SLGS Method?????

Panic said:
There are two methods: Start Low Go Slow and Tight Regulation. TR is pretty exclusive to just Lantus / Levemir I believe. SLGS is what you would use on Prozinc. Below is a sticky with instructions for both protocols. :)

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


Thank you Panic...Yes I have read all the methods and see the different things I can do...But it appears you need to move up to the Modified Method at some point...Im trying to see if I can just stay on the SLGS method, if I can I want to try to ask questions related to that approach so I know how to do it correctly.....I haven't been on for last few days as im redoing my some rooms in my house and shortly the contractors are going to be able to come in and do some work, thank goodness....So my goal is to ask questions related to the method of choice......
 
Yes, you can select one dosing method and stick with it as long as you want to Pat.
So yes, SLGS is a method you can choose and keep Brady on that as long as you want to.

MPM is basically a version of TR (Tight Regulation), with some modifications. TR is specific to lantus and levemir.

MPM (Modified Prozinc Method) is specific to Prozinc. It uses much of what the TR method uses, with some modifications.

Contractors! That can be a lot of work, prepping for them and overseeing what they are doing. With the coronovirus surge still not at it's peak here in MA, I'm delaying things this year. Maybe this fall for some more tree work.
 
Thank you Deb...Im going over that SLGS version and putting together some questions on things im not sure about, I will probably have it ready tomorrow, hopefully you guys can help me out...Things that im not totally understanding so I want to make sure I make the right calls in certain situations. I guess Brady is bouncing, don't know if you peeked at his SS.....These bounces are something else......

Yes, here in Pa they are supposed to be opening up the home improvement guys...Still not 100% sure....I currently have 3 rooms in my house torn apart with furniture stacked in our bedroom and basement from those 3 rooms...ugggghh….They were supposed to be here on March 30th getting my hardwood floors refinished and some other things....hopefully it turns out nice....I had this all going on and then the virus hit and then Brady got sick, almost all at the same time, so its been quite stressful.

It sure would be nice if we could get some good days as well, rain rain rain rain....Good for your garden im sure, hahaha.....
 
Irish Pat said:
Thank you Deb...Im going over that SLGS version and putting together some questions on things im not sure about, I will probably have it ready tomorrow, hopefully you guys can help me out...Things that im not totally understanding so I want to make sure I make the right calls in certain situations. I guess Brady is bouncing, don't know if you peeked at his SS.....These bounces are something else......

Yes, here in Pa they are supposed to be opening up the home improvement guys...Still not 100% sure....I currently have 3 rooms in my house torn apart with furniture stacked in our bedroom and basement from those 3 rooms...ugggghh….They were supposed to be here on March 30th getting my hardwood floors refinished and some other things....hopefully it turns out nice....I had this all going on and then the virus hit and then Brady got sick, almost all at the same time, so its been quite stressful.

It sure would be nice if we could get some good days as well, rain rain rain rain....Good for your garden im sure, hahaha.....
Click to expand...
I didn’t get this tag, sorry. I have been looking for new posts but not this afternoon.

You can definitely stay with SLGS. If that doesn’t work, you can consider changing insulins as well as you can do SLGS with any of them. Usually, if you aren’t seeing progress within six months, it’s smart to try a different insulin.

It’s possible those black numbers are signaling what we call the “high before the break” so please be sure you get a couple tests tonight especially because you raised the dose today.
 
Marje and Gracie said:
It’s possible those black numbers are signaling what we call the “high before the break” so please be sure you get a couple tests tonight especially because you raised the dose today.
Click to expand...


What does "high before the break" mean, so so much to keep up in this little brain of mine...….
 
Here are the questions I came up with so far as im sure I will have more...I tried to make the questions in bold that are important to me at this stage...I need to understand this method inside and out because this is the one that will work the best for our situation...So hopefully you guys can get me on the right track. Sorry for the long post.....


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.


Reducing the Dose:

  • Anytime the BG drops below 90 mg/dL, reduce the dose by 0.25u at the next shot.
Lather, Rinse, and Repeat!


QUESTIONS For: Hold The Dose and Reducing the Dose


  • Unless your cat won’t eat or you suspect hypoglycemia…
Im not sure what this means, can someone explain this comment? I know what it means verbally, don’t know what it means in relation to the SLGS method and what should you do if your cat wont eat? To me it, if your cat doesnt eat you dont give it insulin, howerver, this comment states, HOLD THE DOSE, and then says, Unless your cat wont eat.....confussion is all i have about this rule.

· If kitty falls below 90 decrease the dose by .25. Does this mean if the kitty falls below 90 during any cycle or if the nadir is always below 90 during frequent cycles?


· Lather, Rinse and Repeat….does this mean you decrease the dose .25 because kitty was below 90 and then on the next dose go back to the original dose you were using?


  • 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

Are these instructions to be completed only after completing a week on a current dose?





How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
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.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Prozinc users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:



QUESTIONS:

This section, if im getting it right, you pick a BG number that you feel comfortable with and shoot your insulin. If it meets any of the criteria from Q4 above, you follow the guidelines for low preshot numbers??


If someone could in layman’s terms, sorta explain this to me…Because out of all the methods to use, this one seems to have more, skipping the doses than other methods. Am I correct in that understanding or no?
 
Irish Pat said:
Here are the questions I came up with so far as im sure I will have more...I tried to make the questions in bold that are important to me at this stage...I need to understand this method inside and out because this is the one that will work the best for our situation...So hopefully you guys can get me on the right track. Sorry for the long post.....


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.


Reducing the Dose:

  • Anytime the BG drops below 90 mg/dL, reduce the dose by 0.25u at the next shot.
Lather, Rinse, and Repeat!


QUESTIONS For: Hold The Dose and Reducing the Dose


  • Unless your cat won’t eat or you suspect hypoglycemia…
Im not sure what this means, can someone explain this comment? I know what it means verbally, don’t know what it means in relation to the SLGS method and what should you do if your cat wont eat? To me it, if your cat doesnt eat you dont give it insulin, howerver, this comment states, HOLD THE DOSE, and then says, Unless your cat wont eat.....confussion is all i have about this rule.

· If kitty falls below 90 decrease the dose by .25. Does this mean if the kitty falls below 90 during any cycle or if the nadir is always below 90 during frequent cycles?


· Lather, Rinse and Repeat….does this mean you decrease the dose .25 because kitty was below 90 and then on the next dose go back to the original dose you were using?


  • 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

Are these instructions to be completed only after completing a week on a current dose?





How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
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.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Prozinc users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:

  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:



QUESTIONS:

This section, if im getting it right, you pick a BG number that you feel comfortable with and shoot your insulin. If it meets any of the criteria from Q4 above, you follow the guidelines for low preshot numbers??


If someone could in layman’s terms, sorta explain this to me…Because out of all the methods to use, this one seems to have more, skipping the doses than other methods. Am I correct in that understanding or no?
Click to expand...
I’m just getting up and have to get the morning cat care and coffee going but I’ll be back to respond this morning.

High before the break is high numbers (those blacks) before he clears the bounce which he’s doing now. His BG will likely trend down all cycle.
 
Marje and Gracie said:
I’m just getting up and have to get the morning cat care and coffee going but I’ll be back to respond this morning.

High before the break is high numbers (those blacks) before he clears the bounce which he’s doing now. His BG will likely trend down all cycle.
Click to expand...


You got that right, he is at 145 at +5, must say you guys know your stuff....I will keep an eye on him...looking forward to your responses to the SLGS method questions I asked....and how im supposed to be doing it....Based of off this method and if im reading it right, it appears that if he goes below 90 today I am supposed decrease the dose immediately by .25. That's if im reading this all correctly.
 
Irish Pat said:
You got that right, he is at 145 at +5, must say you guys know your stuff....I will keep an eye on him
Click to expand...
“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.
  • He was bouncing
  • He was due to clear the bounce
  • His BG was wobbling a bit like it might be clearing but then the numbers shot way up.
  • BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle.
Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.


Irish Pat said:
Im not sure what this means, can someone explain this comment? I know what it means verbally, don’t know what it means in relation to the SLGS method and what should you do if your cat wont eat? To me it, if your cat doesnt eat you dont give it insulin, howerver, this comment states, HOLD THE DOSE, and then says, Unless your cat wont eat.....confussion is all i have about this rule.
Click to expand...
This means, if during the week where you are holding the dose, if the kitty is acting off and won’t eat or has any symptoms of hypoglycemia (although you might not have caught it with a test), reduce the dose. If it’s from lack of eating, see below. If you suspect hypoglycemia, reduce the dose when you see the symptoms that make you suspect hypoglycemia.

In regard to not shooting insulin if they aren’t eating, we don’t always recommend skipping the shot. This would particularly apply to cats with a history of DKA or throwing ketones or cats currently throwing ketones. You have to be careful about skipping shots with a sick cat. Most members post here to discuss it before they decide to skip a shot when a cat isn’t eating. There’s always the option of a much smaller dose. You might want to read this post regarding cats that won’t eat and skipping shots. Steve, who wrote the post, was one of the early pioneers here and a very wise member.


Irish Pat said:
· If kitty falls below 90 decrease the dose by .25. Does this mean if the kitty falls below 90 during any cycle or if the nadir is always below 90 during frequent cycles?
Click to expand...
One drop below 90 any time during the cycle means the dose should be reduced by 0.25u.

Irish Pat said:
· Lather, Rinse and Repeat….does this mean you decrease the dose .25 because kitty was below 90 and then on the next dose go back to the original dose you were using?
Click to expand...
No. We use this idiom here to mean repeat the process. If he didn’t earn a reduction during the week, run the weekly curve, and then follow the rules. Then repeat the next week and so on with the caveat always being reduce the dose if he drops below 90.

If you reduce a dose because he earned a reduction by falling below 90, you wouldn’t go back to that higher dose after one shot at a reduced one. You wait a week (unless he falls below 90 again), do another curve, adjust the dose if necessary per the instructions.

Irish Pat said:
Are these instructions to be completed only after completing a week on a current dose?
Click to expand...
Unless he falls below 90 during the week. Then reduce the dose immediately.

Irish Pat said:
This section, if im getting it right, you pick a BG number that you feel comfortable with and shoot your insulin. If it meets any of the criteria from Q4 above, you follow the guidelines for low preshot numbers??
Click to expand...
Here is a really important statement in that (bold is mine):
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.
Click to expand...

Once members following SLGS have a bit of data, understand how to control lower numbers with food and how their cat’s BG responds to different foods, and have gradually learned to shoot lower and lower, then they shoot every number above 90. While, initially, it seems to call for more skipping, in reality, the sooner you learn to shoot lower and lower numbers above 90 (e.g. 150, then 120, then 90), the less you will skip.

Here is one of the most important parts of SLGS (the bold is mine):
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
Click to expand...
SLGS guidelines are just that. They give you a starting point to feel more comfortable with the process. Some members continue to use SLGS but others, once they feel more confident as they build data and learn how to feed their cat through low numbers, switch methods.

Take a look at Yoyo’s SS. He’s on Lantus but the general concept of SLGS and TR are the same as SLGS and Modified PZ dosing. His CG was following SLGS but she was testing plenty for TR. I was working with her closely and she finally got the confidence to start TR because it is more aggressive.

Start with his 2018 AT SS. Then look at 2019 SS and you can see where she started TR on 3/2/2019. She had a bit of up and down changing syringes but once she got consistent with that and then let Lantus (which is gentler than PZ and takes a bit more time to “settle”), look how his BG changed with her closely following the TR protocol we have for Lantus. He is what we call a “tightly regulated” cat. And yes, she tests a lot which is her choice. But she’s doing an incredible job and Yo is doing great.

Does all that help?
 
Marje and Gracie said:
“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.
  • He was bouncing
  • He was due to clear the bounce
  • His BG was wobbling a bit like it might be clearing but then the numbers shot way up.
  • BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle.
Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.



This means, if during the week where you are holding the dose, if the kitty is acting off and won’t eat or has any symptoms of hypoglycemia (although you might not have caught it with a test), reduce the dose. If it’s from lack of eating, see below. If you suspect hypoglycemia, reduce the dose when you see the symptoms that make you suspect hypoglycemia.

In regard to not shooting insulin if they aren’t eating, we don’t always recommend skipping the shot. This would particularly apply to cats with a history of DKA or throwing ketones or cats currently throwing ketones. You have to be careful about skipping shots with a sick cat. Most members post here to discuss it before they decide to skip a shot when a cat isn’t eating. There’s always the option of a much smaller dose. You might want to read this post regarding cats that won’t eat and skipping shots. Steve, who wrote the post, was one of the early pioneers here and a very wise member.



One drop below 90 any time during the cycle means the dose should be reduced by 0.25u.


No. We use this idiom here to mean repeat the process. If he didn’t earn a reduction during the week, run the weekly curve, and then follow the rules. Then repeat the next week and so on with the caveat always being reduce the dose if he drops below 90.

If you reduce a dose because he earned a reduction by falling below 90, you wouldn’t go back to that higher dose after one shot at a reduced one. You wait a week (unless he falls below 90 again), do another curve, adjust the dose if necessary per the instructions.


Unless he falls below 90 during the week. Then reduce the dose immediately.


Here is a really important statement in that (bold is mine):


Once members following SLGS have a bit of data, understand how to control lower numbers with food and how their cat’s BG responds to different foods, and have gradually learned to shoot lower and lower, then they shoot every number above 90. While, initially, it seems to call for more skipping, in reality, the sooner you learn to shoot lower and lower numbers above 90 (e.g. 150, then 120, then 90), the less you will skip.

Here is one of the most important parts of SLGS (the bold is mine):

SLGS guidelines are just that. They give you a starting point to feel more comfortable with the process. Some members continue to use SLGS but others, once they feel more confident as they build data and learn how to feed their cat through low numbers, switch methods.

Take a look at Yoyo’s SS. He’s on Lantus but the general concept of SLGS and TR are the same as SLGS and Modified PZ dosing. His CG was following SLGS but she was testing plenty for TR. I was working with her closely and she finally got the confidence to start TR because it is more aggressive.

Start with his 2018 AT SS. Then look at 2019 SS and you can see where she started TR on 3/2/2019. She had a bit of up and down changing syringes but once she got consistent with that and then let Lantus (which is gentler than PZ and takes a bit more time to “settle”), look how his BG changed with her closely following the TR protocol we have for Lantus. He is what we call a “tightly regulated” cat. And yes, she tests a lot which is her choice. But she’s doing an incredible job and Yo is doing great.

Does all that help?
Click to expand...


Yes you are a big help....Now, some other questions....I will be developing questions throughout this process....but its the understanding part that I need to really get down....But above where it says Lower than normal preshot numbers....If at 150 or below its saying skip the dose....I know this has everything to do with data collection, but where im at I wouldn't know what to do if he was at or below 150? In fact that entire part on Lower than normal preshot numbers....I don't know where Brady would fall in at this stage??

Since I will be asking a lot of questions about this...is there a way to keep this post so I don't ever lose it?
 
Irish Pat said:
Since I will be asking a lot of questions about this...is there a way to keep this post so I don't ever lose it?
Click to expand...
On the upper right hand corner at the top of this thread there is a “watch thread” option. If you select it, it will save it under your “watched threads” tab on the upper left corner of this page. You can decide whether you want to receive email notifications every time someone posts to this thread or not.

I’m right in the middle of something right now so I’ll be back in a bit to respond to your other question.
 
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL

With the above description, it says with the SLGS method your goal is to achieve flat numbers that are great than 90....so can you explain the meaning of flat numbers...Does it mean you would like to have consistent number around the clock of say 165? Is that what it means by flat numbers?
 
Irish Pat said:
Yes you are a big help....Now, some other questions....I will be developing questions throughout this process....but its the understanding part that I need to really get down....But above where it says Lower than normal preshot numbers....If at 150 or below its saying skip the dose....I know this has everything to do with data collection, but where im at I wouldn't know what to do if he was at or below 150? In fact that entire part on Lower than normal preshot numbers....I don't know where Brady would fall in at this stage??
Click to expand...
A lot of the guidance is written for you if you are on your own. But you aren’t. Remember the other night when he was low? I had options for you. You should read back through that post but what most members do who have been dealing with FD the length of time you have and for you to get accustomed to shooting lower preshots above 90 so you don’t have to skip is:

  • for a PS above 150, you should shoot the full dose now. You’ve been around a bit, you’ve had some green numbers.
  • for a PS between 120-150, you should stall without feeding and have someone walk you through the process we started on the other night; an experienced person will help you shoot the full dose and stay with you while you monitor the numbers or they might have you stall a bit and shoot the rise as soon as the BG heads up.
Irish Pat said:
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL

With the above description, it says with the SLGS method your goal is to achieve flat numbers that are great than 90....so can you explain the meaning of flat numbers...Does it mean you would like to have consistent number around the clock of say 165? Is that what it means by flat numbers?
Click to expand...

Flat numbers means little more than a 20% variation that is inherent in meters. It means you don’t see a lot of a smile kind of curve but a bit flatter as you see in Yoyo’s cycles. Each member has to decide whether they want their cat below renal threshold or in healing numbers. I explained that in a previous post to you so you might want to “bookmark” that, too using the “watch thread” button.
 
Marje and Gracie said:
A lot of the guidance is written for you if you are on your own. But you aren’t. Remember the other night when he was low? I had options for you. You should read back through that post but what most members do who have been dealing with FD the length of time you have and for you to get accustomed to shooting lower preshots above 90 so you don’t have to skip is:

  • for a PS above 150, you should shoot the full dose now. You’ve been around a bit, you’ve had some green numbers.
  • for a PS between 120-150, you should stall without feeding and have someone walk you through the process we started on the other night; an experienced person will help you shoot the full dose and stay with you while you monitor the numbers or they might have you stall a bit and shoot the rise as soon as the BG heads up.


Flat numbers means little more than a 20% variation that is inherent in meters. It means you don’t see a lot of a smile kind of curve but a bit flatter as you see in Yoyo’s cycles. Each member has to decide whether they want their cat below renal threshold or in healing numbers. I explained that in a previous post to you so you might want to “bookmark” that, too using the “watch thread” button.
Click to expand...


I know im repeating a lot, that's why I wanted to not start fresh but get a place where I can go to that has all my answers sorta in one place...that was my reasoning for doing this today, glad you guys stayed with me on this....and I know that there are a lot of people out there to help, but right now it just seems like the most experienced people in guiding me on dosing are you and Deb, you two have showed a lot of interest in my posts.....and by no means am I saying that the others aren't here to help me, im just saying im lucky to have you two in my corner.....There have been others that comment on my posts that are the moral support I need as well....I thank all of you. I hope and pray that if im in a crisis someone is here to walk me through if you guys aren't available...…..so pretty much that's why I am asking questions over...and plus, I know its a struggle on you guys, but it does help me learn. Im sorry...I am just really scared of this and I know I have to get over this fear.
 
Marje can wipe the floor with me and my level of knowledge. It's why I tagged her, and have kept on the sidelines, reading all the posts and her replies to you.

By the time I get something written, she has already posted, and usually a nice clear explanation, while I'm only a few sentences in to a reply.

p.s. Pat is red/green color blind, so stating the BG's in the color coded ranges on the SS doesn't work well for him. Trying to remember to put replies both ways, not only in Pat's posts, but in other members threads too.
 
Deb & Wink said:
Marje can wipe the floor with me and my level of knowledge. It's why I tagged her, and have kept on the sidelines, reading all the posts and her replies to you.

By the time I get something written, she has already posted, and usually a nice clear explanation, while I'm only a few sentences in to a reply.

p.s. Pat is red/green color blind, so stating the BG's in the color coded ranges on the SS doesn't work well for him. Trying to remember to put replies both ways, not only in Pat's posts, but in other members threads too.
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I saw that on some of your posts about me being color blind...there is one thing I notice on the spreadsheets tho, which really really helps me...If i click in one of the colored boxes i need it highlights the color being used so i know which color to put in my box.....If i was only that smart with FD i wouldnt need help...lol....And Deb, I could always use your advice so please two people are always better than one........
 
Those human test strips will tell you if there is glucose spilling into the urine. By that I mean that the kidneys are filtering out excess glucose and dumping it in the urine. They test for ketones too, at least the keto diastix do.

They're pretty accurate, as far as seeing glucose in the urine.
They can't tell you what the actual glucose level is, just a rough value.

Urine glucose is hours after blood glucose. So the urine glucose test strips are not good for making adjustments in the insulin dose. They will test for both ketones and glucose in the urine.
 
Deb & Wink said:
Those human test strips will tell you if there is glucose spilling into the urine. By that I mean that the kidneys are filtering out excess glucose and dumping it in the urine. They test for ketones too, at least the keto diastix do.

They're pretty accurate, as far as seeing glucose in the urine.
They can't tell you what the actual glucose level is, just a rough value.

Urine glucose is hours after blood glucose. So the urine glucose test strips are not good for making adjustments in the insulin dose. They will test for both ketones and glucose in the urine.
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I actually ordered the strict glucose ones since I already have the ketone test strips, I have a bunch of the ketone ones that's why I ordered just the glucose ones this time
 
Irish Pat said:
I actually ordered the strict glucose ones since I already have the ketone test strips, I have a bunch of the ketone ones that's why I ordered just the glucose ones this time
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I would suggest you wait on the urine sugar test until he’s in the range below 150 and perhaps has been there a bit. Get a baseline. If that is negative then test as his numbers rise and see when the sugar starts up.
 
Good point Marje. The renal threshold, or when the glucose starts to spill into the urine can be anywhere from 180 - 250 mg/dL. Depends on the cat. So getting a baseline is an excellent idea.
 
Deb & Wink said:
Marje can wipe the floor with me and my level of knowledge. It's why I tagged her, and have kept on the sidelines, reading all the posts and her replies to you.

By the time I get something written, she has already posted, and usually a nice clear explanation, while I'm only a few sentences in to a reply.

p.s. Pat is red/green color blind, so stating the BG's in the color coded ranges on the SS doesn't work well for him. Trying to remember to put replies both ways, not only in Pat's posts, but in other members threads too.
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Thanks, Deb, but we really appreciate all your help and knowledge!

Irish Pat said:
I know im repeating a lot, that's why I wanted to not start fresh but get a place where I can go to that has all my answers sorta in one place...that was my reasoning for doing this today, glad you guys stayed with me on this....and I know that there are a lot of people out there to help, but right now it just seems like the most experienced people in guiding me on dosing are you and Deb, you two have showed a lot of interest in my posts.....and by no means am I saying that the others aren't here to help me, im just saying im lucky to have you two in my corner.....There have been others that comment on my posts that are the moral support I need as well....I thank all of you. I hope and pray that if im in a crisis someone is here to walk me through if you guys aren't available...…..so pretty much that's why I am asking questions over...and plus, I know its a struggle on you guys, but it does help me learn. Im sorry...I am just really scared of this and I know I have to get over this fear.
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No worries. No need to apologize at all. We are here to teach and support. In three months, you’ll be amazed at what you know.

Remember with a meter and food, you are in control.:woot:
 
So what you guys are saying about the urine sample is....at least I think...Are you saying that because he is still all over the place with numbers he would more than likely have glucose in his urine? Is glucose in the urine the common for cats with FD?
 
Irish Pat said:
So what you guys are saying about the urine sample is....at least I think...Are you saying that because he is still all over the place with numbers he would more than likely have glucose in his urine? Is glucose in the urine the common for cats with FD?
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If you can catch him several hours after his BG drops below 150, it would be a good place to start. If that shows glucose in his urine, then you’ll know it takes a little longer for him to clear the sugar from his urine. ECID.

The first clue for us that Gracie might have FD was a normal urine sample showed glucose in it even though her serum glucose was 107. We started monitoring her closely by just checking urine glucose and the next time she showed it, we got her right in and her serum glucose was high.

Any time a cat’s BG goes over their renal threshold, they will spill glucose into the urine. That applies to every diabetic cat (and person). What varies is where that renal threshold is.
 
Irish Pat said:
So what you guys are saying about the urine sample is....at least I think...Are you saying that because he is still all over the place with numbers he would more than likely have glucose in his urine? Is glucose in the urine the common for cats with FD?
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Yes, it's very common for a diabetic to have glucose in the urine. It's one reason they pee such copious amounts, because the kidneys are filtering out the excess glucose from the blood, making for a full bladder, making for more urine and larger puddles in the litter box.

Still worth testing, to see if the urine glucose goes below renal threshold, and to find out what that renal threshold is for cats.
 
Ok, I have some really tough questions to ask....Brady had a BG vet apt today, I took my meter along...His BG at the vets office on their Cat meter registered 589, my meter at the vets only registered 405. I thought I was having a great day today....If you look at his SS his numbers all looked good, I don't know what to think right now.....I took his BG as soon as we got into the house from the vets and his BG was 458, not even close to the 589 the vet got. Now prior to leaving for the vet his BG did jump up into the 400's. But is my meter off that much, I have two meters and I check him on both sometimes just to see if they both read the same and they are always real close to each other......Am I not doing the right thing, is his BG really way higher than im showing....Im worried im not giving him enough insulin, does anyone have any answers for me, please??? Vet wants me to move him up to 2.5 U but I could tell by the look on her face I think she actually wanted it higher...….
 
Does Brady love getting into his carrier? Or does he dislike being in there?
Is Brady a very "chilled out" cat on the drive to the vet, and while at the vet? Any dogs barking, strangers around, were you allowed to go into the vet clinic with Brady? or something else to upset him? Struggling, vocalizing, telling you and the vet he did not want to be there in the clinic?

Vet stress is a well documented phenomenon. Takes several hours to get over that stress too.
A couple of links for you, on controlled studies that show that.
Acute Stress Hyperglycemia in Cats (They gave cats a bath.) That is the abstract. Here is the more complete version.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2002.tb02343.x

Also, check out this article. Stress Hyperclycemia in Sick Cats

Did you and the vet test the exact same drop of blood?
If not, which meter was used first, yours or the vet's pet meter?

The vet used a pet meter. You use a human meter for testing. There are always going to be differences between the 2 types of meters. Different algorithms behind the different types of meters. Different components in a cat's blood vs a human's.

You are looking for ranges, not for exact numbers Pat. That is why we have those number ranges on our standardized spreadsheet. There are going to be variations from test to test.
Is your vet aware of the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats that talks about the less stressful environment at home, leading to greater accuracy of BG testing?

So your vet wants to increase Brady's dose, by 0.25U, based on a single BG test done at the vet's office?
When Brady dropped to the low 100's today, before the vet visit?
Did your vet know about that lower BG reading, before she suggested that dose increase?
Did you share Brady's spreadsheet with your vet?
 
Deb & Wink said:
Does Brady love getting into his carrier? Or does he dislike being in there?
Is Brady a very "chilled out" cat on the drive to the vet, and while at the vet? Any dogs barking, strangers around, were you allowed to go into the vet clinic with Brady? or something else to upset him? Struggling, vocalizing, telling you and the vet he did not want to be there in the clinic?

Vet stress is a well documented phenomenon. Takes several hours to get over that stress too.
A couple of links for you, on controlled studies that show that.
Acute Stress Hyperglycemia in Cats (They gave cats a bath.) That is the abstract. Here is the more complete version.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2002.tb02343.x

Also, check out this article. Stress Hyperclycemia in Sick Cats

Did you and the vet test the exact same drop of blood?
If not, which meter was used first, yours or the vet's pet meter?

The vet used a pet meter. You use a human meter for testing. There are always going to be differences between the 2 types of meters. Different algorithms behind the different types of meters. Different components in a cat's blood vs a human's.

You are looking for ranges, not for exact numbers Pat. That is why we have those number ranges on our standardized spreadsheet. There are going to be variations from test to test.
Is your vet aware of the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats that talks about the less stressful environment at home, leading to greater accuracy of BG testing?

So your vet wants to increase Brady's dose, by 0.25U, based on a single BG test done at the vet's office?
When Brady dropped to the low 100's today, before the vet visit?
Did your vet know about that lower BG reading, before she suggested that dose increase?
Did you share Brady's spreadsheet with your vet?
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I tested Brady before we left the house and for some unknown reason he had jumped up into the 400's....Honestly he was very chilled on the way to the vets, he actually had no problems getting into his carrier or anything and he has been pleasant the last few times we went to the vet, I think he knows he has to go now so might as well be a good boy....And yes I know there are variations to the different meters...Im concerned if mine is way off or theirs is way off...is my low numbers actually a hundred and some points higher....We are not permitted to go into the vets because of the virus, both the vet and the vet tech came out to the car and said he was purring for them and was a good boy, I don't know what test was taken first....I do understand the spreadsheet and the range of numbers and their purpose. I just feel lost when I was feeling so good....I mean his numbers aren't perfect by no means but I was actually getting pretty happy because he was getting a curve, high numbers at PS, lower in the middle and higher at the next PS.....In your opinion, and I know its an opinion but that is a lot of points off and what do you go by? 589 is a very high number....I tell the vet everything...I told her about the numbers I have been getting....I told her about his numbers being in the low 100's today, of course she just gave me a look, lol....I get those looks from my wife time to time and I still don't know what they mean, haha.....I told her about this site and the support we are getting.....Trust me, I think you know me by now, I don't leave anything out and I ask a lot of questions.....
 
Test yourself a few times Pat. Before a meal, then about 3-4 hours later. See what your BG levels are. It's a quick way to test your meter.

Did he see you get out the carrier, before you took that test before the vet visit?

Irish Pat said:
In your opinion, and I know its an opinion but that is a lot of points off and what do you go by? 589 is a very high number.
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Don't focus on the number of points that the meters vary by. Look at the percentage difference.

I went by the human meter that I was using to test my cat Wink. You'd have to look at his first SS tab, labeled 2012-2013 to see the very little bit of parallel testing I did with a pet meter vs a human meter. Remember that this is for only 1 cat, and for a very short period of time. So it can't really be relied on to say that all cats or even most cats or even just Brady would have that 20% difference in the readings that Wink had. Could be more, could be less. Even some human meters are more accurate and reliable as far as reproducibility of the BG test results.

There have simply been no controlled studies that I'm aware of, that have tested for that meter difference between pet and human meters. So we don't use any figures here. You go with the meter you have and can afford to use. For most people here, that is the human meter.

Anecdotally, there is roughly a 20% difference at the higher blood glucose levels when using a pet meter vs a human meter. So this is only my personal opinion, on the difference in the meters. FOR MY CAT ONLY.
 
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Deb & Wink said:
Anecdotally, there is roughly a 20% difference at the higher blood glucose levels when using a pet meter vs a human meter.
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Before I get too far into this discussion, I want to correct this. The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not even apply to human meters of a different type.

There is no equivalence between human and pet meters. You can also look at Gracie’s SS where I have an AT/Micro tab where I ran tests side-by-side to show they are very inconsistent. The very odd thing was the last few days of Gracie’s life when she was so sick, she saw higher numbers than she ever had and the Micro meter I had always used was higher than the AT. Normally, we see human meters across the board reading lower than pet meters but there are instances where they don’t.

Moral of the story, you have to pay attention to what you see on your meter and let the vet’s numbers go. You are not ever going to be able to make a comparison between them. It just doesn’t matter.

IMHO, since you are doing SLGS, today’s numbers were right where you want them, minus the vet stress and the bounce. But we know that Brady’s liver is still getting used to better numbers so the bounce is very normal. Gracie’s BG often went up with vet stress, too. Remember that what goes up comes back down. Breathe.

I would say 90%, over even higher, vets do not know how to dose insulin. I will give you an example. Even if Brady was on Lantus and Levemir and was doing TR, we wouldn’t raise the dose yet.

I’m glad Deb gave you some good links. I don’t need to repeat any of that but don’t ever worry about asking us what you think might be a hard question. Chances are we’ve already heard it as, most of the time, members have the same situations and the same questions. That doesn’t mean you shouldn’t ask them because you should. You should ask any and all questions that help you with this whether it’s the actual hands-on, the understanding, or just help your morale.
 
People have been searching for some sort of "conversion chart" or difference in the pet vs human meters, since 2006 when Abbott Pharmaceuticals saw a market for pet meters and came out with the original Alphatrak meter. More expensive, test strips are very expensive, test strips not available everywhere, but the company saw a "niche" market and they have convinced vet's that their meter is the one to use for pets. So it's the one most vets recommend to their customers.

People have been fruitlessly searching for some comparison values for hand held glucometers, because even a company like Abbott, has no data on cats with a pet vs human meter.

Before Abbott came out with their pet specific meter, everyone, including vets, used the human meters for diabetic cats (and dogs). For decades, many decades. As most people and members have used the human meters here, for decades since the board's inception.

Might as well describe the difference between an apple and a kumquat, trying to compare meters. Even my Relion Micro and Relion Confirm did not read the same always.
 
Do you guys feel a .25 dose increase should be done based off of the SS numbers? He isn't having a good day today...drinking more than usual and his numbers aren't coming down to good so far today......Just looking for some advice
 
He is 496 tonight on PMPS, sticking with the 2.25U until otherwise advised....I know im on the SLGS, but is there a way to jump up if his numbers are staying high...I will get a couple of tests tonight before bed
 
Irish Pat said:
He is 496 tonight on PMPS, sticking with the 2.25U until otherwise advised....I know im on the SLGS, but is there a way to jump up if his numbers are staying high...I will get a couple of tests tonight before bed
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Only if you wish to switch to modified dosing. It’s not advisable to follow one method and then change when numbers don’t look good and then change back.

Also remember he’s bouncing and this high number might be the High before the break.
 
Marje and Gracie said:
Only if you wish to switch to modified dosing. It’s not advisable to follow one method and then change when numbers don’t look good and then change back.

Also remember he’s bouncing and this high number might be the High before the break.
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Ok...the pressure is tough....Just a stupid question, is it a full 7 day week or a 5 day week? Today is day 5....and the other thing is he is hitting the water bowl a lot today...at times he wont leave it.....first he has done this in a very very long time.....
 
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Irish Pat said:
Ok...the pressure is tough....Just a stupid question, is it a full 7 day week or a 5 day week? Today is day 5....and the other thing is he is hitting the water bowl a lot today...at times he wont leave it.....first he has done this in a very very long time.....
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Deb is right...it’s a full 7 days. It looks like he’s still bouncing. I was hoping he’d clear tonight. Maybe tomorrow....paws crossed.
 
He's close to clearing the bounce, but not quite there yet.

When he has those fairly flat BG numbers in the 250-299 range, or even better in the 200-250 range (the flat yellows), that is a sign that he is starting to clear the bounce.

When he drops < 175 - 200, or even better under 150 (mid-range blues) , than the bounce has cleared.
For instance, look back at 4/29 AM cycle.
But then Brady bounced right back up, to those over 300 (pink colors), and the over 400 (red colors) prior to and after that vet visit.

Look back at 4/23/20 AM cycle too.

Let's see what Brady is at for this PMPS pre-shot.
 
Deb & Wink said:
He's close to clearing the bounce, but not quite there yet.

When he has those fairly flat BG numbers in the 250-299 range, or even better in the 200-250 range (the flat yellows), that is a sign that he is starting to clear the bounce.

When he drops < 175 - 200, or even better under 150 (mid-range blues) , than the bounce has cleared.
For instance, look back at 4/29 AM cycle.
But then Brady bounced right back up, to those over 300 (pink colors), and the over 400 (red colors) prior to and after that vet visit.

Look back at 4/23/20 AM cycle too.

Let's see what Brady is at for this PMPS pre-shot.
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Thank you....He is at 249 (yellow)…...

I guess my next question would be about changing the dose after the 7 days (ya know, a week, lol)…..but I seek that advice on either Saturday evening or Sunday....If he continues at these numbers do you recommend a bump up to 2.5 U?
 
Irish Pat said:
Thank you....He is at 249 (yellow)…...
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That 249 means he did not bounce sky high, after the lower 194 today. That's good. Slow but steady progress.

I guess my next question would be about changing the dose after the 7 days (ya know, a week, lol)…..but I seek that advice on either Saturday evening or Sunday....If he continues at these numbers do you recommend a bump up to 2.5 U?
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Yes, the next dose increase would be a 0.25U increase.

Let's make sure Brady needs that, and not "count our chickens before they hatch" and anticipate a dose change right now.
He could surprise us, and be lower 24 hours from now.
 
Deb & Wink said:
That 249 means he did not bounce sky high, after the lower 194 today. That's good. Slow but steady progress.



Yes, the next dose increase would be a 0.25U increase.

Let's make sure Brady needs that, and not "count our chickens before they hatch" and anticipate a dose change right now.
He could surprise us, and be lower 24 hours from now.
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Well hopefully you guys are around Saturday to let me know what you think...
 
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