4/15 Brody AMBG 390 Help - need dosing advice - Newbie

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Michaellh33

Michaellh33

Member Since 2015
Hello,
My at jsut started treatment for diabetes last Thursday although I just began home treatment yesterday. The ver prescribed lantus at 2.5 units 2 times daily but I am not going to feed him the dry food the vet prescribed. I am instead feeding him wellness brad food that has around 15% carbohydrates. I am feeding him several flavors so it varies but never goes over 15%. I tested is blood glucose level just now and it came in at 390. I have not fed him yet but wanted to know what a proper dose would be as someone mentioned 2.5 was a little high. He weighs 10 lbs and I would like to try and follow the right regulation protocol.
I will be gone 8 hours a day except on the weekends.

Edit: He was diagnosed with Ketoacidosis upon arriving at the vet last Thursday but they did stuff (very expensive stuff) to remove the ketones.
 
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Hi Michael, welcome to FDMB and Lantus Land. I don't have any dosing advice but I'm sure someone will be by soon to provide some guidance. Good call on passing on the dry food. I know there are members who have work schedules like yours that can provide some guidance on how best to follow the protocol while keeping Brody safe. I fortunately have flexibility with my schedule so I can't be of much help. Just wanted to welcome you and wish you and Brody the best. You've come to the right place for help. Ask all the questions you have - you'll learn a lot pretty quickly.
 
MrZ said:
Hi Michael, welcome to FDMB and Lantus Land. I don't have any dosing advice but I'm sure someone will be by soon to provide some guidance. Good call on passing on the dry food. I know there are members who have work schedules like yours that can provide some guidance on how best to follow the protocol while keeping Brody safe. I fortunately have flexibility with my schedule so I can't be of much help. Just wanted to welcome you and wish you and Brody the best. You've come to the right place for help. Ask all the questions you have - you'll learn a lot pretty quickly.
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Thank you for the support, I appreciate it.
 
What did you shoot yesterday? Do you have a spreadsheet yet? If not, as I know you have a lot of stress with your job you could ask someone to get that set up for you. We need the spreadsheet to be able to give dosing advice.

How much time do you have until you have to head out for work?
 
The vet gave him 2.5 right when I picked him up from the vet around 4:45pm. I don't have a spreadsheet and not really sure what it is. I have to leave in about 30 minutes. I just put some canned food down for him to give him some time to eat.
 
I got a measurement of 26 (not sure if in error) last night so I gave him some of the dry food the vet prescribed and he seems to not be so tired looking but I did not test him after. (Very nerve racking for me.)
 
Instructions are here for the grid we use to record the shots and tests.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
This is tricky for me (providing dosing advice) because you're new, you won't be able to monitor today, we have no data on Brody so no idea how he may react to the insulin. However since he's been DKA he does need insulin. Will you be leaving food for him? Are you giving him 15% only?
 
I figured it would be. I put have a whole can of food but I have 2 cats. When i checked the nutrient information from someone else post it seemed all of the wellness food was under 15% so it shouldn't be lower than that.
 
Using the formula for a starting dose of (ideal or underweight) weight in kilograms * 0.25, rounding down to the nearest 0.25, he'd get 1.0 unit. If you wanted to be very conservative, 0.5 units.

Is he underweight, or at his ideal weight?
 
BJM said:
Using the formula for a starting dose of (ideal or underweight) weight in kilograms * 0.25, rounding down to the nearest 0.25, he'd get 1.0 unit. If you wanted to be very conservative, 0.5 units.

Is he underweight, or at his ideal weight?
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Well he weighs 10 lbs (before he went into the vet for te treatment) no idea now. Looks maybe a little skinnier.

Edit: That ocmes out to 1.13398 so that would jsut be 1 unit?
 
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Zeke's gets the Wellness Turkey which is only 4%. What formula of Wellness are you feeding? How much has Brody eaten? Can you change you're post heading to "4/15 Brody AMBG 390 Help - need dosing advice - Newbie"
I would think 1 unit would be ok (though I'm not advising that) - I'd really like to see others chime in.

Edited to add: I don't have enough experience given your circumstances to comfortably provide dosing advice. Hopefully one of the more experienced members will be by to help.
 
MrZ said:
Zeke's gets the Wellness Turkey which is only 4%. What formula of Wellness are you feeding? How much has Brody eaten? Can you change you're post heading to "4/15 Brody AMBG 390 Help - need dosing advice - Newbie"
I would think 1 unit would be ok (though I'm not advising that) - I'd really like to see others chime in.
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Chicken and herring formula. Less than 1/4th of the can although I did put the whole cna down for them to eat through the day.
 
Oh, I see BJM is providing you some guidance. I have to start getting ready for work so I'll be signing off soon. Good luck Michael. Hang in there.
 
Chicken and herring is only 6% and would be considered a low carb (LC). Anything under 10% is considered LC. For low BGs one would want to feed moderate carb (MC) or high carb (HC). It's been awhile since I've thought about it but I think anything 15% or more is considered HC.
 
Yes, that would be 1.0 units, unless you're nervous about not being home to monitor him, in which case you could give 0.5 units.
 
You're probably headed out to work yourself shortly but things you might want to consider going forward is (1) is there any way you can separate your cats so that you know the food you leave for Brody he'll get and (2) can you keep a supply of various % carb foods, maybe a 8% or 9% and some MC or HC in case you need to get Brody's BG up? You may also want to consider asking for dosing advice the night before so there's time to get more eyes on your post and you'll have a plan in place to make this a little less stressful come shot time.
 
MrZ said:
You're probably headed out to work yourself shortly but things you might want to consider going forward is (1) is there any way you can separate your cats so that you know the food you leave for Brody he'll get and (2) can you keep a supply of various % carb foods, maybe a 8% or 9% and some MC or HC in case you need to get Brody's BG up? You may also want to consider asking for dosing advice the night before so there's time to get more eyes on your post and you'll have a plan in place to make this a little less stressful come shot time.
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Indeed, I actually need to leave in 5 minutes. 1) I live in a very small studio apartment. I have a small bathroom and closet but I think too small to leave either one of them in it for 8 hours so not an option. 2) I need to go get some friskies today from walmart, not sure which one yet. I tried to do it last night but it was already 12 before I knew what to do.
 
Yes.

I feed all 16 cats at my place the Friskies pates. The civvies (civilians) can have the Mixed Grill, but the diabetic, Gracie, only gets turkey as she is allergic to other foods.
 
BJM said:
Yes.

I feed all 16 cats at my place the Friskies pates. The civvies (civilians) can have the Mixed Grill, but the diabetic, Gracie, only gets turkey as she is allergic to other foods.
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I will look into it today when I get home but I jsut game him his injection (8:00 am)of around .75 or 1. It was hard to tell as the syringe didn't really measure the units easily. Also I am fairly certina the needle went in as I felt it pierce something but how can I know? I have to go to work now though. I will test him as soon as I get home.
 
You want to be sure Brody's blood glucose (BG) test numbers stay above 50. Normal BG is 50 - 120. Numbers that fall below 50 (if you are following the Tight Regulation Protocol) indicate you need to reduce the dose. If you are following the Start Low Go Slow (SLGS) approach, a dose reduction occurs if numbers are below 90. If you are seeing numbers like the 26, I would re-test immediately to make sure it wasn't a bad strip or a bad test. A 26 is VERY low and warrants immediate intervention with high carb food (e.g., canned "gravy" style food that is above 15% carbs or adding corn syrup such as Karo, maple syrup, honey, etc.) to food in order to get the BG numbers up quickly. You feed and re-test in 15 - 20 min. to make sure the food is doing it's work and you keep doing this to insure you cat is safe. In the beginning, testing is nerve wracking. However, Brody will acclimate as will you. It is the absolute best way to keep your kitty safe! All of the ins and outs of managing your cat's diabetes are overwhelming at first. It really does get easier.

A 15% food is considered at the top end of medium carb. Food that is below 10% is considered low carb although most of us feed in the 5% range.

Are you testing Brody's urine for ketones? If not, please get some Ketostix. You can find them at any pharmacy. Ketones can be very dangerous and not easily managed at home. The best way to prevent another expensive stay at the vet hospital is to test at home. As a precaution, I would suggest adding water to Brody's canned food. Water helps to flush ketones.

I'm sorry but I really disagree with BJ. The minimum I would reduce the dose is to 1.0u. With a cat that's recently been treated for ketones and most likely diabetic ketoacidosis (DKA), insulin is essential. The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories. Brody is better served by giving as much insulin as is necessary and feeding a higher carb food to balance the amount of insulin until you are sure the ketones are under control. If you're not going to be home and can't stop home to check on Brody, leave dishes of food out in all of his usual places. I'm hoping that your vet recommended a higher carb food and the suggested dose because of the ketones.
 
Michael, you hold the syringe so it's your call. As BJM responded, 0.75u would be fine. We can only provide guidance - ultimately it's your decision. We strive to give advice that balances keeping the kitty safe and giving the kitty the best chance of remission/regulation.

We have 3 cats. Ivan and Mia, our civvies (i.e. non-diabetic cats), have their food in our study, which access is blocked to Zeke by a baby gate (purchased at Walmart). Zeke can't jump over the gate but the civvies can. We keep the civvies frosty bowl (awesome invention in my opinion) filled with food all day long (they're grazers) so they're not tempted to eat any food we leave for Zeke. We use an automatic feeder for Zeke's meals when we're away. He was quickly conditioned to run to it and eat when it goes off. If this may work for you, let me know. I can provide some helpful tips.

Edited to add (ETA): I agree with Sienne. Better to leave more food/give higher carb so you can give Brody adequate amount of insulin. However, given your circumstances this morning, you made the best decision you could. If I were you I would make preparations so that going forward I could comfortably go with the highest dose recommended in order to help Brody from going DKA.
 
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I left some food out for Brody and when I got home I tested him at +9 and he came in at 253. I am about to feed him again now. I am feeding him Tiki Cat Puka Puka Luau todya which is 0% carbs according to the cat food chart.
Assuming I successfully gave him his injection this morning I game him about 1.0 units to be sure.What should I move to do next?
 
Michael, please buy Ketostix (strips to test for ketones in the urine). My diabetic cat also had Ketoacidosis a few weeks ago. Just like you I spent a lot of money to get rid of ketones but they can come back, especially if your Brody isn't a well regulated diabetic yet. Try to get him to drink more, add some water to food. That works for my cat. Water flushes ketones out.

As for insulin, it's really important to test, always before food/injection and then maybe before you go to bed. +5, +7 might show you how low he goes.
 
Vintry said:
Michael, please buy Ketostix (strips to test for ketones in the urine). My diabetic cat also had Ketoacidosis a few weeks ago. Just like you I spent a lot of money to get rid of ketones but they can come back, especially if your Brody isn't a well regulated diabetic yet. Try to get him to drink more, add some water to food. That works for my cat. Water flushes ketones out.

As for insulin, it's really important to test, always before food/injection and then maybe before you go to bed. +5, +7 might show you how low he goes.
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He has water available all day but I will get some for him. Currently I will not be able to get a +5 or +7 reading. I gave him an injection this morning at 8am (I was almost late for work) and was about to test him at +9 but I am at work all day. I would not be able to do something like that till the weekend.
 
I see you shoot at 8am/8pm? When do you leave and get home from work Michael?

Adding water to the food will help get even more water into him....cats don't have a high thirst drive so even though there's water out, they may not drink enough, so any way you can get water into them really helps flush those ketones

Also, some cats do better with something low carb (like 4-5%) instead of zero carb....it's one of those ECID (Every Cat is Different) things that you just have to experiment with
 
You're off to a good start, Michael. The beginning is by far the hardest part - it gets much easier.

Just coming out of ketones it's important to get enough insulin, food and water into Brody. The suggestion about having high carb food is a good one - you need a hypo kit, just in case.

Because you're at work all day it's going to be helpful for you to leave extra food. With 2 cats, you might want to have 2 automatic timed feeders and have them open at the same time. Hopefully Brody will get at least one of them.

This place is a little overwhelming at first, but hang in there and it also gets easier.

Here is a post that is basically an index to the Lantus/Lev board called "Where Can I Find?" At the bottom of the first post are individual threads with good discussions that can be helpful. I'd suggest you bookmark that link so you can find it in the future.

There is a discussion in the very top about working full-time and following Tight Regulation that might have some helpful ideas for you.
Also in the top section, you'll want to read a little about the Tight Regulation Protocol and the Start Low Go Slow dosing method and decide what's going to work for you and your life.

I'd also take a look at the post in the top about taking care of your insulin - it's expensive enough that you don't want to compromise it by accidentally doing something wrong with it.

In the bottom half, you might want to read about Feeding with timed feeders, and ketones. Ketones are bad and you don't want them to return. As you've seen, going to the vet with them costs a small fortune.

And last, there is a post in the top half called "New to the Group?" that has all the info to help you get started, including how to start a spreadsheet. You can see that each person who has been posting to you today has a spreadsheet link in their signature line. Because of the way Lantus and Levemir work, we evaluate the dose based upon how LOW the dose takes the cat over the past few days. We need to see the blood sugar in context of how many hours it's been since the cat got its insulin injection. We count everything in hours past the injection - so when people say "can you get a +2?" they mean will you check the blood sugar 2 hours after the injection.

There's a ton of reading, but it will all begin to make sense as you go along. Ask a zillion questions - none of us mind. We've all been in your shoes.

Glad to have you & Brody here!
 
Great job on the spreadsheet! You don't have to test hourly at this point. I'd get another test just before your shot time and then give the 1.0u. Then get another test before you go to bed.
 
Chris & China said:
I see you shoot at 8am/8pm? When do you leave and get home from work Michael?

Adding water to the food will help get even more water into him....cats don't have a high thirst drive so even though there's water out, they may not drink enough, so any way you can get water into them really helps flush those ketones

Also, some cats do better with something low carb (like 4-5%) instead of zero carb....it's one of those ECID (Every Cat is Different) things that you just have to experiment with
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I will try to do that to the food.
I am currently trying to find a good food, I may just stick with the wellness as they seem to like it reasonably well.

I have to be into work between 8:00am - 8:30am we have some flex time.
 
On this board we suggest new members go ahead with their shots if the preshot test is over 150ish. If it's under, post and ask for an experienced person to help you.

In your case, you may need to repeat that he just had DKA. The significance of that is that you should not skip shots.
 
julie & punkin (ga) said:
On this board we suggest new members go ahead with their shots if the preshot test is over 150ish. If it's under, post and ask for an experienced person to help you.

In your case, you may need to repeat that he just had DKA. The significance of that is that you should not skip shots.
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I will give him his shot tonight and test tomorrow morning before I give him another one.
I have updated my signature to say that but I will also be sure to mention it.
 
julie & punkin (ga) said:
You're off to a good start, Michael. The beginning is by far the hardest part - it gets much easier.

Just coming out of ketones it's important to get enough insulin, food and water into Brody. The suggestion about having high carb food is a good one - you need a hypo kit, just in case.

Because you're at work all day it's going to be helpful for you to leave extra food. With 2 cats, you might want to have 2 automatic timed feeders and have them open at the same time. Hopefully Brody will get at least one of them.

This place is a little overwhelming at first, but hang in there and it also gets easier.

Here is a post that is basically an index to the Lantus/Lev board called "Where Can I Find?" At the bottom of the first post are individual threads with good discussions that can be helpful. I'd suggest you bookmark that link so you can find it in the future.

There is a discussion in the very top about working full-time and following Tight Regulation that might have some helpful ideas for you.
Also in the top section, you'll want to read a little about the Tight Regulation Protocol and the Start Low Go Slow dosing method and decide what's going to work for you and your life.

I'd also take a look at the post in the top about taking care of your insulin - it's expensive enough that you don't want to compromise it by accidentally doing something wrong with it.

In the bottom half, you might want to read about Feeding with timed feeders, and ketones. Ketones are bad and you don't want them to return. As you've seen, going to the vet with them costs a small fortune.

And last, there is a post in the top half called "New to the Group?" that has all the info to help you get started, including how to start a spreadsheet. You can see that each person who has been posting to you today has a spreadsheet link in their signature line. Because of the way Lantus and Levemir work, we evaluate the dose based upon how LOW the dose takes the cat over the past few days. We need to see the blood sugar in context of how many hours it's been since the cat got its insulin injection. We count everything in hours past the injection - so when people say "can you get a +2?" they mean will you check the blood sugar 2 hours after the injection.

There's a ton of reading, but it will all begin to make sense as you go along. Ask a zillion questions - none of us mind. We've all been in your shoes.

Glad to have you & Brody here!
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I have some honey here in case of emergency.

My other cat, Cerberus, is really good with his paws. He actually eats by picking up the food between his claws in his right paw. He can open draws and doors sometimes so I don't know how well an automatic feeder will stack up against him.
 
If it'll work with your schedule, you might want to consider changing your shot time to 6am/6pm...but don't do it all at once. You can work back by 15 minutes per cycle or 30 minutes once a day

I HATE mornings, but found that by getting up early I could get a +2 before I had to leave (if I had to leave)...that +2 is a good test to get since we've seen a lot of times it can act like an "early warning system"

If the +2 is lower than the Pre-shot number, that can be your clue that you might want to leave some extra food down or even see if you can find a way to come home over lunch or get a neighbor or friend to check on him

By shooting at 6pm, I can usually get a +6 at night too without having to stay up TOO late (I'm a night person, so midnight isn't really late for me) but it sure helps me sleep at night knowing China's numbers are in a safe range before I turn in for the night
 
Chris & China said:
If it'll work with your schedule, you might want to consider changing your shot time to 6am/6pm...but don't do it all at once. You can work back by 15 minutes per cycle or 30 minutes once a day

I HATE mornings, but found that by getting up early I could get a +2 before I had to leave (if I had to leave)...that +2 is a good test to get since we've seen a lot of times it can act like an "early warning system"

If the +2 is lower than the Pre-shot number, that can be your clue that you might want to leave some extra food down or even see if you can find a way to come home over lunch or get a neighbor or friend to check on him

By shooting at 6pm, I can usually get a +6 at night too without having to stay up TOO late (I'm a night person, so midnight isn't really late for me) but it sure helps me sleep at night knowing China's numbers are in a safe range before I turn in for the night
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I have to get up at 6:30am already but maybe I can shift it forward.
Do I give him a shot before or after he eats or does it matter?
I am temporarily living in another state as I am a Co-Op student through my university so I don't know anyone here nor do I have any roommates.
 
Most of us test/feed/shoot....all within about 5-10 minutes

You test...to make sure they're high enough for any insulin

You feed...to make sure they're eating "normally"

You shoot
 
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Wll I made an oops. I didn't realize each tick mark was .5 on the syringe and I only gave him .5 this morning. I just administered 1.0 unit though. Will post a +2.
 
Looking good so far - nice to see you got a spreadsheet up too. That makes it so much easier for all of us to see what's been happening with Brody's numbers when you have questions. :) You're doing great and that 0.5 this morning - much safer than if you'd gone over and getting him into yellow numbers when he could actually be bouncing from that 26 you got means it looks like it worked well for him today. :)
 
manxcat419 said:
Looking good so far - nice to see you got a spreadsheet up too. That makes it so much easier for all of us to see what's been happening with Brody's numbers when you have questions. :) You're doing great and that 0.5 this morning - much safer than if you'd gone over and getting him into yellow numbers when he could actually be bouncing from that 26 you got means it looks like it worked well for him today. :)
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Glad to finally see something good. Testing his blood is terrible for me though. Small fear of stabbing myself and the blood. One question what is nadir though?
 
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