5/2 Pete AMPS 373 +3 348 +6 214 +9 168 +11 258 - TR guidance, feeding schedule

CrazyKaitLady

CrazyKaitLady

Member Since 2024
Hi! First post here so please let me know if there's more info you need from me.

I've been working with my foster Pete since he came to our rescue with a DKA episode at the beginning of the month but didn't learn the protocols in this group until the last couple weeks. Our current schedule is as follows:
  • BG checks every 3h from 6am to midnight
  • Insulin at 9am and 9pm - 2.5u Lantus
  • Full can of food (Fancy Feast pate) with insulin dose (9am/9pm)
  • Snacks: was previously giving another full can at noon and at midnight. Per advice on the Facebook page to spread his food intake out, two nights ago I started distributing the 2nd and 4th cans so he gets 1/3 a can at noon, 3pm, and 9pm and then 1/2 can at midnight and 6am (so I can sleep). When my timed feeder arrives today, we'll go to 1/3 a can at midnight, 3am, and 6am so it's evenly distributed
Things I'd like guidance on:
  1. Feeding: Is the [meal at insulin time] [snacks in between] a good model, or is it better to distribute the food evenly throughout the day? He gets 4 cans total a day and I'm feeding on 3h increments so I can either do [FULL, 1/3, 1/3, 1/3, FULL, 1/3, 1/3, 1/3] -- or -- [1/2 can every 3h all day]
  2. Dosage: ((UPDATE)) Probably not going to increase dose because his +6 readings after I posted this were 225/269/182/214 (I did several to make sure).
    ((ORIGINAL COMMENTS)) We're currently at 2.5u but I'm debating increasing to 3? Would love some feedback. You can see on the spreadsheet I did one anomalous dose of 3u on 4/30 pm because I thought I should increase based on the TR procedure, but then I went back to the original dose because I also changed his feeding schedule to add in the snacks that night and didn't want to change two variables at once. As he's still in the 300s to 400s consistently, I think it might be time to try 3 units? Spreadsheet should be in the signature.
Would appreciate any help. Thank you!
 
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Welcome to LLB. I think most feed meals at amps and pmps and then give small snacks in between. You don’t want to feed a lot of food on the second half of the cycle as it might shorten the insulin duration. If the bg is dropping quickly you might need more snacks to prevent it dropping too low.
 
tiffmaxee said:
Welcome to LLB. I think most feed meals at amps and pmps and then give small snacks in between. You don’t want to feed a lot of food on the second half of the cycle as it might shorten the insulin duration. If the bg is dropping quickly you might need more snacks to prevent it dropping too low.
Click to expand...

Thank you! I stuck with the meal and snacks for today and his numbers actually kinda resemble a curve? So we'll see if that holds through the night...fingers crossed!
 
CrazyKaitLady said:
  1. ORIGINAL COMMENTS)) We're currently at 2.5u but I'm debating increasing to 3? Would love some feedback. You can see on the spreadsheet I did one anomalous dose of 3u on 4/30 pm because I thought I should increase based on the TR procedure, but then I went back to the original dose because I also changed his feeding schedule to add in the snacks that night and didn't want to change two variables at once. As he's still in the 300s to 400s consistently, I think it might be time to try 3 units? Spreadsheet should be in the signature.
Would appreciate any help. Thank you!
Click to expand...
I'm going to tag some experienced members for you about whether you need to increase the the dose , by the way we increase or decrease by 0.25 units at a time
@Wendy&Neko
@Suzanne & Darcy
@Bron and Sheba (GA)
 
Are you testing for ketones in the urine following the DKA a month ago? If not I would encourage you to do so as it’s important to monitor ketones after DKA. To do this you will need a bottle of Ketostix from Walmart or a pharmacy and you will need to collect a urine sample from Pete and follow the direction on the bottle. There should be no ketones in the urine. If there are no ketones in the urine I would continue to monitor twice a week for the time being. And more often if he seems unwell ir off his food.
 
When following TR, you need to have at least six continuous cycles at a particular dose (unless they go below 50). This post on Reminder: Counting Cycles explains it. You had six cycles from 4/25 PM to 4/28 AM, then reduced the dose. You could probably go up to 2.75 units, based on that older data. I wouldn't go to 3.0 units just yet.
 
Bron and Sheba (GA) said:
Are you testing for ketones in the urine following the DKA a month ago? If not I would encourage you to do so as it’s important to monitor ketones after DKA. To do this you will need a bottle of Ketostix from Walmart or a pharmacy and you will need to collect a urine sample from Pete and follow the direction on the bottle. There should be no ketones in the urine. If there are no ketones in the urine I would continue to monitor twice a week for the time being. And more often if he seems unwell ir off his food.
Click to expand...
Thank you! I hadn't been but I now have a borrowed a blood ketone meter and yesterday and he was at 0.3 which is in normal range from what my research shows? I got urine strips and will try to start spot checking with those when I can catch him. We were also doing sub-q fluids pretty consistently for the first week he was home and then when his BGs were high or his drinking increased intermittently after that (in collab with our vet).
 
Thank you everyone! The pattern in his BG definitely changed after adding more snacks earlier this week. Before now, every time his BG got below 200, he would bounce up over the next 12-24h into the 500s. Yesterday we had a 168 @ AM+9, a 407 @ PM+3, but he went back down to 355 @ PM+9 which I'm happy about. I'm going to hold the dose for now because he's showing changes and I also will be out of the house during the day tomorrow so I won't be able to monitor him as closely, but I'm going to reevaluate and maybe bump the dose by .25 at the beginning of the week. Appreciate the feedback!
 
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