’t thrown up but still just not eating much, licks food and leaves most of it. I made it more soupy and he ate little more, tried that again and wants nothing to do with it. Tried freeze fries crumbled over food doesn’t eat much still.

 

If you haven’t give a dose of cerenia.

 

I’d give him a break from food and test an hour from the 7.5. Do you have any ondansetron? It sometimes helps better for nausea and can be given along with cerenia. It works in a different way.

 

It was just at the 2 hour cuff off time till shot so I gave him some friskies chicken dinner in gravy and he had about a tablespoon, hopefully that’s enough to bring his number up some for shot time. Just delayed his time by 15 minutes.
And ok I will add the corn syrup for his next meal if he’s still low.
Just seems that he takes these drops if he’s under 200 BG with only .25 units.
Dropping to .10 as advised. What is a safe number to go by for the new lower dose?
If he’s over 100? Over 150?
Thanks for your help

 

With DKA I’d like you to shoot even if 100 but I will check back. If he’s lower than 150, stall and don’t feed until we decide what to do.

 

Ok

 

It’s shot time he is at 79. Can I feed and give .10?

 

Yes. Have you practiced drawing up that amount? If he won’t eat let me know. It would be good to give him some of the higher low carb food if he will eat it to prop him up. You need to get a +1 and +2 .. You have plenty of test strips?

 

Ok. And yes I did practice. I have 2 flavors of the 8% carb food that he has had no interest at all with. He’s eating FD turkey and gravy right no and seems to be hungry so crossing my fingers he eats more.
I will get +1 and plus +2.
As far as the testing he has a lifestyle libre on which I just scan. I also have a human meter but when I try and use it it’s giving me error codes every time.

 

Maybe you aren’t getting enough blood.

 

Please add your tests to the subject. What was + 1 and +2 must be soon.did he eat after each test?

 

Just took the +2 he is at 50. A had already added the +1 it was 110

 

You need to give some high carb food with a drop of honey and test again in 20 minutes.
Can you let us know when you have done that please Liza?thx

 

He didn’t eat at +1. Trying to get him to eat now

 

Add some syrup to the food. Can you syringe feed him if he won’t eat.

 

Do you still have cerenia Liza for him?

 

He ate about 1 teaspoon of friskies chicken dinner in gravy 13% carbs.
I don’t have syringes to feed that way. And had about 4 soft irresistibles treats. I also put some syrup on his gums

 

Yes he took 1/2 a pill this am. Next dose is tomorrow morning.

 

After this has happened now so many times I don’t know what to do with what’s going on. He keeps dropping with any amount I give him and I don’t know if I feel comfortable continuing to give more insulin given I canny see to get his number up high enough to make the shot safe. Only food he has no problem eating is the dry and he won’t even eat that right know. I don’t want to force feed him either as I’m afraid that will make him throw up.

 

That’s good

How long since he ate these foods?
Is his next BG due soon?

 

You will need to keep getting food into him every 30 for several hours until he’s high enough to stop. I know you are exhausted.

 

I can understand your worries. just concentrate on keeping him up this cycle and I will tag @Marje and Gracie about moving forward.
We really need him to be eating well before we stop insulin.

 

@tiffmaxee I have to leave to do the school pickup in a few minutes. Are you able to stay with Liza?

 

@Bron and Sheba (GA) Yes. I will stay.

 

I don’t understand all the i go too much much my concern has been the drops he’s had on such a small amount of insulin. I am constantly up barely getting sleep giving him small amounts of food almost every hour so his numbers don’t keep dropping once this happens. I just scanned just no and he’s at 43. So he’s gone down more. He’s bouncing between 43 +50 and can t get him to eat enough. Other than the dry food, which seems to be the only food that gets his numbers higher and keeps it there, I’ve tried about 15 different types of food that he is being super picky with. I put syrup in the food and he find t have much of it. So I rubbed some on his gums to see if his number will come up

 

Ask the vet if you can get a RX for ondansetron, a human drug that works even better for nausea for many cats. It’s what I gave Max mostly. It can be given every 8 hours as needed.

 

If all he will eat is the dry food I would give him some. The syrup doesn’t stay with him as long as food will. The .25 dose is effecting this cycle. If he will eat well you won’t have the issue with dropping as much.

 

Ok will call in the am to get some.

 

Another thing that might help is another human medication I gave Max. It’s an antihistamine that also is RX called cyproheptadine.. with cats it acts as an appetite stimulant. It can be given as needed. Just a sliver worked for Max much of the time. Vets like to give mirtazapine but if cyproheptadine works I prefer it as it can be given twice a day and has fewer side effects.

 

If he is at 43 now I would rub some honey on his gums now and test again in 20 mins

 

That’s what live had to fue last few cycles because he just won’t eat much of the wet food. And because I was trying not to give him much it was a struggle to get him past 200.
I know it’s not ideal to be above 200 the goal is to get him down. But if I shoot below this number this starts to happen and it’s very frustrating knowing not to give him dry but it’s the only food that will work fo him to stay in a safe range (for him) to shoot. I know that’s not what happening with other cats but I believe this is the 4th to 5th times it’s happened with him. Now that he is this low I will just be up all night and all day monitoring him. This just isn’t working for him or me, I’m very frustrated following instructions as best I can and then his numbers drop like this

 

He’s on an appetite stimulant called Miratz at the moment. I run it on his ear once a day

 

I totally understand your frustration. The exhaustion doesn’t help either. Will he eat chicken? I wonder if a gently cooked diet would work for him? Have you tried baby food?

 

That’s the same as mirtazapine. Sounds like it’s not helping.

 

I have tried plain cooked chicken and he won’t eat it, won’t even try. I haven’t tried baby food, any kind you recommend?

 

Yes. All my cats have liked Gerbers 2nds ham believe it or not. It also ones in turkey, beef, and chicken. One of my would not eat the chicken. It’s 100% protein with some cornstarch. They didn’t like other brands. Another thing to try is chicken livers which you can sauté in a frying pan. Have you tried any of the freeze dried raw foods? I feed my current two Primal and Small Batch frozen but Primal makes freeze dried.

 

Have you checked the BG again? Wendy mentioned that the Libre sometimes reads even lower than the human meters when under 50.

 

Yes I tried putting some crushed freeze dried on his food today and he grazes the top and that’s it. I don’t know how many more cans of food I can open for him to try and not like is going to grab some of the baby food tomorrow and see if he likes it. Is tha enough carbs you think to keep his numbers more stable?

 

So he liked the freeze dried?

 

The baby food isn’t a complete food but will work in a pinch and you can add syrup to it to get carbs into him. If he will eat freeze dried there are some that are 100% nutritionally complete like Primal and even Stella and Chewy’s.

 

Bg reading please

 

Just posted it. He is at 49

 

You need to get more carbs into him to get him into the 60’s.

 

The libre will give you a reading above 40. If lower than 40. It will say LO, I looked it up and it said it’s too low to read. It will also only go up to 500 anything above that will just said HI won’t give you a reading.
I’ve been afraid to shoot when he is under 200 because I keep struggling to keep his number steady, if I don’t stay on him he drops. My worry is if I fall asleep and he drops. I honestly don’t know what I’m going to do at this point because I can’t take many more of these nights and have the result be the same. I was asked yesterday when I asked this same question and my concern why I’m aiming to stay above 200.
Here’s the thing. He will eat fancy feast pate, but his numbers will come down which is good, so if no DKA this would be his way to remission.
But because he had DKA I can’t stop insulin.
But when u give it under 200 he has drops similar to this.
I’m seriously at a loss here.

 

He ate a small amount of dry food, it’s 14% carbs. Any suggestions on getting more carbs into him? Should I just keep giving him the dry?

 

Let’s see what the dry did. Check in 30.

 

Ok

 

Just did his +5 he’s at 56

 

See if he will eat a little food. If not wet give a little dry.

 

I see he’s at 60 now. What did he eat last?

 

Had about table spoon of dry. And I gave him 5 blue Buffalo crunchy treats and had about 4 temptations. The treats are about 1-2 calories each, know they are higher in carbs.

 

What is the BG now?

 

I’m back. Sorry I was so long. I see you have been battling to keep the BGs up this cycle.

 

Just scanned him and he’s back down to 53

 

Yes really struggling, I’m setting my alarm to 1/2 hours because I’m also struggling to stay awake. He went up a little and now back down to 53.
He is asleep and I tried to feed just now again and he’s not interested and went back to sleep.

 

More food.

 

I tried giving him food but he was sleeping and not interested and went back to sleep.
Very hard to get him to eat as it is, and now that he is sleepy not sure what to do.

 

If he won’t eat, rub some honey or Karo on his gums. We need to get him up a bit higher

 

Ok

 

Test again in 20 minutes please Liza

 

Put karo on his gums. I scanned again and he is down to 46. Will scan again in 20 minutes

 

I would rub a bit more on his gums. Not too much as we don’t won’t to make him sick

 

Liza, would he eat the FFpate with a bit of honey in it?

 

I’ve got about 4 plates of different foods including classic chicken pate. He had a couple of bites of ff beef in gravy just now. His numbers don’t seem to be changing much. Bouncing in low still.
His next shot is in 5 hours and I’m already stressing out about that one. I really don’t feel comfortable giving him any more insulin when he’s in lower numbers. This is happening too many times now.
I understand Falmouth of carbs in foods matter and important to stick to wet food but Sandy just isn’t cooperating with any of it. My biggest worry is he will drop lower next time so if there is anything else I can do besides given insulin when numbers are low I’m open to it.
is it possible to give 1 shot a day?

 

One shot is a possibility. See what Wendy and Marje suggest.

 

Liza I am waiting to hear back from the moderators about Sandy.
We know you are exhausted and having trouble getting Sandy to eat enough to stay up in normal numbers.
Hang in there. I will stay with you now. Elise is heading to bed. Thanks so much Elise!

 

Have you tested again?

 

Yes I did he came up to 62. I just added it on SS. I’m so tired I forgot to put it in when I did it, it was 20 minutes ago. So I’m going to scan again in about another 10 minutes

 

You are doing well.
Its hard to function when you are so tired.

 

It sure is, im not exaggerating I’ve gotten about 20 hours of broken sleep past week.
Even when I can lie down for few hours I’m awake with worry and have even woken up in a panic over Sandy.
He is just the sweetest cat and I love all my pets so much I can’t stand the thought of something happening to him again.

 

He finally went up a little more. He’s at 76

 

Great! Don’t feed him this time and let’s see if he can stay up on his own.
I’ll watch for your next test.
Have you managed to get a ketone test in this cycle?

 

I got one this morning. I usually try and get it early in the day. Is AMPS & PMPS a cycle together? So 24 hours? Or is a cycle counted as every 12? If so should I be testing his urine twice a day?

 

A cycle is 12 hours.
Once a day at this stage is ok if the tests are negative.

 

I see 68 at +9.I would not feed him and test again in 30 mins Liza to see if he is maintaining the BG ok.

 

Ok I’m going to set my alarm as I’m dozing a bit. I’ll post it soon as I take the next one

 

Ok. How long til the next test so I can watch for it.?

 

Just did it he’s at 82

 

Don’t feed him. When did he last eat?

 

It’s been little over 1 hour, he had a few more temptations 5-6. It’s a tiny snack, less than 2 calories each.

 

OK don’t feed him any more so we can see what he’s doing on his own.
Can you test +11.

 

I’m in and out of sleep I’m going to set my alarm again will be taking another one in 40-45 minutes

 

Yes that’s my plan just set my alarm

 

He is now 123 at +12

 

How are you feeling Liza? Are you able to monitor this cycle or are you too exhausted?
And have you got another ketone test in since this morning?

 

I honestly exhausted but I can set alarms to keep monitoring if I need to.

 

What time is it there at the moment? the reason I’m asking is because I’m thinking it is probably in the early hours of the morning...is that correct.

 

Hey Liza, are you there still?

 

It’s 8:30 am over here. And I’m here just getting up with alarms because I’m falling asleep right away sorry for th Edelman in answering

 

Liza I was concerned you had fallen asleep. I know you are really tired after days of close monitoring.
And I know you have been trying to get back to a better schedule for the shots.
What I was going to suggest is, because you have had such a hard time getting Sandy up over 50 and keeping him there today, you skip this dose, get a few hours sleep and then shoot around 8 am tomorrow but it’s already past that time.
You don’t sound in any fit state to be trying to monitor Sandy today.
When did you last test for ketones?

 

Hey Liza, are you still there?

 

Sorry I really am struggling
I’m going to try and see if I can test him soo if I manage to catch him using the litter box.

 

Hi Liza,

Bron asked me to stop by.
I take it you haven't shot yet?
Once you get a ketone test, let us know and maybe grab another test after that pmps, I'm guessing you are about 30min beyond shot time?