? Dosing advice Balthazar

Kelly_Balti

Kelly_Balti

Member Since 2026
Hi,

I would like to get some dosing advice on Balthazar. The reason is that I have been going to the vet for advice and I feel they are not necessarily the best people to be helping me with the dosing. Since June he has been on 1.00 ie and they are very reluctant to increase the dosing. Instead they wanted me to focus on the wetfood given which was the Purina DM wetfood but I have since switched to partially raw food and partially LC wetfood (Wild Freedom) (the plan was to switch to complete raw food) on the 19th of July which he has been doing quite well clinically ( he is not peeing so much and his fur is soft and shiny as well as he is quite active). However the BG remained high. The vets were not concerned because they were ok with that he was improving quite a lot clinically. And told me to slowly switch the diet and then wait 8 weeks to stabilize before changing the dosing.

However, we have reached the point where I have asked them last week what to do as he was getting even higher in the BG and they told me to continue with changing the diet and wait it out and do a curve every hour to determine the nadir on Monday and check if maybe he needed to be on the Lantus. I sent it on Tuesday (yesterday) and they would look at it. As the ketones were also starting to rise in the weekend I have put the food back to the values of last week with regards to the raw food LC wetfood ratio.

Currently the ketones rose this morning even further to 1.2 and I have not received dosing advice yesterday. I have just given him his normal dose and will be away all of today due to work so cannot get extra testing in but can do extra testing tonight and from tomorrow onwards as I will be WFH then and will be off on Friday and the weekend.

I would really appreciate some advice as I am already wondering every day since the diagnosis if I am doing all the right things and going to the right people, but I am starting to worry that despite them getting Balti out of DKA they might not be the most knowledgeable about diabetes.

Thank you!

Kelly
 
Kelly_Balti said:
Update I measured ketones and BG at +10. Ketones were down to 0.2. Please note I am using the World sheet
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That’s a relief about his ketones.
His BG certainly is high. I do not see a problem with switching him over to the 100 percent raw diet if that is what you want to do, although it sounds like the wet food you are feeding is already low in carbs.
 
Hi,

Yeah the plan was to switch him completely over to raw food only he then needs a lot less grams then from the wetfood so I am compromising a bit here that he retains the volume a bit as this is also easier to manage with the multiple meal times a day so that he does not get ridiculously small meals as he then tends to continue to whine about more food and with the current schedule and volume he is not whining a lot about more food. The raw food has as a benefit that his coat and his brothers coat are both really shiny. So I am trying to get the best of both worlds.

I have put him on 1.25u of insulin since yesterday evening as I am WFH today so we will see how that goes. So far he is still quite high in the BG but we will see how it is in a couple of days I will probably do a complete curve on Sunday/ Monday to give him time to adjust and then see how to alter the dosing from there.
 
And you say you are testing for ketones every day? That’s important. I would say that we could fast track his insulin increases a bit if his ketones don’t remain low. This is since he has had a recent DKA and it’s in his best interest to try and get his numbers down —and he is on a 100 percent wet food low carb diet.
 
It would be very good if you made a column to record the ketones (like a column at the end just before the notes/comments column.)
 
Yes I have a blood ketone tester from Amazon KetoBM and am measuring the ketones every day at AMPS as I am also measuring BG then anyway. He is currently back at 0.2 yesterday at +10 and this morning at AMPS so hopefully this remains stable. The Ketone column (column AC) is in the world sheet as I am already recording it in this sheet. I have changed the file so that it now also records in the US sheet.
Column AC Ketones
Column AD Weight ( try to measure weekly)
Column AE food intake
 
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Hi,

I did a curve today and just finished it and have given Balti his PMPS shot. However, he has now had the dose for 4 days (started Wednesday evening) and according to the SLGS method I am supposed to keep him on this dose for 7 days. My dilemma currently is that he has tested 0.7 this morning and again this evening for ketones and has thus increased ketones again. I am WFH tomorrow and Tuesday and am able to monitor a new dose if I would adjust the dose earlier. Otherwise the first chance on a dose increase would be Friday evening probably as Wednesday and Thursday I will be out all day and Friday I have an appointment which will fall around his nadir. Is it wise to keep the dose steady till Friday evening despite the chance of the ketones possibly rising further or should I do a dose increase tomorrow or Tuesday to 1.5?

Thanks for your help! 😊
 
Does he eat an all low carb wet food diet (no dry?). Please add his diet to your signature.

I do think that we need to fast track him a little bit — and as you say, you will be able to monitor him tomorrow. I agree with the increase to 1.5 units because of his recent DKA. 0.7 ketones is not too concerning, but if the trend is that they are going up we should try to stop it. Good luck and keep me posted.
 
Hi,
I did the 1.50 this morning. Ketones were fortunately again down to 0.1 and the AMPS preshot was also pink instead of red or black (Unfortunately the PMPS preshot was red again this evening) All of the numbers from the curve of yesterday were quite similar to today. We will see what happens. If nothing strange will occur this week I will do another curve on Sunday and in the mean time get some spot checks and then lets see how to proceed further.
 
Hi @Suzanne & Darcy,

I am currently in the last couple of hours of the curve check for this week. As it looks now his nadir is still too high. Now I could increase the dosage to 1.75. However, the preshots are not coming down and staying alarmingly high. This is also causing in recent weeks that the ketones are all over the place between 0.2 and 1+. I am wondering whether I should make a vet appointment tomorrow to discuss going over to Lantus? If I understand correctly this insulin might last longer? As it looks like the Prozinc is just not lasting long enough as from the beginning of the diagnosis in June till now he still climbs back in the red/ black numbers at +8 / +10 and only sporadically has a pink preshot number. Despite him going down like a rocket in the first half of the cycle.

Or is this something in your experience which might be able to even out with a higher dose? Because I fear the high numbers and steep drops might be starting to cause damage.
 
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Hello! I would definitely increase the dose to 1.75 units. He is not receiving enough insulin yet (dose too low) so it is hard to say how long it will be before the preshot numbers come down. I see many cats whose preshot numbers come down as they get to their best dose. A lot of the high numbers on Balti’s spreadsheet are due to him bouncing from the lower numbers. His body is not even used to being in yellow numbers at this point and he is reacting to that. It is very frustrating. The only way to stop that bouncing is for him to spend as much time as possible in the lower numbers so that his body will not perceive them as a threat.
 
Did we talk about bouncing and it’s cause yet?

Here is one explanation that I frequently give to FDMB members:

A bounce is where the cat's body reacts to lower numbers that he is not used to being in anymore... since becoming diabetic. It's a protective mechanism where the cat's central nervous system perceives either a steep drop in blood glucose or simply the cat being in lower numbers - and releases adrenaline, cortisol, glucagons and growth hormone, all of which create insulin resistance and can keep numbers high for up to six cycles (the bounce). Bounces don't have to last that long, but in some cats they will. Over time, many cats will start to clear the bounces more quickly. When the bounce does clear, the BG numbers will come back down and give us an accurate picture of what a dose is doing for the cat.
 
Lantus is also a very good insulin for cats, and I don’t see any harm in asking about it. It may give you flatter curves for Balti. It won’t stop the bouncing though. Balti will do that on his own eventually we hope!
 
Whether you decide to make the vet appointment or not, I would advise increasing his dose to 1.75 units at his very next shot. Initially after his diagnosis, his dose was held much too long at 1 unit so he could not make any progress with that dose. If doses are held too long when increases are needed, it can cause glucose toxicity which really just means that it allows Balti to stay in and be accustomed to high numbers — this makes it more difficult to shift him out of the higher numbers.
 
Hi,

Small question. I usually do the curve on Sunday and then adjust the dose, then usually around Tuesday I am starting to see the effects. From next week onwards I need to be consistently away on Tuesday and Thursday (also quite far away so I will also be travelling a couple of hours these days and will be leaving so early that AM midcyle tests are not possible) I have arranged for my mother to come and do the evening shots and I will manage the morning shots. However, she is not confident with that the dose increase usually shows its effect on Tuesday as Balti will be home unsupervised and gradually he is getting in lower territory although still not where we want him to be.
The question is now, is it possible for this week to change the curve and dose change to Friday so 2 days early (which means 5 days instead of 7 days) or is it better to keep this dose till next week Friday where I can do the curve and dose change? This as we are also battling the high preshot BG's and fluctuating that he has been in for an extended period of time.

Thanks!
 
Hi there! I hope all is well for you, and I hope your travel/work will go well!

I would go ahead with the curve and increase. It already looks to me like he needs the increase to 2.25 units based upon the data on his spreadsheet. If you want to increase right away that would be fine. I think you already have sufficient data to go ahead with the increase without doing a full curve. His numbers are quite high, although I like seeing that blue number recently.
 
Kelly_Balti said:
Yeah I am noticing that he is starting to feel even better than I hoped by the day so am really happy about that!
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That makes me even more happy. He’s much more than his numbers! I want to hear that he feels better and better. We are getting closer to a more optimal dose for him.

Remind me, does your mother test his glucose?
 
Hi,
My mom tried testing and shooting today. She did shoot before but then I was testing or Balti had the Libre and was still quite calm and sickly, but that was way in the beginning of our journey a couple of months back, and she was always scared she did a fur shot. However, I see she is quite scared to do this as she has trouble seeing the blood droplet on the black fur and she realized after seeing him today that he is quite alive again.
I know that for the upcoming 3 weeks I can manage to shoot Balti at 5.45 AM on Tuesdays and Thursdays but the PM shot will be around 06.45 worst case 7.15PM (so worst case 1,5 hours after the 12 hour cycle) if I do it myself. Would it be possible for the first couple of weeks that I do the testing and shooting then on Tuesday and Thursday also at the PM? It will give her some more time to get more familiar with testing and shooting. Mid/ end September I would then need her to do the testing and shooting at PM on Tuesdays and Thursdays as I will then need to leave earlier that 05.45 AM and be home later than the 06.45 / 07.15 PM shot.
We will also try again this weekend at the PM shots but just to have a backup in case she is still too anxious to do this alone and I would prefer to prevent fur shots or stressing both of them out as much as possible.
 
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Hi,
Just a small update. Today Balti had a nadir at the AM cycle of 5.6 coming from AMPS 21.8 and at the PM cycle I have just measured at +4 around 5.9 as he is coming down from PMPS 21.4.

He is getting and eating his normal food (adjusted the lc wetfood/ raw food with 10 gr raw food less per day since Saturday as he was gaining 100/ 150gr weight per week and added the liquid snacks for testing instead of only the chicken hearts as he is quite fussy about testing currently) so he is currently getting: 35 gr lc wetfood/ raw food as his main meal, 15 gr chicken or fish in broth as his dessert after the main meal (so that I can easily give him the shot) 20gr fish or chicken in broth at +2 and 20gr low carb wetfood/raw food per snack at +4, and +8 as well as a half package liquid snacks for every testing and some freeze dried chicken hearts in between, he is eating everything.

As these are quite high drops I am bringing Balti to my parents at least for tomorrow the AM cycle and Tuesday the AM cycle (I always bring my dog to them to petsit when I am working anyways, so Balti will just be included in this rotation) as I am just trying to make sure that someone can intervene timely if he goes too low as today he has had extremely steep drops and I am not completely sure about this as this is completely new territory for me and Balti. Moreover as I am now also using a temporary replacement meter (Freestyle Freedom Lite) as my glucose meter (Medisign MM1000) stopped working, the new one (CareSens dual) should arrive Tuesday.

He is doing fine by the way quite active and not sleeping as much as he normally does when he hits new low numbers.
 
Kelly_Balti said:
Hi,
Just a small update. Today Balti had a nadir at the AM cycle of 5.6 coming from AMPS 21.8 and at the PM cycle I have just measured at +4 around 5.9 as he is coming down from PMPS 21.4.

He is getting and eating his normal food (adjusted the lc wetfood/ raw food with 10 gr raw food less per day since Saturday as he was gaining 100/ 150gr weight per week and added the liquid snacks for testing instead of only the chicken hearts as he is quite fussy about testing currently) so he is currently getting: 35 gr lc wetfood/ raw food as his main meal, 15 gr chicken or fish in broth as his dessert after the main meal (so that I can easily give him the shot) 20gr fish or chicken in broth at +2 and 20gr low carb wetfood/raw food per snack at +4, and +8 as well as a half package liquid snacks for every testing and some freeze dried chicken hearts in between, he is eating everything.

As these are quite high drops I am bringing Balti to my parents at least for tomorrow the AM cycle and Tuesday the AM cycle (I always bring my dog to them to petsit when I am working anyways, so Balti will just be included in this rotation) as I am just trying to make sure that someone can intervene timely if he goes too low as today he has had extremely steep drops and I am not completely sure about this as this is completely new territory for me and Balti. Moreover as I am now also using a temporary replacement meter (Freestyle Freedom Lite) as my glucose meter (Medisign MM1000) stopped working, the new one (CareSens dual) should arrive Tuesday.

He is doing fine by the way quite active and not sleeping as much as he normally does when he hits new low numbers.
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This sounds like all very good news to me!! Let me look at his spreadsheet in US mode as I was having to pull up my calculator to understand the numbers. His nadirs are very safe! I am happy.
 
Hooray. He is doing so much on the 2.25 dose! This is wonderful. Remember that those nadirs are very safe. He has a long way to go before he would be in any danger. Will he be stressed out by being taken to your parents? I think it is a reasonable plan to do this, I am just trying to anticipate if his numbers would be slightly higher at your parents if he is stressed. I hope not. Please make a note in the comments on the days that you take him there.
 
Kelly_Balti said:
I see she is quite scared to do this as she has trouble seeing the blood droplet on the black fur and she realized after seeing him today that he is quite alive again.
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Can you help her by getting her some lighted magnifying glasses. I have some that I use for precise work. The light helps tremendously.

Also, do you have some petroleum jelly (Vaseline) to rub on his ear? This can help the blood drop bead up instead of diffusing into the fur.

Another trick is to take the blood drop and scrape it onto the surface of your thumbnail and just test the glucose from there. This can also be helpful if the cat is wiggling or getting irritated.
 
This is the kind of thing I am talking about with regard to lighted magnifying glasses. They have different lenses with different magnification levels and the LED light is so great. My whole family uses these now for different things.

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Hi,

He has been doing fine at my parents. My mom has not done a midcycle test. His preshot was way below his normal preshot value but above the 11.1. To be safe I decreased the dose with 0.25 to 2.00 for the PM cycle just to be sure as this is going fast. I will do an midcycle PM check tonight to see where the dose is taking him. If you think it is best to increase again to 2.25 please let me know and I will increase again to 2.25 but he is currently full of surprises.
 
Well the idea is that we do want lower preshot numbers. That means he will also have lower mid-cycle numbers (also good.) Since this is a preshot number we have not seen before, it is fine to do a temporary dose reduction and then get a test to see how it works out. You are doing well.

Another thing to consider is to delay the shot by 30 minutes and retest to see if his BG is rising. Sometimes you can give the regular dose if it is. I know night time and that could mess up your morning schedule, I know — and you have to travel tomorrow so I am sure your schedule is tight.
 
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