11/28 Mr. Pants amps 172 +2 247 Has anyone heard about this method of regulation?

Zach Pool

Member
I have used this to great success in the past and I think it fits my cat. It looks like Im getting chronic bounces as I decrease his dose because Im not reducing his dose as much each reduction, as I usually do. Although I have heard some say that dose reductions do not work in this way, I have noted this phenomena with my cat over the last five years. The method is as follows.....I may have got it from this forum, Im not sure.

https://thecatclinic.com.au/using-glargine-in-diabetic-cats/
 
I have used this to great success in the past and I think it fits my cat. It looks like Im getting chronic bounces as I decrease his dose because Im not reducing his dose as much each reduction, as I usually do. Although I have heard some say that dose reductions do not work in this way, I have noted this phenomena with my cat over the last five years. The method is as follows.....I may have got it from this forum, Im not sure.

https://thecatclinic.com.au/using-glargine-in-diabetic-cats/
We do not use this as it has no basis other than this particular vet using it for his clients. Many vets have their own preferred method based on their limited experiences. I can find many issues with this but the most standout is the large variance in dose changes from 0.25u to 1u with no basis for how one determines what is best for their cat. I would not suggest this method to anyone. As to whether it has helped your kitty, without more data during the time you used it, we can’t comment but often we find new members think their cat was doing much better than they actually were. If you can add at least the last two weeks data on his SS, we can look at it. If you need those lines added to his SS, please PM me and I’ll add them for you if you don’t know how to do it. They would go above the current data.

There are a few things you should understand:
1. Our TR method was developed by a vet and a scientist based on solid data gathered from use with many cats and it was published in a scientific journal. We have used it successfully here for decades because it works.
2. FD is a marathon, not a sprint. It takes a lot of patience and, for most, remission, if it comes, takes time. We encourage members to work towards regulation and if remission happens, great.
3. Bouncing happens and you will learn that it isn’t “chronic”, it’s a reality. Some cats will always bounce (I’ve seen cats with FD for over ten years still bouncing even with a diligent caregiver). Some techniques help, such as managing the curve with food, but some cats will just keep bouncing.
4. You mentioned before you reduced if your cat dropped below 180. I’ll mention again that is not regulation and you are allowing him to stay close to renal threshold too long which will affect the kidneys over time.
5. Based on what I see on his SS, you are dose hopping and that is not how you use Lantus successfully. I have no idea why you have taken any reductions from 0.75u. Once the depot from that dose empties (which can take up to six cycles), you’ll likely see his BG go up. Take a look, at Ivy’s SS starting 11/7 when her CG started arbitrarily dropping the dose. Eventually, the depot caught up and now she’s having to go back up which means Ivy has lost healing time. Keep in mind the CG uses a Libre and those BGs always run lower than a handheld meter so Ivy is spending a lot of time higher than the BGs shown.

Housekeeping:
1. Please do your signature block. We’ve asked several times. There are reasons why this is important such as it provides us with quick info in case you have an emergency of finding your cat in the 30s and needing quick help here.
2. Please remember to add his name and date to the subject line. I’ve done it for you today but it’s important you do it since those who help scan the list of posts and prioritize where to post first based on the BGs. If they don’t know what date your post is or who the cat is, you might get overlooked.
3. Please read the guidelines I posted yesterday and be sure you link your previous thread in the first post of the day. That is really important so those helping you can quickly go back and read what has occurred prior. People will be less likely to help if they have to go searching for your prior posts to see what has happened and what advice has been given.
Here is yesterday’s post.
4. Please complete the requested info at the top of the SS. It is there to help us help you as it gives us important data quickly as we are looking at his SS.

Happy Thanksgiving!
 
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Reading the link and trying to find other articles by this vet it appears to me (and I could be wrong) that when he talks about adjusting the dose he doesn’t mean day by day (as it appears you may be doing), it sounds like after a week or more a curve is done and adjustments made. I don’t get what he’s basing an adjustment made on PS although I haven’t transposed mmol to mg/dl—I think if a PS falls below a certain number AAHA might have an opinion just as I believe I’ve been told this forum’s SLGS would (for the earned reduction)—but I think those reduction earning numbers (be they preshot or not) are like 80ish
 
At any rate if it were me if I wanted to follow an unknown (to me) vet’s program I’d get clarification how often those reductions should happen.
 
Ive noticed that when he drops to the 70's and 80's he typically ends up with a fairly high pre shot number. I believe that happened last night. I gave him .6u this morning
and we were looking great most of the day. I believe that the dose reductions are based on daily values. Something thats always worked in the past for me. I will familiarize myself with SLGS. Pre shot numbers were really good today IMO.
 
Ive noticed that when he drops to the 70's and 80's he typically ends up with a fairly high pre shot number. I believe that happened last night. I gave him .6u this morning
and we were looking great most of the day. I believe that the dose reductions are based on daily values. Something thats always worked in the past for me. I will familiarize myself with SLGS. Pre shot numbers were really good today IMO.
Fwiw these are the 2018 AAHA guidelines. I can’t find a more recent pub but one may exist. I don’t advocate blindly following their algorithm without consulting a vet. This forum may or may not agree with what it says to do for nadir under 80.
https://www.aaha.org/wp-content/upl...iabetes-management-guidelines-2022-update.pdf

I don’t know what you are using to check BG. If a human meter I do NOT think you can use the guidelines for nadir under 80 since human meters read (edit: LOWER) than the actual number (edit: SO READINGS CONSIDERED HYPOGLYCEMIC ON A HUMAN METER IS LOWER) —in that case I’d say refer to your vet or if getting help here follow one of the dosing regimens they use, either SLGS or TR (TR moves the doses faster). My understanding of the AAHA guidelines is the dose is left stable for a period of time EXCEPT for mandatory reductions for values below 80 (but again I think they assume 80 in the lab or on a pet meter)

I’m new so I can’t say what you ought to be doing

edit: thanks to @Marje and Gracie for correcting my error
 
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If a human meter I do NOT think you can use the guidelines for nadir under 80 since human meters read lower than the actual number
I’m not sure what you mean by this. Generally, pet meters read higher than human meters at lower numbers but not always and comparisons I’ve done have often shown the human meters can be higher than the pet meter at high numbers.
 
experiences. I can find many issues with this but the most standout is the large variance in dose changes from 0.25u to 1u with no basis for how one determines what is best for their cat.
These were NOT instructions or guidelines for clients. This vet has published several papers and presented at conferences when Glargine was first used by vets—this link is from his website section FOR VETS. The dose reduction range is referenced for the VET to use as guidance for their professional judgement following a glucose curve done in hospital or at home. Viewed in that light it’s similar to AAHA giving guidelines for start points and increase/reductions EXCEPT the reliance in part on the preshot number (otoh AAHA relies in part on the time spent below the renal number)

edit: also on this page: thorascopy. I don’t think he considers that DIY for pet parents.
 
I’m not sure what you mean by this. Generally, pet meters read higher than human meters at lower numbers but not always and comparisons I’ve done have often shown the human meters can be higher than the pet meter at high numbers.
You’re right. I meant to say the cut off for reductions are lower because human meters read lower. I will correct thanks
 
limited experiences. I can find many issues with this but the most standout is the large variance in dose changes from 0.25u to 1u with
Otoh this DOES appear to be his guidance for pet parents so I don’t know what to say other than he isn’t here to explain his method, and the mmol keep confusing me


Selecting insulin dose
For newly diagnosed diabetic cats (less than 2 months):
If BG is above 12mmol/L then increase insulin dose 0.5 units (half a unit)
If BG is between 6 and 11mmol/L then keep insulin dose the same
If BG is between 3 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 3mmol/L then don’t give insulin and call the clinic to discuss

For longer-term diabetic cats (more than 2 months of insulin therapy):
If BG is above 25mmol/L then increase insulin dose 1 units
If BG is between 14 and 25mmol/L then increase insulin dose 0.5 units
If BG is between 6 and 13mmol/L then keep insulin dose the same
If BG is between 4 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 4mmol/L then don’t give insulin and either check for remission or call the clinic to discuss.
 
Otoh this DOES appear to be his guidance for pet parents so I don’t know what to say other than he isn’t here to explain his method, and the mmol keep confusing me


Selecting insulin dose
For newly diagnosed diabetic cats (less than 2 months):
If BG is above 12mmol/L then increase insulin dose 0.5 units (half a unit)
If BG is between 6 and 11mmol/L then keep insulin dose the same
If BG is between 3 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 3mmol/L then don’t give insulin and call the clinic to discuss

For longer-term diabetic cats (more than 2 months of insulin therapy):
If BG is above 25mmol/L then increase insulin dose 1 units
If BG is between 14 and 25mmol/L then increase insulin dose 0.5 units
If BG is between 6 and 13mmol/L then keep insulin dose the same
If BG is between 4 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 4mmol/L then don’t give insulin and either check for remission or call the clinic to discuss.
Pretty aggressive for a cat with a BG above 216 (12 mmol/L) to increase by 0.5u or after only. 2 months to raise by a unit for a BG above 450. And reductions are pretty big.
 
Pretty aggressive for a cat with a BG above 216 (12 mmol/L) to increase by 0.5u or after only. 2 months to raise by a unit for a BG above 450. And reductions are pretty big.
Well as I said, he’s not here to explain. It could be some errors in putting up on his website and either he doesn’t know or he ignores bc he probably doesn’t expect a nonpatient of his to download it and use it. Idk. I’m tempted to write and ask because the presentation notes I saw seemed pretty mainstream what he was telling other vets at a conference
 
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