Here’s the gist of it:
“START LOW, GO SLOW (SLGS)
The Start Low, Go Slow Method (SLGS) with Lantus, Levemir, or Biosimilars for Diabetic Cats has been adapted from the FDMB's original
5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus, Levemir, and their Biosimilars insulins.
Requisites when following the Start Low, Go Slow Method:
- Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
- Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
- Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
- Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
- Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.
Starting Dose:
- 1u BID if kitty is not on a wet/canned low carb diet
- 0.5u BID if kitty has been switched to a wet/canned low carb diet
- If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
- Generally, shots are to be given 12 hours apart.
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).
Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!”
