Questions about TR and SLGL

[Evey]

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

1. After I bought a new Lantus insulin (the old one doesn't work anymore), i gave my cat 1U. But her nadirs were not as low as before. I increased the dose to 1.25U two days ago and today her nadir was under 100 this morning. So based on the TR, I need to hold this dose for 5 days? Can anyone look at the SS and tell me if I've been doing it correctly? I'm really appreciated.

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin

2. With SLGL, it suggests no insulin below 150mg/dl. But 150mg/dl is still pretty high. Can a cat's BG go down without insulin?

3. It seems insulin is shot based on the nadir numbers instead of preshot numbers with TR and SLGL. The vet suggests me to shoot based on the preshot number. This is the range he gave me:
>10.1 1.25U
6.1-10 1U
<6 0.5U

Can anyone explain why it is better to shoot based on nadir instead of preshot numbers? The vet would've asked me to give less insulin when my was at 8.9mmol this morning and I was quite nervous when I continue to gave her 1.25U because I was really worried she might get low blood sugar.

4. Compared to TR, it seems SLGL is less aggressive. How can I tell which method is more suitable for my cat to help her get to remission?

Thank you!

 

[tiffmaxee]

Here’s your last post on main. We
Ink for continuity.
https://felinediabetes.com/FDMB/threads/advice-on-dosage-reduction.287427/#post-3165544

Wendy answered your question about changing the dose and it is based upon nadir and not the preshots. Before posting here you need to set up a spreadsheet and decide upon a dosing method be it one of ours or your vet’s. I strongly suggest you follow one of ours. Would you please start a post on main?
You can shoot lower numbers but only if you test. Lantus kicks in usually around +2 and continues to fall until it hits nadir and then goes back up when a cat is new to insulin. Testing and feeding will prevent a drop so low it causes a symptomatic hypo.

 

[Wendy&Neko]

Nadir this morning was 3 (54) and I see a 3.1 so far tonight, perhaps Evey will go even lower tonight. You do not have any room to increase any further, unless her nadirs start creeping up.

As for dosing based on preshots - that what vets used to do with the older in and out type of insulins like Caninsulin/Vetsulin. Maybe that is what your vet is used to? Lantus on the other hand, tends to give flatter cycles when you shoot lower preshots. Dosing based on nadirs has several benefits. Not the least of which is trying to prevent hypos. Also, cats reaction to insulin varies a lot. Most recently diagnosed cats are a lot more bouncy than yours with a lot of higher preshots. If you shot based on preshots, you might well give too much insulin and cause hypos. I have seen a spreadsheet of a cat that did just that, unfortunately it didn't end well for the cat. Also, Lantus is a depot style insulin, meaning you can see better results as you shoot more of the same size dose, at least with the dosing methods we use here. There is at least one community that doses Lantus based on preshot, but when I've looked at those spreadsheets I've found it really hard to know what a good dose is.

TR has a better track record to get cats into remission, as it allows the cat to spend more time in healing normal blood sugar levels. However, it does require more testing and monitoring than some people's lifestyle permits. Plus, TR requires an all low carb wet or raw food diet. Any cats getting kibble or higher carb food have to be on SLGS, for safety of the cat.

 

[Evey]

Nadir this morning was 3 (54) and I see a 3.1 so far tonight, perhaps Evey will go even lower tonight. You do not have any room to increase any further, unless her nadirs start creeping up.

As for dosing based on preshots - that what vets used to do with the older in and out type of insulins like Caninsulin/Vetsulin. Maybe that is what your vet is used to? Lantus on the other hand, tends to give flatter cycles when you shoot lower preshots. Dosing based on nadirs has several benefits. Not the least of which is trying to prevent hypos. Also, cats reaction to insulin varies a lot. Most recently diagnosed cats are a lot more bouncy than yours with a lot of higher preshots. If you shot based on preshots, you might well give too much insulin and cause hypos. I have seen a spreadsheet of a cat that did just that, unfortunately it didn't end well for the cat. Also, Lantus is a depot style insulin, meaning you can see better results as you shoot more of the same size dose, at least with the dosing methods we use here. There is at least one community that doses Lantus based on preshot, but when I've looked at those spreadsheets I've found it really hard to know what a good dose is.

TR has a better track record to get cats into remission, as it allows the cat to spend more time in healing normal blood sugar levels. However, it does require more testing and monitoring than some people's lifestyle permits. Plus, TR requires an all low carb wet or raw food diet. Any cats getting kibble or higher carb food have to be on SLGS, for safety of the cat.

Nadir this morning was 3 (54) and I see a 3.1 so far tonight, perhaps Evey will go even lower tonight.

Thank you for your reply Wendy! You're right. she keeps going lower. I fed her 20g of canned food at 00:34am when her reading was 2.6. At 1:17am, her sensor said she was at 2.6mmol/L again. so we pricked her ear. At 1:20am (+6), She was at 2.8mmol/L ( measured by human glucosemeter) while the sensor said 2.9. She was still at 2.9 at 2am but she is up to 4.7 at 2:17am. That's a big jump up from 2.9 to 4.7 but I can relax and go to bed now.
So she definitely earns a reduction. I will give her 1U in the morning.

As for dosing based on preshots - that what vets used to do with the older in and out type of insulins like Caninsulin/Vetsulin. Maybe that is whatyour vet is used to?

I don't think so because neither Vetsulin or Caininsulin is available here.

Lantus on the other hand, tends to give flatter cycles when you shoot lower preshots.

I used to think the higher the preshot is, the more insulin a cat needs because it takes more insulin to lower the BG down. Now It makes sense. that's why some of her BGC looks flatter than the rest. i thought it might be the food. so actually it was caused by shooting low numbers.

thanks for explaining this in details. understanding how it works makes me less anxious. Thank you so so much!!

 

[Wendy&Neko]

I don't think so because neither Vetsulin or Caininsulin is available here.

Where is "here"?

 

[Evey]

Where is "here"?

I am in China currently. The vet told me neither of these two are available here. Most pet owners use Lantus. Some use Tresiba, the short-term one.

 

[Evey]

Here’s your last post on main. We
Ink for continuity.
https://felinediabetes.com/FDMB/threads/advice-on-dosage-reduction.287427/#post-3165544

Wendy answered your question about changing the dose and it is based upon nadir and not the preshots. Before posting here you need to set up a spreadsheet and decide upon a dosing method be it one of ours or your vet’s. I strongly suggest you follow one of ours. Would you please start a post on main?
You can shoot lower numbers but only if you test. Lantus kicks in usually around +2 and continues to fall until it hits nadir and then goes back up when a cat is new to insulin. Testing and feeding will prevent a drop so low it causes a symptomatic hypo.

Your profile pic is your cat? The cat looks like Evey!

I'm sorry, I thought this is where I am supposed to post his. I will start a post on the main.

Before posting here you need to set up a spreadsheet and decide upon a dosing method be it one of ours or your vet’s. I strongly suggest you follow one of ours.

I have already set up a spreadsheet. I was following my vet's dosing method. But I think his method is way more aggressive than TR. He suggests that the nadir under 3 is better (basically more red lines on the FreeStyle Libre apps the better) as long as the cat doesn't have low blood sugar symptoms. I think his dosing method works. It brought her BG down and she never showed low blood sugar symptoms. But every time she went under 3 I was just way too stressed out and couldn't sleep at night. So I switched to TR. Hopefully TR will work out and get her into remission.

 

[Sienne and Gabby (GA)]

I think you're fine to post here. We get concerned about members posting on the insulin specific forums if they haven't set up a spreadsheet, don't know about diet, aren't yet giving insulin, etc.

 

[Wendy&Neko]

Thanks for the country location - I had noticed a time zone quite a bit ahead of mine. And I'm glad your kitty is on Lantus and vets are not giving Caninsulin or Vetsulin as it's not a good insulin for cats. It's still relatively common in Europe.

 

[Evey]

Nadir this morning was 3 (54) and I see a 3.1 so far tonight, perhaps Evey will go even lower tonight. You do not have any room to increase any further, unless her nadirs start creeping up.

• If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
• If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose. Sometimes, a cat can even manage to keep its BGs low for a day or two, but then the BGs begin to rise again because the beta-cells haven't recovered enough yet.

I'm not sure if I understand how to know if an attempted reduction fails. "as soon as you see kitty's numbers trending upwards" does it refer to the general numbers or nadir numbers?

On March 30, her BG dropped to 2.6 so i reduced her dose to 1U the next morning. But after the reduction, nadirs are in the range of 79 - 106mg/dL, most of which are not in the range of 50 - 80 mg/dL. Her nadir numbers are trading upwards. But it seems her numbers are not really treding upwards overall, at least not yet. Her BG is quite flat tonight and didn't really drop. Does it mean the attempted reduction fails? Should I increase the dose or should i hold the same dose and wait to see if it's going up?

Sorry I kept bugging you with so many questions.

 

[Wendy&Neko]

does it refer to the general numbers or nadir numbers?

Nadir numbers. You also have to wait for the bounce to be over (if it happens) and then see where the nadirs land. I think I'd give her another day before deciding if the reduction has failed.

A favour to ask, the next time you want to post here, could you start a new thread. Due to the number of kitties on this forum, we have some posting guidelines that help us make sure people aren't missed and we are looking at the most current activity for that cat.
POSTING GUIDELINES PLEASE READ

 

[Evey]

Nadir numbers. You also have to wait for the bounce to be over (if it happens) and then see where the nadirs land. I think I'd give her another day before deciding if the reduction has failed.

A favour to ask, the next time you want to post here, could you start a new thread. Due to the number of kitties on this forum, we have some posting guidelines that help us make sure people aren't missed and we are looking at the most current activity for that cat.
POSTING GUIDELINES PLEASE READ

I'm sorry I didn't read the guidelines. I just read it and will follow it. ^_^