? 12/28. Little confused on TR & SLGS - especially with dose reductions

D

DBSG & Lily

Member Since 2025
Still new here. If I’m understanding correctly , for TR (OR NDW) .. if there’s a failed dose reduction , there’s no waiting ? In the SLGS section, there’s a line that says to lengthen the time between dose increases, and also don’t rush by increasing doses more quickly.

I’m just currently overwhelmed rn and confused. I suppose I think I’m following the SLGS method. So do I hold on with the dose reduction ? I thought it takes some time in general with dose changes, regardless if it’s an increase or decrease ?
TIA
 
Hi D,

We always link our previous post with each new post so that when someone needs to look back at her progress, they'll have that information handy: Hi. New member here 12/20/25. Questions about Lantus and dosing

I see on your other post that you do not plan to change her from dry food; in order to follow TR, Lily must be eating only wet food (no dry).

Here is the language from the SLGS sticky (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)):
______________
"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)."
_____________
Lily fell below 90, so you took an earned dose reduction. Under SLGS, you'll hold that dose for a week and observe the nadirs under the new dose, taking an immediate reduction if Lily falls below 90 again.

For clarification, NDW stands for New Dose Wonkiness, and it is typically only applied with TR when a kitty has received a dose increase. What can happen is the bg numbers can increase for about a 24 hour period in the first day or two following the increase. Here is a sticky that explains this in case you want to understand it better: Info - New Dose Wonkiness (NDW) and Failed Reductions

Also, it's completely normal to feel overwhelmed when FD is first diagnosed. It's a HUGE learning curve (added to the other learning curves you've already had to encounter with her). This is a great place for question asking, guidance, and information. :bighug:
 
Hi
I didn’t know about the linking posts or even how to do that.
Prior to this posting , I did read everything you pasted above on SLGS. I also did read on the NDW. In my first line, I did sort of relate NDW with TR because that’s what I got out of reading it.
I read almost everything I could , I just wanted to make sure I was understanding everything correctly .. hence my post. (I don’t think i knew about the wet food only with TR- so good to know)

Yes , I don’t plan on changing her diet.
I will hold her reduced dose then for one week - which is exactly the answer I was looking for. Thank you!

I’m just mostly overwhelmed rn bc she been doing really well on her dose , until yesterday and
I suffered half the day with anxiety due to her HYPO alarms going off simultaneously on two phones - I eventually had to just mute one. Also, now her BG is rising due to her reduced dose which is also what led me to post.
I guess I have to be a little patient for her to get used to the new dose.
Thanks again.
 
Mary & Jude said:
Hi D,

We always link our previous post with each new post so that when someone needs to look back at her progress, they'll have that information handy: Hi. New member here 12/20/25. Questions about Lantus and dosing

I see on your other post that you do not plan to change her from dry food; in order to follow TR, Lily must be eating only wet food (no dry).

Here is the language from the SLGS sticky (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)):
______________
"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)."
_____________
Lily fell below 90, so you took an earned dose reduction. Under SLGS, you'll hold that dose for a week and observe the nadirs under the new dose, taking an immediate reduction if Lily falls below 90 again.

For clarification, NDW stands for New Dose Wonkiness, and it is typically only applied with TR when a kitty has received a dose increase. What can happen is the bg numbers can increase for about a 24 hour period in the first day or two following the increase. Here is a sticky that explains this in case you want to understand it better: Info - New Dose Wonkiness (NDW) and Failed Reductions

Also, it's completely normal to feel overwhelmed when FD is first diagnosed. It's a HUGE learning curve (added to the other learning curves you've already had to encounter with her). This is a great place for question asking, guidance, and information. :bighug:
Click to expand...
Mary & Jude said:
Hi D,

We always link our previous post with each new post so that when someone needs to look back at her progress, they'll have that information handy: Hi. New member here 12/20/25. Questions about Lantus and dosing

I see on your other post that you do not plan to change her from dry food; in order to follow TR, Lily must be eating only wet food (no dry).

Here is the language from the SLGS sticky (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)):
______________
"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)."
_____________
Lily fell below 90, so you took an earned dose reduction. Under SLGS, you'll hold that dose for a week and observe the nadirs under the new dose, taking an immediate reduction if Lily falls below 90 again.

For clarification, NDW stands for New Dose Wonkiness, and it is typically only applied with TR when a kitty has received a dose increase. What can happen is the bg numbers can increase for about a 24 hour period in the first day or two following the increase. Here is a sticky that explains this in case you want to understand it better: Info - New Dose Wonkiness (NDW) and Failed Reductions

Also, it's completely normal to feel overwhelmed when FD is first diagnosed. It's a HUGE learning curve (added to the other learning curves you've already had to encounter with her). This is a great place for question asking, guidance, and information. :bighug:
Click to expand...

DBSG & Lily said:
Hi
I didn’t know about the linking posts or even how to do that.
Prior to this posting , I did read everything you pasted above on SLGS. I also did read on the NDW. In my first line, I did sort of relate NDW with TR because that’s what I got out of reading it.
I read almost everything I could , I just wanted to make sure I was understanding everything correctly .. hence my post. (I don’t think i knew about the wet food only with TR- so good to know)

Yes , I don’t plan on changing her diet.
I will hold her reduced dose then for one week - which is exactly the answer I was looking for. Thank you!

I’m just mostly overwhelmed rn bc she been doing really well on her dose , until yesterday and
I suffered half the day with anxiety due to her HYPO alarms going off simultaneously on two phones - I eventually had to just mute one. Also, now her BG is rising due to her reduced dose which is also what led me to post.
I guess I have to be a little patient for her to get used to the new dose.
Thanks again.
Mary & Jude said:
Hi D,

We always link our previous post with each new post so that when someone needs to look back at her progress, they'll have that information handy: Hi. New member here 12/20/25. Questions about Lantus and dosing

I see on your other post that you do not plan to change her from dry food; in order to follow TR, Lily must be eating only wet food (no dry).

Here is the language from the SLGS sticky (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)):
______________
"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)."
_____________
Lily fell below 90, so you took an earned dose reduction. Under SLGS, you'll hold that dose for a week and observe the nadirs under the new dose, taking an immediate reduction if Lily falls below 90 again.

For clarification, NDW stands for New Dose Wonkiness, and it is typically only applied with TR when a kitty has received a dose increase. What can happen is the bg numbers can increase for about a 24 hour period in the first day or two following the increase. Here is a sticky that explains this in case you want to understand it better: Info - New Dose Wonkiness (NDW) and Failed Reductions

Also, it's completely normal to feel overwhelmed when FD is first diagnosed. It's a HUGE learning curve (added to the other learning curves you've already had to encounter with her). This is a great place for question asking, guidance, and information. :bighug:
Click to expand...
not sure if i even replied properly. I think I did 😔
Click to expand...
 
DBSG & Lily said:
Hi
I didn’t know about the linking posts or even how to do that.
Prior to this posting , I did read everything you pasted above on SLGS. I also did read on the NDW. In my first line, I did sort of relate NDW with TR because that’s what I got out of reading it.
I read almost everything I could , I just wanted to make sure I was understanding everything correctly .. hence my post. (I don’t think i knew about the wet food only with TR- so good to know)

Yes , I don’t plan on changing her diet.
I will hold her reduced dose then for one week - which is exactly the answer I was looking for. Thank you!

I’m just mostly overwhelmed rn bc she been doing really well on her dose , until yesterday and
I suffered half the day with anxiety due to her HYPO alarms going off simultaneously on two phones - I eventually had to just mute one. Also, now her BG is rising due to her reduced dose which is also what led me to post.
I guess I have to be a little patient for her to get used to the new dose.
Thanks again.
Click to expand...
It's okay that you didn't know about linking the posts :)--we'll guide you as you go and let you know if there is anything you need to provide in your posts. You'll get the hang of everything soon enough. Most everything here in terms of the board's posting rules/guidelines is pretty much finely tuned to make it easier for experienced folks to help you in a hurry, if you need it.

Also, I try to always provide the language of the board's guidelines with responses because, for me, it helps to look at specific language again (and again!). It's not because I assume someone hasn't read it. :)

And you're right about being patient. Lily has a few things going on right now with her numbers.
  • First, she dropped to 53 yesterday (drops into those unfamiliar lower numbers can cause kitties to bounce (which is likely why you saw higher numbers last night)).
  • Then, last night you skipped a dose (likely to cause some instability in the depot and her numbers, overall).
  • Thirdly, you took an earned dose reduction this morning, so she is now receiving a new dose and is building a new depot with the .50 (though that .75 might still be in play, even though you skipped a dose).
The good news is that it looks like she broke her bounce last night at +6, although it looks like she might be going back up with the AM +6. Let's hope it's a short-lived, not too high bounce!
 
Mary & Jude said:
It's okay that you didn't know about linking the posts :)--we'll guide you as you go and let you know if there is anything you need to provide in your posts. You'll get the hang of everything soon enough. Most everything here in terms of the board's posting rules/guidelines is pretty much finely tuned to make it easier for experienced folks to help you in a hurry, if you need it.

Also, I try to always provide the language of the board's guidelines with responses because, for me, it helps to look at specific language again (and again!). It's not because I assume someone hasn't read it. :)

And you're right about being patient. Lily has a few things going on right now with her numbers.
  • First, she dropped to 53 yesterday (drops into those unfamiliar lower numbers can cause kitties to bounce (which is likely why you saw higher numbers last night)).
  • Then, last night you skipped a dose (likely to cause some instability in the depot and her numbers, overall).
  • Thirdly, you took an earned dose reduction this morning, so she is now receiving a new dose and is building a new depot with the .50 (though that .75 might still be in play, even though you skipped a dose).
The good news is that it looks like she broke her bounce last night at +6, although it looks like she might be going back up with the AM +6. Let's hope it's a short-lived, not too high bounce!
Click to expand...
TYSM. I appreciate the help and thoroughness.

Patience is not at all my strong suit 😅.

I called the dr in a panic yesterday as she just kept dropping for hours. (Not for what to do in regards to hypo) but more so for moving forward.
He said her pancreatitis seems to have finally cleared up a bit due to the lows. Which makes sense. (Also something I was fearing on her higher dose)
He advised me to skip last night’s dose if <300 or to give 0.5 if >300.
Last night was also her steroid night, hence the more spiking.
Then for this AM To resume insulin to 0.5 BID.

I’ve always hated diabetes and treating it. It’s just all so frustrating. Also, she was doing just fine until pancreatitis decided to join the party.
This is the first time I’ve had to deal with that on top of her diabetes. Prior to that, her pancreatitis alone was manageable enough 🙄
 
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