TR vs SLGS explanation please

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Michele&Errol

Michele&Errol

Member Since 2013
I was reading the sticky on the Insulin Support Group and this opening sentence has this newbie confused : confused_cat
"Our motto in the Tight Regulation Insulin Support Group is "Shoot Low to Stay Low". We follow a Tight Regulation Protocol with Lantus or Levemir not a "Start Low - Go Slow" (SLGS) method..."

Could someone please explain exactly what the difference is between TR and SLGS?
Thanks
 
I don't hear a lot of discussion of SLGS either, so I'm not very familiar with it, but the explanation I can find for SLGS (I followed the link to this from the Lantus & Levemir TR Protocol sticky, not sure if there are other versions?) says:

After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve ...
follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Click to expand...

Compare to TR:

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit.
Click to expand...

I think the two differences that stand out to me are that SLGS holds a dose for a lot longer than TR, and that TR wants to see lower numbers overall than SLGS. SLGS calls for reductions after nadirs of 90, whereas TR keeps the dose until nadirs drop below 50 (or 40).
 
There are two Lantus forums on this site - a TR forum and a Relaxed Lantus forum. The Relaxed forum was started because there were people whose lives would not allow them to test as often as Tight Regulation might require and who might want to go slower with dose increases. The Relaxed forum is smaller and less active than the Tight Regulation forum. It might be helpful if you would check out the threads/spreadsheets on that forum to see differences.

http://www.felinediabetes.com/FDMB/viewforum.php?f=32
 
You can post in either TR or Relaxed Lantus. TR is much more active and geared moreso toward daily dosing assistance whereas Relaxed is just that: a lot more leisurely. You don't have to follow TR to post in TR (just make sure you note that somewhere in your signature) and you don't have to not follow TR to post in Relaxed. It's more in where your comfort lies and what your particular needs are. (Do you need a lot of dosing advice or have you got it figured out for the most part? Are you posting daily or weekly?) Some people even sometimes cross-post in both on occasion.
 
If you want to see what a couple of Relaxed Lantus kitties spreadsheets look like you are welcome to take a look at either Autumn's or K.C. (Casey ran out of characters in my signature..lol) both are SLGS protocol although Casey is a recent addition to my home as a foster, he was being grossly overdosed by his previous vet and being shot blind 11u b.i.d. and being fed prescription dry food (Science Diet W/D) so the first part of his spreadsheet is a little wacked. as I tried to find his ideal dose, deplete a shed the size of Lake Michigan and find any wet canned food he would eat. I do most of the dosing advice over in Relaxed Lantus as right now I'm the one with the most years of experience even though of my 3 sugarcats one is OTJ and has been for the last 3 years, one is lifetime insulin dependent (Levemir) and Casey is new and also Levemir. My only true Lantus boy is the one in remission.

Basically Relaxed is just that Relaxed not in the care of our sugarcats but in our posting style, and frequency of testing. We are much much smaller group so a lot of time there isn't always someone around to answer questions that need immediate answers. But we to have a lot more time to walk through the wherefores and whys of protocol just because we don't have 30+ cats to check in on. We are the ideal place for those that have been at it awhile and have it pretty much figured out, as well as those that are just starting out and need a little more one on one hand holding..

TR is awesome for those that have testing down and are ready and able to be aggressive in treatment, because they do strive for holding cats in lower numbers which obviously requires more testing to keep the kitty safe. They are also awesome for those folks with cats that have other complicating health issues, just because they are so much larger of a group so there is a greater chance that someone there has already faced what you are facing.

I happen to post in both forums because Autumn and Casey are two completely different cases. Autumn was left untreated for nearly a year before I adopted her, and needed to gain weight, Casey was severely overdosed and obese so he needs to lose weight....Putting on weight and dialing in a dose for ground zero I have done a few times ....Taking the pounds off and trying to bring a dose back to a reasonable level, that was a new one on me so Casey is in TR, Autumn is in Relaxed and both are SLGS because I also have 13 civies, a large drooler and a DH to care for so I don't have the time to always test a bunch of times during the day and especially at night.

Mel and The Fur Gang
 
I feel that TR is a bit more aggressive in dosing and gets your cat regulated or into remission a bit faster - useful when the remission window is only 6 months from diagnosis. And TR doesn't allow for insulin resistance to build up.

But SLGS could in theory ignore bouncing too if you are only doing a curve once every 2 weeks day?


Wendy
 
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