If you were going to design a study for your cat's glucose...

[Heather&Dagron]

So that's essentially what we all try to do, right? At least in the beginning? We figured out what variables we want to test for and what sorts of parameters would give us usable data, and then we do it (as well as we can, anyway).

So how would you do it? Would you start with 1u, regardless of what your vet says, and go from there? Obviously with the SLGS method, you would go up in 1/4u increments (but I'm not sure after what period of time/how many BG curves). I also still don't know how TR is different from SLGS. Haven't been able to figure that one out.

Food has to stay the same, that I know. Too big of a variable, that.

I'm still struggling with Dagron's numbers and I can't find a good pattern other than he is obviously still bouncing. My vet thinks that 3u is a small amount (ineffectual), but I really have to wonder. If I tried SLGS, would I immediately bring him down to 1u and give him a week or two to level out before doing a curve and raising the dose? Or would I taper down to it? I don't want his BG too high, obviously, but more than that I am worried about him being hypo.

I still don't know what variables I am testing for or what parameters will give me usable data.

 

[LizzieInTexas]

Need more testing. Until we can see what multiple cycle numbers are it is just a guessing game. Not even sure when nadir is.

 

[tiffmaxee]

Hi. First time I've been to your condo. Here's what I see. You are only testing at shot time. Lantus is dosed by the nadir or lowest point in the cycle which typically is between +5-7 but can be earlier or later. So before you increase I recommend getting random tests in between +4-8 in every cycle that you can with a minimum of four tests every 24 hours.

With SLGS you hold a dose for a week and then do a curve. If any test is under 90 on that curve you decrease the dose. Cats often go lower at night so a before bed test is helpful.

 

[Kris & Teasel]

As you know a living organism is a very complex system. When treating FD you can control: insulin type/dose/timing, food type/amount/timing, when to take your system measurements (BG) and that's about it. FD treatment works best when you take a very disciplined approach to handling these variables.

• Insulin: Lantus works best when dosed on a strict 12/12 schedule. The recommended starting dose is 1 unit BID. Any increases should be in small increments of 0.25 u to avoid missing a good dose. The purpose of the TR and SLGS guidelines is to assist caregivers in making dosing decisions and when to alter the dose. TR is a more aggressive approach in that dose changes can be made as close together as every 3 days (6 cycles) and a reduction is given only after BG test result of under 50 on a human meter has occurred. SLGS is a less aggressive approach in which a dose is held at least 5 to 7 days and a dose reduction is given if a BG test result under 90 occurs.
• Food: Low carb wet is best, fed on whatever schedule works for your kitty. The only requirement is that food is removed for 2 hours prior to the PS tests.

In my opinion, your kitty was started on too high a dose. Your vet is incorrect about a 3 u dose being a small amount - that is often the highest dose a diabetic cat will need. The dose has been increased in increments that are too large and you don't have enough mid cycle data at any dose to be able to evaluate it properly. I'd work on getting more data in the evenings and on days off to fill in the gaps.

 

[Wendy&Neko]

I also still don't know how TR is different from SLGS. Haven't been able to figure that one out.

The main differences are the length of time you hold a dose before increasing and the point at which a kitty earns a reduction. TR also requires that kitty be on low carb wet food or raw.

To figure out your cat's response to insulin, do enough testing to determine the onset, nadir, and duaration. Knowing how much they spike from food and response to various levels of food also helps. Some cats are more or less carb sensitive than others.

The best approach to dosing is to gather enough data to know how low it is taking the cat (the lowest points or nadir), and use that data to figure out how to change the dose. If you are following SLGS, 4.0 units is too much because you got that 71, which means a reduction to 3.75 units was earned.

And 3.0 units is neither a high nor a low dose. We have active cats here on doses from mere drops to almost 30 units, and have seen higher. But the high doses were only for cats with high dose conditions and increases were done safely with sufficient data to do so.