9/28/21 Squints pmps 89 ??

I am going to assume you are following SLGS until you decide. When you get a lower than usual amps or pmps , stall, do no feed, and recheck in 20-30 minutes. You then would see if on the way up. Most feed in between shots. Not eating all day can lead to a lower pmps.

Here is your last post for continuity.
https://felinediabetes.com/FDMB/thr...-hi-reading-what-do-i-do.253474/#post-2858296

With Slgs a reduction has been earned. You never shoot under 90 and every time you get a bg under 90 you reduce and hold the new dose for 7 days unless another decrease is earned. I don’t understand why you went back to 1.50. Please explain. It’s too high a dose for you to be able to shoot every 12 hours. I actually think you should go down to 1.0 and see if you get a safe bg to shoot every cycle.
 
tiffmaxee said:
I am going to assume you are following SLGS until you decide. When you get a lower than usual amps or pmps , stall, do no feed, and recheck in 20-30 minutes. You then would see if on the way up. Most feed in between shots. Not eating all day can lead to a lower pmps.

Here is your last post for continuity.
https://felinediabetes.com/FDMB/thr...-hi-reading-what-do-i-do.253474/#post-2858296

With Slgs a reduction has been earned. You never shoot under 90 and every time you get a bg under 90 you reduce and hold the new dose for 7 days unless another decrease is earned. I don’t understand why you went back to 1.50. Please explain.
Click to expand...

We arent home during the day to feed in between.
So, once i did the 1.25 i shoulf have stayed at that dose??
We just started home testing on 9/9/21. So all this info is really new, and its alot to understand.
 
StephanieNJ said:
We arent home during the day to feed in between.
So, once i did the 1.25 i shoulf have stayed at that dose??
We just started home testing on 9/9/21. So all this info is really new, and its alot to understand.
Click to expand...

I understand. It’s why until you get familiar with how lantus works you should post every day. I’m glad you asked for dosing advice today. Is there any way you can shoot earlier so you can get a +2 or even +1 before you leave or will that mean you won’t be home to shoot on time at night?
 
START LOW, GO SLOW (SLGS)

The Start Low, Go Slow Method (SLGS) with Lantus, Basaglar, or Levemir for Diabetic Cats has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus, Basaglar, and Levemir insulins.

Requisites when following the Start Low, Go Slow Method:
  • Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
  • Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
  • Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other
medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?


A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • 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
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

If kitty is dropping faster or lower than you'd like, please see "Don't Panic! or How to Handle Low Numbers" and post for help or suggestions.

Remission:
Remission is reached when kitty can go 14 days without insulin. Most cats will remain in the range of a healthy cat 50 - 80mg/dL (2.7 - 4.4 mmol/L) with only sporadic higher or lower BG numbers.

Occasionally, some will experience infrequent BG numbers higher than the norm. Continue feeding low carb food. Test the cat's BGs once per month. If BG numbers begin to trend upwards, it's time to bring kitty in to see your vet for a check-up. Common reasons for kitty falling out of remission include dental issues, infection, inflammation, pancreatitis, etc. Just about any illness or disease can do it.

Journal of Veterinary Medicine, 2015:
Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission


Sometimes there are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines and suggestions. Please ask for guidance if any of these or other circumstances present themselves or are of concern.

Random Notes:
  • In the case of a furshot, NEVER give another shot. There's no way of knowing how much of the first shot "got into" the cat.
  • NEVER give a second shot because "numbers are too high" in a 12 hour cycle.
  • Test often for ketones.
  • Be consistent in timing and type of food.
  • KNOW THY CAT. Shooting early or late is a practice best reserved for those who have a full understanding of the insulin used and it's effects on their kitty. Because of the cumulative nature of Lantus and Levemir, please be aware:
    • Shooting an hour or two early *could* act like a slight dose increase.
    • Shooting an hour or two late *could* act like a slight dose reduction. Please ask for guidance if you're unsure.
  • A "cycle" refers to the period of time between shots. There are 2 cycles in every 24 hours when shooting on a 12/12 schedule.
====================================
Adaptation of the original SLGS Method written from suggestions










 
tiffmaxee said:
I understand. It’s why until you get familiar with how lantus works you should post every day. I’m glad you asked for dosing advice today. Is there any way you can shoot earlier so you can get a +2 or even +1 before you leave or will that mean you won’t be home to shoot on time at night?
Click to expand...

Yes he is fed around 515am...then while hes eating we give shot... i can recheck at 615am and/or 715am... i leave for work at 8am..
 
Good. Make sure you test and feed again at +2. If the bg has dropped you need to leave out food for him. It is good to get an audio feeder and set it to go off while you are away and at night so you can sleep and know he won't get too low. Once a reduction is earned you hold it and don't go back up even if high when it is dosing time. Lantus is dosed based upon the nadir, lowest point in the cycles. We look for trends and so after 7 days on the same dose you do a curve to see what the nadir is. Make sense?
 
tiffmaxee said:
Good. Make sure you test and feed again at +2. If the bg has dropped you need to leave out food for him. It is good to get an audio feeder and set it to go off while you are away and at night so you can sleep and know he won't get too low. Once a reduction is earned you hold it and don't go back up even if high when it is dosing time. Lantus is dosed based upon the nadir, lowest point in the cycles. We look for trends and so after 7 days on the same dose you do a curve to see what the nadir is. Make sense?
Click to expand...

Ok. I think I understand. So he should get 1.25 from now until another change?
 
StephanieNJ said:
Ok. I think I understand. So he should get 1.25 from now until another change?
Click to expand...

Since you are gone all day I would even consider dropping to 1.0 and working your way up if needed but technically the dose would be 1.25.
There is a lot to learn so post and we will help you.There almost always someone around. On 9/19 he made it clear that 1.5 was too much.
 
tiffmaxee said:
Since you are gone all day I would even consider dropping to 1.0 and working your way up if needed but technically the dose would be 1.25.
There is a lot to learn so post and we will help you.There almost always someone around. On 9/19 he made it clear that 1.5 was too much.
Click to expand...

Perfect. Thank you!
 
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