(11/1) Guidance for dosing methods

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Now that I’m done panicking a little ;) 7 isn’t that low on a human meter, is it? I thought I was putting a green number on the list, dang! Lol

I know you like to stall under 10, but if this happened again, should I just continue with regular scheduling? Should I stall and retest again?
 
Gus the Furminator said:
He’s now at 12.3 (125ish)
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If 7 was 126, 12.3 would be 221 not 125ish...LOL

If you're able to test and have plenty of supplies, there's no reason not to shoot the scheduled dose at either of those numbers. Stalling is really more for the human than the cat.

Remember, Lantus doesn't usually start to "kick in" for 2-3 hours after it's given and in that time, Gus is going to be eating which will bring the BG up anyway.

You may get more help if you start posting on the Lantus Forum too.

Have you ever decided if you want to do Tight Regulation or Start Low, Go Slow? It matters because the advice we'd give depends on the dosing method you want to use.
 
Chris & China (GA) said:
If 7 was 126, 12.3 would be 221 not 125ish...LOL

If you're able to test and have plenty of supplies, there's no reason not to shoot the scheduled dose at either of those numbers. Stalling is really more for the human than the cat.

Remember, Lantus doesn't usually start to "kick in" for 2-3 hours after it's given and in that time, Gus is going to be eating which will bring the BG up anyway.

You may get more help if you start posting on the Lantus Forum too.

Have you ever decided if you want to do Tight Regulation or Start Low, Go Slow? It matters because the advice we'd give depends on the dosing method you want to use.
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Lol! You are not wrong! 12.3 is definitely a bigger number than 7… D’oh! It was early and I was a little off with his single digit number :)

Good point, I was banking on it being Lantus and having a slower onset time and that his numbers have been a little higher lately. Thank you for confirming this for me.

Honestly, I’m in a bit of a rock and a hard place with deciding on which protocol to go with - thinking TR…seems like a bit more stressful but a little more successful. I’m still in a good place with my vet (he’s great and knowledgeable) and want to keep that good relationship with him. It’s tough for him to help me if I go off on my own, ya know.

I should be talking with my vet this week to discuss data and the increase to 2u. I think I will have a good chat with him about the two protocols suggested here. I would want him to be in the know of what I decide to do.

Once I figure that out I will start posting in the more appropriate forum.
 
One of the advantages of TR as far as vets may be concerned is that the protocol was published in one of the major vet journals.

Just a comment about dosing. Regardless of whether you opt for TR or SLGS, you are holding the dose for too long. With TR, doses are held for 3 days and SLGS for a week -- providing a dose reduction isn't indicated. Holding the dose for too long can cause glucose toxicity (i.e., your cat's body treats the higher numbers as the new "normal").
 
Diane Tyler's Mom said:
Looking at your SS he's already on 2 units
Plus you have increased by a full unit
We increase or decrease by 0.25 units at a time
You could be missing what a good dose would be for Gus
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Oh yes, sorry if it was unclear. The call is to discuss what has happened during the time we increase from 1u to 2u.

I was a little unsure of the full unit increase but trusted in my vet. I will however fight him, lol, if he suggests another full unit increase after our call. I won’t do more than .5 at this point (preferably .25 as you noted)… too risky, a risk im not willing to take.
 
Sienne and Gabby (GA) said:
One of the advantages of TR as far as vets may be concerned is that the protocol was published in one of the major vet journals.

Just a comment about dosing. Regardless of whether you opt for TR or SLGS, you are holding the dose for too long. With TR, doses are held for 3 days and SLGS for a week -- providing a dose reduction isn't indicated. Holding the dose for too long can cause glucose toxicity (i.e., your cat's body treats the higher numbers as the new "normal").
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Thank you this info, Chris had also brought this to my attention. I will also bring this up. Kinda why I’m leaning towards TR
 
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Sienne and Gabby (GA) said:
One of the advantages of TR as far as vets may be concerned is that the protocol was published in one of the major vet journals.

Just a comment about dosing. Regardless of whether you opt for TR or SLGS, you are holding the dose for too long. With TR, doses are held for 3 days and SLGS for a week -- providing a dose reduction isn't indicated. Holding the dose for too long can cause glucose toxicity (i.e., your cat's body treats the higher numbers as the new "normal").
Click to expand...

Is there a link somewhere to the TR protocol that was published? Is that the one that gets shared here? If so, I have it.

I think sharing that with my vet would be helpful, if he doesn’t already know about it.

Ty!
 
I'm back. Currently writing an email to my vet.

I have a few questions so far:

For TR:
If Gus is on 2u at the moment, and suggested starting for TR is .25u per kg? He is ~6.8kg (he’s a big structured boy). Would I increase the dose from the current dose he's on since we know that he is currently needing more with the data taken or would I start with insulin dose/kg that was recommended "when starting"

Could I get guidance from the forum to know what dosage is ‘too low’ or ‘too high’ on whether or not to increase/decrease by .25 or .5 - the paper is a bit vague on this, but I'm assuming there are #'s that we follow here that dictates this?

For SLGS:
To check that I have this correct, this protocol involves the following:
Simply upping the dose by .25units for a week and at the end of that week, perform a curve to see how that went - depending on nadirs, we would then increase or decrease (a decrease might be found/needed before the end of the week if spot checks are too low). This would continue until we find that "perfect" dose...

Originally I was leaning on TR, but I'm starting to lean towards SLGS after reading.

I know I haven't been taking enough tests lately, Gus has been a little bit annoyed with tests this past week. I would love if someone could have a look at his spreadsheet and suggest times that I should be focusing on. I know that I should stagger them but sometimes I feel like I wasted a test time... if that makes sense - I know that it's not really a waste and all data is good... but would like to make the best out of the poke.

General question: Do I have enough data for anyone to make a guess at Gus’ nadir time… he seems to be a little all over and I can't seem to pin point it - almost looks like his AMPS might be on average his lowest or maybe his +5..

Thanks for your help, I'd be happy to clarify if I'm not making sense, lol

@Diane Tyler's Mom
@Sienne and Gabby (GA)
@Chris & China (GA)
 
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tiffmaxee said:
Hi. Nobody can give you dosing advice without mid cycle tests. You need a curve with slgs.
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Hi. I’m not looking for dosing advice at the moment. Just trying to gather information on both dosing methods before I choose and/or discuss with my vet.

The only question about dosing was IF I do go with TR, if I would start at my current dose or if we would start lower as per TR doc that was shared (.25 per kg). The other dosing question was if I did go with TR if I would have help deciding if I increased or decrease by .25 or .5 as per paper - it’s is vague.

There are other questions there also… like if I understood SLGS properly.

l do have a few mid cycle tests… but as I mentioned above was hoping I could get some advise on where I should be focusing or if anybody can see where his nadirs are as his numbers are a little all over.

Thanks
 
Got it. With both methods you will continue with your current dose. The starting doses are for cats new to insulin, not new to the method.

Nadirs move around. When tightly controlled you don’t often even have one as the cycles are flat. That’s why whichever method you follow you need spot checks. Cats often drop lower at night. That’s why even if you go with SLGS you occasionally will need mid tests and sometimes tests in the second half of the cycle. TR requires a minimum of two tests each cycle. If you have an active cycle with either method more tests will be needed. Often if the +2 is lower than the pretest or about the same it’s worth grabbing another test because that’s when lantus often onsets. For some it’s earlier and for others like my boy later.
 
tiffmaxee said:
Got it. With both methods you will continue with your current dose. The starting doses are for cats new to insulin, not new to the method.

Nadirs move around. When tightly controlled you don’t often even have one as the cycles are flat. That’s why whichever method you follow you need spot checks. Cats often drop lower at night. That’s why even if you go with SLGS you occasionally will need mid tests and sometimes tests in the second half of the cycle. TR requires a minimum of two tests each cycle. If you have an active cycle with either method more tests will be needed. Often if the +2 is lower than the pretest or about the same it’s worth grabbing another test because that’s when lantus often onsets. For some it’s earlier and for others like my boy later.
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Thank you! This helps.

So it’s not odd that his nadirs seem to move around.

I will try my best to get minimum of 4 per day, preshot and one per cycle unless sometime indicates I need to do more. I’ll scatter the spot checks and get more in the second half of the cycle as well.
 
I was originally wanting to go with TR but it’s a bit more aggressive with testing, I believe. I feel like TR would get us to where we need to be faster.

Honestly, I’d be testing all day along if I could he’s actually getting pretty good about it and follows me to our test spot and lays down and let’s me do it but this past week Gus seems extra annoyed with testing. So that made me think that I might so with SLGS.

(off topic a bit..)
He seems to be bruising I think. When I shine a light there are one or two red spots… not big ones but they are there. I rotate ears and move it around the sweet spot.

When I test, i warm the ear with a rice sock… Poke, get the sample and put the meter down while it gets the number. I immediately put pressure on the spot with the cotton round. I know that they say for 20 secs or so… but honestly I hold it until the meter turns off…Which is like almost a minute! I really don’t know why or how to prevent the bruising… if it’s bruising.. do pokes leave little red dots? I change the lancet every time.. don’t want anything to infect him… I use a lancet device. Im just not sure what’s happening. Might be why he’s annoyed… everything seems to go smoothly though
 
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