She's only gotten worse, why am I dosing?

Chelon Nickolette

Chelon Nickolette

Member Since 2019
Sadie was in the 300's before starting Lantus and then shot up to the 400-500's once treatment began. I started her at 1 unit, half of the prescribed dose by my vet because I wasn't comfortable starting so high. Then I was told on the facebook group that the Lantus starting dose is .25. So I went from 1 to .25 and have held that dose for the past 8 days and am still seeing 500's. I was told that when you first start insulin, the body may try to overcompensate for the sudden drop by releasing sugar which would cause bounces and spikes, which is why I lowered her does to .25, thinking 1 unit was too high. However, why would her bg still be so high at the lowest dose? It doesn't make any sense to me. It seems like a little insulin would help a little or not be enough, but not push her levels from 300 to 500. Why am I treating her when she is 200 points higher on insulin? I just raised her dose to .5 this morning, but I honestly don't understand what's going on or why I should treat her when all it's done is increase her numbers. Some people may say it's because I missed a couple shots but I have not missed a shot since I was told to drain her depot and start at .25. Can anyone give me information that will make this make sense?

https://docs.google.com/spreadsheets/d/1mJNeT1DhlhDZLkHBSHWN1_ZcwcZ-Teeeis6kcgTzSDg/edit?usp=sharing
 
How much does Sadie weigh? Are you following TR or SLGS? How much can you monitor (work schedule)? Can you test any in the PM cycle? It is important to get some test in the PM cycle to complete the picture.

It takes up to 6 cycles for the depot to fill on the new dose so at this point just hold the 0.5U and evaluate the nadir numbers (unless she earns a reduction).
 
Hi and welcome to the FDMB! I was also about to ask how much Sadie weighs?
"It seems like a little insulin would help a little".......it sounds logical but it doesn't really work that way. Once a good starting dose is decided upon, then it's important to hold the dose for 6-8 cycles..... after that then increasing by .25u, hold for 6-8 cycles, increase etc etc until the BG starts to move in the right direction.
I'm happy to see that Sadie is eating Friskies pate....I'm not familiar with Dr Elsey's dry but most dry is way too high in carbs.
It's also important to grab some tests mid cycle as you'll need to determine when Sadie is hitting her "nadir" (lowest BG in the cycle) and how low she is going.
 
Hey there. The starting dose for kitties following SLGS is as Follows:

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

  • As Lizzie said since there is dry food in the mix, you will be following SLGS.
If it were my kitty, I would take the dose back to 1 unit and get as many test as you can to find how low the nadir is and proceed from there.

0.25 is not enough insulin. Keep posting and asking questions. We are here to help each other.
 
Bobbie And Bubba said:
Hey there. The starting dose for kitties following SLGS is as Follows:

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

  • As Lizzie said since there is dry food in the mix, you will be following SLGS.
If it were my kitty, I would take the dose back to 1 unit and get as many test as you can to find how low the nadir is and proceed from there.

0.25 is not enough insulin. Keep posting and asking questions. We are here to help each other.
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I would also do 1u
 
I'm going to get on my soapbox and will likely make an unpopular statement.

If you notice, there are statistics here on how long people have been a member, how much we've posted, and we have our spreadsheets linked to our signature. (Click on our photo/avatar for the stats other than the "Joined" date although the date is somewhat artificial since there was a switch to a new server and many of the starting dates got wiped out.) You get none of this on Facebook. In fact, many times when I monitor the FB page, I walk away shaking my head or screaming at my computer. Very frequently, there is someone with 5 minutes more experience than you giving "authoritative" advice. The moderator does her best but posts get pushed down and it's next to impossible to read from the beginning and weed out bad information. I feel badly that you received bad information.

You done great on two counts -- you're home testing and you've got a spreadsheet set up. I want to encourage you to start getting some tests during the PM cycle. Many cats see lower numbers at night. And, without the PM numbers, you're missing half of your data. Please get at least a a "before bed" test every night so you know your cat is in safe numbers before you go to sleep.

I suspect whoever told you about "bounces" gave you a rather confused explanation. For now, ignore the information. Bounces are normal -- annoying but normal. If we see one, we'll point it out and provide a more comprehensive explanation.

Is it feasible with the holiday weekend for you to increase Sadie's dose? If. you're not going to be around or won't be able to monitor, I'd rather take it slow.
 
To make it simple, the first week on lantus is filling the depot. Cats do get some but not the full dose. Glucoses will continue to rise in most cats.

Because you are giving insulin doesn't necessarily mean the dose you are giving is the correct dose. It takes time to find the dose that will work for your cat. My Ollie went up to 8.75 units but she does have a high dose condition.

Cats are usually diabetic awhile before you get the dx. They get use to high glucosex, then it takes time to get glucoses down.

Diabetes is not a quick fix. As the saying goes it is not a sprint it's a marathon.

Hang in there you will see results, it just might take awhile.
 
Bobbie And Bubba said:
Hey there. The starting dose for kitties following SLGS is as Follows:

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

  • As Lizzie said since there is dry food in the mix, you will be following SLGS.
If it were my kitty, I would take the dose back to 1 unit and get as many test as you can to find how low the nadir is and proceed from there.

0.25 is not enough insulin. Keep posting and asking questions. We are here to help each other.
Click to expand...

She is mainly on Friskies pate, she only has 1/4 cup of Dr. Elsey's 4% a day to nibble on. Does that mean she is still on SLGS?
 
Judy and Boomer said:
Hi and welcome to the FDMB! I was also about to ask how much Sadie weighs?
"It seems like a little insulin would help a little".......it sounds logical but it doesn't really work that way. Once a good starting dose is decided upon, then it's important to hold the dose for 6-8 cycles..... after that then increasing by .25u, hold for 6-8 cycles, increase etc etc until the BG starts to move in the right direction.
I'm happy to see that Sadie is eating Friskies pate....I'm not familiar with Dr Elsey's dry but most dry is way too high in carbs.
It's also important to grab some tests mid cycle as you'll need to determine when Sadie is hitting her "nadir" (lowest BG in the cycle) and how low she is going.
Click to expand...
I think she is 12-13 pounds but I'd have to check with the vet for her latest weight.
 
Sienne and Gabby (GA) said:
I'm going to get on my soapbox and will likely make an unpopular statement.

If you notice, there are statistics here on how long people have been a member, how much we've posted, and we have our spreadsheets linked to our signature. (Click on our photo/avatar for the stats other than the "Joined" date although the date is somewhat artificial since there was a switch to a new server and many of the starting dates got wiped out.) You get none of this on Facebook. In fact, many times when I monitor the FB page, I walk away shaking my head or screaming at my computer. Very frequently, there is someone with 5 minutes more experience than you giving "authoritative" advice. The moderator does her best but posts get pushed down and it's next to impossible to read from the beginning and weed out bad information. I feel badly that you received bad information.

You done great on two counts -- you're home testing and you've got a spreadsheet set up. I want to encourage you to start getting some tests during the PM cycle. Many cats see lower numbers at night. And, without the PM numbers, you're missing half of your data. Please get at least a a "before bed" test every night so you know your cat is in safe numbers before you go to sleep.

I suspect whoever told you about "bounces" gave you a rather confused explanation. For now, ignore the information. Bounces are normal -- annoying but normal. If we see one, we'll point it out and provide a more comprehensive explanation.

Is it feasible with the holiday weekend for you to increase Sadie's dose? If. you're not going to be around or won't be able to monitor, I'd rather take it slow.
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I will be home most of the weekend and able to test more throughout the day and I can get a before bed test. What dose would you have me go up to? I still don't understand why her levels are higher on insulin then they were before I started.
 
Hello Chelon and WELCOME to the forum! You're in the right place now! You'll be getting lots of advice and help here. Please try not to panic at the numbers you're seeing.

You guys are new to this and often when new to diabetes and new to all of this tracking we see some wild and crazy numbers.

You've already gotten some great advice above - so take a breath - keep testing and recording in your SS. Once you settle into a routine, and get the dose figured out - it'll go much better. You're doing a wonderful job already - believe it or not! There is a big learning curve to this whole thing...hang in there!
 
Hello and welcome to the best place you never wanted to be. Make sure you read the Sticky Notes on the top of this forum.

Yes, still on SLGS, and I am glad you increased. The other thing to note, is that we determine how to change the Lantus dose based on the nadir, or how low the dose takes the cat. So we wait for the depot to fill, and try to get some tests in the middle of the cycle when the Lantus is strongest.
 
Sue and Luci said:
Hello Chelon and WELCOME to the forum! You're in the right place now! You'll be getting lots of advice and help here. Please try not to panic at the numbers you're seeing.

You guys are new to this and often when new to diabetes and new to all of this tracking we see some wild and crazy numbers.

You've already gotten some great advice above - so take a breath - keep testing and recording in your SS. Once you settle into a routine, and get the dose figured out - it'll go much better. You're doing a wonderful job already - believe it or not! There is a big learning curve to this whole thing...hang in there!
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Thank you, I have so much self doubt and general fear I'm doing the wrong thing for her.
 
Wendy&Neko said:
Hello and welcome to the best place you never wanted to be. Make sure you read the Sticky Notes on the top of this forum.

Yes, still on SLGS, and I am glad you increased. The other thing to note, is that we determine how to change the Lantus dose based on the nadir, or how low the dose takes the cat. So we wait for the depot to fill, and try to get some tests in the middle of the cycle when the Lantus is strongest.
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Ok, so if I'm o SLGS I should up her dose to 1 unit at her evening shot? Or do I need to give the .5 the 6 cycles?
 
Chelon Nickolette said:
Ok, so if I'm o SLGS I should up her dose to 1 unit at her evening shot? Or do I need to give the .5 the 6 cycles?
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Gosh... I’m sorry to see no one followed up with your question earlier today :-|
It’s thanksgiving day and peeps that might be around is slim...
With that said, have you short yet tonight? If so, what dose? If not, what is the time you normally shoot?
 
Krystina & Nelli said:
Gosh... I’m sorry to see no one followed up with your question earlier today :-|
It’s thanksgiving day and peeps that might be around is slim...
With that said, have you short yet tonight? If so, what dose? If not, what is the time you normally shoot?
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I understand it wasn't the best day to post, but I didn't know I was doing the right thing or if I should continue to treat her. But no I have not shot yet, actually her shot is in 20 minutes if you get this before then. But I will be around to monitor this weekend if I'm supposed to do more...I just don't know how to proceed with her numbers so high from her pre-treatment numbers.
 
Chelon Nickolette said:
I will be at home most of the weekend and able to monitor if the best course is to go with a higher dose. Let me know.
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Hang in there- I promise, promise... promise you- all will settle down and start to make better sense. It’s all about t.i.m.e. Patience. The more data (I.e. days that pass), you collect the easier all will be to understand.
The STICKY NOTES are your best friend in the beginning... Nelli and I have been here since July 2018 and I still refer back to STICKY NOTES :):cat::)
 
Chelon Nickolette said:
Ok, so if I'm o SLGS I should up her dose to 1 unit at her evening shot? Or do I need to give the .5 the 6 cycles?
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If you're following SLGS you need to hold the dose for 14 cycles.

This is from the stickie: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

The Start Low, Go Slow Method (SLGS) with Lantus, Basaglar, or Levemir 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, Basaglar, and Levemir 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!
 
Sue and Luci said:
If you're following SLGS you need to hold the dose for 14 cycles.

This is from the stickie: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

The Start Low, Go Slow Method (SLGS) with Lantus, Basaglar, or Levemir 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, Basaglar, and Levemir 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!
Click to expand...
Thanks, I saw that and read that, but it says start at 1 and I just went up to .5, so do I go up to 1 or do I hold .5 for 14 cycles?
 
I would hold the dose for a week. If you can post a reminder at day 5, how about if we evaluate. We typically don't fast track a dose with SLGS but given where you started out, it may be warranted. You have got to start getting a before bed test every night, though.
 
Chelon Nickolette said:
Ok, I shot .75 tonight. So do I hold this for a week or should I go up to 1 tomorrow? I will be around with her all weekend. And thank you!
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Hi!! So I had the same problems when I started on lantus. This insulin is a slow release and it can be very touchy in some cats. I made the mistake of increasing or decreasing randomly based on her value before breakfast and dinner- wrong! Then I found this group- thank God! You must collect lots of data and as you do collect, her numbers may go up higher. Be patient and as time moves on, the insulin will start to work. It is an odd insulin but this group is great at monitoring and guiding you so take it slow. I know, the high numbers are counterintuitive and you think that something is wrong but eventually it starts to make sense and work!!
 
Charlotte’s mom said:
Hi!! So I had the same problems when I started on lantus. This insulin is a slow release and it can be very touchy in some cats. I made the mistake of increasing or decreasing randomly based on her value before breakfast and dinner- wrong! Then I found this group- thank God! You must collect lots of data and as you do collect, her numbers may go up higher. Be patient and as time moves on, the insulin will start to work. It is an odd insulin but this group is great at monitoring and guiding you so take it slow. I know, the high numbers are counterintuitive and you think that something is wrong but eventually it starts to make sense and work!!
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Thank you for the encouragement! It helps :)
 
Sienne and Gabby (GA) said:
I would hold the dose for a week. If you can post a reminder at day 5, how about if we evaluate. We typically don't fast track a dose with SLGS but given where you started out, it may be warranted. You have got to start getting a before bed test every night, though.
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Ok got it. I'll be back in touch in 5 days. And thank you so much for your help!
 
Chelon Nickolette said:
Ok got it. I'll be back in touch in 5 days. And thank you so much for your help!
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You can also post in between these 5 days too and keep us updated on Sadie’s progress too if you’d like :) It’s a great way to meet and learn from others. I would check out other member’s kitty’s SS and daily threads to get an idea of what to expect from Sadie in the future.
 
Sienne and Gabby (GA) said:
I agree with Crista. Keep posting!! We'd like to get to know you and Sadie.
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It's been 6 cycles on the .75 and her numbers are still high and in the black several times. I wasn't able to get blood last night or this morning for the pmps and amps but I still shot and am guessing they were still high given today's nadir is 384. I still don't understand why her numbers are higher on insulin then before I was treating her. I've been trying to research it and can't find anything. It seems like if her dose wasn't high enough her numbers wouldn't go higher when her nadir isn't dropping too low. This is so frustrating. I'm wondering if I should go up to 2 since that's what the vet recommended and I tried 1 before with only higher numbers. What do you think, stay the course on .75 for a couple more days? Try higher? Do you know what's going on with her numbers so high?
 
Chelon Nickolette said:
'm wondering if I should go up to 2 since that's what the vet recommended and I tried 1 before with only higher numbers
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I wouldn't go to 2units, the 1u did get him into the blues, perhaps lower, since you were not getting midcycle tests back then we don't know, but I suspect she may have gone lower than 160 on 11/9 am cycle(she was pink at amps and then blue by pmps) and 11/11 pm cycle (again started that cycle in pink and ended it in blue)

Take a look at George's ss it took him a good while before we saw any lower numbers. We did TR/ he was on just a wet low carb diet, so we could follow TR which allowed us to change the dose more quickly, unfortunately with Sadie still eating dry food you are stuck with the slower progress of SLGS.

The principle of both dosing methods is to make the dose increases steadily until you reach a good dose, you can see that just a 0.5u change for got him from a sea of red/pinks to blues/yellows.
The problem with taking the dose from 0.75u to 2u overnight is that you could very well miss a good dose and end up overdosing your cat.

I know how hard it is to see those high numbers, the insulin is getting in there, you just haven't got to a good dose yet.

You mention you have had problems with getting a test? Was it a not enough blood issue? or was Sadie being uncooperative?
 
The FD journey is a marathon, not a sprint.

If you want to try a more aggressive approach, TR is the way to go but like Gill said, since Sadie is on dry, you don’t have that option. You can try to get her off the dry and have that be your next goal in achieving better numbers.

I also recommend you look at other cat’s SS. What I’m seeing on Sadie’s SS is quite typical of a new cat on insulin. And the frustration you’re experiencing is well known throughout the community. Most of us all started feeling confused and hopeless at not seeing results despite doing all we could.

And that’s when you need to remind yourself, again, that this is a marathon. Keep following the SLGS protocol and keep testing.

let us know how we can help you with getting a test on Sadie if that’s not working well for you and Sadie.
 
Gill & George said:
I wouldn't go to 2units, the 1u did get him into the blues, perhaps lower, since you were not getting midcycle tests back then we don't know, but I suspect she may have gone lower than 160 on 11/9 am cycle(she was pink at amps and then blue by pmps) and 11/11 pm cycle (again started that cycle in pink and ended it in blue)

Take a look at George's ss it took him a good while before we saw any lower numbers. We did TR/ he was on just a wet low carb diet, so we could follow TR which allowed us to change the dose more quickly, unfortunately with Sadie still eating dry food you are stuck with the slower progress of SLGS.

The principle of both dosing methods is to make the dose increases steadily until you reach a good dose, you can see that just a 0.5u change for got him from a sea of red/pinks to blues/yellows.
The problem with taking the dose from 0.75u to 2u overnight is that you could very well miss a good dose and end up overdosing your cat.

I know how hard it is to see those high numbers, the insulin is getting in there, you just haven't got to a good dose yet.

You mention you have had problems with getting a test? Was it a not enough blood issue? or was Sadie being uncooperative?
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The problem getting a test was that Sadie was twisting her ear around and smearing the blood. I tried both ears and she eventually started growling at me so I just let it go. I understand not going up to 2 overnight, but should I at least go up to 1? Even on 1 last time I was still getting numbers in the black.
 
The concern is that if you don't stick with a method for dosing and just go by your gut, there's a decent chance you won't know what may be causing the changes. With a systematic means of raising doses, you don't run into that problem.

Take a look at Scooter's spreadsheet. Start at the 2018 tab and look at where Scooter is now -- starting an OTJ (off the juice) trial. We never know how long a cat has been diabetic. All we know is when the cat becomes symptomatic or our kitty is at the vet for a check up and the glucose levels come back sky high.

If you can eliminate the dry food, you can switch over to the Tight Regulation Protocol which is more aggressive with regard to increasing the dose. The stipulation, though, is no dry food, even if it is low carb. If you're concerned about food being available throughout the cycle, a timed feeder will let you put out canned food that will be available during the cycle.
 
Sienne and Gabby (GA) said:
The concern is that if you don't stick with a method for dosing and just go by your gut, there's a decent chance you won't know what may be causing the changes. With a systematic means of raising doses, you don't run into that problem.

Take a look at Scooter's spreadsheet. Start at the 2018 tab and look at where Scooter is now -- starting an OTJ (off the juice) trial. We never know how long a cat has been diabetic. All we know is when the cat becomes symptomatic or our kitty is at the vet for a check up and the glucose levels come back sky high.

If you can eliminate the dry food, you can switch over to the Tight Regulation Protocol which is more aggressive with regard to increasing the dose. The stipulation, though, is no dry food, even if it is low carb. If you're concerned about food being available throughout the cycle, a timed feeder will let you put out canned food that will be available during the cycle.
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Looked at the ss. Why did you keep shooting when he was in the green? I thought that was the remission healthy level? Also, why did you keep shooting when it was under 200? I thought it was a no shoot for anything under 200 - another thing I was told on the facebook group? Also it looks like you changed the dose at some times after 6 cycles - do you think I can go up from .75 to 1 tonight for the 7th cycle? I'm sorry for so many questions - I did read the protocol but it is different from other information I've gotten.
 
The aim of insulin therapy is to get to a dose that will see the cat in healthy numbers, or in other words to attain regulation.

When you get to those numbers you don't just stop the insulin, it just means you have got to a good dose. So you continue shooting that dose until the cat drops below the reduction point (50 with TR / 90 with SLGS)(human meter). In the same way that you take the dose up slowly, you take the dose down slowly. If you just stopped insulin when they first got to good numbers the BG would just shoot back up. It takes time for the pancreas to heal, if you are lucky and it heals, you will find yourself coming back down in dose, until eventually they reach remission.
Take a look at Georges SS look at the 2016 tab he went into remission in april 2016 you can see how slowly we did it.

Chelon Nickolette said:
I thought it was a no shoot for anything under 200 - another thing I was told on the facebook group? A
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Here we would normally recommend that you ask for some experienced advice when you first get a preshot below 200, as you gain confidence and gather data on your cat you will slowly learn to shoot on TR anything above 50 on a human meter/ and on SLGS anything above 90 on a human meter.


Chelon Nickolette said:
Also it looks like you changed the dose at some times after 6 cycles - do you think I can go up from .75 to 1 tonight for the 7th cycle?
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That's because Scooter was doing TR, as Sienne mentioned this approach requires Sadie to be on just a wet LC diet. Do you think you could swap her to an all wet diet? If you can do that and monitor consistently then you could try TR and that would allow you to be more aggressive with the dosing, but you have to eliminate the dry food even if it is low carb.

Additionally as you can see from Scooters ss the CG was also getting enough tests in to make sure she wasn't missing any low numbers, so you would need to be aiming to get at least one test in each cycle that means morning and night, and if possible more when the numbers require it. We can help you with a plan for that if you don't know where best to start.

Chelon Nickolette said:
do you think I can go up from .75 to 1 tonight for the 7th cycle?
Click to expand...
I'm not sure what to suggest here, technically, because of the dry you are stuck with SLGS, so there is not a provision for you to fast track the dose, it's a safety thing. Secondly I'm uncomfortable recommending a dose increase because there's a big gap in data, almost 24hrs, because of the trouble with getting a test. She could have been doing anything numbers wise.
Lantus is a depot insulin, so we often don't see the full effect of the dose until the depot builds up and stabilises, that can take up to 6 cycles. The missing data falls right in that window where we would be looking to see if the dose was doing anything for Sadie.
 
First, I was following Tight Regulation. There are differences between the two dosing methods

When someone is new to managing their cat's diabetes, we want the caregiver to get experience with the basics. We set an arbitrary point (i.e., 200) as a "no shoot" number. This doesn't literally mean that you shouldn't shoot. Rather, it's a more of a post and ask for help number. With SLGS, that number is 200. With TR, the number is 150. However, once I was comfortable with managing Gabby's numbers, I would shoot anything over 50. I know -- you're sitting there scratching your head and thinking I was crazy. Scooter's numbers are gorgeous and Jill has been shooting low numbers for quite some time. With a depot insulin, the goal is to "shoot low to stay low." The ideal Lantus curve is flat.

For a cat to go into remission, it's a matter of the kitty being in normal numbers (50 - 120) for 14 days. That means that the dose is reduced to a drop before you stop insulin. We gradually reduce the dose in order to give insulin support to a healing pancreas as much time as possible before stopping insulin altogether.

Tight regulation differs from SLGS with regard to how long you hold a dose. With TR, you evaluate the dose every 3 days/6 cycles. With SLGS, you have to wait a week. Since Sadie is being fed a dry food, you are unable to use TR for your dosing method. You're restricted to SLGS. So, you have to wait out the week. I actually pushed up your dose given that you were misinformed about what the starting dose should be.

I know how hard it is to see your kitty is less than lovely numbers. The one thing this process will school you in is patience. I also feel badly that. you were given so much misinformation.
 
Gill & George said:
The aim of insulin therapy is to get to a dose that will see the cat in healthy numbers, or in other words to attain regulation.

When you get to those numbers you don't just stop the insulin, it just means you have got to a good dose. So you continue shooting that dose until the cat drops below the reduction point (50 with TR / 90 with SLGS)(human meter). In the same way that you take the dose up slowly, you take the dose down slowly. If you just stopped insulin when they first got to good numbers the BG would just shoot back up. It takes time for the pancreas to heal, if you are lucky and it heals, you will find yourself coming back down in dose, until eventually they reach remission.
Take a look at Georges SS look at the 2016 tab he went into remission in april 2016 you can see how slowly we did it.


Here we would normally recommend that you ask for some experienced advice when you first get a preshot below 200, as you gain confidence and gather data on your cat you will slowly learn to shoot on TR anything above 50 on a human meter/ and on SLGS anything above 90 on a human meter.



That's because Scooter was doing TR, as Sienne mentioned this approach requires Sadie to be on just a wet LC diet. Do you think you could swap her to an all wet diet? If you can do that and monitor consistently then you could try TR and that would allow you to be more aggressive with the dosing, but you have to eliminate the dry food even if it is low carb.

Additionally as you can see from Scooters ss the CG was also getting enough tests in to make sure she wasn't missing any low numbers, so you would need to be aiming to get at least one test in each cycle that means morning and night, and if possible more when the numbers require it. We can help you with a plan for that if you don't know where best to start.


I'm not sure what to suggest here, technically, because of the dry you are stuck with SLGS, so there is not a provision for you to fast track the dose, it's a safety thing. Secondly I'm uncomfortable recommending a dose increase because there's a big gap in data, almost 24hrs, because of the trouble with getting a test. She could have been doing anything numbers wise.
Lantus is a depot insulin, so we often don't see the full effect of the dose until the depot builds up and stabilises, that can take up to 6 cycles. The missing data falls right in that window where we would be looking to see if the dose was doing anything for Sadie.
Click to expand...
Thank you so much for patiently answering all of my questions. Is there still any explanation for why she has higher numbers on insulin then before treatment? That is the one thing that makes me question whether I should be treating her at all because it looks on paper like she's worse off.
 
Sienne and Gabby (GA) said:
First, I was following Tight Regulation. There are differences between the two dosing methods

When someone is new to managing their cat's diabetes, we want the caregiver to get experience with the basics. We set an arbitrary point (i.e., 200) as a "no shoot" number. This doesn't literally mean that you shouldn't shoot. Rather, it's a more of a post and ask for help number. With SLGS, that number is 200. With TR, the number is 150. However, once I was comfortable with managing Gabby's numbers, I would shoot anything over 50. I know -- you're sitting there scratching your head and thinking I was crazy. Scooter's numbers are gorgeous and Jill has been shooting low numbers for quite some time. With a depot insulin, the goal is to "shoot low to stay low." The ideal Lantus curve is flat.

For a cat to go into remission, it's a matter of the kitty being in normal numbers (50 - 120) for 14 days. That means that the dose is reduced to a drop before you stop insulin. We gradually reduce the dose in order to give insulin support to a healing pancreas as much time as possible before stopping insulin altogether.

Tight regulation differs from SLGS with regard to how long you hold a dose. With TR, you evaluate the dose every 3 days/6 cycles. With SLGS, you have to wait a week. Since Sadie is being fed a dry food, you are unable to use TR for your dosing method. You're restricted to SLGS. So, you have to wait out the week. I actually pushed up your dose given that you were misinformed about what the starting dose should be.

I know how hard it is to see your kitty is less than lovely numbers. The one thing this process will school you in is patience. I also feel badly that. you were given so much misinformation.
Click to expand...
Ok, thank you. I don't feel comfortable removing her dry food. I think she enjoys it as a tasty treat and she won't eat freeze dried treats so I don't want to take away something she enjoys so I'll just stay the course with SLGS. I really appreciate your help and explanations and patience with me!
 
Chelon Nickolette said:
I thought it was a no shoot for anything under 200 - another thing I was told on the facebook group?
Click to expand...
I'm wondering if you're talking about the other FB group that isn't associated with FDMB?

But like Sienne said, 200 is a guideline for those starting and more of a way to prompt caregivers to be extra vigilant with testing if/when they shoot and also to post for help. The number goes down as you gather more data and experience.

We try to shoot low to stay low. A cycle where you shoot a lower number tends to be flatter with Lantus/Levemir.
 
Chelon Nickolette said:
Is there still any explanation for why she has higher numbers on insulin then before treatment?
Click to expand...
I can think of a couple of possible explanations. First is that a cat’s body gets used to higher numbers and builds up a bit of resistance called glucose toxicity. Name is scarier than it is, it just means giving more insulin to get over the resistance it takes surprisingly little time for that resistance to build. A week in higher numbers will do it.

A second possibility is that Sadie, like many cats, is going lower at night. Her body then reacts to lower numbers than she is used to and bouncing and you are seeing those temporary higher numbers during the day. You can only determine if this is happening by getting a before bed test every night.
Chelon Nickolette said:
I don't feel comfortable removing her dry food. I think she enjoys it as a tasty treat and she won't eat freeze dried treats
Click to expand...
Keep trying other freeze dried treats, there are many flavours and formats out there. Some like the jerky or dehydrated format. Freeze dried turkey heart pieces are a hit here, so were freeze dried quail necks when I could get them. Dry food can be a major impediment to regulation.
 
Chelon Nickolette said:
Ok, thank you. I don't feel comfortable removing her dry food. I think she enjoys it as a tasty treat and she won't eat freeze dried treats so I don't want to take away something she enjoys so I'll just stay the course with SLGS.
Click to expand...
Have you tried the Orijen FD treats? My kitties all like FD treats but they go absolutely nuts for these. I've heard many cats like these when they don't like others. They are pricier than others, but the dog version are the same but a bit larger, and more economical, I get those and break them up.
If my guys are being fussy they get a sprinkle of a FD treat on their food and they eat it the whole dish up. Felix, my civie, loves a FD garnish on all his food (I created a monster:joyful:)

I know you are reluctant to take away the dry all together.
How about this as an option.
If you temporarily got rid of the dry, that would allow you to follow TR, and raise the dose more quickly till you started seeing better numbers. Once you got to a better place with the numbers, if you still felt you wanted to continue with feeding her some dry, you could swap back to SLGS. But at least then you would have got her out of the red and black.


I really feel for you, I know how hard it is to see all that red and black on the SS, so just trying to think outside the box to see if there is a way to get you back on track a little quicker.
 
Hi and welcome. I haven’t posted on your thread before.
I know how disheartening it can be to see high numbers but hang in there. Things will get better. Once you get closer to the best dose you will see better numbers.
You are getting lots of really good advice from experienced people.
I really like @Gill & George idea of temporarily stopping the dry so you can do TR for a time to get the dose up quicker.
Is there another suitable food you could add while you take out the dry to keep Sadie’s interest.
It’s certainly an option worth thinking about.
:bighug:
 
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