Balvin has entered the chat

[Balvin's Nurse]

Hello, this is Cat, Balvin’s mom.

Balvin is a 4.5 year old Ragdoll who was diagnosed with diabetes about a week ago when we brought him to the ER in DKA

It was very scary and he spent 3 days at the hospital on IV insulin and now transitioned to Glargine twice a day and is home We promptly got a CGM, and as warned by the ER doc, we have been freaking out about the glucose fluctuations. We are now feeding ProPlan DM but unsure about the quantity. At first, we gave him 1/2 can because his glucose was high (300-400s), but since he has lost quite some weight we decided (and we’re advised) to give him what the brand recommends. We went to 3/4 can per feed + 40gr of shredded chicken to up the protein content in his meal (he eats every 12 hours along with 1u of Glargine). He is weighing 11 lbs now but back in Sep 2023 he was 15.3 lbs. (his dad weighs 20lbs so he comes from a line of large Ragdolls). We couldn’t get an appointment to see an internist any sooner than May 8th so we are experimenting and trying things at home. My biggest concern is going into DKA again, and with the glucose levels in the 300s I don’t know if we can dodge that before we see the doctor next week.

Any advice? I need peace of mind. ER doc said she prefers his glucose is high than low but… I know this is not good for his little body.

 

[Diane Tyler's Mom GA]

Hello, this is Cat, Balvin’s mom.

Balvin is a 4.5 year old Ragdoll who was diagnosed with diabetes about a week ago when we brought him to the ER in DKA

It was very scary and he spent 3 days at the hospital on IV insulin and now transitioned to Glargine twice a day and is home We promptly got a CGM, and as warned by the ER doc, we have been freaking out about the glucose fluctuations. We are now feeding ProPlan DM but unsure about
the quantity. At first, we gave him 1/2 can because his glucose was high (300-400s), but since he has lost quite some weight we decided (and we’re advised) to give him what the brand recommends. We went to 3/4 can per feed + 40gr of shredded chicken to up the protein content in his meal (he eats every 12 hours along with 1u of Glargine). He is weighing 11 lbs now but back in Sep 2023 he was 15.3 lbs. (his dad weighs 20lbs so he comes from a line of large Ragdolls). We couldn’t get an appointment to see an internist any sooner than May 8th so we are experimenting and trying things at home. My biggest concern is going into DKA again, and with the glucose levels in the 300s I don’t know if we can dodge that before we see the doctor next week.

Any advice? I need peace of mind. ER doc said she prefers his glucose is high than low but… I know this is not good for his little body.

Welcome Cat and Galvin you couldn't have found a better group to join
I'm going to tag Bron for you one of our members who is experience with DKA meantime can you fill out what we call our signature and spreadsheet ,tap on this blue link
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you
If you need help setting up the spreadsheet just ask and I can ask a member to do it for you

This is the info we need about Galvin in your signature

• 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.

 

[Diane Tyler's Mom GA]

Hello, this is Cat, Balvin’s mom.

Balvin is a 4.5 year old Ragdoll who was diagnosed with diabetes about a week ago when we brought him to the ER in DKA

It was very scary and he spent 3 days at the hospital on IV insulin and now transitioned to Glargine twice a day and is home We promptly got a CGM, and as warned by the ER doc, we have been freaking out about the glucose fluctuations. We are now feeding ProPlan DM but unsure about the quantity. At first, we gave him 1/2 can because his glucose was high (300-400s), but since he has lost quite some weight we decided (and we’re advised) to give him what the brand recommends. We went to 3/4 can per feed + 40gr of shredded chicken to up the protein content in his meal (he eats every 12 hours along with 1u of Glargine). He is weighing 11 lbs now but back in Sep 2023 he was 15.3 lbs. (his dad weighs 20lbs so he comes from a line of large Ragdolls). We couldn’t get an appointment to see an internist any sooner than May 8th so we are experimenting and trying things at home. My biggest concern is going into DKA again, and with the glucose levels in the 300s I don’t know if we can dodge that before we see the doctor next week.

Any advice? I need peace of mind. ER doc said she prefers his glucose is high than low but… I know this is not good for his little body.

@Bron and Sheba (GA)
Hi Bron Cat the human ,her kitty Balvin
Balvin is a 4.5 year old Ragdoll who was diagnosed with diabetes about a week ago when we brought him to the ER in DKA

It was very scary and he spent 3 days at the hospital on IV insulin and now transitioned to Glargine twice a day and is home

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Cat and Balvin.
I am very sorry you are going through DKA with your kitty. It is scary but you have come to the very best place to get help and support.
It is very normal for the blood glucose (BG) to fluctuate during the cycles, so try not to freak out about that. The BG will start off higher at the beginning of the cycle and then start to go down as the insulin starts to work, around +2 (2 hours after the dose) with glargine. It will stay lower for a few hours until the insulin wears off and then it will start to go back up again until the next cycle starts.

In relation to the food, I would recommend you feed Balvin a lot more than twice a day. Food is very important to a diabetic cat, especially after DKA as food is one of the things that helps stop the ketones reforming.it is ketones that start forming that can then progress progress to DKA, so we want to stop them forming again.
The other thing that will help stop ketones forming again is insulin, so downer skip any doses.
And fluids are also important.
How is his appetite?
It is not necessary to feed prescription food. Any low carb canned cast food is ok as long as it is 10% carbs or less. Here is a FOOD CHART to look at

So I am going to give you a list of things you need to be doing during Balvin’s recovery.

• you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. A snack is a teaspoon or 2 of low carb food. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. This is really important. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. To test for ketones you will need o buy a bottle of Ketostix from Walmart or a pharmacy and follow direction on the bottle. You will need to collect a urine sample from Balvin.
• Give antinausea medication if needed. It is a good idea to have some cerenia or ondansetron at home in case it is needed as a lot of DKA kitties are nauseated when they come home.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids
• Set up a spreadsheet and test the BG frequently. We can help you if you have trouble setting it up . I can ask @Bandit's Mom to help you. Also your signature so we know all about Balvin.
• Post daily with updates and ask for help as often as needed.

Here is how to CATCH A URINE SAMPLE

Looking forward to hearing back from you and hearing how Balvin is progressing.
Bron

 

[giotto]

Hello, this is Cat, Balvin’s mom.

Balvin is a 4.5 year old Ragdoll who was diagnosed with diabetes about a week ago when we brought him to the ER in DKA

It was very scary and he spent 3 days at the hospital on IV insulin and now transitioned to Glargine twice a day and is home We promptly got a CGM, and as warned by the ER doc, we have been freaking out about the glucose fluctuations. We are now feeding ProPlan DM but unsure about the quantity. At first, we gave him 1/2 can because his glucose was high (300-400s), but since he has lost quite some weight we decided (and we’re advised) to give him what the brand recommends. We went to 3/4 can per feed + 40gr of shredded chicken to up the protein content in his meal (he eats every 12 hours along with 1u of Glargine). He is weighing 11 lbs now but back in Sep 2023 he was 15.3 lbs. (his dad weighs 20lbs so he comes from a line of large Ragdolls). We couldn’t get an appointment to see an internist any sooner than May 8th so we are experimenting and trying things at home. My biggest concern is going into DKA again, and with the glucose levels in the 300s I don’t know if we can dodge that before we see the doctor next week.

Any advice? I need peace of mind. ER doc said she prefers his glucose is high than low but… I know this is not good for his little body.

Hi Cat - I recently joined this group as my ragdoll mix, a 14+ yo male, just got diagnosed with Diabetes. I am heartbroken, in shock and on auto pilot. He had an all clear checkup end of December and fast forward to last week, when I thought he had a UTI, it wound up being Diabetes. He had 350 glucose. His blood showed his kidneys and liver were good. She said he could go on bexcat or insulin, or wait a month and try to reverse/stablize with a low carb diet. She recommended purina pro plan. She said her 15 year old diabetic cat is treated with low carb diet only. I went this route, and he did well at first. But a few days into the low carb he vomited after a meal and had diarreah. This happened two times in the space of a few days. He also began to get weak and lethargic quite suddenly. I tested his ketones, and they were neg/trace. I took him to vet and she felt he had a mild case of pancreatitis. His glucose was 320, so she said he could still stay on diet only for now and finish the month to see if the diet changes his glucose levels. She sent us home with cerenia which is an anti-nausea, for 15 days. He is still weak, but eating about 1/2 and lots of steam chicken breast. He goes up and down. I am watching closely and will bring him back to vet if anything changes. It is a nightmare. I hope you have better news and are doing well with your baby.

 

[Balvin's Nurse]

Hi and welcome to the forum Cat and Balvin.
I am very sorry you are going through DKA with your kitty. It is scary but you have come to the very best place to get help and support.
It is very normal for the blood glucose (BG) to fluctuate during the cycles, so try not to freak out about that. The BG will start off higher at the beginning of the cycle and then start to go down as the insulin starts to work, around +2 (2 hours after the dose) with glargine. It will stay lower for a few hours until the insulin wears off and then it will start to go back up again until the next cycle starts.

In relation to the food, I would recommend you feed Balvin a lot more than twice a day. Food is very important to a diabetic cat, especially after DKA as food is one of the things that helps stop the ketones reforming.it is ketones that start forming that can then progress progress to DKA, so we want to stop them forming again.
The other thing that will help stop ketones forming again is insulin, so downer skip any doses.
And fluids are also important.
How is his appetite?
It is not necessary to feed prescription food. Any low carb canned cast food is ok as long as it is 10% carbs or less. Here is a FOOD CHART to look at

So I am going to give you a list of things you need to be doing during Balvin’s recovery.

• you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. A snack is a teaspoon or 2 of low carb food. Food is like a medicine and helps keep ketones away. If your kitty won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.
• Test daily for ketones. This is really important. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all. To test for ketones you will need o buy a bottle of Ketostix from Walmart or a pharmacy and follow direction on the bottle. You will need to collect a urine sample from Balvin.
• Give antinausea medication if needed. It is a good idea to have some cerenia or ondansetron at home in case it is needed as a lot of DKA kitties are nauseated when they come home.
• Give appetite stimulant if needed after the antinausea medication
• Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
• Ask the vet about subQ fluids
• Set up a spreadsheet and test the BG frequently. We can help you if you have trouble setting it up . I can ask @Bandit's Mom to help you. Also your signature so we know all about Balvin.
• Post daily with updates and ask for help as often as needed.

Here is how to CATCH A URINE SAMPLE

Looking forward to hearing back from you and hearing how Balvin is progressing.
Bron

Hi Bron,

We are so thankful for all of this insight. I am going to elaborate a little more about his DKA and see if you have any feedback.

He was brought into the ER on 4/23 because of lethargy and vomiting. That’s when he got diagnosed with DKA. He stayed on IV insulin and IV fluids for 3 days and then they transitioned to Glargine BID. Since he came home he has been eating full meals twice a day as instructed by the ER doctor but we might want to consider splitting those meals in 4 as he will need a lot of food to put back some weight. He went from 15lbs to 11lbs in a matter of a couple of months. So we haven’t needed the appetite stimulant and thankfully he has been ravenous with his food as he has always been He has also been drinking a lot of water, which will scare us at times because that was one of the signs of DKA, thank you for letting us know that fluids are ok!

Now when you talk about ketones… when he left the ER, he wasn’t acidotic anymore but he still had ketones in urine and blood. Doctor said she was ok with him going on with ketones as long as the rest of the imbalances cleared up. Do you think it’ll be safe to say the ketones would have cleared by now? That’s one of the main reasons why I haven’t been eager to test with the ketostix yet.

I think our biggest mistake has been withholding food to prevent spikes in blood sugar but we did start recently giving him 3/4 can of ProPlan DM and 40gr of chicken with every meal. Surprisingly this guy will eat the whole thing in one sitting and not even get nauseous. He just sits to digest for a long time. So maybe the multiple feedings throughout the day are a good idea.

My fiancé has been working on the spreadsheet and will work on our signature as well so we can communicate better. Thank you again for such prompt response to our kitty concerns.

 

[Bron and Sheba (GA)]

Do you think it’ll be safe to say the ketones would have cleared by now? That’s one of the main reasons why I haven’t been eager to test with the ketostix yet.

I have no idea if the ketones have cleared or not yet. The only way to find out is to test daily to check them. I’m very surprised the vet did not tell you to test for them. It is far better to know if there are any ketones then to just hope there isn’t. If there are, then we can put strategies in place to help get rid of them.

yet.
I think our biggest mistake has been withholding food to prevent spikes in blood sugar but we did start recently giving him 3/4 can of ProPlan DM and 40gr of chicken with every meal. Surprisingly this guy will eat the whole thing in one sitting and not even get nauseous. He just sits to digest for a long time. So maybe the multiple feedings throughout the day are a good idea.

You are very lucky if he is eating well for you. Many post DKA cats are nauseated and can’t eat which is a major issue. He needs 1and a half times as many calories as he would normally eat, and the best way to do this is to give 2 main meals before the doses of insulin and then give snacks of food every few hours. A snack is a teaspoon or two of low carb food. Just don’t feed for the two hours before you take the Preshot BG as we don’t want that BG to be good influenced. The snacks won’t spike the BGs and it is better for the pancreas to have several smaller meals throughout the day than two enormous ones.
Let him drink all he wants. And add a bit of warm water to snacks. Until the BGs come down to normal, he will be very hungry as his body can’t absorb all the nutrients in the food and he will be wanting to drink a lot.
With the testing, always test before every dose to see it is safe to give the dose and then check during the cycles to see how low the dose is taking him. So you test, then feed then give the insulin.
Put your ketone results into the remarks column of the spreadsheet please so we can see.
Bron

 

[Sienne and Gabby (GA)]

We generally recommend that a cat that is recovering from DKA eat about 1.5 times as much as their normal food intake. DKA is the result of an underlying inflammation or infection + not enough calories + not enough insulin. If Balvin is eating, as Bron noted, it's positive sign! Frankly, I'd let him eat as much as he wants.

Just a word about the DM. Many cats get tired of it. It really isn't a "diabetes" food. If you look in the ingredients, there's nothing in the food that is prescriptive for diabetes. Balvin has lots of choices for low carbohydrate foods. This food chart includes most of the canned foods available in the US with information on the carb content. You want to choose foods that are under 10% carb -- which is what we consider low carb. (Although most people here feed their cats in the 5% range.) Water also helps to dilute ketones.

We are very careful about monitoring cats that are recently post-DKA. Ketones can develop quickly and as you've seen, are an expensive emergency. We want you to have the tools to know how and when to intervene. You can use either urine test strips (Ketostix or Ketodiastix) to test or there are blood ketone meters. You will also want to home test Balvin to monitor his blood glucose so you have more control over how the insulin is effecting him. I couldn't quite tell from your post if you're home testing. If not, we have information on how to do so.

If you're wanting to do some reading about glargine, the sticky notes at the top of the Lantus board will be helpful.

 

[Balvin's Nurse]

We generally recommend that a cat that is recovering from DKA eat about 1.5 times as much as their normal food intake. DKA is the result of an underlying inflammation or infection + not enough calories + not enough insulin. If Balvin is eating, as Bron noted, it's positive sign! Frankly, I'd let him eat as much as he wants.

Just a word about the DM. Many cats get tired of it. It really isn't a "diabetes" food. If you look in the ingredients, there's nothing in the food that is prescriptive for diabetes. Balvin has lots of choices for low carbohydrate foods. This food chart includes most of the canned foods available in the US with information on the carb content. You want to choose foods that are under 10% carb -- which is what we consider low carb. (Although most people here feed their cats in the 5% range.) Water also helps to dilute ketones.

We are very careful about monitoring cats that are recently post-DKA. Ketones can develop quickly and as you've seen, are an expensive emergency. We want you to have the tools to know how and when to intervene. You can use either urine test strips (Ketostix or Ketodiastix) to test or there are blood ketone meters. You will also want to home test Balvin to monitor his blood glucose so you have more control over how the insulin is effecting him. I couldn't quite tell from your post if you're home testing. If not, we have information on how to do so.

If you're wanting to do some reading about glargine, the sticky notes at the top of the Lantus board will be helpful.

Thank you for the very informative post. We will be looking into different options for food different from Purina DM. We had been adding boiled chicken or browned turkey to his food to add more protein until this ‘wonderful’ internist we found said a few things that contradicted what we believed, read, and were hopeful for. First of all she told us that cats mainly suffer from Type I diabetes, which is not what we have read. Second of all, when asked about our chances of remission, she said that’s not a possibility and very unlikely to happen in cats. She also went on to saying how cats’ physiology is different and they will not have the annoying side effects from glucose toxicity such as neuropathy or blindness. Additionally she recommended not to test for glucose or ketones

I left there nearly crying and very discouraged from not getting the answers we wanted and the tailored plan for Balvin we had so anxiously been waiting for. Also a bit confused with such different information provided to us.

I now come back here to vent and hope to continue adhering to the treatment plan we initially had from our ER vet, which aligns more with the Forum ideas/tips. Looking forward to learning a ton from this forum.

To answer your question, we are testing a lot. We got our second CGM today after taking a few days off since our last one died after 7 days. We also are using the AlphaTrak 3 whenever we don’t have data from the CGM. We have purchased the ketostix as @Bron and Sheba (GA) recommended and they’ve been negative to trace.

I am still struggling with finding information on the right amount of food for Balvin. The vet internist we saw did not answer that for us. We are unsure what the ideal body weight is for a 4.5 year old Ragdoll male. Balvin had weighed ~15lbs for the last few years (last weight before DKA was in sept 2023) and his dad max weight is 20lbs. We were told in September that he could shave a couple pounds. We are now ~11lbs post-DKA and showing quite some bone on the spine and rib cage area. We are currently feeding 3/4 can (5.5oz) of DM twice a day, and adding turkey or chicken as a cherry on top. He seems to be super full after each meal and sits to digest for a couple hours. Any idea where I can find ideal body weight for a cat so I can better decide how much food is appropriate for him?
@Bron and Sheba (GA) @Sienne and Gabby (GA)

 

[Sienne and Gabby (GA)]

I'm not sure where the vet you saw trained, but the information is wrong. I did not do an extensive search. But in doing a minimal amount of searching, you may find the information below supportive of what you've been reading and not consistent with the vet's statements. I did not include posts from FDMB or other message boards or vet clinics. The sources I linked are reputable. (We're really not crazy cat ladies!)

Cornell University has a top tier veterinary program and a specialized clinic for cats. This is a link to their page on diabetes. You'll note that they point out the cats are most commonly diagnosed with Type II diabetes.

This is a link to the guidelines for the treatment of diabetes that was published by the American Animal Hospital Assn (AAHA). On page 2, in the introduction, the authors note that cats can achieve remission. In the original paper in the Journal of Feline Medicine and Surgery published by Rand & Roomp on the Lantus (glargine) tight regulation protocol for diabetes, they note the remission rates for newly diagnosed cats and this is why Lantus is a good choice for diabetes management.

Glucose toxicity is mentioned on p. 7 of the linked AAHA guidelines. It was mentioned as early as 2003 at the World Small Animal Veterinary Assn meeting as well as in a slew of journal articles and other professional publications.

The link from Cornell also mentions diabetic neuropathy.

I have access to veterinary and medical libraries. Even searching via Google, I'm coming up with citations that the vet you saw should be aware of. Either this vet is exceedingly poorly trained or has done zero continuing education on feline diabetes. It may be helpful to keep in mind that no matter how many years of education someone has, they can still be an idiot. There is a reason that most professionals have to complete continuing education credits to keep their license. However, it seems like this vet has read nothing about feline diabetes. FWIW, I've never used an internal medicine vet. I have routinely taken my cats to "cat only" practices. Vets in general practice have to be familiar with treating a broad range of species. This vet does not seem to be knowledgeable about cats.

The key issue regarding food is low carbohydrate. I provided a link to a food chart (post #8) that lists the carbs in most of the canned food available in the US. You can feed Balvin anything. With a post-DKA cat, you want to make sure he's eating. If you think he's lost too much weight, let him eat as much as he wants. If he's getting too "fluffy," start to cut back on his food. This is a formula provided by Lisa Pierson, DVM from her site on feline nutrition: (The formula is from the section on obesity)
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70
Hopefully, this will give you a general guideline for how much to feed Balvin. A lot depends on your cat's activity level, metabolism, etc. in terms of weight. It's not all that different than with humans.

Most of us tend to spread out our cat's meal over a few hours rather than give them a meal twice a day. It's a bit easier on a healing pancreas if you're not loading them up all at once.

I'd also encourage you to review the dosing guidelines for SLGS since according to your spreadsheet, that's the method you're following. It may be time to consider a dose increase of 0.25u. With SLGS, you evaluate the dose every week and increase unless a dose reduction is warranted should numbers drop below 90.

 

[Balvin's Nurse]

I'm not sure where the vet you saw trained, but the information is wrong. I did not do an extensive search. But in doing a minimal amount of searching, you may find the information below supportive of what you've been reading and not consistent with the vet's statements. I did not include posts from FDMB or other message boards or vet clinics. The sources I linked are reputable. (We're really not crazy cat ladies!)

Cornell University has a top tier veterinary program and a specialized clinic for cats. This is a link to their page on diabetes. You'll note that they point out the cats are most commonly diagnosed with Type II diabetes.

This is a link to the guidelines for the treatment of diabetes that was published by the American Animal Hospital Assn (AAHA). On page 2, in the introduction, the authors note that cats can achieve remission. In the original paper in the Journal of Feline Medicine and Surgery published by Rand & Roomp on the Lantus (glargine) tight regulation protocol for diabetes, they note the remission rates for newly diagnosed cats and this is why Lantus is a good choice for diabetes management.

Glucose toxicity is mentioned on p. 7 of the linked AAHA guidelines. It was mentioned as early as 2003 at the World Small Animal Veterinary Assn meeting as well as in a slew of journal articles and other professional publications.

The link from Cornell also mentions diabetic neuropathy.

I have access to veterinary and medical libraries. Even searching via Google, I'm coming up with citations that the vet you saw should be aware of. Either this vet is exceedingly poorly trained or has done zero continuing education on feline diabetes. It may be helpful to keep in mind that no matter how many years of education someone has, they can still be an idiot. There is a reason that most professionals have to complete continuing education credits to keep their license. However, it seems like this vet has read nothing about feline diabetes. FWIW, I've never used an internal medicine vet. I have routinely taken my cats to "cat only" practices. Vets in general practice have to be familiar with treating a broad range of species. This vet does not seem to be knowledgeable about cats.

The key issue regarding food is low carbohydrate. I provided a link to a food chart (post #8) that lists the carbs in most of the canned food available in the US. You can feed Balvin anything. With a post-DKA cat, you want to make sure he's eating. If you think he's lost too much weight, let him eat as much as he wants. If he's getting too "fluffy," start to cut back on his food. This is a formula provided by Lisa Pierson, DVM from her site on feline nutrition: (The formula is from the section on obesity)
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70
Hopefully, this will give you a general guideline for how much to feed Balvin. A lot depends on your cat's activity level, metabolism, etc. in terms of weight. It's not all that different than with humans.

Most of us tend to spread out our cat's meal over a few hours rather than give them a meal twice a day. It's a bit easier on a healing pancreas if you're not loading them up all at once.

I'd also encourage you to review the dosing guidelines for SLGS since according to your spreadsheet, that's the method you're following. It may be time to consider a dose increase of 0.25u. With SLGS, you evaluate the dose every week and increase unless a dose reduction is warranted should numbers drop below 90.

Thank you for your input.

I don’t know where she trained either and why in the hell she is still practicing ‍ very discouraging and we’ve found ourselves looking into finding a new internist vet.

To your point of spreading the meals… we have considered it. Is this something you’ll do in the meantime while the pancreas heals and you can go back to feeding twice a day? It is hard for me because I work 12hr shifts and might not always have support from my fiancé at home. We want to make this something sustainable in the long run.

We have recently noticed higher glucose readings and Balvin is meowing for more food. We are afraid to spike up his glucose by feeding him more because we don’t want DKA again. I have gotten to a point where I think it’ll be safe to increase 0.25 units since his lows haven’t gotten below 109 (on the Alphatrak). We have continued to use CGM for trending and double check the big or low numbers with the Alphatrak. I just want to make sure I understand how to manage this before I increase dose. Any input?

@Bron and Sheba (GA) @Sienne and Gabby (GA)

We got Balvin’s ultrasound result and not sure what to make of it?

Of note, at the time of this ultrasound, fPL is 2.5 (reference 0.0-4.4) and according to this questionable vet, blood test is 90% diagnostic. Reading goes:

• Liver: The liver parenchyma is moderately hyperechoic and heterogenous.
• Gallbladder: The gallbladder is moderately contracted. The gallbladder wall is normal in thickness.
• Spleen: The spleen is mildly heterogenous.
• Pancreas: The pancreas is mildly hypochoic and enlarged. The mesentery surrounding the pancreas is mildly hyperechoic.
• Stomach: The stomach is markedly gas and fluid dilated. There is a hyperechoic shadowing structure seen within the lumen of the stomach. Gastric wall thickness and layering are normal.
• 
  CONCLUSIONS: The changes seen on this exam are consistent with pancreatitis. This patient also has marked distention of the stomach which could be indicative of a concurrent gastritis. There is hyperechoic shadowing foreign material seen within the stomach which is of unknown clinical significance. This could be contributing to the patient's clinical symptoms. The hyperechoic liver parenchyma may represent diabetic hepatopathy however hepatic lipidosis can have this appearance as well.

 

[Bron and Sheba (GA)]

I agree with what @Sienne and Gabby (GA) has said.
I would continue to feed one and a half times as much food as normal. Don’t be afraid that the food will spike the BGs. He needs to eat and eat plenty.
Continue to test for ketones.
Can you get a test in every pm cycle?
Have you tried a probiotic for the looser poops?

 

[Balvin's Nurse]

I agree with what @Sienne and Gabby (GA) has said.
I would continue to feed one and a half times as much food as normal. Don’t be afraid that the food will spike the BGs. He needs to eat and eat plenty.
Continue to test for ketones.
Can you get a test in every pm cycle?
Have you tried a probiotic for the looser poops?

Yes, we started Proviable but have also been switching from ProPlan DM to Weruva so probably still causing tummy issues. We have been doing it slowly but this guy has always had a sensitive tummy. What do you think about dose increase?

 

[Bron and Sheba (GA)]

What do you think about dose increase?

If you are doing the switch to low carb food, I would do that first before increasing the dose. You don’t want to be doing 2things at once.
I notice you are saying there is a trace of ketones in the urine. Are you reading it exactly 15 seconds after you dip it into the urine? Can you post a photo of the result please?… to do that you copy and paste the photo.

 

[Sienne and Gabby (GA)]

Many of us work full time. What I found to be helpful with providing food while I was at work was a timed feeder. There are a variety of models. Some have just two bins for food and others have 5. They are great for ensuring that food is available for your cat.