3/20 NEW MEMBER - Raphael AMPS 211

Robyn P

Robyn P

Member
I have an 11 yo 14lb siamese. He was prescribed prednisolone. After 6 weeks of 6mg/day of prednisolone, he was diagnosed as diabetetic. So I think he may have Glucocorticoid-induced hyperglycaemia. The vet has since tapered the prednisolone down to 1.5mg every other day. He was started taking Lantus about 3 weeks ago and I am having trouble with interpreting his BG numbers (starting on day 11 of the Lantus he was down to taking 1.5mg of prednisolone every other day). He also starting vomiting starting 5 days after beginning Lantus and has since vomited over ten times (I have not found a pattern based on type of food, day of prednisolone administered, high BGs/low BGs, or time of day to account for the vomiting). I am having trouble regulating his BG. My question is: is his BG pattern typical for a newly diabetic cat on Lantus with Glucocorticoid-induced hyperglycaemia? Or could his diabetes be caused by another illness such as pancreatitis? Here is his BG graph starting from day 8 of Lantus, it shows all pre-shots (twice/day) and all nadirs (twice/day), as well as his insulin dosage (in IU at the bottom). Can someone tell me if the repeated days of elevated BGs in a seems abnormal at all for a cat in his situation?
 
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Robyn P said:
I have an 11 yo 14lb siamese. He was prescribed prednisolone. After 6 weeks of 6mg/day of prednisolone, he was diagnosed as diabetetic. So I think he may have Glucocorticoid-induced hyperglycaemia. The vet has since tapered the prednisolone down to 1.5mg every other day. He was started taking Lantus about 3 weeks ago and I am having trouble with interpreting his BG numbers (starting on day 11 of the Lantus he was down to taking 1.5mg of prednisolone every other day). He also starting vomiting starting 5 days after beginning Lantus and has since vomited over ten times (I have not found a pattern based on type of food, day of prednisolone administered, high BGs/low BGs, or time of day to account for the vomiting). I am having trouble regulating his BG. My question is: is his BG pattern typical for a newly diabetic cat on Lantus with Glucocorticoid-induced hyperglycaemia? Or could his diabetes be caused by another illness such as pancreatitis? Here is his BG graph starting from day 8 of Lantus, it shows all pre-shots (twice/day) and all nadirs (twice/day), as well as his insulin dosage (in IU at the bottom). Can someone tell me if the repeated days of elevated BGs in a seems abnormal at all for a cat in his situation?


https://replay.dropbox.com/share/8XbcgElK1yu4OpHh?variant=v2&media_type=image
Click to expand...

@Bron and Sheba (GA)
@Sienne and Gabby (GA)
@Diane Tyler's Mom GA
 
What health issue does your cat need prednisolone for?

It's not uncommon for some cats to be steroid-induced diabetics. My cat is one :rolleyes: He was taking pred for his IBD and asthma. He's now on a different steroid which does affect his blood glucose levels somewhat but other diabetic cats who take the same steroid do not have any affect on blood glucose levels.

It's only been 3 weeks on Lantus. Have patience :) Few cats can be regulated in a mere 3 weeks and those that do typically don't have any other health conditions.

What are you feeding your cat?
 
squeem3 said:
What health issue does your cat need prednisolone for?

It's not uncommon for some cats to be steroid-induced diabetics. My cat is one :rolleyes: He was taking pred for his IBD and asthma. He's now on a different steroid which does affect his blood glucose levels somewhat but other diabetic cats who take the same steroid do not have any affect on blood glucose levels.

It's only been 3 weeks on Lantus. Have patience :) Few cats can be regulated in a mere 3 weeks and those that do typically don't have any other health conditions.

What are you feeding your cat?
Click to expand...
 
okay, thank you. I wasn't sure about how long it would/should take to see more regulated data. Just wanted some reassurance that this wasn't unusual or worse. He is on prednisolone because he has severe chronic stomatitis, he had to have 3 surgeries last year, two to remove all his teeth, and a third because he was allergic to the sutures. So far we found steroid are the only thing that kills the severe pain because it prevents his gums from swelling back up. I feed him Zero mature health dry food.
 
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Robyn P said:
I like your spreadsheet, would you mind sending me a template?
Click to expand...
@Robyn P
Hi
Can you please fill out your signature
Here is the information we need for your signature
Just click on your name up top and then tap signature and add this information. It's at the end of everyone's post in gray letters
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Read all the yellow stickys when you get a chance about Lantus one of them will explain the 2 dosing methods to follow for Lantus. They will tell you when an increase or decrease is needed.

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

Here are the links to our spreadsheet where we enter our cats BG numbers . If you need help setting it up just ask we have a member thT will be happy to do it for you


How to Create a Spreadsheet

How to Use the Spreadsheet

There is a link understanding the spreadsheet but I'm going to explain it anyway
About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers

Tap on any members spreadsheet to see what it looks like

Just checking do you have the U-100 syringes with the half unit markings. We use these because we adjust the doses by 0.25 units at a time
 
You're very welcome. One thing though you can't follow the TR dosing method of you are feeding any kibble at all, even if it's low carb. You will have to follow the SLGS method . So please change that on your spreadsheet and signature .
I have to tell you Raphael's numbers are not that bad at all . If possible try and vary the times that you check his BG .
Great job setting up the spreadsheet and signature so fast :cat:

From the SLGS sticky

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

You can delete that drop box you posted
 
Diane Tyler's Mom GA said:
You're very welcome. One thing though you can't follow the TR dosing method of you are feeding any kibble at all, even if it's low carb. You will have to follow the SLGS method . So please change that on your spreadsheet and signature .
I have to tell you Raphael's numbers are not that bad at all . If possible try and vary the times that you check his BG .
Great job setting up the spreadsheet and signature so fast :cat:

From the SLGS sticky

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

You can delete that drop box you posted
Click to expand...

Ok, thank you, will do
 
I see many times he dropped below 90 and you should have reduced his dose
by 0.25 units, but at the time you didn't know about the SLGS method .
If possible try and get a test @+3, +5 and +7 one day
Another day maybe get a test @+4 +6 and +8
Same goes for the night cycle
Feel free to keep asking questions and if I can't help you I will tag someone who can. I have to say you couldn't have found a better group to join . Even though my Tyler passed away from cancer 2 months ago, this group helped me get him into remission for over 3 years giving me their advice
Raphael is a handsome boy, will he eat low carb wet food ?
@Robyn P
 
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Diane Tyler's Mom GA said:
I see many times he dropped below 90 and you should have reduced his dose
by 0.25 units, but at the time you didn't know about the SLGS method .
If possible try and get a test @+3, +5 and +7 one day
Another day maybe get a test @+4 +6 and +8
Same goes for the night cycle
Feel free to keep asking questions and if I can't help you I will tag someone who can. I have to say you couldn't have found a better group to join . Even though my Tyler passed away from cancer 2 months ago, this group helped me get him into remission for over 3 years giving me their advice
Raphael is a handsome boy, will he eat low carb wet food ?
@Robyn P
Click to expand...

Thanks! He will eat Fancy Feast Naturals, but I am on a tight budget and cannot afford to put him on a strictly wet-food diet. Since you're saying I shouldn't have increased his dose, do you recommend I reduce his dose by 0.25u IMMEDIATELY? and YES, he is VERY handsome, I tell him every day! He is also quite large for his breed.
PS: In the future, if his nadirs drop below 90 ONE TIME, should I reduce the dose? Or do you recommend a few times below 90 before I reduce?
 
If you knew that you you couldn't follow TR then yes you would have reduced anytime he dropped under 90. I really don't give dosing advice but I'm going to tag a few experienced members for you and see what they say , meaning to stay with 2 units for now. In the future if he drops below 90 anytime you would then reduce the next dose by 0.25 units
@Robyn P
 
Diane Tyler's Mom GA said:
If you knew that you you couldn't follow TR then yes you would have reduced anytime he dropped under 90. I really don't give dosing advice but I'm going to tag a few experienced members for you and see what they say , meaning to stay with 2 units for now. In the future if he drops below 90 anytime you would then reduce the next dose by 0.25 units
@Robyn P
Click to expand...

Got it. Thanks.
 
Robyn P said:
Thanks! He will eat Fancy Feast Naturals, but I am on a tight budget and cannot afford to put him on a strictly wet-food diet. Since you're saying I shouldn't have increased his dose, do you recommend I reduce his dose by 0.25u IMMEDIATELY? and YES, he is VERY handsome, I tell him every day! He is also quite large for his breed.
PS: In the future, if his nadirs drop below 90 ONE TIME, should I reduce the dose? Or do you recommend a few times below 90 before I reduce?
Click to expand...
@Bandit's Mom
@Bron and Sheba (GA)
@Angela & Cleo
@Sienne and Gabby (GA)
@Wendy&Neko

Hi ladies we have a new member here ,see her introduction post. She just filled out her signature and spreadsheet today and I saw she had TR in her signature and spreadsheet. I told her since she was feeding the Young Again kibble she had to follow SLGS so she just changed it .

She could have reduced many times if she knew about this . She is now asking should she stay with the 2 units now
@Robyn P
 
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Diane Tyler's Mom GA said:
@Bandit's Mom
@Bron and Sheba (GA)
@Angela & Cleo
@Sienne and Gabby (GA)
@Wendy&Neko

Hi ladies we have a new member here ,see her introduction post. She just filled out her signature and spreadsheet today and I saw she had TR in her signature and spreadsheet. I told her since she was feeding the Young Again kibble she had to follow SLGS so she just changed it .

She could have reduced many times if she knew about this . She is now asking should she stay with the 2 units now
Click to expand...
@Diane Tyler's Mom GA
 
Hi and welcome to the forum Robyn and Raphael
Diane has given you some good advice.
As you are going to have to follow SLGS dosing methods, you need to reduce the dose of the Lantus immediately down to 1.75 units.
Looking at the SS this may not be enough of a reduction. If he drops under 90 again you will need to reduce the dose further.

The food you are feeding is almost certainly high carb food and you will need to look around for some low carb food alternative.
There are a few low carb dry foods but I think they are not cheap. @Diane Tyler's Mom GA can help you with those.
If I were you I would look for a low carb wet food. There are some that are not expensive. Maybe Diane can help with that as well. I don’t live in the US so don’t know the price of cat food over there.
If you do decide to go with a low carb wet food, and I hope you do, as you will have a much better chance of Raphael going into remission.
But you will need to do this slowly as a change over to low carb food will reduce the blood glucose and most likely the amount of insulin will need to be reduced to keep Raphael safe.
If you are lucky enough to get him into remission, he will need to remain on a low carb diet for life as he will still be a diabetic, just a diet controlled one. So look for a low carb wet food you can continue to feed.
 
Robyn P said:
Thanks! He will eat Fancy Feast Naturals, but I am on a tight budget and cannot afford to put him on a strictly wet-food diet.
Click to expand...
@Bron and Sheba (GA)
Hi Bron she is feeding low carb dry kibble
The young again zero mature
It's very expensive, feeding the Fancy Feast Classic Pates might be a little bit cheaper than the Fancy Feast Naturals or she can feed Friskies they are cheaper than Fancy Feast

I'm going to tell her

Young Again ZERO Mature is formulated to meet the nutritional levels established by the AAFCO Cat Food Nutrient Profiles for maintenance.

Zero Mature Health
4 lb $42.90
8 lb $59.90
25 lb * $165.00
 
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Bron and Sheba (GA) said:
Hi and welcome to the forum Robyn and Raphael
Diane has given you some good advice.
As you are going to have to follow SLGS dosing methods, you need to reduce the dose of the Lantus immediately down to 1.75 units.
Looking at the SS this may not be enough of a reduction. If he drops under 90 again you will need to reduce the dose further.

The food you are feeding is almost certainly high carb food and you will need to look around for some low carb food alternative.
There are a few low carb dry foods but I think they are not cheap. @Diane Tyler's Mom GA can help you with those.
If I were you I would look for a low carb wet food. There are some that are not expensive. Maybe Diane can help with that as well. I don’t live in the US so don’t know the price of cat food over there.
If you do decide to go with a low carb wet food, and I hope you do, as you will have a much better chance of Raphael going into remission.
But you will need to do this slowly as a change over to low carb food will reduce the blood glucose and most likely the amount of insulin will need to be reduced to keep Raphael safe.
If you are lucky enough to get him into remission, he will need to remain on a low carb diet for life as he will still be a diabetic, just a diet controlled one. So look for a low carb wet food you can continue to feed.
Click to expand...
@Robyn P
Robin I guess you didn't see this about shooting 1.75 units tonight ,please read the test of her advice
So tomorrow morning you need to shoot 1.75 units
If someone doesn't tag you please keep checking the Alerts to see if a member replied back to you


Is this the dry food you are feeding see the pic below
Young Again ZERO Mature is formulated to meet the nutritional levels established by the AAFCO Cat Food Nutrient Profiles for maintenance.


Zero Mature Health
Description▼
Health Benefits▼
Guaranteed Analysis▼
Ingredients▼
Dry Matter Analysis▼
Feeding Instructions▼

This is very expensive

Zero Mature Health
4 lb $42.90
8 lb $59.90
25 lb * $165.00
Don't you think feeding Friskies or Fancy Feast Classic would be cheaper than the Young Again zero Mature

The Friskies wet cat food is pretty cheap, it's less expensive than The Fancy Feast
Take a look at our food chart, most feed around 6% carbs or less . I fed Tyler Fancy Feast Classic Pates 2 and 3 % carbs

Here is our food chart which lists the carbs
Here is the new link: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Look at all the Fancy Feast Flavors and the Friskies Pates carbs

Do you have a hypo kit yet in case you need to bring his BG up
Hypo Kit if needed to bring his BG up
Good idea to mark the cans with magic marker how many carbs

. Doesn't have to be Fancy Feast just an example about the med and high carb foods, The Friskies med and high carb ones are probably cheaper



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.

Also have some karo in the house



Just wanted you to know on Dr Pierson's food chart

the Fancy Feast Gravy Lovers Beef Feast In Roasted Beef Flavor Gravy (which. Dr Pierson’s list says is 20%
Comes back with 14%

These are correct for med carbs
Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs



Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

You can even look at the Friskies for high carb and med carbs.
So buy a few cans of each

I would say check some of these out and then Google them and see how much they are
 
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@Robyn P
 

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Bron and Sheba (GA) said:
Hi and welcome to the forum Robyn and Raphael
Diane has given you some good advice.
As you are going to have to follow SLGS dosing methods, you need to reduce the dose of the Lantus immediately down to 1.75 units.
Looking at the SS this may not be enough of a reduction. If he drops under 90 again you will need to reduce the dose further.

The food you are feeding is almost certainly high carb food and you will need to look around for some low carb food alternative.
There are a few low carb dry foods but I think they are not cheap. @Diane Tyler's Mom GA can help you with those.
If I were you I would look for a low carb wet food. There are some that are not expensive. Maybe Diane can help with that as well. I don’t live in the US so don’t know the price of cat food over there.
If you do decide to go with a low carb wet food, and I hope you do, as you will have a much better chance of Raphael going into remission.
But you will need to do this slowly as a change over to low carb food will reduce the blood glucose and most likely the amount of insulin will need to be reduced to keep Raphael safe.
If you are lucky enough to get him into remission, he will need to remain on a low carb diet for life as he will still be a diabetic, just a diet controlled one. So look for a low carb wet food you can continue to feed.
Click to expand...

the Zero Mature Health IS a low-carb food actually. he has been eating it solely since 3/7/25. Here is the
Guaranteed Analysis▼
Crude Protein (min) 54%
Crude Fat (min) 24%
Crude Fiber (max) 2.0%
Soluble Fiber 2.76%
Carbs/Starch (digestible)Trace <1%
Ash (max) 4.85%
Moisture 10%
 
Diane Tyler's Mom GA said:
@Bron and Sheba (GA)
Hi Bron she is feeding low carb dry kibble
The young again zero mature
It's very expensive, feeding the Fancy Feast Classic Pates might be a little bit cheaper than the Fancy Feast Naturals or she can feed Friskies they are cheaper than Fancy Feast

I'm going to tell her

Young Again ZERO Mature is formulated to meet the nutritional levels established by the AAFCO Cat Food Nutrient Profiles for maintenance.

Zero Mature Health
4 lb $42.90
8 lb $59.90
25 lb * $165.00
Click to expand...


actually, it's not as expensive as you may think. I did the math before purchasing the Zero and it is cheaper than the wet food, the reason is it is VERY calorie dense (4510 kcals/kg, 654 kcals/cup) so he is fed VERY little each day, much less than traditional cat food, so an 8lb bag lasts about 67 days for only $60, 120 cans of Fancy Feast Naturals per month will be much more.
 
Diane Tyler's Mom GA said:
@Robyn P
Robin I guess you didn't see this about shooting 1.75 units tonight ,please read the test of her advice
So tomorrow morning you need to shoot 1.75 units
If someone doesn't tag you please keep checking the Alerts to see if a member replied back to you


Is this the dry food you are feeding see the pic below
Young Again ZERO Mature is formulated to meet the nutritional levels established by the AAFCO Cat Food Nutrient Profiles for maintenance.


Zero Mature Health
Description▼
Health Benefits▼
Guaranteed Analysis▼
Ingredients▼
Dry Matter Analysis▼
Feeding Instructions▼

This is very expensive

Zero Mature Health
4 lb $42.90
8 lb $59.90
25 lb * $165.00
Don't you think feeding Friskies or Fancy Feast Classic would be cheaper than the Young Again zero Mature

The Friskies wet cat food is pretty cheap, it's less expensive than The Fancy Feast
Take a look at our food chart, most feed around 6% carbs or less . I fed Tyler Fancy Feast Classic Pates 2 and 3 % carbs

Here is our food chart which lists the carbs
Here is the new link: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Look at all the Fancy Feast Flavors and the Friskies Pates carbs

Do you have a hypo kit yet in case you need to bring his BG up
Hypo Kit if needed to bring his BG up
Good idea to mark the cans with magic marker how many carbs

. Doesn't have to be Fancy Feast just an example about the med and high carb foods, The Friskies med and high carb ones are probably cheaper



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.

Also have some karo in the house



Just wanted you to know on Dr Pierson's food chart

the Fancy Feast Gravy Lovers Beef Feast In Roasted Beef Flavor Gravy (which. Dr Pierson’s list says is 20%
Comes back with 14%

These are correct for med carbs
Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs



Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

You can even look at the Friskies for high carb and med carbs.
So buy a few cans of each

I would say check some of these out and then Google them and see how much they are
Click to expand...

yeah, I didn't get the message in time and unfortunately his numbers went very low that night, but no worries, I always have Karo in the house because I love to bake.
 
Robyn P said:
Thanks for the tip.
Click to expand...

If you are in US you can purchase Fancy Feast from CHEWY.COM I have 2 cats, I use 4 cans a day, I feed several times a day 1/2 can each, that's 84 cans a month I also buy the Pretty Litter 2 bags a month, I pay no shipping and spend between $140.-$160. a month total, no shipping charge. that would be $0.81- $0.83 a can Vs over$1.00 at the stores, And delivered in less then 2-3 days You cannot buy a single can I have narrowed down to 4 of their favorite flavors, I do not know many people in a such a tight budget as I am, believe me when I say this.:bighug::cat::cat:
 
CORKY said:
If you are in US you can purchase Fancy Feast from CHEWY.COM I have 2 cats, I use 4 cans a day, I feed several times a day 1/2 can each, that's 84 cans a month I also buy the Pretty Litter 2 bags a month, I pay no shipping and spend between $140.-$160. a month total, no shipping charge. that would be $0.81- $0.83 a can Vs over$1.00 at the stores, And delivered in less then 2-3 days You cannot buy a single can I have narrowed down to 4 of their favorite flavors, I do not know many people in a such a tight budget as I am, believe me when I say this.:bighug::cat::cat:
Click to expand...

My cat is bigger than average (14lbs) so he needs 4 full cans/day. and trust me I know about tight budgets, i'm on food stamps and medicaid. Rafael is my ESA.
 
Robyn P said:
My cat is bigger than average (14lbs) so he needs 4 full cans/day. and trust me I know about tight budgets, i'm on food stamps and medicaid. Rafael is my ESA.
Click to expand...

Corky is a very large cat as well he weighs 16 lbs and my other cat Coco is 1/2 Main Coon she weighs 18 lbs and I feed them 1/2 can on AMPS/PMPS at +2 I give them ham snack then T +2-6 & 5 1/2 can you can see his SS IN remarks I log everything they eat, welcome to the club financially we are equal with the same benefits most of every month I’m left with only $5-10 for the rest of the month so we relate:bighug::bighug::bighug::bighug::cat::cat:,
 
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