Benny post DKA at home being tube fed

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Kindagot

Member Since 2021
Morning everyone. I have just started this thread for Benny as the previous one was getting a little long. He woke up at +6 and started eating some kibble, had more at +7. I have reduced his tube feeds to 2/3. I think that he gets hungry every 6 hours so I think I will keep to those feed times today in order for him to get some appetite back. He had 8 days in hospital 6 of those in ICU.
Does anyone have any experience in DKA tube feeding?

Any tips would be appreciated!
 
Here is your previous thread for continuity
https://felinediabetes.com/FDMB/threads/a-week-in-icu.255673/page-2#post-2880930
I’m glad to hear he is eating a bit on his own. Remember he still needs to eat more than he normally does, so be careful reducing any of the feeds. I would try offering him some food before you do the tube feeding to see if he will eat
Did you manage to get a urine ketones test done yet?https://felinediabetes.com/FDMB/threads/a-week-in-icu.255673/page-2#post-2880930

Here are a couple of names of members who have had DKA kitties and tube fed. I don’t know if any of them are online today.
What questions do you have about tube feeding?
@Dyana
@Kris & Teasel
@dwildha
@AliceMeowliss (GA)
 
Did you manage to get a urine ketones test done yet?
No, I ran to get sticks when he went to go and missed it. We use the Breeze Tidy Cats system so it had been absorbed. Can I remove pad and test urine that is maybe an hour old?
Questions re tube feeding.
Any tips on how to transition, or as @Bron and Sheba (GA) has said, he needs extra calories, so perhaps I should just let him snack on kibble for now? I am keeping small amounts available to him at all times and basically with him 24/7 ( or husband and sons will watch over him, they like the cuddles!)
 
No, I ran to get sticks when he went to go and missed it. We use the Breeze Tidy Cats system so it had been absorbed. Can I remove pad and test urine that is maybe an hour old?
Keep the Ketostix next to the littler box. It is better to try and catch a fresh urine if you can. You could try testing the hour old urine but I don’t know how accurate it would be.

With the transition from tube feeding I would leave out some wet and dry food for him to snack on…….will Billy leave it for Benny or will Billy eat it?
I would offer some food before you tube feed as well.
it’s possible he could still be feeling nauseated. That’s not uncommon at this stage.
Is he still getting the antinausea meds twice a day? What antinausea is it? It’s possible if he’s getting cerenia, he might do better on ondansetron (zofran). Zofran is a human drug and the vet doesn’t carry it, but he can write a script for it and you can get it from the pharmacy. I used to give Sheba ondansetron and it worked well. The usually dose is 1/2 (2 mg) of a 4 mg wafer which you put on the tongue. It can be given 8 hourly if needed. Zofran often works better for nausea whereas cerenia is better for vomiting. Not all vets (especially in Australia and NZ) know about zofran….my vet didn’t but after reading up about it, he was happy to prescribe it.
 
Have just got a negative urine ketones! @Bron and Sheba (GA)

I am sure my usual Vet will prescribe Zofran. She loves teh boys and Billy had Leprosy in 2016 for which we had to treat him with many different ABX , I consulted a specialist in Melbourne and my Vet followed her advice on ABX. I might have some Zofran in the house somewhere.
 
I can see Benny is still running quite high on the SS but he could still be bouncing from those low greens two days ago. This is only the 4th cycle since the lows and he doesn’t have any ketones so I think it is worth waiting to see if he comes off the bounce in the next two cycles or if he is just in high numbers and needs an increase in dose.
Did @Bandit's Mom contact you about putting in the low BGs from 2 days ago into the SS? We really need them in there to get the full picture. At the moment the BGs are not reflecting what happened at all.
How has Benny been today? And you…how are you coping?
 
Hi there @Bron and Sheba (GA) I am ok thanks. Benny enjoyed a couple of Prawns and has picked at kibble now and again. He is up and down. Not much energy at all which is to be expected (?) I really regret the 1.0unit last night now seeing the numbers.I think I will get the Zofran tomorrow. He sees the specialist tomorrow. I think she will adjust the dose. Looking at the scanner data from 18/11-21/11 when he was in hospital he was pretty high most of teh time. Possibly bring him in to do a curve? He also sees the cardiologist tomorrow, to see how his heart condition is going and whether it will need medicating.
This is the data from the scanner.
18/11 9.28 26.8

11.27 16.7

12.55 11.8

14.56 12.1

17.16 14.3

19.14 18.4

21.46 22.1

19/11

00.49 8.2

02.50 13.2

05.05 22

06.40 26.2

9.36 hi

11.03 hi

11.55 hi

13.24 26.1

1406 25

16.59 22.3

20.02 20.6

22.30 hi

20/11

1.36 hi

2.20 hi

3.28 hi

4.23 hi

4.52 hi

6.34 26

7.19 hi

10.53 25.5

1.33 15.9

13.35 16.3

16.35 13.8

21.27 26

21/11

00.22 20.2

02.49 14.5

05.34 24.6

7.57 hi

10.52 23.8

13.49 11.6

15.00 10.7

15.56 14.6

17.38 27.5

19.54 hi

20.42 hi 1.5u

22/11

00.07 hi

1.08 Hi

1.52 Hi

3.44 Hi

5.02 hi

9.08 26.4 Chenged dose from 1.5 to 2.0 as per Vet

10.11 26.8

11.10 20.9

12.09 14.4

Headed for hypo
 
If the dose was adjusted at all I would only adjust it to 1.75 units. It is safer and better to go up i 1/4 unit increments.
Tomorrow morning’s cycle will be the 6th cycle after the bounce so we will be able to see if he is going to come down off the bounce or if he is just in high numbers and needs an increase.
Also a curve at the vet is not necessary as you are doing home testing. A curve at the vet would just stress Benny out unnecessarily. I would not agree to that. You can sent them your results.
I would ask the specialist if they can do a blood test just to check all the electrolytes etc are still ok.
Thanks for all the BG data. Can we also have the BGs from when he started to go low please.?
I’m glad he ate a couple of prawns….lucky boy!
Thanks Bhooma @Bandit's Mom for doing that :bighug:
 
@Bron looking at the data and his clinic notes, I think they started him off with 2u and then IM as well. He had the Hypo and it was reduced. They have been giving him extra insulin because of his hyper and the plan plan for weekend was "Friday overnight and weekend: Glargine charted to be increased from 1.4IU/cat to 2IU/cat for evening dose (8pm)"
He was given an extra 1unit at 3am on Saturday morning and then all of a sudden he was fit for discharge on Sunday morning at 1.5u twice a day. I am a bit puzzled.
 
screenshot_20211123-122433-jpg.63038
 
@Bron looking at the data and his clinic notes, I think they started him off with 2u and then IM as well. He had the Hypo and it was reduced. They have been giving him extra insulin because of his hyper and the plan plan for weekend was "Friday overnight and weekend: Glargine charted to be increased from 1.4IU/cat to 2IU/cat for evening dose (8pm)"
He was given an extra 1unit at 3am on Saturday morning and then all of a sudden he was fit for discharge on Sunday morning at 1.5u twice a day. I am a bit puzzled.
They do give an insulin drip to DKA kitties so they could be talking about that.
He is doing what most post DKA kitties do when they come home. The BGs are not going to come down straight away, so don’t worry about that.
Insulin is a hormone, not a medicine like an antibiotic and the body has to get used to it.
The main things are to make sure he is getting enough food, and enough insulin and the ketones are negative.
As I said above, I would ask for a repeat blood test just to check all the bloods are still in order. Sometimes they might need a supplement.
Are you still giving some extra feeds of low carb food to Benny via the tube.?

BtW I can’t see the photo you posted
 
He is grazing on prawns! The tube feeds I have upped from 254 Kcal a day to 290kcal. Although I am reducing tube feed when he has eaten kibble or prawns, however the Kcal /day is 290 not 254 (Vet) in total and I am planning on giving him some extra fluids at +5 tonight to help with those night spikes. He is on 240ml a day usually.
 
Good to hear that the high BG as a DKA boy is normal. He has made progress today. He has jumped on the bed and also run up the stairs and tried to have a sniff outside the front door this evening! Although he is still very subdued for Benny norms.
 
Good to hear that the high BG as a DKA boy is normal. He has made progress today. He has jumped on the bed and also run up the stairs and tried to have a sniff outside the front door this evening! Although he is still very subdued for Benny norms.
So good to hear he jumped on the bed and ran up the stairs!
We want to get those BGs down to more normal numbers but we can’t do it overnight. If he’s bouncing still, which I think he probably is, there is nothing to do but wait it out.
Keep testing for ketones in the urine as that is really important to keep them away.
Sounds as if you are doing a great job with the tube feeds and offering snacks. It will be interesting to see if zofran makes a difference.
Some DKA kitties come home and start eating well straight away and others take a lot longer. Having the tube insitue makes it much easier all round. Much less stress for Benny.
 
I stalled a little and got 16.2, fed him and have given the 1.5 (5 minutes ago) . I will test through the night to make sure he doesn't go low.
 
I stalled a little and got 16.2, fed him and have given the 1.5 (5 minutes ago) . I will test through the night to make sure he doesn't go low.
Well done! I’m so sorry I didn’t see your tag.
I’m glad you stuck with the 1.5 units. He might start coming off the bounce with that lower preshot so keep an eye in the BGs. If you can post them in the SS I will check them.
 
Did you manage to get a urine ketones test done yet?
No, I ran to get sticks when he went to go and missed it. We use the Breeze Tidy Cats system so it had been absorbed. Can I remove pad and test urine that is maybe an hour old?
Questions re tube feeding.
Any tips on how to transition, or as @Bron and Sheba (GA) has said, he needs extra calories, so perhaps I should just let him snack on kibble for now? I am keeping small amounts available to him at all times and basically with him 24/7 ( or husband and sons will watch over him, they like the cuddles!)
Hi Fiona! I have a cat named Benny also <3 did you still have questions regarding assisted ( syringe) feeding? If so im happy to tell you my experience with assist feeding Lando. Im sorry Benny isnt feeling so great. Sending him all the well wishes (also to you)!

i am going to put the info below just in case im wrapped up at work today Fiona.
First this video
was extremely helpful getting me started with assist feeding lando.
I did not want to buy the blender straight away so i used a metal whisk with LC pates from weruva like the slide and serve pouches. The pouches with a bit of water wisked up nicely to load into a baby syringe. I fed him 4 syringe fulls 4 xs a day ( which wasnt quite enough for his 18.5 lbs.
More to your point ( on transitioning) i would let lando try and eat as much as he could be coaxed into, then made a judgement call on how many syringes he needed right after.

once he started eating more, i would only do the assist feeding in the am and pm and let him snack on his own throughout the day.

lando was very cooperative so i was lucky, but i suggest getting an old shirt to wear and old blanket or towels to protect from the meat shower that happens during assist feeding!

good luck!

btw i was able to read your thread. Sounds like you have a good handle on things
 
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@Lando demando Thank you for that info. It's really helpful and just what I was looking for on transitioning him to self feeds! He has a O/E tube so a bit different. Are you a Star Wars fan?! "Lando"
We had a review with Cardiologist today. Good News! Benny's heart is looking much better. No need for medicating his Hypertrophic Cardiomyopathy right now. Recheck in 6 mos.
Diabetes. Continual monitoring by the Vet Specialist via the Libre and app. She will monitor remotely and advise on dose changes. He will have a new sensor fitted in 7 days. She says he has a 25% chance of remission. I feel much better with it all now, not only because Benny is so much brighter today. He bombed up the stairs after my son for a smooch, wolfed down a couple of prawns. The Vet has given him some more anti nausea tablets and also Mirtazapine as an appetite stimulant. We are sticking to teh 1.5 units twice a day and will increase very slowly as needed.
I don't know how to thank you all enough!
@Bron and Sheba (GA) @Bandit's Mom @tiffmaxee
You are wonderful!
 
@Lando demando Thank you for that info. It's really helpful and just what I was looking for on transitioning him to self feeds! He has a O/E tube so a bit different. Are you a Star Wars fan?! "Lando"
We had a review with Cardiologist today. Good News! Benny's heart is looking much better. No need for medicating his Hypertrophic Cardiomyopathy right now. Recheck in 6 mos.
Diabetes. Continual monitoring by the Vet Specialist via the Libre and app. She will monitor remotely and advise on dose changes. He will have a new sensor fitted in 7 days. She says he has a 25% chance of remission. I feel much better with it all now, not only because Benny is so much brighter today. He bombed up the stairs after my son for a smooch, wolfed down a couple of prawns. The Vet has given him some more anti nausea tablets and also Mirtazapine as an appetite stimulant. We are sticking to teh 1.5 units twice a day and will increase very slowly as needed.
I don't know how to thank you all enough!
@Bron and Sheba (GA) @Bandit's Mom @tiffmaxee
You are wonderful!
All of this is great news. I am so happy for you <3 Lando is short for Orlando ( woolf) . i had a difficult time determining his sex as a kitten… i figured orlando worked for both!
 
So good to hear that report!
That’s wonderful Benny’s heart is looking much better. What a relief! And he sounds as if he is getting more energy.
That’s good you got some more anti nausea meds and an appetite stimulant. Make sure you give the antinausea med first before the appetite stimulant because you don’t want him to be nauseated when the appetite stimulant starts to work.
Today is the 6 th cycle of the bounce. If he doesn’t start to go down soon, we will need to look at increasing the dose. So come in Benny… come on down off the trampoline!

Any more ketone tests?
 
@Bron the vet called with his blood results which were great. Kidney function ok. Electrolytes etc. She wants to up one of his doses to 2u. She thinks that it is best done during the day so I can watch him carefully. So tomorrow it's 2.0
Thank you for advice regarding the nausea and mirtazapine. They have given capsules so I can empty and dissolve in water i go down his tube.
 
@Bron the vet called with his blood results which were great. Kidney function ok. Electrolytes etc. She wants to up one of his doses to 2u. She thinks that it is best done during the day so I can watch him carefully. So tomorrow it's 2.0
Thank you for advice regarding the nausea and mirtazapine. They have given capsules so I can empty and dissolve in water i go down his tube.
I’m glad the tests were all ok. That’s reassuring.
Please increase to 1.75 units not 2 units if the BGs don’t drop down to blues tonight.
If you go straight to 2 units the depot will fill over 3 days and he might be OK for a couple of cycles but as the depot fills you will see the full effect of the 2 units. It might be ok or he might drop again. I think it is best to hasten slowly.
It is of course up to you, but from my experience, I would only increase to the 1.75 units ….. if there are still no ketones.
Would you mind updating the SS so we can see today’s BGs… thanks.
 
@
I’m glad the tests were all ok. That’s reassuring.
Please increase to 1.75 units not 2 units if the BGs don’t drop down to blues tonight.
If you go straight to 2 units the depot will fill over 3 days and he might be OK for a couple of cycles but as the depot fills you will see the full effect of the 2 units. It might be ok or he might drop again. I think it is best to hasten slowly.
It is of course up to you, but from my experience, I would only increase to the 1.75 units ….. if there are still no ketones.
Would you mind updating the SS so we can see today’s BGs… thanks.
I thought you would say that! I agree with you. It seems a bit much to jump up to 2 after his lows the other day. Good to hear reassurance. Thank you
 
Here is your previous thread for continuity
https://felinediabetes.com/FDMB/threads/a-week-in-icu.255673/page-2#post-2880930
I’m glad to hear he is eating a bit on his own. Remember he still needs to eat more than he normally does, so be careful reducing any of the feeds. I would try offering him some food before you do the tube feeding to see if he will eat
Did you manage to get a urine ketones test done yet?

Here are a couple of names of members who have had DKA kitties and tube fed. I don’t know if any of them are online today.
What questions do you have about tube feeding?
@Dyana
@Kris & Teasel
@dwildha
@AliceMeowliss (GA)
Hi there! I'm very rarely on the forum these days. My experience with tube feeding was decades ago and involved what is called a PEG tube that goes into the stomach from the chest wall rather than the usual current method of inserting the tube into the neck. The cat I was treating was not diabetic. She'd stopped eating for other reasons. I can tell you, though, that it went far better than I anticipated at the time. My cat had the tube for three weeks, adjusted well and settled nicely for each feeding (every few hours, small amounts at a time). Getting the consistency of the wet food right to avoid blocking the valve could be a challenge but that was it.

Re DKA: Teasel had two bouts, one in the spring of 2016 (diagnosed in January 2016) and the other in the summer of 2018. Each time he spent many expensive days in the ICU at the emergency clinic. It took a long time to get him back to normal at home and it involved anti nausea meds, appetite stimulant meds, etc. As for what set him off those times, it's hard to say. His response to insulin was extremely volatile for many years and I had to work at finding a low carb wet food without additives that seemed to trigger his vomiting (followed by dehydration, followed by DKA). I found that Wellness brand turkey pâté agrees with him and even though it took almost 5 years his BG is quite well regulated now. Touch wood, he's been fine since.

Caveat: if you look at his SS you'll see I rarely test between PSs now. DO NOT copy this! I've settled on this because he's stable and because I have physical issues that limit my mobility.
 
He is pretty much on his way back to normal. Playful with ribbon and purring lots. Wanting to go out (smh) and grazing on kibble, prawns and topped up by tube feed (which is more difficult as he wants to be on the move more). I gave the anti nausea before the stimulant this morning. His BG have been pretty high all day so I guess it is a question of getting him on the right dose. Ketones were negative again today and he and Billy are friends again.
 
That is good to hear he is getting back to normal, eating better and he is friends with Billy again. You must be so happy.
While he is eating that high carb kibble, he is going to be higher. Is he interested at all in any of the low carb food yet?
Excellent the ketones were negative!
As long as the ketones are negative and he’s eating I would stay with the 1.75 dose to see if it changes things as the depot fills.
Any photos?
 
Lovely photo.
Billy is a beautiful boy too.
Look at that lovely thick fur….my Harry who is 1/2 Burmese has fur like that.
Is Benny bothered by the feeding tube and collar?
 
Lovely photo.
Billy is a beautiful boy too.
Look at that lovely thick fur….my Harry who is 1/2 Burmese has fur like that.
Is Benny bothered by the feeding tube and collar?
No he is ok. Benny is the most chilled cat I have ever met! Billy is actually more friendly with strangers, although once the night before we were going to UK Benny disappeared. We cancelled our trip and scoured the neighbourhood. Literally everyone knew our cats. Benny has a thing for flip flops, crocs and yoga mats. He has amassed quite the collection. My neighbours didn't mind him destroying and stealing! They liked the fact that he visited them. He returned rather hungry 24 hours later. He had been locked in somewhere, although we don't know where I have my suspicions! One neighbour had lost a Burmese and I think she just wanted to hang on to Benny.
 
Hi there! I'm very rarely on the forum these days. My experience with tube feeding was decades ago and involved what is called a PEG tube that goes into the stomach from the chest wall rather than the usual current method of inserting the tube into the neck. The cat I was treating was not diabetic. She'd stopped eating for other reasons. I can tell you, though, that it went far better than I anticipated at the time. My cat had the tube for three weeks, adjusted well and settled nicely for each feeding (every few hours, small amounts at a time). Getting the consistency of the wet food right to avoid blocking the valve could be a challenge but that was it.

Re DKA: Teasel had two bouts, one in the spring of 2016 (diagnosed in January 2016) and the other in the summer of 2018. Each time he spent many expensive days in the ICU at the emergency clinic. It took a long time to get him back to normal at home and it involved anti nausea meds, appetite stimulant meds, etc. As for what set him off those times, it's hard to say. His response to insulin was extremely volatile for many years and I had to work at finding a low carb wet food without additives that seemed to trigger his vomiting (followed by dehydration, followed by DKA). I found that Wellness brand turkey pâté agrees with him and even though it took almost 5 years his BG is quite well regulated now. Touch wood, he's been fine since.

Caveat: if you look at his SS you'll see I rarely test between PSs now. DO NOT copy this! I've settled on this because he's stable and because I have physical issues that limit my mobility.
Thank you for replying! Gosh Teasel has had a tough time 2 x DKA. I am glad to hear he is doing well now. How did you spot the second DKA?
 
No he is ok. Benny is the most chilled cat I have ever met! Billy is actually more friendly with strangers, although once the night before we were going to UK Benny disappeared. We cancelled our trip and scoured the neighbourhood. Literally everyone knew our cats. Benny has a thing for flip flops, crocs and yoga mats. He has amassed quite the collection. My neighbours didn't mind him destroying and stealing! They liked the fact that he visited them. He returned rather hungry 24 hours later. He had been locked in somewhere, although we don't know where I have my suspicions! One neighbour had lost a Burmese and I think she just wanted to hang on to Benny.
Oh goodness. I hope you got your money back from the trip. I had a Burmese girl years ago, Ming…a tortie.. and she was the most beautiful kitty. She lived to 21.
My Harry is very chilled and loves people. Always 2 steps behind me.
How is Benny’s appetite today?
 
Oh goodness. I hope you got your money back from the trip. I had a Burmese girl years ago, Ming…a tortie.. and she was the most beautiful kitty. She lived to 21.
My Harry is very chilled and loves people. Always 2 steps behind me.
How is Benny’s appetite today?
Appetite is very good. I am going to start transitioning to a low carb wet food from the kibble, to help those BG numbers! I love Burmese cats but I am desperate for a Silver Tabby. My first cat as a child was Tabitha and she had kittens (full silver tabby) we kept one, Oliver. Tabitha was the most beautiful cat ever! I miss her to this day. Although with the stress from Benny's illness I am not sure I could do it again. Your Sheba is very beautiful cat. I don't know much about Australian Mists.
 
Thank you for replying! Gosh Teasel has had a tough time 2 x DKA. I am glad to hear he is doing well now. How did you spot the second DKA?
I'd seen the symptoms the first time - extreme lethargy, lack of appetite - generally a sick cat. The second time was the same.
 
Hey Fiona…Why are you giving him 1.75 at AMPS and 1.5 units at PMPS?
Glargine likes consistency and by changing the dose all the time you are messing up the depot. You need to be giving 1.75 units each dose. We need to be getting those BGs down into better numbers.
 
Hey Fiona…Why are you giving him 1.75 at AMPS and 1.5 units at PMPS?
Glargine likes consistency and by changing the dose all the time you are messing up the depot. You need to be giving 1.75 units each dose. We need to be getting those BGs down into better numbers.
The vet said 2.0 for AM dose to make sure he is ok, not the evening dose because Benny is sensitive. I must have misunderstood her, in that perhaps she meant if he was ok on the 2 in the day to do that at night as well. I will check and adjust as you suggest! Thank you @Bron and Sheba (GA) for spotting that!
 
I would stay with 1.75 twice a day for now as long as there are no ketones in the urine
Thanks Bron. I have been reading the info on tjis site and a link to https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-algorithms/monitoring/ It says about 7-14 day changes. So I can see it is a slower process in order to get it right. I think I need to gradually change from the kibble now he is eating well. I don't want to go too fast because obviously his shots are based on high carb intake (CKD kibble). He ate some wet food this morning, he does graze though and wet food in summer is hard to manage! Incidentally, I always fed them on wet food twice a day until a cattery got them hooked on dry!
 
With DKA in the picture, we would need to be doing changes quicker than 7to 14 days if needed. We like to have DKA kitties on Tight Regulation because we can change the dose more often but as he is eating dry food we can’t do so. DKA changes everything and we can increase the dose more often if necessary.
If you are going to try and decrease the dry though and increase the wet, I think we should stay at 1.75 units twice a day, providing there are no ketones in the urine…..and see if the reduced carbs from the dry being removed makes a difference. I don’t like seeing all those black and red BGs though. If removing the dry doesn’t bring down the BGs we will need to increase the dose.
 
With DKA in the picture, we would need to be doing changes quicker than 7to 14 days if needed. We like to have DKA kitties on Tight Regulation because we can change the dose more often but as he is eating dry food we can’t do so. DKA changes everything and we can increase the dose more often if necessary.
If you are going to try and decrease the dry though and increase the wet, I think we should stay at 1.75 units twice a day, providing there are no ketones in the urine…..and see if the reduced carbs from the dry being removed makes a difference. I don’t like seeing all those black and red BGs though. If removing the dry doesn’t bring down the BGs we will need to increase the dose.
think his Libre sensor might be failing. He has read HI for 12 hours. He is happy though, playing with toy, just had 1/2 a can of FF pate!
 
I just managed to do a manual BG reading. he did not like it at all! 24.9. (if we did it properly) So it is high today I will give some water through the tube.
 
think his Libre sensor might be failing. He has read HI for 12 hours. He is happy though, playing with toy, just had 1/2 a can of FF pate!
That’s great he ate so well!


I just managed to do a manual BG reading. he did not like it at all! 24.9. (if we did it properly) So it is high today I will give some water through the tube.
Are you letting him eat a small snack of something as you test him? Just a teaspoon…enough to keep him occupied.
Have you tested for ketones today? Not happy seeing all those black BGs.
Please make sure to give the 1.75 dose tonight.
 
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