? 03/08 Zot | AMPS 78, +2.75 113, +6 87, +8 85, PMPS 82, 86

ThisIsAllForZot

ThisIsAllForZot

Member
Previous: https://felinediabetes.com/FDMB/thr...1-4-93-7-94-9-92-pmps-83.298924/#post-3251472

I am still struggling to shoot green numbers below 90 and need a bit of assistance. I have read through TR, as I feel like it might be the best thing for Zot. He doesn't really seem to want to "go slow" and has responded much quicker to insulin than I initially suspected.

I chose SLGS initially because it seemed similar to how my Vet was going to treat him at the time, as well as beginner-friendly. In yesterday's thread, I spoke a little about my experience with it so far. I got comfortable shooting numbers under 200, he stopped sitting near 200. So I tried to get comfortable with 150, but he isn't reading 150 at pre-shots anymore, either. I tried getting comfortable with 120 readings, and the same thing happened. Now, 2 pre-shots in the last 2 days have been around 90 or below, and it's been very hard for me to make a decision comfortably while being new to all of this.

I also don't entirely know how he responds consistently to insulin, but his diagnosis is so recent. I know he responds quickly/well (or has so far), but that is it. So it makes it a little harder to be comfy with shooting when I don't entirely understand him yet as a diabetic kitty or his usuals, apart from him sitting in greens/blues.

I read through all the links, and I don't know if I'm missing something. I think I remember @Sienne and Gabby (GA) saying something about anything over 50 being okay to shoot? Correct me if I'm wrong; I've posted so much that I'm struggling to find the conversation. (Tagging you here to get your input <3)

Basically, I'm nervous, and I may need to have this explained to me like I'm a complete child. The SLGS felt very direct with the numbers (eg, Beginners don't shoot if under 200, etc), and obviously, with each cat being different and him responding much quicker than I thought he would, this has all been happening so fast. It is very hard to keep up mentally with remembering all the information about numbers and dose reductions and his numbers going low blues/high greens so quickly (and additional things like the functions of the body producing natural insulin or healing, depots, etc). Ultimately, I just want to make the best decision moving forward, and I might need someone to give me the nudge to shoot below 90 if that is what is necessary. I don't want to hinder his progress.
 
Hi Stephanie,
Until a moderator pops in with dosing advice, here is the sticky that explains both dosing methods: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I'll specifically highlight this section:

"How to handle a lower than normal preshot number:

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. 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 Lantus, Levemir, and Biosimilars 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:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

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. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat."

It's normal to feel nervous about shooting greens.
 
Last edited:
Marielle said:
Hi Stephanie,
Until a moderator pops in with dosing advice, here is the sticky that explains both dosing methods: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I'll specifically highlight this section:

"How to handle a lower than normal preshot number:

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. 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 Lantus, Levemir, and Biosimilars 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:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

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. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat."

It's normal to feel nervous about shooting greens.

I'll tag a few others for you in case Sienne is not around:

@Wendy&Neko
@Angela & Cleo
@Bandit's Mom
@tiffmaxee
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Thanks so much, I've read through these so many times, but I still somehow always manage to space something out of there. I am putting this on my wallpaper as well so that I will remember its there to look at when I get stressed about numbers <3
 
Marielle said:
Also, when you are stalling and waiting for advice, it's helpful for the moderators to know that at a glance, so if you can change your title to reflect (after your dosing information) "stalling--waiting for advice." Leave the "?" up.
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That is assuming you are stalling. I saw "stall" on your sheet, so I'm not sure.
 
Marielle said:
Also, when you are stalling and waiting for advice, it's helpful for the moderators to know that at a glance, so if you can change your title to reflect (after your dosing information) "stalling--waiting for advice." Leave the "?" up.
Click to expand...
Thank you, will add in the future, I have already skipped this dose, but next time I am stalling, I will make sure it is in the title.
 
ThisIsAllForZot said:
Thank you, will add in the future, I have already skipped this dose, but next time I am stalling, I will make sure it is in the title.
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Gotcha! I wasn't sure what your dosing time was, and since you just posted, I thought you might be waiting. I'm going to untag some of those folks since you're not stalling.
 
ThisIsAllForZot said:
Thanks so much, I've read through these so many times, but I still somehow always manage to space something out of there. I am putting this on my wallpaper as well so that I will remember its there to look at when I get stressed about numbers <3
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It's easy to get nervous in the moment, too, and sometimes hard to re-read the instructions when you're under pressure to make a decision.
 
With TR, you can shoot any number above 50. There are a couple of caveats:
  • Are you able to monitor? You don't want to shoot a low number, especially if you are new at seeing low numbers and giving a shot, and leave the house for the day. You definitely want to be able to get a few tests early in the cycle to be sure where the numbers are going.
  • Do you have supplies? Inevitably, if you are new to this, the day you decide to shoot low, you only have a few strips or manage to dump the container of strips into a sink full of water.
  • Do you have high carb on hand? Karo is not the only high carb! Corn syrup (Karo), honey, maple syrup, sugar water, even ice cream (as long as it's not chocolate), as well as high carb cat food are all options for bumping up low numbers.
Let me also make an observation. You shot a PMPS of 99 a couple of days ago. It helps to remember that there's a 20% measurement error with any test due to the monitor and strips. It's inherent error. What that means is that any test value is plus/minus 20%. Thus, your 99 pre-shot is actually somewhere in the neighborhood of 80 - 120. That knowledge may give you a bit more confidence when deciding whether to shoot. You shot yesterday morning and had a gorgeous green cycle. What you're seeing is that shooting lower numbers is not causing Zot to drop into a dangerous blood glucose range.

The other thing to consider is that every time you skip, you are emptying the depot. From the standpoint of TR, if you skip a shot, the cycle count starts over. Rather than holding the dose for three cycles in order to evaluate how well the dose is working, your 3-cycle count starts over.

I would have suggested that you keep stalling this morning unless it wasn't possible for you to get off schedule. This weekend is weird given daylight savings time, as well. We generally tell members that stalling needs to fit with your schedule and that you can stall more than once.
 
Last edited:
Sienne and Gabby (GA) said:
With TR, you can shoot any number above 50. There are a couple of caveats:
  • Are you able to monitor? You don't want to shoot a low number, especially if you are new at seeing low numbers and giving a shot, and leave the house for the day. You definitely want to be able to get a few tests early in the cycle to be sure where the numbers are going.
  • Do you have supplies? Inevitably, if you are new to this, the day you decide to shoot low, you only have a few strips or manage to dump the container of strips into a sink full of water.
  • Do you have high carb on hand? Karo is not the only high carb! Corn syrup (Karo), honey, maple syrup, sugar water, even ice cream (as long as it's not chocolate), as well as high carb cat food are all options for bumping up low numbers.
Let me also make an observation. You shot a PMPS of 99 a couple of days ago. It helps to remember that there's a 20% measurement error with any test due to the monitor and strips. It's inherent error. What that means is that any test value is plus/minus 20%. Thus, your 99 pre-shot is actually somewhere in the neighborhood of 70 - 120. That knowledge may give you a bit more confidence when deciding whether to shoot. You shot yesterday morning and had a gorgeous green cycle. What you're seeing is that shooting lower numbers is not causing Zot to drop into a dangerous blood glucose range.

The other thing to consider is that every time you skip, you are emptying the depot. From the standpoint of TR, if you skip a shot, the cycle count starts over. Rather than holding the dose for three cycles in order to evaluate how well the dose is working, your 3-cycle count starts over.

I would have suggested that you keep stalling this morning unless it wasn't possible for you to get off schedule. This weekend is weird given daylight savings time, as well. We generally tell members that stalling needs to fit with your schedule and that you can stall more than once.
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Okay, this is reassuring. Thank you again; you have helped me so frequently thus far. Your opinions and knowledge are so greatly appreciated; words can't even explain! I was equally excited as I was nervous to see so many greens.

The 20% measurement error is one of the most vital pieces of information I keep forgetting. I struggle a lot with my ADHD, and this is the first time I've had to be super particular and organized for something incredibly important. Still a little all over the place over here!
I have been so concerned about skipping doses because of the depot and truly do not want to do it anymore if avoidable.

I am still strongly considering TR still I will think about it for a few more days and stock up on more supplies (I only purchased 100 test strips initially and had no idea how fast they went- Oh my).

As for stalling longer, it got really unexpectedly busy here, so I had to make a decision quickly.
 
ThisIsAllForZot said:
Yes, in a super anxious state, things move too quickly. I could keep calm and collected while caregiving for human beings, but cannot for the life of me pull my anxiety together when it's my cat, sigh. It's so difficult!
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You're not alone, Stephanie! I feel this exact same way. It's really hard. I just started TR relatively recently after keeping with SLGS for a while for the same reasons as you. While Xander's not regulated yet I already like this so much better. I hope TR works well for Zot too! ❤️
 
Brianna & Xander said:
You're not alone, Stephanie! I feel this exact same way. It's really hard. I just started TR relatively recently after keeping with SLGS for a while for the same reasons as you. While Xander's not regulated yet I already like this so much better. I hope TR works well for Zot too! ❤️
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Thank you so much. This is also very encouraging! I'm always over here telling all my friends about how supportive, patient, and understanding/relatable everyone is on this forum!

It is so hard adjusting, Zot seems physically ready to fight to kick diabetes in the butt as hard as he can, and I'm just here in a little anxiety bubble trying not to obsess over certain readings lol! And, meanwhile, Zot has no clue what's going on, and he's just happy to exist and eat wet food for meals and watch the stray cats outside. He's blissfully unaware of the mental war I'm having over here, haha.
 
Angela & Cleo said:
For some reason, I'm not getting notifications when I'm tagged. Sorry @Marielle I was not ignoring you.

@ThisIsAllForZot if it makes you feel better, and since you are both so new, I probably would have advised skipping since you're still following SLGS. :bighug::bighug::bighug:
Zot is looking like he wants regulation and earned another reduction. Congratulations :cat:
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Just FYI, I removed the tag once I understood Stephanie wasn't waiting for dosing advice. Maybe that's why you weren't notified??
 
ThisIsAllForZot said:
Thank you so much. This is also very encouraging! I'm always over here telling all my friends about how supportive, patient, and understanding/relatable everyone is on this forum!

It is so hard adjusting, Zot seems physically ready to fight to kick diabetes in the butt as hard as he can, and I'm just here in a little anxiety bubble trying not to obsess over certain readings lol! And, meanwhile, Zot has no clue what's going on, and he's just happy to exist and eat wet food for meals and watch the stray cats outside. He's blissfully unaware of the mental war I'm having over here, haha.
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I do too! Everyone here is so nice and I'd be completely lost without this forum. It really feels like being left alone in the middle of the ocean because the boat left you behind.

I know exactly what you mean! Although in my case, Xander is just like me in general. We're anxiety buddies together, for better or worse! lol I'm glad that it at least sounds like Zot isn't suffering too much, just chugging along while you do all the hard work for him lol
 
Brianna & Xander said:
I do too! Everyone here is so nice and I'd be completely lost without this forum. It really feels like being left alone in the middle of the ocean because the boat left you behind.

I know exactly what you mean! Although in my case, Xander is just like me in general. We're anxiety buddies together, for better or worse! lol I'm glad that it at least sounds like Zot isn't suffering too much, just chugging along while you do all the hard work for him lol
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I guess the whole "orange cats are tanks" thing is confirmed. He seems completely unbothered, aside from being picky about his wet foods. He really only wants to eat the real expensive stuff lol.
Xander is a cutie <3

@Angela & Cleo Yes, he's going down to 0.25 next dose! Thank you!
 
@ThisIsAllForZot, FYI, Jude did sort of the same thing Zot is doing when he was first diagnosed. Take a look at Jude's spreadsheet, back in 2024. Once I made a food adjustment after he was diagnosed, he was pretty much in remission. He came out of remission in October when he developed a UTI--that caused his numbers to spike, and he was quite unregulated for a good part of last year up until just recently. We're still working on regulation, but he's doing much better now. I sure hope Zot does the same thing! By the way, how old is Zot?
 
Marielle said:
@ThisIsAllForZot, FYI, Jude did sort of the same thing Zot is doing when he was first diagnosed. Take a look at Jude's spreadsheet, back in 2024. Once I made a food adjustment after he was diagnosed, he was pretty much in remission. He came out of remission in October when he developed a UTI--that caused his numbers to spike, and he was quite unregulated for a good part of last year up until just recently. We're still working on regulation, but he's doing much better now. I sure hope Zot does the same thing! By the way, how old is Zot?
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Yes! I did take a peek at your SS a couple of days ago and I saw that. It's a little scary when it happens so fast, and I am sorry about the relapse :( I am glad Jude is doing a lot better now!

Zot is 13, he will be 14 in June! He's a bit of a senior kitty but doesn't really show it in his personality.
 
ThisIsAllForZot said:
Yes! I did take a peek at your SS a couple of days ago and I saw that. It's a little scary when it happens so fast, and I am sorry about the relapse :( I am glad Jude is doing a lot better now!

Zot is 13, he will be 14 in June! He's a bit of a senior kitty but doesn't really show it in his personality.
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It's wonderful when it happens! I hope Zot is lucky enough to see it, and remain in remission (ANTIJINX!). Lantus is a good insulin for getting them into remission, as is the TR method. That said, Jude went into remission on SLGS. He just needed that food adjustment. It will be interesting to see how things transpire for Zot.
 
Marielle said:
It's wonderful when it happens! I hope Zot is lucky enough to see it, and remain in remission (ANTIJINX!). Lantus is a good insulin for getting them into remission, as is the TR method. That said, Jude went into remission on SLGS. He just needed that food adjustment. It will be interesting to see how things transpire for Zot.
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I hope so, too! I am not in the greatest place financially, and the double whammy of diabetes (even though it can be affordable) along with the tooth extraction he needs is very expensive. So, remission would be amazing for both of us! However, I am worried that if he goes into remission before I can get his teeth taken care of, he'll just relapse again. He has a bad tooth causing a toothroot abscess, so the infection will definitely come back in weeks or months. So close to saving enough for it!

Zot's numbers were pretty high in October for BG due to stress most likely as well as diabetes; they went well over 500mg/dL, and then was confirmed on the 25th when his BG read 300mg/dL at the vet. The vet was very encouraging of home testing and seemed incredibly supportive, which has been nice.
 
ThisIsAllForZot said:
I hope so, too! I am not in the greatest place financially, and the double whammy of diabetes (even though it can be affordable) along with the tooth extraction he needs is very expensive. So, remission would be amazing for both of us! However, I am worried that if he goes into remission before I can get his teeth taken care of, he'll just relapse again. He has a bad tooth causing a toothroot abscess, so the infection will definitely come back in weeks or months. So close to saving enough for it!

Zot's numbers were pretty high in October for BG due to stress most likely as well as diabetes; they went well over 500mg/dL, and then was confirmed on the 25th when his BG read 300mg/dL at the vet. The vet was very encouraging of home testing and seemed incredibly supportive, which has been nice.
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It's okay if he goes into remission and then comes back out. I definitely wouldn't worry about that. You'll just keep testing and restart insulin as needed. Is he on antibiotics for the dental issue?
 
A suggestion for you that might help you feel more comfortable shooting under 100. Next time you see a green preshot and want to shoot, get a +1 and a +2 test. Those two tests will give you an idea how the cycle is going to go, and whether you need to intervene early with carbs. The +1 test has a second benefit. It tells you how much of a numbers bump he'll get from dinner. You aren't really shooting the preshot number, but rather his number at onset, which is typically a couple hours later. When you've gotten +1 tests so far, he's had blue preshots and gotten between 10-20 points bump. Today it looked like he went up 35 points from preshot over a couple hours.

One other thing - Lantus is great at keeping low number preshot cycles flat. I loved shooting when Neko was in the 80's, cause she'd move no more than 10 points the entire cycle, unless she bounced. :rolleyes: But it took a lot of nervous shooting before I got that data.

Just make sure to keep your subject line up to date with the most current data, so experienced people can see whether you need help.

@Marielle Just a FYI, moderators aren't the only people who can help with dosing suggestions. There are lots of experienced people here like Angela who can also help out. Moderators means we do extra things, like getting rid of spammers, and making sure what is posted is in keeping with the FDMB guidelines.
 
Marielle said:
It's okay if he goes into remission and then comes back out. I definitely wouldn't worry about that. You'll just keep testing and restart insulin as needed. Is he on antibiotics for the dental issue?
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Currently, there is no infection, so he is not on antibiotics at the moment. This is true, though. Just rinse and repeat, and as long as he's happy and healthy, so am I.
 
Wendy&Neko said:
A suggestion for you that might help you feel more comfortable shooting under 100. Next time you see a green preshot and want to shoot, get a +1 and a +2 test. Those two tests will give you an idea how the cycle is going to go, and whether you need to intervene early with carbs. The +1 test has a second benefit. It tells you how much of a numbers bump he'll get from dinner. You aren't really shooting the preshot number, but rather his number at onset, which is typically a couple hours later. When you've gotten +1 tests so far, he's had blue preshots and gotten between 10-20 points bump. Today it looked like he went up 35 points from preshot over a couple hours.

One other thing - Lantus is great at keeping low number preshot cycles flat. I loved shooting when Neko was in the 80's, cause she'd move no more than 10 points the entire cycle, unless she bounced. :rolleyes: But it took a lot of nervous shooting before I got that data.

Just make sure to keep your subject line up to date with the most current data, so experienced people can see whether you need help.

@Marielle Just a FYI, moderators aren't the only people who can help with dosing suggestions. There are lots of experienced people here like Angela who can also help out. Moderators means we do extra things, like getting rid of spammers, and making sure what is posted is in keeping with the FDMB guidelines.
Click to expand...

Thank you! I will make sure to start doing more +1 and +2 preshots, I think that will help me feel a lot better about testing. I guess I didn't put as much thought into that because it usually takes a couple of hours for it to kick in, and yeah, I do see the 10-20 point bumps. Good eye. I'm not good with this sort of stuff yet, so I probably would have just missed that for a while.

Yes, nervous shooting, it's just a bump in this journey I need to get past. I usually keep my SS up to date as soon as I get the reads on information, and of course, the one time I didn't, it cleared off my meter, and I lost some clear readings. Never doing that again unless I have no choice.
 
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