? SLGS - after 1 week at a given dose. curve timing and nadirs

JOJI and Kit

JOJI and Kit

Member Since 2019
hi,
in the dosing method guidance it says:

1. do a curve after one week.
does that mean to do a curve on the 7th day (either AM or PM cycle) or to do a curve on the 8th day?​
2. if nadirs are ...
because is say more than one nadir, i'm guessing we consider all the data from the 7 days and not just the curve day data? if that's correct then:
how many nadirs in a given interval would you like to see to decide which action to take?
i feel like the below 90 mg is clear, because you should take the decrease immediately.
but what if you only saw 1 or 2 nadirs between 90 mg and 149 mg and the rest of the 14 cycles were more than 150 mg.
would you with increase by 0.25U or hold?​

thanks, jw



http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

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
,
 
Good day to you and Kit!

1. I would start the curve on the 8th day, after 7 days; 14 cycles, so today, unless you need to do it over the weekend - you have already been doing a good job of testing and capturing data.

2. Correct, you want to consider all the nadirs during the cycles on a particular dose.
"what if you only saw 1 or 2 nadirs between 90 mg and 149 mg and the rest of the 14 cycles were more than 150 mg.
would you with increase by 0.25U or hold?"
I'd want more input than my own for you! Personally, I would give a small increase, possibly even less than .25u (but not likely since Kit is getting 4u). If you increased by .25 and watched closely, Kit could ask to be reduced by going under 90 and that would give your answer:)
Since you are using SLGS, you have an extra safety margin. Many kitties off insulin have regular BG numbers in the 50s, 60s, so under 90 is not unsafe:D
 
You can do the curve on the 7th day and increase the next if you want. You really don't want to hold a dose that's not working any longer than you need to. The thing that causes a wrinkle in your case, is that you gave a smaller dose the PM of the third day in. You do want to make sure the depot is full when you do a curve, so it should be done at least three full days after any change in the regular dose (skip, reduced dose, fur shot, etc.).

When evaluating a dose, ask yourself the question "how low can this dose take my cat?" - yes, you do look at all the low points you've seen. If you saw one random lower number once and never again anything near it, it may or may not be indicative of the typical nadirs of the dose. Since you do a good job testing, what you are seeing is what you are getting. Some people following SLGS don't have the ability to test much, so it's harder to see what is really happening. If you did see two nadirs between 90 and 149, I would hold the dose as two shows it's not an accident.

If after you do the curve, Kit doesn't show you anything under 150, I would do the full 0.25 units dose. Given the size of dose that Kit is on, anything less than 0.25 units change is such a small change it'll be barely noticed. Most cats do better with the full 0.25 unit changes.
 
Wendy&Neko said:
The thing that causes a wrinkle in your case, is that you gave a smaller dose the PM of the third day in.
Click to expand...

yes. so i know we talked about that restarting the 7 day counter. based on that conversation our current plan is to do the curve on 6/16 barring a 90 or lower.
do you still see that as the plan?

Wendy&Neko said:
make sure the depot is full when you do a curve, so it should be done at least three full days after any change in the regular dose (skip, reduced dose, fur shot, etc.).
Click to expand...
or are you suggesting we do sooner than 6/16?
on a practical matter. since we missed the opportunity to curve today, that would mean curve tomorrow. and then a potential dose change on sunday. but, we won't be around on sunday to monitor ....

Wendy&Neko said:
If after you do the curve, Kit doesn't show you anything under 150, I would do the full 0.25 units dose. Given the size of dose that Kit is on, anything less than 0.25 units change is such a small change it'll be barely noticed. Most cats do better with the full 0.25 unit changes.
Click to expand...

great, thanks for the input.
i'm not sure how relevant her prozinc experience is here, but larger dose changes didn't seem to be her cup of tea which is partly why we are doing SLGS.

and an additional question. today she's pretty pink. would you consider that a bounce coming off last PM blues?
 
Today is definitely a bounce!

As for curve day, it's not a strictly, must be day X thing. Do it when you have the ability to do so. Since she's bouncing today, she probably will be tomorrow too. Curving on a bounce day doesn't tell you much either. You do want to wait until the depot is full. It'll be close to that tomorrow. You can curve whenever able after that.
 
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