2/7/19 LILY AMPS is 92, what dosage should be given?

Calicos are Best (GA)

Calicos are Best (GA)

Member Since 2019
Good morning everyone,

Lily's AMPS is 92 this morning and I gave her 1.25 units of insulin at 8:30PM 12 hrs ago. How much should she be given this morning? Should I reduce to 1 unit?
 
Well she hasn't earned a reduction, because she's not dropped under 90. Which is the reduction point if you are still doing SLGS, I know you were pondering changing to TR.

Initially on SLGS the recommendation is not to shoot below 150, so I think you should probably skip the shot this morning, but maintain the dose.
 
Just fixed it. Had wrong date sorry! I noticed that too. I accidently wrote the wrong date and made yesterdays numbers today's. It's because I checked Lily's blood 3 times in the morning because as it was very high. Should be better now!
 
I think that the depot from the larger 1.5u dose is still influencing the numbers, pulling them down, so perhaps draining the depot by skipping will allow you to get into the swing of things with the 1.25u, hopefully allowing you to shoot consistently.

Are you heading off out?
It might be interesting and informative to get a +1, from a data gathering point of view you can see how her numbers come up with the food, and if the numbers are still going down (this can sometimes happen as the depot continues to influence, we can see if you are getting some carryover, with the dose.
 
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Ok, so you think I should just feed Lily and give no insulin this morning? Then check her blood throughout the day and check her blood at night before dinner, but your saying at the PM shot keep the 1.25 dose of insulin?
 
Calicos are Best said:
Just fixed it. Had wrong date sorry! I noticed that too. I accidently wrote the wrong date and made yesterdays numbers today's. It's because I checked Lily's blood 3 times in the morning because as it was very high. Should be better now!
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No worries, because I'd been helping you the last couple of days I knew what was going on. :) It's the date auto fills on the ss.:rolleyes:
 
Yes I will be around so I can definitely check Lily's +1. I'll check her throughout the day before dinner again. Thanks Gill & George!!!! lol thank goodness for you! I don't know what Lily and I would do without you!:cat:
 
Calicos are Best said:
Ok, so you think I should just feed Lily and give no insulin this morning? Then check her blood throughout the day and check her blood at night before dinner, but your saying at the PM shot keep the 1.25 dose of insulin?
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Yes if you are still doing SLGS yes. At least for now, Lily hasn't been on insulin that long, and there are times where I think she may have dropped lower than you caught, so I don't want to put you in a position where you are having to fight BG like you did the other day.
On SLGS you would not shoot below 90, so it's a bit close to the mark.
 
Calicos are Best said:
Yes I will be around so I can definitely check Lily's +1. I'll check her throughout the day before dinner again. Thanks Gill & George!!!! lol thank goodness for you! I don't know what Lily and I would do without you!:cat:
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You're welcome, as you gather more data, and understand Lily's patterns you will hopefully get to a point where you can shoot when she's in the 90's.
 
With the excitement of that amps, I forgot to say, thanks for the history you provided in yesterday's post about Lily and your journey with FD.

She's been Diabetic for quite a while, sounds like the diet change was enough to put her into remission the first time round.
Calicos are Best said:
Lily was hospitalized in October 2018 from pancreatitis. They did mention she had ketones in her urine. I haven't been able to stabilize Lily and have been so eager to get her back in remission.
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If you want to aim for remission, and given that she has fallen out of remission, SLGS is probably not the best choice. Cats can go into remission on SLGS, but it takes longer to get them into a normal BG range and studies have shown that the quicker you get BG into normal range the greater the chance of remission. Add to that that she's come out of remission, experience tells us that we need to be a wee bit more aggressive with the dosing with kitties returning from remission. TR would be a better choice
I hate to suggest making any changes, because with your mum being so sick:bighug::bighug::bighug::bighug:, sadly I know from my own experience how hard it will be to concentrate on anything but your mum, treasure your time with her, but from what you said in your post last night, I imagined that you would want to know what we thought was the best treatment option for Lily.

With TR if you are busy with mum, you can be a bit more conservative with the dose increases until you are certain she needs to be taken up.
You could stick with SLGS for now, until you are more comfortable with the testing and feeding and the whole dosing routine like we do it here and when you feel able to you can swap to TR if that's what you want to do.

It sounds that Lily had ketones but not DKA, which is good, but it also suggests to me that you should be monitoring her ketones daily, especially when we are seeing high numbers, if she's sick, goes off her food, or your spidey senses tell you somethings up.

You can monitor ketones with a blood ketone monitor or with ketostrix, I found the ketostrix easy enough to use, George isn't shy about going for a pee, I just wait for him to start, scooch a ladle under his bottom to get a sample and then use the strip, some folk pop the strip into the stream of pee directly, George is a low rider so I can't do that the ladle works better for us.
 
Gill & George said:
If you want to aim for remission, and given that she has fallen out of remission, SLGS is probably not the best choice. Cats can go into remission on SLGS, but it takes longer to get them into a normal BG range and studies have shown that the quicker you get BG into normal range the greater the chance of remission.
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I think I need to study both methods closer. I think it will be difficult to do TR right now with my Mom, that is true. Is it possible to do the TR method without feeding small meals throughout the day? Probably not though, right?...that must be essential for this method? We may have to revisit TR. Thank you for the support on my Mom. Extremely difficult time now.

Gill & George said:
It sounds that Lily had ketones but not DKA, which is good, but it also suggests to me that you should be monitoring her ketones daily, especially when we are seeing high numbers, if she's sick, goes off her food, or your spidey senses tell you somethings up.
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I think the animal hospital Lily went to in October did mention ketoacidosis. They think that was just a result from the pancreatitis and the diabetes being so out of control. I have some strips to check ketones in the urine, but they are in NY. I could ask my Aunt to ship them to me. OR if I bought more I wonder if it would be terribly expensive? Is is required to check ketones everyday?

I skipped Lily's insulin and fed her. Her BG was 148 at +1. Going to check +3 soon.
 
I no longer test since Rhubarb is in remission. When her numbers were high, I tested every day I could. Mine also tested glucose, which was handy for when I didn't know which cat left the wet spot.
 
When I did TR with Rex, I did not do the mini meals. I fed him 2x a day because my work was right after AMPS until his +10 and I couldn't feed him the 2 hours before PMPS. He made up for it with all his snacks during his lime greens. Right after he went into remission, I changed the meal times to be 3x (morning, when I get home - the +10, and bed). The only requirements with TR are no dry food and at least 4 tests every day - 2 each cycle.
 
Oh nice! Congratulations on achieving remission @majandra ! Good deal to test both. Especially with multiple kitties. how smart!

Thanks for confirming that @Mandy & Rex ! I would prefer to do 2 meals because I think it is such a pain to do mini meals. I can handle no dry food. 4 tests every day is not too bad. TR sounds a little more disciplined for me right now. I have some other things going on right now and I don't think I can do that approach just yet.
 
I use the petsafe 5 feeder. Originally I had it set to just rotate to an empty dish 2 hrs before shot time so I knew there was no food influence. Then when I found that Rhubarb was getting better sugars with snacks at +8, I set the feeder to also give her the snack. It was quite handy (and still is, to avoid her chowing down everything at once).

The urine strips that test both are called keto diastix.
 
Whoa the petsafe 5 feeder is pretty impressive! A little pricey, but looks like it would be more than worth it. I will keep that in mind if I ever switch to small meals. I'll have to see if I will order urine strips online or buy locally.
 
Will Lily Graze,? If you left food out for her as you headed out the door? I couldn't do that because he would eat all food I put down straight away.

I have a multi feeder similar to the petsafe, but I also have a couple of these, Trixie tx4
https://www.tiendanimals.es/comeder...m3z9yCLfC_58MppDifLgQ0ioTIqjpBhRoCOekQAvD_BwE
Not as hi tech but for ease of use they're great, and have a little icepack, George eats his snack as soon as it opens so I don't have to worry about him eating it too late in the cycle. He's never tried to get into it some kitties are born cat burglars and will break into feeders, but I've not had that problem with George.

As long as you are back a couple of hours before shooting, to pick up food, that could work.

I gave to go grab a shower before I go out, but I want to get back to you regarding, her hospitalisation last October and what the vets said at the time. The mention of DKA is an important consideration when it vocom to dosing and food.
 
There is also a CatMate 3 feeder and 5 meal feeder which i think isn't as expensive. It also comes in handy overnight if you need to sleep. Caring for your mum and kitty can catch up with you. You want to be sure you are getting good rests in. Having the feeder for daytime and night can take some stress away from you.
 
No, Lily is always starving. She would eat all her food right away too. When I feed her the regular amounts of food for breakfast and dinner those hold her over. But if I kept feeding her she would glady keep eating. lol.

I suspect that Lily might be a cat burglar. If I forget to throw away the cans of food in the sink after putting the food in her dish, she climbs in the sink to lick the cans later when she sees I forgot. :p

In Lily's hospitalized summary (from Oct 2018) it says she had severe diabetic ketosis. Her Urinalysis showed semi-concentrated urine, glucose in the urine, protein in the urine, ketones in the urine. The Serum ketones were positive (small +1). The notes go on to elaborate that Lily has pancreatitis that is contributing to diabetic ketosis. I believe I remember them telling me the ultra sound showing evidence of inflammations with pancreas and fatty liver. The notes are very extensive. More information than I know what to do with.

Honestly before I joined I have been interested in changing Lily's diet. I had a running list for foods that might be helpful with dealing with pancreatitis. I figured that if I get Lily's diabetes under control I could hit 2 birds with one stone and not have to change the diet. I fear I may have to though.

Pet feeders could be helpful. I will have to think about them. Feeding Lily food is not too bad for me right now. The insulin and checking blood can be stressful. Lily is very good at letting me do it. I just feel bad poking her ears all day long. She is a sweet kitty though, she takes it better than I ever would. Thankfully with everything going on I am not working right now. It makes things difficult with finances, however it is convenient for caring for my Mom and Lily. I don't think any job would allow me this much time from work.

The brands of food I was trying to mix with fancy feast were Weruva, Wellness, glycobalance, science diet sensitive stomach, and authority sensitive support. I stopped mixing as it only seemed to complicate things. Those other foods have potatoes, carrots, guar gum, cranberries, seeds, rice, etc...which are carbs and will make her sugars higher. They might help with pancreatitis, but they will make stable numbers in blood sugars tricky. I am on a solid kitten fancy feast diet for now. I will revisit diet change once diabetes is better.

Since Lily's 2nd hospitalization in January 2019, sometimes I think I hear bowel noises from Lily's stomach or different noises I didn't hear before. Almost like a hiccup in her tummy or gargle? (not sure how describe) Not constant, just sporadically. And some mornings I wake up to Lily dry heaving. She sounds like she has to puke or has a hair ball, but then I look around and I don't see anything she puked up.

So much going on. Thankful for you guys and this site! You all have been helping me very much and I am so grateful.
 
Calicos are Best said:
In Lily's hospitalized summary (from Oct 2018) it says she had severe diabetic ketosis.
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OK this is really important to know.
A kitty that has had DKA is more at risk of developing it again.
The 'recipie' for DKA if you like is
  • Not enough calories
  • Not enough insulin
  • High BG
  • Systemic stress/infection
Skipping insulin shots, for Lily is risky, if I'd known about the DKA this morning I would never have suggested you skip.
I'm not sure that you will get enough calories into her with just to feeds a day. I would really encourage you to look into the autofeeders, they will allow you to
  1. make sure she gets enough food
  2. make it easier to shoot even when her numbers are low and you have to be away
  3. keep her safe when you can't be there.
I'm sorry, I know this is an extra expense, when you are not working and looking after your mum, but I hope that it will provide you with a tool that will avoid any more hospitalizations.

The implications of DKA are as dangerous as a hypo. DKA can develop quickly, monitoring for Ketones is going to give you an early warning, which will allow you to take measures to avoid a situation turning critical and needing hospitalization. The blood ketone meters are great, but as far as I understand the strips are a little pricey. The Ketostix are more economical, and readily available at any pharmacy, but you of course have to catch your girl on a LB visit. You'll need to weigh up what will work best for you. But I do think it is imperative that you should be testing regularly for ketones, certainly when her numbers are high, or if anything seems of, especially if she is off her food.

How is Lily feeling?
Is she eating OK this afternoon?
Anything off at all?
I don't like seeing that black there.
Did she have DKA again in January 2019?

Here are a couple of links one to a recent condo of kittiy that has had DKA some very experienced members whose own kitties have had DKA talk a little bit about DKA and strategies to keep kitty safe. And a little NK to a sticky Inthe FAQs which has more info on DKA and testing for ketones
http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

http://www.felinediabetes.com/FDMB/...ng-the-amount-of-insulin.210357/#post-2331212

I am sorry if you feel like I am overwhelming you at this difficult time for you.
 
Gotchya! Ok, hmm lots to think about. My mom has been very sick today. Been trying to juggle Lily's readings. Luckily I have other family here too. My mom is a little better now. Lily has been great today. She did have quite the high numbers today, which I don't like either. She was eating and being normal.

2/7/19
Her AMPS = 92
+1 = 148
+3 = 346
+6 = 539
+10.5 = 471

I do like the idea of a timed feeder, however I was wondering what kind I should be getting. I am concerned about wet food sitting out all day, even if it is covered. I know you said the one you use has a ice pack. That is cool. How do you know how many calories a cat needs to eat who has diabetes? When she was hospitalized in October they said she should get 250 calories / day to maintain her weight. I have been feeding her 3 cans of kitten fancy feast/day. which is about 270-285 calories/day depending on the flavor. Her weight fluctuates between 9-10 lbs.

Gill & George said:
The Ketostix are more economical, and readily available at any pharmacy
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I am going to get some keto diastix tomorrow. The local pharmacy said they should get some in after 3pm. A little pricey at $19 for 50. Driving to Walmart is 30 mins away. The local pharmacy is right down the street. I could order online, but I am curious to get the stix sooner.

Gill & George said:
Did she have DKA again in January 2019?
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Yes in January, Lily did have this as a result of listening to the vet and stopping insulin cold turkey. The vet had advised to stop insulin and did not say anything about checking her blood. Lily was off insulin for 2 weeks and got sick. She got a bladder infection and her diabetes was out of control for those 2 weeks I am sure. She didn't act sick until 2 weeks.

This was the curve Lily had before the doctor said to stop insulin...(Please don't yell at me for this, eeek! I already posted on here when I first start and everyone was very upset that I did this) I did not know better until coming here. My vet said not to look at the numbers and to always give the same dose no matter what. I asked her even if it was too low? She said that because Lily was eating it was ok. And because of the high number she insisted she did not think Lily had any issues with hypoglycemia.

FROM 1/2/19:
AMPS = 66, Then I gave Lily 1 unit of insulin with her breakfast.
+2 = 263
+4 = 269
+6 = 197
+8 = 135
+10 = 68
+12 = 42

Thank you for the links Gill!!! It's ok, I do feel a little overwhelmed, but I know it is necessary. Especially if I don't want to hospitalize Lily. Some of my family thought I should have put down Lily in October because of how expensive the hospital bill was. She is just too special to me! I couldn't put down a family member like that. Diabetes is manageable. And I think Lily is a special kitty who is worth it!

I plan to check Lily's blood again in about an hour and I am thinking 1.25 units of insulin would be good to do.
 
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