Insulin dosing advice, please!!

K

KClawson

Member
My boy Olver (17 year old, neutered male) was diagnosed 12/12. I switched to strictly Friskies pate fodd at that time, but did not start insulin until 1/18 due to travel/holiday plans. He was on 0.5u lantus until his first BG curve 2/1-2/2 when I reduced him to 0.25 based on his numbers. I curved him again yesterday and, based on numbers again, decided to not give insulin today (& continued the curve). Looking for advice to see if this looks like remission (I know he has to be insulin free for 14 days to be officially declared). If not, what numbers should I be looking for to indicate going back on insulin?

**Hope I did this right**
https://docs.google.com/spreadsheet...IXjeB6lMts9ds_FXvqWfs5cgfPQ/edit?usp=drivesdk
 
@KClawson
Here is the information we need for your signature
Just click on your name up top and then tap signature and add this information. It's at the end of everyone's post in gray letters
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
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Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

I tagged a few members to take a look at your spreadsheet
 
KClawson said:
My boy Olver (17 year old, neutered male) was diagnosed 12/12. I switched to strictly Friskies pate fodd at that time, but did not start insulin until 1/18 due to travel/holiday plans. He was on 0.5u lantus until his first BG curve 2/1-2/2 when I reduced him to 0.25 based on his numbers. I curved him again yesterday and, based on numbers again, decided to not give insulin today (& continued the curve). Looking for advice to see if this looks like remission (I know he has to be insulin free for 14 days to be officially declared). If not, what numbers should I be looking for to indicate going back on insulin?

**Hope I did this right**
https://docs.google.com/spreadsheet...IXjeB6lMts9ds_FXvqWfs5cgfPQ/edit?usp=drivesdk
Click to expand...
@Bron and Sheba (GA)
@Bandit's Mom
@Christie & Maverick
@Sienne and Gabby (GA)
 
I am wondering why you are not doing the TR dosing protocol. You are feeding a low carb wet diet and are testing enough to do it.
I see you have 2 spreadsheets. I would just continue with the human meter one. Our dosing methods are based on those and it is easier to help you when you use the human meter.

Re the dosing…I would continue with the 0.25 unit dose. Oliver is starting to get some lovely green BGs with this dose and that is what you are aiming for. When he has had all green BGs for a week we can look at reducing the dose further.
Keep asking questions:)
 
Bron and Sheba (GA) said:
I am wondering why you are not doing the TR dosing protocol. You are feeding a low carb wet diet and are testing enough to do it.
I see you have 2 spreadsheets. I would just continue with the human meter one. Our dosing methods are based on those and it is easier to help you when you use the human meter.

Re the dosing…I would continue with the 0.25 unit dose. Oliver is starting to get some lovely green BGs with this dose and that is what you are aiming for. When he has had all green BGs for a week we can look at reducing the dose further.
Keep asking questions:)
Click to expand...

My understanding of TR vs SLGS is that there is much more frequent testing with TR. During the week, due to my work schedule, I really can't test more than at PS & ~+5-6 after AM dose. I can test more in the evenings, but not during the day. Weekends, I can test much more.

I only use the Alpha track for curves & only as "control" for the relion meter since it is programmed for cat values. The strips are too expensive for daily use.

I will continue at 0.25 & go from there.

Thank you.
 
KClawson said:
My understanding of TR vs SLGS is that there is much more frequent testing with TR. During the week, due to my work schedule, I really can't test more than at PS & ~+5-6 after AM dose. I can test more in the evenings, but not during the day. Weekends, I can test much more.
Click to expand...

Hi there
Quite a few caregivers here do work full time, and are following TR. You might find this discussion interesting if its something you want to consider, now or in the future:
https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/

Best of luck!
 
The minimum number of tests with either TR or SLGS is 4 -- your two pre-shot tests and at least one additional test during the AM and PM cycles. While more tests are always better, Helen is correct. There are many of us who were working or in school and not home to get lots of tests.

If you're gone during the day, one thing I found helpful was a timed feeder. That way, Oliver will have access to food.

Also, you're skipping doses at blood glucose levels where insulin is needed. You're also holding the dose for longer than what is indicated on SLGS. How can we help?
 
Sienne and Gabby (GA) said:
The minimum number of tests with either TR or SLGS is 4 -- your two pre-shot tests and at least one additional test during the AM and PM cycles. While more tests are always better, Helen is correct. There are many of us who were working or in school and not home to get lots of tests.

If you're gone during the day, one thing I found helpful was a timed feeder. That way, Oliver will have access to food.

Also, you're skipping doses at blood glucose levels where insulin is needed. You're also holding the dose for longer than what is indicated on SLGS. How can we help?
Click to expand...
What do you mean by "skipping doses at blood glucose levels where insulin is needed. You're also holding the dose for longer than what is indicated on SLGS."? I just want to be sure I am understanding this.
 
Sienne and Gabby (GA) said:
The minimum number of tests with either TR or SLGS is 4 -- your two pre-shot tests and at least one additional test during the AM and PM cycles. While more tests are always better, Helen is correct. There are many of us who were working or in school and not home to get lots of tests.

If you're gone during the day, one thing I found helpful was a timed feeder. That way, Oliver will have access to food.

Also, you're skipping doses at blood glucose levels where insulin is needed. You're also holding the dose for longer than what is indicated on SLGS. How can we help?
Click to expand...

I actually do have a timed feeder for him (PetLibro Polar feeder) So, he has access to food 3x per day with that & 4x direct from me (breakfast, lunch, dinner & bedtime). Sometimes my other cat gets to the food in the feeder before he does, but mostly he gets it.
 
KClawson said:
What do you mean by "skipping doses at blood glucose levels where insulin is needed
Click to expand...
Sienne means on your spreadsheet where you have 0 in the unit cell or square, since you are following SLGS method when Oliver dropped under 90 you should have given 0.1 units of insulin. Pic of it below. Oliver did drop under 90 a few times already
@KClawson
 
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@KClawson
When you are following SLGS method this is from the SLGS sticky

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
 
Diane Tyler's Mom GA said:
@KClawson
When you are following SLGS method this is from the SLGS sticky

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
Click to expand...
So, now I think I am even more confused. We started at 0.5u. After 2 weeks I curved him (on 2/1 & 2/2). On 2/1 he dropped into the green at AM+4 & +5, but stayed up in blue the rest of the day. I curved again on 2/2 to see if that was just a one-off day or not & he stayed below 90 for several hours, so I went to 0.25.

I did a partial curve a week later, but he was staying up in blue, so I continued at 0.25 for another week.

This Saturday (2/15) I curved again & he stayed below 90 again for several hours, so I reduced to 0 (can't really go lower than 0.25 on the syringe- that dose is hard enough) on Sunday & recurve, where he still went below 90 for a couple of hours. Yes he did go up to 203 in the PM, but went back down again to 111 by bed time (+4).

Based on the initial response on this thread I got this morning advising me to stay at 0.25 for another while longer (which I read before morning test/shot), I went back to 0.25, with the understanding that I am looking for more time in the green than what I have seen so far.

Please guide me. I need to go do his PM test now & will update his SS once done.
 
@KClawson
Just wanted to let you know ,I tagged @Bron and Sheba (GA) for you to see if you should still stay with 0.25 units like she told you in her post #4 even though Oliver dropped below 90 a few times
There is another dose after 0.25
It would be 0.1


upload_2025-2-17_23-59-8.jpeg


After that it would be what we call a drop dose

Do you have the syringes with the half unit markings
  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg
 

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KClawson said:
So, now I think I am even more confused. We started at 0.5u. After 2 weeks I curved him (on 2/1 & 2/2). On 2/1 he dropped into the green at AM+4 & +5, but stayed up in blue the rest of the day. I curved again on 2/2 to see if that was just a one-off day or not & he stayed below 90 for several hours, so I went to 0.25.

I did a partial curve a week later, but he was staying up in blue, so I continued at 0.25 for another week.

This Saturday (2/15) I curved again & he stayed below 90 again for several hours, so I reduced to 0 (can't really go lower than 0.25 on the syringe- that dose is hard enough) on Sunday & recurve, where he still went below 90 for a couple of hours. Yes he did go up to 203 in the PM, but went back down again to 111 by bed time (+4).

Based on the initial response on this thread I got this morning advising me to stay at 0.25 for another while longer (which I read before morning test/shot), I went back to 0.25, with the understanding that I am looking for more time in the green than what I have seen so far.

Please guide me. I need to go do his PM test now & will update his SS once done.
Click to expand...
@Bron and Sheba (GA)
@Sienne and Gabby (GA)
@Bandit's Mom
@Suzanne & Darcy

Bron should she still hold the 0.25 units like you said in post #4
 
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KClawson said:
My understanding of TR vs SLGS is that there is much more frequent testing with TR. During the week, due to my work schedule, I really can't test more than at PS & ~+5-6 after AM dose. I can test more in the evenings, but not during the day. Weekends, I can test much more.

I only use the Alpha track for curves & only as "control" for the relion meter since it is programmed for cat values. The strips are too expensive for daily use.

I will continue at 0.25 & go from there.

Thank you.
Click to expand...
I gave you incorrect advice in post 4 above. I am sorry. As you are doing SLGS and dropped under 90, I should have advised you to reduce the dose to 0.1U

However as long as you can get at least 2 tests in a cycle, you can do TR. If you decide to do that, you would stay with the 0.25 U dose. He is doing really well for a newly diagnosed cat and TR will give him his best shot at remission.


If you decide to stay with SLGS you will need to reduce the dose to 0.1 U as the BG has dropped under 90. You will need a good light and I always used a magnifying glass when drawing up small doses.
Here is what 0.1 Unit looks like

upload_2025-2-18_17-51-22.jpeg
 

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@KClawson
If you do decide to switch to the TR method

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
When you get a chance can you update your spreadsheet :cat:
 
Diane Tyler's Mom GA said:
@KClawson
Just wanted to let you know ,I tagged @Bron and Sheba (GA) for you to see if you should still stay with 0.25 units like she told you in her post #4 even though Oliver dropped below 90 a few times
There is another dose after 0.25
It would be 0.1


View attachment 72881

After that it would be what we call a drop dose

Do you have the syringes with the half unit markings
  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg
Click to expand...
I do have half unit syringes. Not sure my eyes are good enough for less than .25u, but we will see. (I have updated my SS for yesterday's numbers-today's AMPS was 115).
 
Diane Tyler's Mom GA said:
@KClawson
If you do decide to switch to the TR method

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
When you get a chance can you update your spreadsheet :cat:
Click to expand...
Ok. Let me review TR again & get my brain rapped around it. I'm sure I will have more questions once I do.
Thank you.
 
KClawson said:
No, I did 0.25. I didn't see any of the messages until after that. His +5 today was 104.
Click to expand...
I would still reduce and shoot 0.1 tonight since Oliver dropped under 90 multiple times
Myself and Bron posted images of what 0.1 looks like
We also tagged you so try and check the Alerts :cat::cat:
You will stay with 0.1 for 7 days and do a 12 hour curve, but if Oliver drops under 90 before that you will shoot what is called a drop dose

A drop dose
a “drop dose” where you insert the syringe into your pen or vial with the plunger fully pressed and then let go. It sucks in a tiny amount of insulin
@KClawson
 
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Diane Tyler's Mom GA said:
I would still reduce and shoot 0.1 tonight since Oliver dropped under 90 multiple times
Myself and Bron posted images of what 0.1 looks like
We also tagged you so try and check the Alerts :cat::cat:
You will stay with 0.1 for 7 days and do a 12 hour curve, but if Oliver drops under 90 before that you will shoot what is called a drop dose

A drop dose
a “drop dose” where you insert the syringe into your pen or vial with the plunger fully pressed and then let go. It sucks in a tiny amount of insulin
@KClawson
Click to expand...
I did see the images (just not until after AM dose), thank you.

So, are you recommending to stick with SLGS at this point? Bron had recommended to stay at .25 if I decide to go with TR or do 0.1 for SLGS. I've been trying to wrap my brain around TR, but keep getting interrupted by work, lol.

So, here is my query...
IF I stay with SLGS, go to 0.1 tonight & recurve in 7 days (it will have to be more like 10 due to work) & do a drop dose if he goes below 90. If I do go to a drop dose, would that 7 day count restart (depending on when, of course)? What numbers should I be looking for to indicate I need to reduce again (below 90?)? What about to indicate a need to increase?

IF I switch to TR, it looks like I should stick with 0.25 until his numbers stay under 100 for a week, then I would reduce? Would I then go to 0.1 before I stop completely (following the same protocol)? Would I do a drop dose before stopping?

I'm sure I have so many more questions, but I keep loosing my train of thought (lol, I started this response an hour ago).
 
KClawson said:
I did see the images (just not until after AM dose), thank you.

So, are you recommending to stick with SLGS at this point? Bron had recommended to stay at .25 if I decide to go with TR or do 0.1 for SLGS. I've been trying to wrap my brain around TR, but keep getting interrupted by work, lol.

So, here is my query...
IF I stay with SLGS, go to 0.1 tonight & recurve in 7 days (it will have to be more like 10 due to work) & do a drop dose if he goes below 90. If I do go to a drop dose, would that 7 day count restart (depending on when, of course)? What numbers should I be looking for to indicate I need to reduce again (below 90?)? What about to indicate a need to increase?

IF I switch to TR, it looks like I should stick with 0.25 until his numbers stay under 100 for a week, then I would reduce? Would I then go to 0.1 before I stop completely (following the same protocol)? Would I do a drop dose before stopping?

I'm sure I have so many more questions, but I keep loosing my train of thought (lol, I started this response an hour ago).
Click to expand...
Let me tag Bron for you ok :cat:
@Bron and Sheba (GA)


@KClawson
If I were you I would start posting on the Lantus Board
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
There are more eyes in there To the right it will say post new thread

We have a way of posting on there , in your title you will put the
Date Oliver AMPS number and any additional tests after that, you can continue with the PMPS in the title and any additional tests after that.

To add those tests in the title click on Thread Tools that is to the right then tap on Edit Title add them and tap save

You can introduce yourself and Oliver and say it's your first time posting on the Lantus Board.

If you start this tomorrow we always like to link your previous post to your new post. So you would link the one you posted


To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it, only way I can explain it :cat:









austin-logo-240.jpg


@Bron and Sheba (GA)
 
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Okay, I started a post over there. I did go ahead & give 0.1 tonight (not an easy task, even with the photo guides you provided & a magnifying glass, lol). I think I linked this post correctly.

Thank you & any more words of wisdom always welcome.
 
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