03 20 21 Malki AMPS 17.8 (320) +6 2.9 (52) Dosing Advice

miribluebeard

miribluebeard

Member Since 2021
Hi there,
My apologies if I have worded anything incorrectly or missed any information. I'm brand new to using any sort of forum.

Malkis chart is here: https://docs.google.com/spreadsheets/d/11VI0HnquaXEdcMMY5OJ4JqLXktHjXqc1pZ_-qfmSckM/edit?usp=sharing and should also appear in my signature along with her details.

My vet has advised me to "hold on 1U twice a day and stay for a very long time" <-- their wording. I was started off on 2U twice a day but was advised by the FB group that was a large starting dose so after talking to vet dropped it to 1U twice a day as per the notes on the chart.

Could one of you experienced cat parents please view her chart and offer your opinion?


I would specifically like advice on:
*Does the dosing look correct?
*What method do you suggest I use to help her into remission?
*Her freestyle libre runs out in 6 days and I will not be putting a new one on as it causes her great distress, what is the ear prick frequency recommendations (I have been doing AMPS, +6, PMPS in conjunction with the libre)

I am personally feeling that she is falling too harshly these last couple days and then bouncing back but don't have enough experience. Please ask any questions you feel would help clarify.
Thank you :)
 
There are two dosing methods you can follow.
The TR...tight regulation which is quite an aggressive dosing method but safe if you follow the guide lines with testing and reducing the dose when needed. You can increase every 3 days if needed and you take reductions when the BG drops to 2.8
You need to be feeding a fully wet/canned diet to do TR and be testing at least once during the cycles as well as preshot.

The other method is the SLGS method which is the Start Low Go Slow method which is where you hold the dose for a week and then do a curve to see if you need to increase the dose. You take reductions at 90 ( 5). You can feed dry with this method although we don’t recommend it.

Here is a link to the two dosing methods. Have a look and see which one suits you better.
If you are looking to try and get remission, the TR is better but first you need to get Malki into regulation.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

He is getting very close to a reduction is dose with that 2.8 at +6 today.

Are you giving snacks during the cycle as well as preshot meals?
I would suggest giving a snack at +2 , +4 and +6 to slow the drops. Can you give those snacks during both the cycles?
an automatic feeder is a great investment for a diabetic cat.

Depending on what method you choose, I would at least always get a preshot test and at least one test during the cycles. With TR we usually test a few more times during the cycles, especially if the BG is dropping.
Do you work from home and are able to test more often?
It is best to give treats every time you test the BG and he will get very used to having them. Sheba used to come running when she heard me at the testing kit.

Do you have a hypo kit set up?
You will find that a d other useful information in this link https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
I hope I’ve answers all your questions, if not let me know.I am happy to answer as many as you like.

Here is a link to home testing https://felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

And here is a link to Aussie caregivers information https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

Bron
 
Thank you so so much for the thorough reply and advice.

I'll try to answer it all as best I can. I currently work from home but not sure how much longer my boss will be happy to let me do so. I also have other commitments I can't avoid (disability care) but have managed to work around it so far.

I would like to try Tight Regulation, I'm having a little trouble interpreting it but I'll keep reading it over. I'm running on 2-3hours sleep a night haha so not firing on all cylinders. I think I might need a dumbed down versions that just say if number = this, do this. I'm a bookkeeper so really should have a better grasp of numbers haha.

Malkovich is on all wet food. 1 can Fancy feast pate at AM after shot, 1 can Ultimates Indulge 1% carbs can after PM shot. She also has raw snacks at AM+3,+9 and PM+3,+9 (if she's finished first her can and then what I put out at +3, she is a grazer not a full meal eater) They consist of little pieces of chicken liver, giblets, wing tip, neck, or a plain canned sardine.

She has dried single ingredient beef liver treats before each test and shot and runs to her "spot" for them each time. I just crush one little piece up into tiny bits.

I've made up a little hypo kit for her with gravy canned food, one of those creamy soup meal sachets, glucose syrup, feeding syringe, temptations treats (her old favourite snacks), emergency vet info and spare bits and pieces for my meter like strips, lancets, battery etc.

Thank you again for all the info and links I'll check them all out. Hopefully I'll know where to go from there in regards to dose reductions etc.

Bron and Sheba (GA) said:
There are two dosing methods you can follow.
The TR...tight regulation which is quite an aggressive dosing method but safe if you follow the guide lines with testing and reducing the dose when needed. You can increase every 3 days if needed and you take reductions when the BG drops to 2.8
You need to be feeding a fully wet/canned diet to do TR and be testing at least once during the cycles as well as preshot.

The other method is the SLGS method which is the Start Low Go Slow method which is where you hold the dose for a week and then do a curve to see if you need to increase the dose. You take reductions at 90 ( 5). You can feed dry with this method although we don’t recommend it.

Here is a link to the two dosing methods. Have a look and see which one suits you better.
If you are looking to try and get remission, the TR is better but first you need to get Malki into regulation.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

He is getting very close to a reduction is dose with that 2.8 at +6 today.

Are you giving snacks during the cycle as well as preshot meals?
I would suggest giving a snack at +2 , +4 and +6 to slow the drops. Can you give those snacks during both the cycles?
an automatic feeder is a great investment for a diabetic cat.

Depending on what method you choose, I would at least always get a preshot test and at least one test during the cycles. With TR we usually test a few more times during the cycles, especially if the BG is dropping.
Do you work from home and are able to test more often?
It is best to give treats every time you test the BG and he will get very used to having them. Sheba used to come running when she heard me at the testing kit.

Do you have a hypo kit set up?
You will find that a d other useful information in this link https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
I hope I’ve answers all your questions, if not let me know.I am happy to answer as many as you like.

Here is a link to home testing https://felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

And here is a link to Aussie caregivers information https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

Bron
Click to expand...
 
Hi can you tell us your name please?)
It sounds as if you are pretty organised. That’s great!
I don’t know the strength of glucose syrup, I’ve only ever used honey which brings up the BG petty quickly.

Try and get a bit more sleep if you can otherwise you will end up crashing and be no good to anyone.:(
When I had to do a lot of testing at night, I always set the alarm and managed to get sleep that way, even though it was broken sleep. Are you able to wake up easily with the alarm? Luckily I was able to.

Make sure you read the TR protocol...I would print it off and hilight the important bits as you will refer to it often.
Here are the important points you need to know:
  • If you get a number under 150 (8.3) at preshot stall, dont feed and test again in 20 minutes to see if the BG is going up. Post and ask for help. Change the subject line to reflect what is happening ....eg STALLING..AMPS XX HELP . that will alert us. If the BGis rising you can probably shoot. As we get more data the no shoot number will drop.
  • I would give the snacks during the first half of the cycle when the insulin is strongest. This will help stop the fast drops. If they continue we will show you have to feed the curve to slow down the drop further.
  • You hold the dose for at least 6 cycles unless the BG drops under 50 [2.8)
  • We increase and decrease the dose in 1/4 unit increments so as not to go past the best dose.
  • Post a new thread each day on the Lantus forum linking your previous thread for continuity. Everyone who posts there is either a Lantus or a Levemir user so will be able to help you. We start a new thread each day as it is a busy forum and we don’t want long threads.
  • When you post you put the date, name and BG and any question ....so 3/21 Malki AMPS 201 (11)
  • Add any tests to the subject line as you go along during the day so we can see.
  • Lantus works best If the dose is not chopped and changed except when increasing or reducing the dose.
  • Are you using the U100 3/10 insulin syringes.? We don’t have 1/2 unit syringes here in Australia but they can be ordered online from the UK and they come within about 10 days. The info for them is in the Australian info link.
I think I have been referring to Malki as a he....I am sorry Malki. I can see you are a beautiful girl!
 
Whoop sorry! My name is Miri, Miri and Malki haha

I've been setting alarms but like most of us in here, Malki is my best friend so I'm terrified of missing a hypo or another symptom. I'm sure as the weeks go by I'll be able to relax a bit more, especially after I know all the things to look out for and how to deal with them.

I'll definitely print out the protocol, I've got screen fatigue from reading so much on computer screens haha

Thank you for the simplification though, it already is starting to make more sense. I'll surely be making lots of use of the forum in regards to stalling/asking for help etc.

I use the U100 3/10s with single unit markings, I have digital calipers from work I can use to assist with quarter and half doses.

Haha yes she does have a very gender ambiguous name and is named after a male actor so it's only natural everyone thinks she's a boy

Thank you again for all your help, it's made a huge difference. Might even get some sleep tonight!!




Bron and Sheba (GA) said:
Hi can you tell us your name please?)
It sounds as if you are pretty organised. That’s great!
I don’t know the strength of glucose syrup, I’ve only ever used honey which brings up the BG petty quickly.

Try and get a bit more sleep if you can otherwise you will end up crashing and be no good to anyone.:(
When I had to do a lot of testing at night, I always set the alarm and managed to get sleep that way, even though it was broken sleep. Are you able to wake up easily with the alarm? Luckily I was able to.

Make sure you read the TR protocol...I would print it off and hilight the important bits as you will refer to it often.
Here are the important points you need to know:
  • If you get a number under 150 (8.3) at preshot stall, dont feed and test again in 20 minutes to see if the BG is going up. Post and ask for help. Change the subject line to reflect what is happening ....eg STALLING..AMPS XX HELP . that will alert us. If the BGis rising you can probably shoot. As we get more data the no shoot number will drop.
  • I would give the snacks during the first half of the cycle when the insulin is strongest. This will help stop the fast drops. If they continue we will show you have to feed the curve to slow down the drop further.
  • You hold the dose for at least 6 cycles unless the BG drops under 50 [2.8)
  • We increase and decrease the dose in 1/4 unit increments so as not to go past the best dose.
  • Post a new thread each day on the Lantus forum linking your previous thread for continuity. Everyone who posts there is either a Lantus or a Levemir user so will be able to help you. We start a new thread each day as it is a busy forum and we don’t want long threads.
  • When you post you put the date, name and BG and any question ....so 3/21 Malki AMPS 201 (11)
  • Add any tests to the subject line as you go along during the day so we can see.
  • Lantus works best If the dose is not chopped and changed except when increasing or reducing the dose.
  • Are you using the U100 3/10 insulin syringes.? We don’t have 1/2 unit syringes here in Australia but they can be ordered online from the UK and they come within about 10 days. The info for them is in the Australian info link.
I think I have been referring to Malki as a he....I am sorry Malki. I can see you are a beautiful girl!
Click to expand...
 
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