Question about SLGS vs TR (also vet insisting on curve..)

[Mimis mom]

Hey! So, the last 3 years Mimi has been following TR-
Is SLGS for someone that doesn’t have enough data? In TR do we ever do curves? I read the info but maybe I missed Somewhere it says that.
If I’ve been following TR would it be silly to switch to SLGS? NSLGS is there a curve performed and then all the other times you just take an a.m. reading and a PM reading. I also saw (in SLGS info) something like don’t shoot below 150? Is that only when someone doesn’t have enough data?

I sent Mimi‘s vet over a link to her spreadsheet which I’ve been keeping track of the last three years. I feel like the vets don’t believe that we know what the heck we’re doing. Which isn’t totally untrue it’s just I wish they educated themselves more so we wouldn’t have to be doing so much of the guessing. They are the ones that write the prescription for insulin After all. I remember about a year and a half ago I sent her the link to this forum and after reading the protocols she thought that the “shootable” numbers were way too low and didn’t seem to have much else to say. She probably skimmed this site.:
She’s been the only that that hasn’t tried to push prescription diet on me for her, so I guess she’s the best I can get for now. Still waiting to find a vet that has one, hears of this website and protocol and or two- willing to learn all about it and use their “doctor” brains to be able to interpret it better and easily than us lay people do.

 

[Diane Tyler's Mom GA]

Previous posts
https://felinediabetes.com/FDMB/threads/mimi-5-29-11-59-amps-59-3-44.263909/

https://www.felinediabetes.com/FDMB/threads/mimi-5-20-11-83-question.263540/#post-2952341

@Bron and Sheba (GA)

@Bandit's Mom

@Wendy&Neko

@Chris & China (GA)

 

[Ashleigh & Ares]

Hey! So, the last 3 years Mimi has been following TR-
Is SLGS for someone that doesn’t have enough data? In TR do we ever do curves? I read the info but maybe I missed Somewhere it says that.
If I’ve been following TR would it be silly to switch to SLGS? NSLGS is there a curve performed and then all the other times you just take an a.m. reading and a PM reading. I also saw (in SLGS info) something like don’t shoot below 150? Is that only when someone doesn’t have enough data?

I sent Mimi‘s vet over a link to her spreadsheet which I’ve been keeping track of the last three years. I feel like the vets don’t believe that we know what the heck we’re doing. Which isn’t totally untrue it’s just I wish they educated themselves more so we wouldn’t have to be doing so much of the guessing. They are the ones that write the prescription for insulin After all. I remember about a year and a half ago I sent her the link to this forum and after reading the protocols she thought that the “shootable” numbers were way too low and didn’t seem to have much else to say. She probably skimmed this site.:
She’s been the only that that hasn’t tried to push prescription diet on me for her, so I guess she’s the best I can get for now. Still waiting to find a vet that has one, hears of this website and protocol and or two- willing to learn all about it and use their “doctor” brains to be able to interpret it better and easily than us lay people do.

I just re-read the regulations on SLGS...
Yes you are correct, it says WITHOUT enough data, don't shoot if PS is under 150...

The other time #150 was mentioned says, WITH data, that if nadirs are 150 or more to increase.

Some vets are just... Some just don't even want you to home test at all!! Makes no sense since sooo many kitties get this!

In TR, I believe if you are searching for a nadir time, a curve is what you will do. Ive seen a LOT of SS in which cats basically get a curve daily! You are definitely allowed to do them. If u want to just get the vet off your back, just do one...if you can. Just so you can get your insulin!!!

 

[Wendy&Neko]

Nothing stops you from doing a curve anytime on TR. we just don’t depend on it as much for dosing decisions.

There are two parts to shooting low numbers in the SLGS description, the part “in the beginning” and the part “with experience” after it. Numbers are lower once you have the data to shoot lower. “In the beginning” is for new people, not you. Plusnover time, once you know your cat, you can tweak SLGS, with guidance. However, you aren’t testing enough for TR. you need to get the preshot test plus one other each cycle, and you are missing several second tests.

 

[Mimis mom]

Nothing stops you from doing a curve anytime on TR. we just don’t depend on it as much for dosing decisions.

There are two parts to shooting low numbers in the SLGS description, the part “in the beginning” and the part “with experience” after it. Numbers are lower once you have the data to shoot lower. “In the beginning” is for new people, not you. Plusnover time, once you know your cat, you can tweak SLGS, with guidance. However, you aren’t testing enough for TR. you need to get the preshot test plus one other each cycle, and you are missing several second tests.

Do I always have to get a +1 number? Or can I do a nadir if I am around to do one?

I’m going to write what my vet sent after I linked her to the page and to my SS


Hello Rosa,
I have concerns about the tight regulation protocol, especially regarding what they consider normal values for feline blood sugar. Idexx is a national laboratory that sees thousands upon thousands of cat blood samples daily and based upon statistical analysis, normal cat blood sugar values in cats range between 72 and 175 mcg/dl. If you use the recommendations given in the tight control protocol it seems the aim is to keep the cat near hypoglycemic levels of blood sugar. Regardless of which protocol you choose, the blood glucose curve should be the basis for deciding whether or not to increase or decrease your dose of insulin. This is by no means a perfect tool since you can feed your cat exactly the same in two days, give the same amount of insulin in two days, and still have two different blood glucose curves.

There is a device called the Freestyle Libre that some veterinarians are using as a continuous BG monitoring device over a 2 week period of time. The device is applied to the cat's skin and a monitor takes readings that can be used to adjust insulin doses. This is not a device we have used at Colonie Animal hospital, but we could give it a try if you are interested.

The reason for the curve is twofold. First, it helps to give you an idea when in the day your cat's lowest blood sugar will be. Secondly, it gives you an idea how long the insulin is lasting. Sometimes the reason there is poor control of a pet's diabetes mellitus is because we have not chosen the best insulin.

To do the curve, start your process just before you would normally feed your cat. Take a BG reading and offer food. As long as your cat eats a normal meal, start the curve. If your cat does not eat well, this is not a good day to do a curve. Measure the BG every two hours through the day. If the BG goes below 150 mcg/dl, start measuring the BG every hour until it returns to 150mcg/dl or more. The curve can end after 12 hours, but sometimes going to 18 hours adds helpful information. It is important to also record when insulin is administered, how much insulin is administered, and when the cat eats.

I hope this helps.
Dr. Kinne

 

[Wendy&Neko]

Do I always have to get a +1 number? Or can I do a nadir if I am around to do one?

With TR, you only have to get the preshot number, plus at least one other each cycle. Ideally you'd get one close to nadir, but that can move around a bit so not necessarily so predictable.

As for your vet's comments, there are a few things I disagree with. First of all, we are using human meters, not pet meters (for the most part) or lab meters. The ranges are different between them all. If you were using a pet meter, for example, the low end would be 68 for TR, instead of 50. That's much closer to the 72 the vet stated. I'm not suggesting you get a pet meter, just using that as an example of differences. As for the Libre, that's up to you. We'd still suggest you retest the low numbers with a hand held meter, as the Libre's are often out there.

We do not use the curve as the basis of deciding how to adjust the dose, but rather one of the inputs into the decision. We use the answer to the question "how low does this dose take your cat" to determine how to change the dose. If you did a curve on a bounce day, after a night time low, you might get all high numbers that your vet would have you increase the dose, when in fact a reduction might be in order.

First, it helps to give you an idea when in the day your cat's lowest blood sugar will be

Again, vet is not exactly right here. The nadir can change based on circumstances, such as bounce breaking etc. The curve can tell you when the lowest blood sugar is for that particular curve cycle, but may not be the same time for every other cycle.

 

[Marina & Chico]

Idexx is a national laboratory that sees thousands upon thousands of cat blood samples daily and based upon statistical analysis, normal cat blood sugar values in cats range between 72 and 175 mcg/dl.

I would add one more thought on what Wendy already wrote: our cat (and i know that most cats on this forum can confirm the same) has always (100% of the time) higher BG values at the vet compared to what he has at home, so to make an average of what is the "normal" BG value for cats based on results from the vet is skewed in my opinion. Additionally vets tolerance to what is normal in cats are based on the fact that feline diabetes is still very often considered a death sentence, so it's "ok" to accept BG in the range of 200 as long as this would "give them a couple more years". Our vet even mentioned euthanasia as a "solution" (and it was not in bad heart, he genuinely thought he had to give us this option).

Do I always have to get a +1 number? Or can I do a nadir if I am around to do one?

What Wendy meant above is not that you have to get a +1 value, but to follow TR you need to always get a preshot and an additional measurement, which you often miss like for example in the PM cycle of 07/06/2022, 06/30/2022 both AM and PM cycle, 07/02/2022 both AM and PM cycles but as well others around the same period.

Take care