Looking for advice on SLGS/TR

Curt & Leo

Curt & Leo

Member Since 2019
So, when I started treating my guy after diagnosis 3 months ago, I didn't really fully read and understand the TR & SLGS dosing methods.

I started maybe kinda following the SLGS protocol the past week, sticking with a 0.5u dose, even when his pre-shot numbers were pretty low. His numbers have been good. Maintaining generally between 50-150 and no hypoglycemia issues at all. But I'm still a little confused about whether I'm doing this correctly or not.

I'd love it if anyone could take a look at his stats over the past week and let me know if I'm on the right track. Should I maintain this dosage or change it up? Any advice is much appreciated...

Leo.curtbonnem.com
 
Looking pretty good. But with SLGS, you reduce by 0.25 units if they go below 90, and he has done that. Time to try 0.25 units now.
 
Wendy&Neko said:
Looking pretty good. But with SLGS, you reduce by 0.25 units if they go below 90, and he has done that. Time to try 0.25 units now.
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That's pretty much what I was wondering. He hasn't been consistently below 90. Not in the last 4 days, so I wasn't sure.
 
We look at how low the dose can take the cat. As soon as he sees one under 90, a reduction is earned.
 
Hi there. He probably went lower on the PM cycle on 11/25. IF you are following SLGS, you should have reduced the dose that day and it doesn’t look like there were anymore test in that night. A lot of cats go lower during the night so getting at least a test in before you go to bed is very important.

He probably went lower that PM and has been bouncing since.

You test enough to follow TR which would mean you wouldn’t reduce unless under 50 and he could have more time to spend in greens. If any dry food is in the mix, you would need to stick with SLGS.
 
Bobbie And Bubba said:
Hi there. He probably went lower on the PM cycle on 11/25. IF you are following SLGS, you should have reduced the dose that day and it doesn’t look like there were anymore test in that night. A lot of cats go lower during the night so getting at least a test in before you go to bed is very important.

He probably went lower that PM and has been bouncing since.

You test enough to follow TR which would mean you wouldn’t reduce unless under 50 and he could have more time to spend in greens. If any dry food is in the mix, you would need to stick with SLGS.
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Thanks, I just want to be super clear on this...

No dry food in the mix at all, only wet.

If you look at those first several days before 11/25, when I was testing in the night, his numbers were actually consistently higher at night. It's stayed that way, which I thought was odd. I probably, hopefully, won't continue to stay up as late as I have been and won't be testing through the middle of the night. Maybe make it to +2 or +3 for a test, as well as put out a little more food. My PM test and feeding is at 11:30PM already.

I feel like with his numbers back up near or above 100 in the past four days, I shouldn't do a reduction. I realize now that I should have reduced it before when he went below 90 if I follow SLGS. This is kinda why I'm confused about exactly what to do from here. Do I wait until he goes below 90 again and then reduce to 0.25? If I'm able to continue testing all through the day and maybe a little into the night, do I stay at 0.5 and see if I can get his numbers down even lower and wait until he goes below 50 following TR? If it was a bounce after 11/25, does that last this many days?

Thanks again for the help. I feel like I'm on the right track and want to make sure I keep at it correctly. I don't know if I'll be able to get him into remission since I may have waited too long before getting him diagnosed and started on the insulin, but I'm hoping. I've cured his neuropathy and he's been doing really well overall. No issues at all.
 
If no dry food is in the mix, you could follow TR protocol which would let you keep him in green numbers longer.

Bounces can last up to 6 cycles or 3 days until they clear. Without data the couple of nights no test were recorded , it could be he hit some lower numbers again and bounced again.

If you can follow TR with your schedule, you could hold this dose of 0.5 unless he goes below 50 then reduce to .25

With your late PM shot of 11:30 that does make it really hard to get night time test. Is it possible to change his shot times so you could grab some test at the PM cycle?

A good test to get is a +2 and if that number is lower than the pre shot number it could indicate an active cycle and some more test would be necessary.
 
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I could definitely make sure to keep myself up (I'm generally a late nighter anyway, just trying to change that up a bit) to get a +2 or +3 PM test in. His +3PM last night was slightly lower than his PMPS, but he was still not much lower than that AMPS today.

If I do stick with TR at 0.5, do I only reduce if he goes below 50 (which scares the heck out of me) or also if he's maintaining between 50-80 for a period of time?

I'm also slightly confused about SLGS as far as remission goes. Does that method attempt getting into remission or just keeping them stable around 90?
 
Curt Bonnem said:
I could definitely make sure to keep myself up (I'm generally a late nighter anyway, just trying to change that up a bit) to get a +2 or +3 PM test in. His +3PM last night was slightly lower than his PMPS, but he was still not much lower than that AMPS today.

If I do stick with TR at 0.5, do I only reduce if he goes below 50 (which scares the heck out of me) or also if he's maintaining between 50-80 for a period of time?

I'm also slightly confused about SLGS as far as remission goes. Does that method attempt getting into remission or just keeping them stable around 90?
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TR has a much higher remission rate because of them being able to hang in safe green numbers longer. With SLGS, as soon as they go under 90 you are to reduce. And that said, we have seen a few kitties go into remission using the SLGS method.

And yes, with TR you would reduce as soon as he goes under 50. Another way for them to earn reductions is by staying in all greens (above 50) for one week.
 
Okay, thanks. I guess I will continue going for TR and try and make sure he doesn't bounce. One other thing I'm confused about with TR...It says the starting dose should be 0.25u per kg of ideal weight, which should be about 4.5kg. That would mean the dose should be just above 1u. Should I be increasing his dose? Or should I stick with 0.5u for now, since I had previously been giving him up to 1.25u before I started on this and his numbers fluctuated more and rarely stayed in the green like they have been since sticking with 0.5.
 
As Sue said , you are way past that now. Let’s stick with the 0.5 dose for now and see how he dies with it.

And as far as bouncing, you can’t prevent it. It is a normal response that cats have to being in lower numbers than they are used to. They bounce until it stops and some cats bounce all the way into remission!

Keep up on all the data collecting! You are doing a great job !


ETA : Below is the explanation of bouncing taken from Nee to the a Group Sticky.


  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
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Ugh. Of all the things... Last night he had a 94 PMPS. I tested him at +1.5 and he'd gone up to 112. I'd wanted to test him again but I fell asleep. I also forgot to pull up the dog's dry food, which he never eats except sometimes in the middle of the night when he isn't getting fed, so I've been putting it away at night.

This morning he's at 320. He hasn't been this high for ages. I am assuming it's because he's ate the dog food, but I wish I could be sure it wasn't because he dropped and had a bounce. But the last time he seems to have a bounce, it wasn't anywhere near that high.

Just to be sure, I should increase his dosage just because of this, should I? Just keep to the 0.5?
 
That's why I am bummed I fell asleep and didn't get to test him in the middle of the night like I wanted.

And yeah, I've read through all the info on TR and SLGS. For some reason, I just wasn't absorbing it as clearly as I wanted.
 
How can I help re. the dosing methods?

The basic difference is that TR is more aggressive in that you can adjust doses every 3 - 5 days. (With numbers that are under 200, you hold the dose for 5 days.) The point at where you decrease the dose is also lower -- you decrease at 50. Because it's an aggressive approach, more testing is needed but your frequency of testing fine. TR has also been tested and published in a leading veterinary journal and has an excellent track record for getting cats into remission. There is one caveat -- your cat must be eating a low carb, canned food diet.

With SLGS, you hold the dose for a week before evaluating whether an increase is indicated. Typically, you should run a curve to assess this. Decreased are given if numbers drop below 90. Not as much testing is needed -- you need pre-shot tests and it's helpful to get a test around the middle of the cycle (or wherever your cat's nadir falls) since Lantus dosing is based on the nadir. SLGS has been around this Board before TR existed. It works. I suspect that the current thinking is that TR has more than just subjective information to support its use.
 
Curt Bonnem said:
Since I work from home, I figured I should attempt TR. Feel free to take a look at his chart and tell me what you think. Particularly the past couple weeks. Before that, I wasn't really following any method properly.
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Since you've chosen a dosing protocol could you please post a new thread tomorrow?

Like this: 12/1 Leo AMPS ###

We can all start fresh tomorrow :)
 
I'm happy to take a look. Just an FYI, I use a laptop when I'm at home. There is so much information taking up so many lines at the top of your spreadsheet that I can't view that may lines of your data. (You've got 4 lines just for the color coded dose ranges. (And below "normal" is not necessarily considered a "hypo".) If you use more width for your notes at the top of the page, you will also reduce the amount of space at the top for all of the information you've included.

With all of the skipped shots, I don't know if the data from earlier in the month is relevant. It does look like Leo likely did drop low last night and you're seeing a bounce today. As Bobbie noted, bounces are tremendously annoying to us but are a normal part of the process. I'll be curious to see how long it takes Leo to clear the bounce, though.

I would hold the 0.5u dose. Looking at Leo's numbers, you always want to ask yourself, "How low is this dose taking the numbers?" You're seeing nadirs in the 70s - 80s. You have a little room to increase, but not much. It's hard to know for sure if Leo dropped low last night and if he did, you wouldn't want to raise his dose. Of course, he could have found contraband (Did you leave any pumpkin pie or sweet potatoes sitting out for Leo to snack on?) and that upped his numbers but most caregivers are pretty careful about leaving carbs sitting out and unattended.

I'd also encourage you to start thinking about how low you feel comfortable shooting. With TR, you can shoot any number higher than 50. However, you need to be comfortable doing so. I generally urge people to think about what's the lowest number you'll feel comfortable shooting and go from there. You've shot as low as in the 70s, which is great!
 
Curt Bonnem said:
Ugh. Of all the things... Last night he had a 94 PMPS. I tested him at +1.5 and he'd gone up to 112. I'd wanted to test him again but I fell asleep. I also forgot to pull up the dog's dry food, which he never eats except sometimes in the middle of the night when he isn't getting fed, so I've been putting it away at night.

This morning he's at 320. He hasn't been this high for ages. I am assuming it's because he's ate the dog food, but I wish I could be sure it wasn't because he dropped and had a bounce. But the last time he seems to have a bounce, it wasn't anywhere near that high.

Just to be sure, I should increase his dosage just because of this, should I? Just keep to the 0.5?
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Bummer with him getting into contraband. I have 2 dog and 1 cat household. (Was 2 cars until 6/4 :(). What I did was put the whole house on Bubba’s feed schedule. No more free grazing for the dogs with kibble. Everyone gets 6 little meals a day. No more worries of high carb kibble hanging around. It took getting into the contraband off the table. Made my life easier.

He’ll come back down soon. No worries.
 
Just a note...I got lazy about recording last month, which is why there are a lot of blank shot fields, when I actually was shooting. I just don't remember how much I gave, so I left them blank.

At this point, I'm pretty comfortable shooting him at least into the 70s and I'd probably feel okay going as low as 55ish, as long as he's being fed.

If I forget to pull up the dog food bowl before I go to bed and it still has food in it, he will eat it if he runs out of his food through the middle of the night. I have seen him do it and then seen his numbers go up. So, I'm still not entirely sure that was a bounce. Luckily, he will only eat it if he's been out of food for several hours. He doesn't go near it any other time. I also free feed my other kitty dry food, but I have it in a place which Leo somehow either doesn't know or doesn't think he can jump up to because he never goes there. Thank goodness.
 
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