2/8Oliver 56@+4,73@4.5,78@5.5,98@6.5,519 @9.25, PMPS HI, HI @+2

Marje and Gracie said:
Shelley

The importance of what Wendy asked is if he has any chance to get into dry, then you’ll have to use SLGS as the method of regulation and so he earned a reduction today to 0.75u; the reduction point formSLGS is a drop below 90.

If he now has absolutely no access to dry food and is only getting canned or raw, you could do TR and the dose wouldn’t change as the reduction point is a drop below 50.
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I think I would like the option where the dose doesn’t change a lot. I understand we would have to be really diligent about no crunchies.
 
I think it was from the fast drop this morning in combo with the green numbers, while safe and healing, are nee to him. While every cat is different, my Cosmo bounces from drops between 80 to 100 over 2 hrs.
 
So, if we choose to be diligent about no dry food, I could use the TR method of only adjusting the dosage if it falls below 50. Does that mean I would give him 1u again tonight?
 
I’m not sure what you mean?

No matter which method you choose, you would shoot the same dose at am and pm shot, unless a reduction is earned or unless it is time and appropriate to increase.

TR - or tight regulation, you hold the dose for 6 cycles (3days) unless kitty goes below 50, in which case you would reduce by 0.25 on the next available shot. Increases or decisions to hold the dose are based on how low (nadirs) the dose is taking kitty. This is determined after 6 cycles. More testing is needed than SLGS and is a more aggressive, but also more effective method to achieve regulation and/or remission.

SLGS - you hold the dose for 7 days, unless kitty goes below 90 at any time, in which case you would reduce by 0.25 on the next available shot. After 7 days a curve is done to determine whether an increase is advised or whether you maintain the same dose. Less testing is required. At minimum preshot tests are advised and at least 1 mid cycle test.
 
Shelley,
I don’t post all that often in the Lantus forum these days but have been following your journey and wanted to commend you for how diligent you’ve been, how quickly you’ve come up to speed, and how open you’ve been to accepting (and following!) the guidance and advice you’ve been offered. Kudos!

As for SLGS or TR ... that’s a personal choice. However, I’ll wade in and offer my opinion only because you probably bear some trauma from that recent symptomatic hypo and you have a lot of other variables to consider in the short term (removing dry food, large swings in BG at the moment, limited food choices in your location, where you live (I think you said deliveries are made to a snow bank??), not being a night person, and so forth). All that said, my two cents is that it’ll probably be less stressful for you to start with SLGS, then consider switching to TR later after the food changes are complete and you have a little more experience and are more comfortable seeing lower numbers. The comfort level will come, and some day you’ll shoot lower numbers confidently, but it’s completely understandable if you’re still a little gun-shy. I know I would have been if I were in your shoes.

So just my two cents. Keep up the good work.
 
JL and Chip said:
Shelley,
I don’t post all that often in the Lantus forum these days but have been following your journey and wanted to commend you for how diligent you’ve been, how quickly you’ve come up to speed, and how open you’ve been to accepting (and following!) the guidance and advice you’ve been offered. Kudos!

As for SLGS or TR ... that’s a personal choice. However, I’ll wade in and offer my opinion only because you probably bear some trauma from that recent symptomatic hypo and you have a lot of other variables to consider in the short term (removing dry food, large swings in BG at the moment, limited food choices in your location, where you live (I think you said deliveries are made to a snow bank??), not being a night person, and so forth). All that said, my two cents is that it’ll probably be less stressful for you to start with SLGS, then consider switching to TR later after the food changes are complete and you have a little more experience and are more comfortable seeing lower numbers. The comfort level will come, and some day you’ll shoot lower numbers confidently, but it’s completely understandable if you’re still a little gun-shy. I know I would have been if I were in your shoes.

So just my two cents. Keep up the good work.
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Oh! Ok. I just saw this. I like the less stress part. So start low go slow SLGS it is. Now I need help through that. I believe because he went below 60, I reduce to 0.75.
 
Shelley & Oliver said:
So, if we choose to be diligent about no dry food, I could use the TR method of only adjusting the dosage if it falls below 50. Does that mean I would give him 1u again tonight?
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If you were choosing TR and commit to 100% no kibble, yes, that is correct, according to the protocol. But...your scenario is a little more delicate given the history, so I would wait for @Wendy&Neko @Marje and Gracie to advise on tonight. They are tagged in my post so hopefully advise soon.
 
thebigfuzz said:
@Wendy&Neko @Marje and Gracie do you have any advisement on dosing method and also for tonight? I think you are trying to assess if TR is appropriate?
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Thank you, Tanya! Yes, you are very correct.

Shelley.. as long as you can assure he will stay out of the dry, I’d shoot the 1u. You saw the value of the +2 today so please be sure and get one. If you cannot be positive he will stay out of the dry and won’t have access, then you should reduce the dose to 0.75u. I hope that helps.

Edited to add: yes, you’ve had a bit of a trial by fire but, typically, unless a cat does not meet the requisites for TR or the CG has a crazy work schedule, we suggest TR. If you follow SLGS, that means if you reduce the dose and his BG goes up and stays there, you leave it for a week and then reassess. With TR, we can adjust the dose quicker.
 
Marje and Gracie said:
Thank you, Tanya! Yes, you are very correct.

Shelley.. as long as you can assure he will stay out of the dry, I’d shoot the 1u. You saw the value of the +2 today so please be sure and get one. If you cannot be positive he will stay out of the dry and won’t have access, then you should reduce the dose to 0.75u. I hope that helps.
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It does. No dry food down all day and we are now going to remove it completely, from today on.


LC wet food for all! Will definitely get a +2 this night.
 
thebigfuzz said:
I’m not sure what you mean?

No matter which method you choose, you would shoot the same dose at am and pm shot, unless a reduction is earned or unless it is time and appropriate to increase.

TR - or tight regulation, you hold the dose for 6 cycles (3days) unless kitty goes below 50, in which case you would reduce by 0.25 on the next available shot. Increases or decisions to hold the dose are based on how low (nadirs) the dose is taking kitty. This is determined after 6 cycles. More testing is needed than SLGS and is a more aggressive, but also more effective method to achieve regulation and/or remission.

SLGS - you hold the dose for 7 days, unless kitty goes below 90 at any time, in which case you would reduce by 0.25 on the next available shot. After 7 days a curve is done to determine whether an increase is advised or whether you maintain the same dose. Less testing is required. At minimum preshot tests are advised and at least 1 mid cycle test.
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Oh thank you for this. I know it is in the sticky note files , but I just copied this here and sent it to Oliver’s diabetes folder for reference when I get confused. Thank goodness I’m retired now. Heh
 
thebigfuzz said:
I think it was from the fast drop this morning in combo with the green numbers, while safe and healing, are nee to him. While every cat is different, my Cosmo bounces from drops between 80 to 100 over 2 hrs.
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I see. This is starting to make sense to us. You guys are the best. All of you.
 
Thank y
Marje and Gracie said:
Thank you, Tanya! Yes, you are very correct.

Shelley.. as long as you can assure he will stay out of the dry, I’d shoot the 1u. You saw the value of the +2 today so please be sure and get one. If you cannot be positive he will stay out of the dry and won’t have access, then you should reduce the dose to 0.75u. I hope that helps.

Edited to add: yes, you’ve had a bit of a trial by fire but, typically, unless a cat does not meet the requisites for TR or the CG has a crazy work schedule, we suggest TR. If you follow SLGS, that means if you reduce the dose and his BG goes up and stays there, you leave it for a week and then reassess. With TR, we can adjust the dose quicker.
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Thank you. I like this.
 
Shelley, my apologies if my input confused you. For what it’s worth, I don’t disagree with any of what @Marje and Gracie posted. I truly believe you’re on the right track either way and it’s clear you’ll do whatever is needed for Oliver (even it it’s hard on you).

We’re all colored by our experiences. You’re in good hands with this board and I’ll be watching your progress. :-)
 
JL and Chip said:
Shelley, my apologies if my input confused you. For what it’s worth, I don’t disagree with any of what @Marje and Gracie posted. I truly believe you’re on the right track either way and it’s clear you’ll do whatever is needed for Oliver (even it it’s hard on you).

We’re all colored by our experiences. You’re in good hands with this board and I’ll be watching your progress. :)
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No worries! And, Thank you. I appreciate the support I am getting from all of you.
 
Shelley & Oliver said:
Done. :)
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Thank you.

JL and Chip said:
Shelley, my apologies if my input confused you. For what it’s worth, I don’t disagree with any of what @Marje and Gracie posted. I truly believe you’re on the right track either way and it’s clear you’ll do whatever is needed for Oliver (even it it’s hard on you).

We’re all colored by our experiences. You’re in good hands with this board and I’ll be watching your progress. :)
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The value of this board is also hearing other sides and opinions. Thanks, JL!
 
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