Big George New Thread Dosing advise ASAP AMPS 83 and ketones .3

Hey there! I dosed a super skinny 1.25u this AM and am thinking that I should have just done 1u since he dropped below 90 last night! He has dropped below 90 again today, so tonight should I just shoot the 1u? Also, just curious of why not to go below 1u? I think it’s because he was DKA/had ketones but just trying to understand/know what to follow/handle since his numbers have been lower! I do see that he starts to rise after +4/+5 but still just trying to take all of this in! Thanks in advanced! 😊
 
Answering over here so it’s not on the old thread but @Marje and Gracie I’m glad that @Suzanne & Darcy was too! 😊 I appreciate everyone’s help on this so much!

As for tonight, am I okay to lower dose to 1u or do I need to stay at 1.25u (I did a super skinny this morning) since he fell below 90 overnight and he dropped below again today? I think that I’m supposed to stay above 1u because he was DKA/had ketones but just trying to understand! I think that all of the lower numbers are a great thing but being two weeks in, I still have so much to learn! Thanks!
 
Hey there! AMPS is 83 and ketones .3 this morning! Was going to dose .75 due to him being 83 @+5.75 but worried about ketones!
 
He’s been a little lethargic the past day but I read that could be due to lower numbers but and going to get an appointment for bloodwork to make sure infection hasn’t returned! He is eating but not as much last night!
 
Steph & Big George said:
He’s been a little lethargic the past day but I read that could be due to lower numbers but and going to get an appointment for bloodwork to make sure infection hasn’t returned! He is eating but not as much last night!
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You can still shoot 0.75u. That ketone level is still within the “normal” range. But try to get more food in him today. Are you able to do subq fluids at home? If not, add lots more water to his food.

Be sure you get a +1 and +2. Will you be there to monitor him and feed if necessary?

We can’t skip like we might with another cat so I’m hoping you’ll be there to test/feed.
 
Marje and Gracie said:
Let’s hope he will be a very good boy today.
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I hope so! Thank goodness he doesn’t have teeth or just has numbs for teeth or we’d be in trouble! I’m sure he needs a dental and I know you or someone said the q-tip trick would show troubled teeth!

Is there a time period I need to wait, like until he gets more stable or when we are more than 2.5 weeks in, to think about a dental…or just wait to see if bloodwork shows any kind of infection!

I guess his ketones could just be that he didn’t eat as much last night (but did eat a lot with my mom during the day) and I stopped adding water to his food so he didn’t drink enough because there hasn’t been much water missing from his bowl? I need to go and read the ketones info again!
 
Steph & Big George said:
I hope so! Thank goodness he doesn’t have teeth or just has numbs for teeth or we’d be in trouble! I’m sure he needs a dental and I know you or someone said the q-tip trick would show troubled teeth!

Is there a time period I need to wait, like until he gets more stable or when we are more than 2.5 weeks in, to think about a dental…or just wait to see if bloodwork shows any kind of infection!

I guess his ketones could just be that he didn’t eat as much last night (but did eat a lot with my mom during the day) and I stopped adding water to his food so he didn’t drink enough because there hasn’t been much water missing from his bowl? I need to go and read the ketones info again!
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It “can” show a feline resorptive lesion but it’s not 100%.

Most often, when to the dental is not dependent on their diabetes but when the vet feels comfortable doing it. If he’s fairly stable and ketones are normal for a few weeks, it then depends on his labs, what might need to be done (how extensive & how long under anesthesia), and how the vet feels about doing it.
 
Marje and Gracie said:
It “can” show a feline resorptive lesion but it’s not 100%.

Most often, when to the dental is not dependent on their diabetes but when the vet feels comfortable doing it. If he’s fairly stable and ketones are normal for a few weeks, it then depends on his labs, what might need to be done (how extensive & how long under anesthesia), and how the vet feels about doing it.
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Gotcha! I’m in the process of trying to find another vet so I need to establish that first too! Thank you!
 
Does your mom have the ability to update the spreadsheet so we can see what’s going on? Does she know how to post here for help? I am sure she will contact you. If his +2 is lower, does she have higher end but still LC food options up to 10% carbs? Does she have medium carb foods to feed him?

Ketones are still very good at .3, but you are doing well to keep testing them every day since there is that possibility of the dental infection returning and then his ketones could rise quickly. It is also possible that he just isn’t as hungry right now because he’s in better numbers — that’s pretty normal. Also, you are right about the possibility that he could feel a little odd in these lower numbers that he’s not used to, and that could cause him to be a little lethargic. It doesn’t do that with all cats, but some do react that way. So many variables! If his tooth is hurting, that could definitely put him off his food and make him a little more subdued. I definitely hope that’s not it! Keep up the good work!
 
Thank you! I just updated the spreadsheet from what’s she sent! He was 77@+1 and 80@+2.25! She’s been giving him 5% food (normally eats 3%) a tsp every hour! I haven’t been out to get a good mid carb but I think you said previously we could maybe mix a little HC with LC to make a MC?

I have other FF medleys that I thought were mid carb but don’t exactly match the food sheet so I think they are HC and have FF gravy lovers for HC!

Also, for tonight….probably all depends on BG then and ketones, but do we keep the .75 or drop to .5? Sorry to get ahead but just trying to have a little plan!
 
Steph & Big George said:
Thank you! I just updated the spreadsheet from what’s she sent! He was 77@+1 and 80@+2.25! She’s been giving him 5% food (normally eats 3%) a tsp every hour! I haven’t been out to get a good mid carb but I think you said previously we could maybe mix a little HC with LC to make a MC?

I have other FF medleys that I thought were mid carb but don’t exactly match the food sheet so I think they are HC and have FF gravy lovers for HC!

Also, for tonight….probably all depends on BG then and ketones, but do we keep the .75 or drop to .5? Sorry to get ahead but just trying to have a little plan!
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It sounds like he’s doing very well, and your mom is doing great! Let’s wait and see how the rest of the cycle goes today – – at least let’s see what his nadir will be.
 
I would stop feeding him now if you think he’s taken in enough calories for the morning, but if not, just switch to the lowest carb food that you have and just remember to stop feeding two hours prior to PMPS.
 
I would like to see how he continues to do on the .75 unit dose, but I suppose we had better go ahead and follow SLGS for now and see — as long as his ketones are staying low. We can always go back up if necessary.
 
Suzanne & Darcy said:
I would like to see how he continues to do on the .75 unit dose, but I suppose we had better go ahead and follow SLGS for now and see — as long as his ketones are staying low. We can always go back up if necessary.
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Okay, so go with .5u since we dropped below 90 and then if we have to go back to .75u we can! Just want to make sure I got it right?
 
Hey there! @Suzanne & Darcy! Hope you’ve had a good day!

Big George has stayed below 90 all day! He has snacked some all day and just ate the most he has at one time in two days (he’s been eating but just not quite like he was which may be a good thing since he does need to lose weight and maybe the diabetes aren’t driving his hunger…and could be that we started added water back which he doesn’t love now for some reason)!

I gave him a .5 skinny this morning since he had dropped from my test ant 5:30am and his ketones were low at AMPS! Since we are following SLGS I need to reduce to .25 tonight, correct? Thanks!
 
Just so you know, there are doses smaller than .25 units, in case he needs it. We may need to switch dosing methods— depending upon his numbers. What we want is to try to keep him in green numbers above 50 as much as possible for his pancreas to heal… but for now I am so happy about how great he is doing.
 
Suzanne & Darcy said:
Just so you know, there are doses smaller than .25 units, in case he needs it. We may need to switch dosing methods— depending upon his numbers. What we want is to try to keep him in green numbers above 50 as much as possible for his pancreas to heal… but for now I am so happy about how great he is doing.
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Okay, good to know! I will start looking at that the other method sometime too! I am so happy for him too! Thank you!
 
Hello Steph. Just checking in since I have not seen a post from you for a while. George's numbers look good. How is everything? The last four days his AMPS have been a little higher (just a little). Any idea why? Have you been having difficulty getting tests lately? The night tests (at least one) are as important as the daytime tests as they can help us interpret the AMPS better. Also, cats often drop lower at night.

It’s great to see the ketones staying low!
 
Hey @Suzanne & Darcy! Thank you for checking in! 🥰

I think that his AMPS have been higher since he may have something going on with one of his ears! We took him to the vet earlier this week and all his bloodwork came back great with no sign of infection but the vet started him on antibiotics just to be sure! He wouldn’t eat the first antibiotic so we got another one and he got the first real dose this morning! I’m hoping that it is just that since nothing else with diet, etc. has changed! He had just started twitching and scratching his ear more!

I went out of town for work last week and have just got to get back into checking more often but will do that! Also not sure if from having a few days off of doing his dose if I’ve been giving slightly less than I had before?
 
Suzanne & Darcy said:
Hi there. I hope his ear stops bothering him soon. That can’t make testing easier either!

He’s made a lot of progress! 🙂
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It does not and he gets so angry sometimes but I don’t blame him! It wouldn’t be my favorite thing either! He’s been getting better at testing here the past few times too! I just tested him and he was perfect and it was easy! 🤩

Yeah, we were worried something was off when his numbers kept being higher plus ketones being .2 so hopefully his ear and everything will clear up and we can get back to staying in the green!

I hope we continue to make progress! We are where we are because of your and everyone else’s help! I am beyond grateful for finding this forum and the guidance found here! 🥰
 
Hey @Suzanne & Darcy! Hope you are doing well! Big George has continued to have higher numbers even when on antibiotics and now after! I started giving him .25F units to see if that would help and was just wondering if I should increase back to .5 units? He has stopped itching his ear and is eating and acting like normal, although he did throw up twice in the past week! I work in the office tomorrow so if I need to go back up to .5 units I may wait until the pm so I am home!

Everything has stayed the same so I just wasn’t sure if we should be seeing this regression or if I need to think about something else going on? Thanks!
 
Hi Steph. It’s good to hear from you. It sounds like Big George is doing well. I wouldn’t go looking for any troubles unless you think there’s something wrong. He has been seeing some green numbers on the .25 unit dose, so if you want to increase to .5 units then you should switch your dosing method to the Modified ProZinc Method. That would just allow him to move into more green numbers below 90. He is on an all low carb wet food diet, I believe, so he can safely do the Modified ProZinc Method. I do understand about wanting to do the increase while you’re at home!
 
Thank you! He is on a low carb diet…only eating FF Classic Pate Chicken, Chicken & Liver and Turkey & Giblets!

I will go and reread the Modified ProZinc Method again since it’s been a bit and with everything else, I don’t remember! 🤦‍♀️ Now thinking about it, I may also wait until next week to make any changes since he’s doing okay! My parents are going out of town and I won’t have a backup/afternoon check in person the days I work in the office/I’ll be taking care of all the animals at both places…and we have a crew!

I appreciate the response and help like always! 😊 Hope everything is good your way!
 
Let me know if you have any questions or concerns about MPM. It’s not a big deal really. It just gives us a lot more flexibility in dosing.

I agree that there is no rush to increase. He is still doing very well and is not in dangerously high numbers. Keep an eye on the ketones.

I have a crew too so I understand! I got some bad news (more bad news) about one of my cats yesterday. We will keep fighting.
 
Steph & Big George said:
He is a feral that I trapped ~2 years ago and he either doesn’t have any or they are numbs so they are terrible!
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FIV+ cats have notoriously bad teeth. Recently I have had several cats with broken teeth that had to be removed. I have two right now with stomatitis and they are receiving a new treatment for that which combines an antiviral with Doxycycline (because of its immunomodulatory properties.) It seems to be working. One of my girls had a hole all the way through one of her teeth. She was in so much pain. We had to give Buprenorphine several times a day until the vet returned from vacation to do the dental. It’s been a bad spring and summer for dental problems here!
 
I will let you know if I have any questions!

I’m so very sorry about the bad news about one of your cats! Will be thinking of you guys! Sometimes to keep fighting is all we can do!

Poor girl and her teeth! Thank you for mentioning the new treatment as I’ll have to look into that!
 
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