well.. methods.

[kitten68]

hello!!

well im trying to decide which method or if the two methods suggested here (not sure if any more, lmk) are good to use for remission as much as is possible (along with the insulin used, tho some have had great results with short acting and remissions..).. understand TR is the method with the most success with that.. what about SLGS?

trying to acclimate to all this and not comfortable yet shooting low #s but understand over time when you know how your cat will respond, its ok (?)

any thoughts appreciated.

 

[Bron and Sheba (GA)]

With TR you can increase every three days if needed instead of waiting a week when on SLGS, so you have a better change of getting into better numbers earlier. With TR you reduce the dose at 50.
You are testing enough to do TR.
Cats have also gone into remission on SLGS. It is really up to you what you are comfortable with and what works for you.

 

[Sienne and Gabby (GA)]

The biggest difference for me is that TR is based on research. The two authors, Jacqui Rand, DVM and Kirsten Roomp (I think she's a PhD), used preliminary data from Dr. Rand's clinic at University of Queensland and generalized it to the German Lantus forum. They found similar results in their research lab at the university and with Lantus users. Those results have held up for quite some time now.

SLGS was developed here. It was the method that was used with every insulin until TR was published for use with Lantus and Levemir. We have seen any number of cats go into remission using SLGS. The research does indicate that TR is most effective for getting cats into remission within the first year of diagnosis. We've seen cats go into remission in weeks and I can think of one who went into remission following TR after 2 years. I also tend to think TR lays out the guidelines a bit more clearly most likely because they had to make sure that caregivers could follow the instructions. I still struggle with some of the flexibility with SLGS.

But, like Bron noted, there are good reasons to opt for each of the approaches. Some of it depends on lifestyle and what will work for you.

 

[kitten68]

With TR you can increase every three days if needed instead of waiting a week when on SLGS, so you have a better change of getting into better numbers earlier. With TR you reduce the dose at 50.
You are testing enough to do TR.
Cats have also gone into remission on SLGS. It is really up to you what you are comfortable with and what works for you.

appreciate that.. thanks. may consider it. truly. just have noticed that on the 4th day is when i see how things really look w the new depot thats accumulated.. am i wrong on this or?.. and so maybe can increase after 4 days?.. or how do ppl determine it?.. if depot takes a bit of time and things can be different from day to day the first weekd? sorry if already answered..

 

[kitten68]

The biggest difference for me is that TR is based on research. The two authors, Jacqui Rand, DVM and Kirsten Roomp (I think she's a PhD), used preliminary data from Dr. Rand's clinic at University of Queensland and generalized it to the German Lantus forum. They found similar results in their research lab at the university and with Lantus users. Those results have held up for quite some time now.

SLGS was developed here. It was the method that was used with every insulin until TR was published for use with Lantus and Levemir. We have seen any number of cats go into remission using SLGS. The research does indicate that TR is most effective for getting cats into remission within the first year of diagnosis. We've seen cats go into remission in weeks and I can think of one who went into remission following TR after 2 years. I also tend to think TR lays out the guidelines a bit more clearly most likely because they had to make sure that caregivers could follow the instructions. I still struggle with some of the flexibility with SLGS.

But, like Bron noted, there are good reasons to opt for each of the approaches. Some of it depends on lifestyle and what will work for you.

i see thanks for this, appreciate the suggestion.. well. just glad to hear SLGS has good remission rates too.. staying w that for now.. it is easiest for us at the moment. but TR is very enticing because finding his dose would come faster, and is more assured…. :/ what to do.

 

[JL & Cooper]

appreciate that.. thanks. may consider it. truly. just have noticed that on the 4th day is when i see how things really look w the new depot thats accumulated.. am i wrong on this or?.. and so maybe can increase after 4 days?.. or how do ppl determine it?.. if depot takes a bit of time and things can be different from day to day the first weekd? sorry if already answered..

I think it’s important to note that TR slows down as you get into better numbers. You hold longer when blue nadirs begin, hold even longer when green begins, and continue to hold when consistently in green. I held the lower doses on Cooper longer than TR because of vet preference, but you can see even at day 3-4 on each dose it was already clear he’d need another increase. I could have avoided some of the extra yellow/pink days by increasing him sooner (TR guidelines).

I hope that makes sense. That perspective, especially in hindsight when looking at his SS, made sense to me and helped TR feel comfortable instead of rushed compared to SLGS.

Glad to see you back on here! I’ve been looking at Pudge’s SS periodically- yay for a bit of blue yesterday!

 

[kitten68]

I think it’s important to note that TR slows down as you get into better numbers. You hold longer when blue nadirs begin, hold even longer when green begins, and continue to hold when consistently in green. I held the lower doses on Cooper longer than TR because of vet preference, but you can see even at day 3-4 on each dose it was already clear he’d need another increase. I could have avoided some of the extra yellow/pink days by increasing him sooner (TR guidelines).

I hope that makes sense. That perspective, especially in hindsight when looking at his SS, made sense to me and helped TR feel comfortable instead of rushed compared to SLGS.

Glad to see you back on here! I’ve been looking at Pudge’s SS periodically- yay for a bit of blue yesterday!

i read this and realize it also! ~ figured once regulated and working with the numbers doses are kept longer and longer.. just was wondering if after only 3 days is what u see enough to determine increases cuz i thought the depot took a few days to adjust before you could decide.. im DYING to get out of pink and yellow as soon as possible.. (i do appreciate his starting isn't as high as some other cases.. and im going to be thankful for that.. tho they can come down too!)

rushing tbh is truly fine by me lol just keep hearing don't rush don't rush.. lalala. and also cause u want to prevent any events. :/ for sure. TR seems to require a truckload of strips tho.. woof!!!

 

[kitten68]

soo.. did more readin, and do have a better grasp. the differences between each, far as i can tell, is generally that TR shoots low #s and you change doses quickly after 3 days.. while SLGS does not, and you change doses after 7.. testing all the time with TR is important because changes are being made so frequently, right? and because low numbers are being shot.. SLGS testing is definitely PS, and if can do at least one other time per cycle?

(sorry if this was said! just getting it..)

hm. will probably continue on SLGS for now.. but am wondering, if you're pretty sure after day 4 or 5.. would adjusting the dose a bit earlier then be bad? also, its suggested always to try to change by .25 increments but on Tilly's Diabetes page (which is linked in the Dosing methods stickie..) it says there that .25 U OR .5 U is ok to also use.. especially if #'s and the dose is higher.. .25 is more important for lower doses and lower #s. could you mix some parts of the methods up?.. has that been done?

well was thinking for us, i don't know if .25 is enough again too. was thinking to do another .5.. haven't got down to 150 at all. so idk. adjustments due Friday..

 

[tiffmaxee]

Even with TR you would not increase by .50. You would just take the increases sooner. You test more than enough to do TR.

 

[kitten68]

everyone. nadir +6 and it's 157... on Day 7 (I guess?.. notice some low #s at all hours of the day.. tho seems to be more around +5, +6 ..)

so.. since 157. thinking not to change now for a few days. it's nearly 150. he'd eaten some too I think... I can't remember good. maybe just a .25 IS what's needed eventually?.. .5 to go down maybe below 100s, if do TR.. yikes or idk. hm.
interesting. thinking will stay here for some days more now.. (1.5 U..)

and my thing with TR is that im just afraid of dealing with a hypo event.. SLGS seems a little more safer in regards to that or am i missing it? nice to hear could do TR if wanted @tiffmaxee , do I recall correct that just minimum two tests needed, outside of PS? so could get away with just 4 a day on TR, although of course more is better.. or which? what's the minimum for SLGS?.. I just test cause I wanna know and am nervous.. and cause we're finding dose too right..

just have been feeling like ive been actually testing too much.. he hates being tested sometimes. was gonna scale back a little give him a break now we've changed and settled pretty much in (Lantus)... but when I look at SS.. most days really aren't more than 2 tests outside of shots unless dose changed or was watching something.. just looks that way all together I think. guys I see all these colored boxes.. and just ugh. but it's to help him get better.. it's to help him get better...... *cries

thank you everyone for listening. advice..

@JL & Cooper @Bron and Sheba (GA) @Sienne and Gabby (GA)

 

[kitten68]

Even with TR you would not increase by .50. You would just take the increases sooner. You test more than enough to do TR.

ah! I see ~ and thanks for that! just from reading, on Tilly's Diabetes page.. she says you could do .5 IF you wanted. it is an option on TR.. .25 or .5, according to there.. apparently for higher BGs and higher doses (Phase 2, increasing from web). eh? idk. but I know here is always stressed to try .25 when doing increases..

 

[tiffmaxee]

You could increase but if you want to give it a couple more days that’s fine. Stick with SLGS for now but only decrease if the bg is under 90 rather than 100. With TR reductions are under 50 and in my opinion you are not ready for that yet based upon what I hear you saying. Nothing wrong with sticking with SLGS.

 

[tiffmaxee]

ah! I see ~ and thanks for that! just from reading, on Tilly's Diabetes page.. she says you could do .5 IF you wanted. it is an option on TR.. .25 or .5, according to there.. apparently for higher BGs and higher doses (Phase 2, increasing from web). eh? idk. but I know here is always stressed to try .25 when doing increases..

Reducing in larger amounts is for higher doses. At 4.5 or 5 units if you needed to increase it would be by .50 . SLGS is much less aggressive so it’s not suggested you reduce by .50. I suggest you go by the SLGS recommendations as that’s what we use here.

 

[kitten68]

You could increase but if you want to give it a couple more days that’s fine. Stick with SLGS for now but only decrease if the bg is under 90 rather than 100. With TR reductions are under 50 and in my opinion you are not ready for that yet based upon what I hear you saying. Nothing wrong with sticking with SLGS.

okay! will consider.. but thinking to hold dose few a little more.. will keep in mind. yeah thinking SLGS still.. thanks for that!! (so.. should indeed be/get comfortable/knowledgeable with potentially treating hypo/low #s especially on TR right?..)

 

[kitten68]

Reducing in larger amounts is for higher doses. At 4.5 or 5 units if you needed to increase it would be by .50 . SLGS is much less aggressive so it’s not suggested you reduce by .50. I suggest you go by the SLGS recommendations as that’s what we use here.

right, on her website says when increasing too. I don't have any idea, just what it says.. eh? but here it's .25. ahhh I see. right. well, she mentioned if the BGS were higher also.. could do that as well, increase by .5.. idk.