I seem to have made a huge mistake following SLGS

Status
Not open for further replies.
C

colin72

Member Since 2014
I can't believe I did this.

I just realized that on the sticky with the SLGS protocol it clearly says, "REFERENCE NUMBERS GIVEN ARE FOR BLOOD GLUCOSE METERS CALIBRATED FOR HUMANS, NOT PET-SPECIFIC METERS. THEREFORE THE USE OF PET-SPECIFIC METERS IS DISCOURAGED."

I'm using an AlphaTrak and I've been following the reference numbers of the SLGA protocol as outlined on that sticky. What is confusing however is that everything seems to be going great (check out Leo's SS).

I'm not sure what to do. Apparently I shouldn't be using the protocol the way that I am. Is there some way to know what the reference numbers are for the SLGS protocol using pet-specific meters like the Alpha Trak?

Does anyone know why it seems to be working even though I screwed up?

Thanks
 
Last edited:
It's a protocol. I use an AlphaTrak for TR but I have been encouraged to just use the human meter numbers---except for the 68 vs 50 cutoff.
I usually adjust the numbers for the AlphaTrak, but...
It's just important to have a logical plan/protocol and stick to it.
 
I think this is the important thing:

colin72 said:
everything seems to be going great (check out Leo's SS).
Click to expand...

:)

That said, if you are going to follow SLGS, I'm seeing a lot of dose changes in the past few days, and your last reduction was from 0.75U to 0.25U, which might have been too much Now that you're on 0.25U, though, I'd try to stick with that for a bit longer to let the depot settle, but be prepared to have to go up again.

How is Leo acting/feeling these days?
 
SLGS is not a protocol. It is a dosing method designed by people here over the years, developed before Tight Regulation was published. At that time, hardly anyone used pet meters. Since we didn't have the AT data at that time, we just use the same numbers on the AT as people use on the human meters.
 
Hi Nan

About the dose changes.... I was just doing what I thought the protocol called for. I shot AMPS 234 and gave .75U and then had (+3) 99 and (+6) 70. I then shot a PMPS 194 (and gave no insulin, following SLGS), had a (+6) 196 and then when I shot a PMPS of 217, SLGS says, "If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit" and concerning the pre-shot , "Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.".

I was going to do .5U but thought I'd be safe and go with .25. So you think I should have gone with .5?

Could you explain what you mean by "let the depot settle" in terms of how it applies here?

Thanks so much!

I gave an update on how Leo is doing in comment #32 in this thread ( Thanks for asking!):
http://www.felinediabetes.com/FDMB/...vet-thinks-is-near-death.192299/#post-2151136


Nan & Amber said:
I think this is the important thing
:)

That said, if you are going to follow SLGS, I'm seeing a lot of dose changes in the past few days, and your last reduction was from 0.75U to 0.25U, which might have been too much Now that you're on 0.25U, though, I'd try to stick with that for a bit longer to let the depot settle, but be prepared to have to go up again.

How is Leo acting/feeling these days?
Click to expand...
 
Lantus is a depot insulin, so a part of the dose goes to today's immediate action and part is kept in the system for later use (hence the longer action affect of lantus). So once the depot (pool) is full to the current dose then you will hopefully see consistency in the numbers. If you take the dose up...it will take 3-6 cycles for the depot to "stabilize" and for you to see the full affect of the current dose (lowering of numbers). The same happens when you reduce the dose - that is why you may see some lower than expected numbers after a reduction - the depot is draining back down so there is still extra insulin available for use.

As for SLGS - the dose increases are done after holding a dose for 14 cycles (7 days) and assessing the overall nadirs before another 0.25 increase is done. If Leo drops below 90 you take a 0.25u reduction right away.

So you should hold that 0.25 dose for another 5 days, unless he drops below 90, then look to see if the dose is a good dose are not.
 
Oh wow! I haven't been able to fully keep up on the boards lately, so I missed Leo's story, but you guys have really been through it lately!

Tracey did a great job explaining the depot action of Lantus. Basically, when dosing this insulin you want to think like you are turning a big ocean liner. It'll turn eventually, but spinning the wheel (do ocean liners have actual wheels?) back and forth isn't going to help do much of anything. Especially with SLGS, you want to hold doses for several days (unless he drops below 90).
 
I'm more confused now. So it's OK that I was using an AlphaTrak even though SLGS says not to? The sad thing is that I do have a human meter. I only bought the AlphaTrak because my vet has guiding me with Leo's doses and he was used to AlphaTrak numbers (and thought a human meter couldn't be used... yes, I know that's that true). So I've spent HUNDREDS of dollars on test strips for the AlphaTrak when I could have been using the human meter and strips??? Agh.

So I guess the question right now is can I switch to the human meter? Or will that throw off what I've been doing?

Also, I've shot a 500 AMPS (with AlphaTrak) and it seems like I'm stuck only giving .25 for another 4 days. Leo can not afford to have his BG go up again and start causing problems with CKD and dehydration. Am I really stuck giving the .25 or can I go up to .5? It's hard to believe the depot would make a big difference since I've been giving such a small dose.
 
Absolutely you can switch to the human meter to save money. Many people here have done the same. If you do so, pick a day, and on your SS, put in a blank line before the day you start with the new meter so people can easily see the change.

One of the reasons for the high number today is that you skipped the shot yesterday morning. The effects of a skip can be seen in later cycles. Out of curiosity, why did you skip? We tell new members that shooting over 200 is OK. When you are new to SLGS, the guidelines suggest a reduced dose is OK, but as you gather data over time, people shoot lower and lower numbers. With a low preshot, the cycles are flatter. And you have shot a 215 before, not much difference from yesterdays 201. As Leo recovers from that skip, his depot will rebuild and his numbers will come down.
 
To all...

As I said previously, "Also, I've shot a 500 AMPS (with AlphaTrak) and it seems like I'm stuck only giving .25 for another 4 days. Leo can not afford to have his BG go up again and start causing problems with CKD and dehydration. Am I really stuck giving the .25 or can I go up to .5? It's hard to believe the depot would make a big difference since I've been giving such a small dose."

Since the 500 AMPS, I shot a 244 (+5) and now a 602 PMPS (by the way, I checked and that 602 is 504 on a human meter). So am I still stuck only giving .25U or can I go up to .5?



Wendy&Neko said:
Absolutely you can switch to the human meter to save money. Many people here have done the same. If you do so, pick a day, and on your SS, put in a blank line before the day you start with the new meter so people can easily see the change.
Click to expand...

When I realized I was using the AlphaTrak when I should have been using a human meter, I thought people would say what it says in the SLGS protocol... basically, don't do it (by the way, it's called both a protocol and method in the sticky).

I would think that using the AlphaTrak has messed things up. For example, on 3/12 and 3/13 I skipped shots. Would that have happened if I was using a human meter? Two skipped shots led to me shooting a .75, then NS, then a series of .25s. That seems to have messed everything up. It would seem to me that not using a human meter caused problems right there... but no one else seems to think so????



Wendy&Neko said:
One of the reasons for the high number today is that you skipped the shot yesterday morning. The effects of a skip can be seen in later cycles. Out of curiosity, why did you skip? We tell new members that shooting over 200 is OK. When you are new to SLGS, the guidelines suggest a reduced dose is OK, but as you gather data over time, people shoot lower and lower numbers. With a low preshot, the cycles are flatter. And you have shot a 215 before, not much difference from yesterdays 201. As Leo recovers from that skip, his depot will rebuild and his numbers will come down.
Click to expand...

About skipping when I shot AMPS 201.... I skipped because SLGS says, "Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise." Also, the 201 nearly falls into the category, "Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value." So it's telling me a reduced dose may be wise (and I can't reduce a .25U) and the 201 almost falls into the category of "give nothing" and "give a token dose".
 
I think considering the high numbers and the fact that you were just at 1U a few days ago, you could go to .5 for the next few days and see how it goes

Giving a "token dose" due to a lower than expected Pre-shot number isn't the same as earning a reduction.....as soon as his Pre-shots were high enough, you could have gone back to the next "scheduled" dose....which would have been .5 (since he earned a reduction on the .75 by dropping to 70)
 
Last edited:
colin72 said:
"Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value." So it's telling me a reduced dose may be wise (and I can't reduce a .25U) and the 201 almost falls into the category of "give nothing" and "give a token dose".
Click to expand...

There's really another option.....to stall, DON'T feed and test again in 20-30 minutes to see if the number starts to rise on it's own without the influence of food. If it does, it's usually going to be safe to go ahead and shoot the scheduled dose because the last shot is starting to wear off. Remember, you usually have 2-3 hours before the shot starts to "kick in", so if you're home and able to test, you can intervene early if you need to.

Even on SLGS, once you have enough data, the decisions you make will change from the "official" method. You'll gradually learn to shoot lower Pre-shot numbers until you'll shoot anything over 90.

SLGS is really a "thinking-man's" method....you have to consider how much experience you have, how well you know how your cat responds, if you're going to be home and able to test as often as necessary, etc.
 
Nan & Amber said:
Oh wow! I haven't been able to fully keep up on the boards lately, so I missed Leo's story, but you guys have really been through it lately!

Tracey did a great job explaining the depot action of Lantus. Basically, when dosing this insulin you want to think like you are turning a big ocean liner. It'll turn eventually, but spinning the wheel (do ocean liners have actual wheels?) back and forth isn't going to help do much of anything. Especially with SLGS, you want to hold doses for several days (unless he drops below 90).
Click to expand...

Those liners do have a wheel - used to steer, like in car, but much bigger.
 
Rather that changing your first post, if you have a new question, it's best to add a new comment/question and change your subject line to something like "Leo - dose advice". Most people don't go back and reread the first post.

In your case, I think the decision is up to you. Leo started out yellow this morning so he is starting to come down on 0.25u. If you are following SLGS, you should hold the dose at 0.25 units and see if his numbers come down more as the depot fills after that missed shot. If you are able to monitor (test frequently), have high carb food and plenty of test strips around, some have suggested you could increase to 0.5, though it would be outside of what SLGS suggests. He did get down to low blues on 0.25 units, which is pretty good for the AT. SLGS suggests hold the dose if the low points (nadirs) are between 90 and 150. With the missed shots and changes in doses (not blaming, just saying), it's harder for us to say exactly what a good dose is, because the depot has been messed with.
 
When you switch to the human meter, don't look back! Don't try to do comparisons with the AlphaTrak. You'll drive yourself nuts!
You've got lots of good suggestions here. It will all fall into place soon. Don't worry. Just try to be consistent and follow SLGS as best as you can. Always give the depot a chance to settle in before changing the dose.
Good luck. You're doing just fine and asking good questions.
 
Chris & China said:
There's really another option.....to stall, DON'T feed and test again in 20-30 minutes to see if the number starts to rise on it's own without the influence of food. If it does, it's usually going to be safe to go ahead and shoot the scheduled dose because the last shot is starting to wear off. Remember, you usually have 2-3 hours before the shot starts to "kick in", so if you're home and able to test, you can intervene early if you need to.

Even on SLGS, once you have enough data, the decisions you make will change from the "official" method. You'll gradually learn to shoot lower Pre-shot numbers until you'll shoot anything over 90.

SLGS is really a "thinking-man's" method....you have to consider how much experience you have, how well you know how your cat responds, if you're going to be home and able to test as often as necessary, etc.
Click to expand...

Thank you so much for the explanations Chris. I really appreciate it. I think I have a better grasp of it now.
 
Thanks for the advice Wendy and Ella! I am going to switch to the human meter. I was curious about the difference between the AT and human meter so when I took Leo's BG the last couple days, I used both.

Here are the #s (AT/HM)...

3/17
PMPS 602/504 .25U
+5 220/147

3/18
AMPS 274/215 .25U
+4.5 200/142
PMPS 212/144 .25U
+5.5 no AT reading/ 82

As you can see, Leo's #'s look especially good with the HM. Considering those #s, it seemed like the best choice to hold the dose @ .25U as some of you have suggested.

Thanks again to everyone for taking the time to help. It means a lot.
 
Last edited:
colin72 said:
Thanks for the advice Wendy and Ella! I am going to switch to the human meter. I was curious about the difference between the AT and human meter so when I took Leo's BG the last couple days, I used both.

Here are the #s (AT/HM)...

3/17
PMPS 602/504 .25U
+5 220/147

3/18
AMPS 274/215 .25U
+4.5 200/142
PMPS 212/144 .25U
+5.5 no AT reading/ 82

As you can see, Leo's #'s look especially good with the HM. Considering those #s, it seemed like the best choice to hold the dose @ .25U as some of you have suggested.

Thanks again to everyone for taking the time to help. It means a lot.
Click to expand...
I have a question for you specifically. How do you consistently shoot .25U? I just purchased needles with half units. I've been thinking I'm giving .25U, so I tested one with water to see how much I was giving her, and it turns out NONE for 3 days! It didn't feel like I was giving her anything, and it seems I was right!
What's your secret?
 
Marylou and Malika said:
I have a question for you specifically. How do you consistently shoot .25U? I just purchased needles with half units. I've been thinking I'm giving .25U, so I tested one with water to see how much I was giving her, and it turns out NONE for 3 days! It didn't feel like I was giving her anything, and it seems I was right!
What's your secret?
Click to expand...
We're at .25 units now too. It's not easy! It's basically 1 fat drop.
 
Marylou and Malika said:
I have a question for you specifically. How do you consistently shoot .25U? I just purchased needles with half units. I've been thinking I'm giving .25U, so I tested one with water to see how much I was giving her, and it turns out NONE for 3 days! It didn't feel like I was giving her anything, and it seems I was right!
What's your secret?
Click to expand...
I am going to take the liberty of answering this question, too.

First of all, insulin syringes differ greatly: by brand, by individual syringes of the same brand and in the same lot, etc. Often the lines on the syringes are inaccurate: the zero line does not line up with the disc at the top of the syringe; the lines are crooked; etc. This is not usually a problem with humans, who have large doses and therefore tiny discrepancies don't matter; cats with large doses also do not generally have problems. The most accurate way to measure small doses is by using digital calipers. See Marje's excellent discussion on dosing with calipers: http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/
(Unfortunately the Terumo syringes Marje uses in her video demonstration are no longer available, but the technique for determining the dose is valid for all syringes.)

Another--less accurate-- way is to count drops: Try to find a syringe where the zero line lines up with the plastic disc. Fill your syringe to the 1 Unit mark with insulin (not water, which does not have the same consistency as insulin) Then gently twist the plunger until a drop of insulin forms on the needle and drops down the needle. Continue this process until the syringe is empty. How many drops did you count? If it was 5 drops, then 1/2 unit would be 2.5 drops, and 1/4 unit would be 1.25 drops. Different syringes will wind up with different numbers of drops in 1 Unit, so don't switch syringes when doing this procedure. For every technique of measurement, it is always recommended to draw out more insulin than your dose and slowly twist the plunger until arriving at your dose. In the illustration above, you would draw out 1 Unit and work down to your 0.25 U dose.

Hope this helps. Measuring small amounts is hard!
 
Last edited:
Marylou and Malika said:
I have a question for you specifically. How do you consistently shoot .25U? I just purchased needles with half units. I've been thinking I'm giving .25U, so I tested one with water to see how much I was giving her, and it turns out NONE for 3 days! It didn't feel like I was giving her anything, and it seems I was right!
What's your secret?
Click to expand...

Hi Marylou

Unfortunately I don't have any secrets on getting a .25U dose. I assume you are using a Lantus pen and using the needle to draw from that? I'm just drawing a unit or more into the needle and then slowly pressing the plunger and moving down until I'm halfway in between the .5 line and the bottom line. I think all needles have a "bottom line". I assume you know that the bottom line isn't a measuring line? (I'm not sure of the terminology).

It is hard to see the marks because they're black and the end of the plunger is black. When I do it I have to be in very good light and I always hold it up to the light to see what I'm doing.

I've had two different brands of syringes. I can't remember the name of the first but sometimes the end of the plunger looked a little wonky to me. The brand I have now are Relion.
 
colin72 said:
Hi Marylou

Unfortunately I don't have any secrets on getting a .25U dose. I assume you are using a Lantus pen and using the needle to draw from that? I'm just drawing a unit or more into the needle and then slowly pressing the plunger and moving down until I'm halfway in between the .5 line and the bottom line. I think all needles have a "bottom line". I assume you know that the bottom line isn't a measuring line? (I'm not sure of the terminology).

It is hard to see the marks because they're black and the end of the plunger is black. When I do it I have to be in very good light and I always hold it up to the light to see what I'm doing.

I've had two different brands of syringes. I can't remember the name of the first but sometimes the end of the plunger looked a little wonky to me. The brand I have now are Relion.
Click to expand...
Thanks! I've gotten several good responses and the bottom line is - it's not easy but it can be done! Thanks for your reply.
 
Could I get some thoughts on what has happened with Leo's #s since I switched to a human meter on 3/18 @ +5.

As you'll see his numbers have been very good and I've skipped shots. I realize that I could have shot something at the AMPS on 3/20 or at +2.5 but as you can see without shooting, his numbers came down. I think if I would have shot .25 he might have went too low.

Thoughts and opinions please?
 
Status
Not open for further replies.
Back
Top