? 4/17, Susie, 199 AMPS, Question About Dosing Protocol (SLGS/TR)

https://felinediabetes.com/FDMB/threads/4-16-susie-243-amps-260-2.246213/#post-2778555

I do not want to disrupt the system but I believe I have seen one member has a "modified" SLGS (or TR). My question is: Do I have to hold firmly to when I can take a reduction? Being on SLGS I would not want to take a reduction if I got an 85. Being on TR I would want to take a reduction if Susie fell below 60. Can a CG make their own decision regarding when they can take a reduction? I would like to stay on TR with the option to reduce if Susie falls below 60. Maybe with time and more data I would be more comfortable with holding a dose at 50 but I doubt it and I am not aiming for remission - at least not at this point.

On another note, Susie is enjoying her early morning at the beach! This was short-lived with a 246 @+2. Thinking the higher carb FF (chopped grill and beef) probably don't help. Susie likes the seafoods (lower carb) and I know this board does not like the seafoods but I am going to stick with them from time to time. I noticed on 4/4, when Susie had a 110 @2.5 that she had eaten the FF salmon at AMPS.

 

I like these blues popping up!

The advice I've seen here before is that no, you cannot modify TR. I wanted to do the same thing - I like that I can increase doses faster on TR and I test often regardless, but can't currently manage the low numbers on a regular basis.

I think the idea is that Tight Regulation is a very strict method that requires a lot of safety - and it's easier for forum users to give advice based on one set of rules.

I personally do not see the harm (for Mr Kitty and I) of continuing to test like I do, reduce after 2x below 60 or once below 50, and increase after 4-5 days if needed. That's technically like a weird TR/SLGS hybrid and will probably drive some people nuts...but I've been at this awhile now, have a lot of data, and it's what I think I need to do to balance my current lifestyle and keep him in relatively good numbers.

 

If I remember correctly you are on SLGS right? I think I might go back if it gives me a little more leeway to be flexible. I think you should be doing what you feel is right for Mr. Kitty and not have to follow a strict protocol. I can handle the seven days on a dose (unless I need a reduction). I'm pretty much already doing that anyway.

Update: I just saw where you are on TR. I think it is Carla on SLGS. Will have to check.

 

I do a modified SLGS with Furball where I take reductions when she gets 60 or below. I've never seen anyone recommend modifying TR because you have to have such a low number for reductions and it has safety protocols built in. If you know when Susie typically onsets and when her nadir usually is, i think you test enough to modify the number you can take a reduction if you switch to SLGS.

 

It’s strongly suggested not to modify TR but ok to modify SLGS once you have data.

 

I do know some people with diabetic cats that have higher BG with beef. I personally don't feed beef because it's such an "unnatural" food for cats (meaning they don't kill cows in the wild) but I have been considering it recently because I like the lower phosphorus in a lot of the low carb beef / beef mixture formulas that I have been researching.

 

I like that blue this morning and the blues last night. I think this is encouraging. It's the second day, though, so sit tight.

 

Thanks, Carla. I feel like I am taking a step back but I will go back to SLGS. I want to be in control if Susie ever drops below 60. I don't know when she onsets. I guess that is after the shot when she first starts to go down. Can you look at her spreadsheet and take a guess for me? I will look at it too.

 

Elise do I need to do anything special to return to SLGS other than change my spreadsheet. Do I need a moderator's approval?

 

She came back down for my +4 and +6. I'm not ready to go what you went through last night. As I said, I would be happy with numbers between 80 and 120 (70 - 110). I know it is impossible to control that though. Hope Darcy ate something for you today.

 

Wow. How exciting! I just looked at her spreadsheet again and I am so happy to see those blue numbers!

 

I just wanted to remind that you switched to TR only because you want to be able increase Susies dose a bit quicker in order to get to a better dose faster and not let insulin toxicity to settle in. Susie still is not at a perfect dose, maybe it would make sense to stick to TR until you start seeing more consistent blues and then switch to SLGS back.

After she reaches a better dose i like your initiative to follow the modified SLGS. I know that thats what would make you more comfortable and it gives Susie a higher healthy range to stay in: thumbs up for that

 

So when I first started, I wanted to do a "modified TR". Answer: doesn't exist. So, if you're going to modify anything, you're not doing TR and if you call it "TR" on your signature line/in your converstaions, it will confuse people trying to help you and you won't get the advice you need for the method you are using, because "TR" has certain requirements, and you won't be adhereing to those requirements.

 

Hi Summer! Looking at your spreadsheet, it looks like Susie onsets somewhere between the +2 and +3. She's usually a little higher at +2 than she was at AMPS, then at +3 she's lower than AMPS... so somewhere in there is when the insulin seems to start kicking in. What do you think?

 

I like how blues are becoming more common for Susie.

If you want to switch back to SLGS, just change your spreadsheet and the signature. That's it. If you have any modifications to SLGS you are using, it'll help to note those, otherwise people will be constantly wondering.

We don't take bits from SLGS and bits from TR and make our own dosing method. You might want to read this post, especially the post #37 by Libby. She also links a post that gives guidelines on when and how to think about changes you could or should not make to SLGS.

 

I usually hold the dose for about 7 days anyway. I'm going back to SLGS. I understand what you are saying but I am also liking the results right now with the new dose so I'd feel more comfortable with the options I have on SLGS that I don't have on TR. Thanks, Marina. Not to oppose you. Just preparing for the future.

 

I guess that is why they call TR tight regulation. I will not try to sway from those protocols. I just feel like I have more control with the SLGS. I usually hold Susie to a certain dose for seven days, anyway. I am testing enough, at least during the daytime hours, and I am liking what I see with the new dose. I just want to have some control if the numbers drop to where I am not comfortable.

 

Thanks, Wendy. Consider me one of those that is not taking a chance with hypoglycemia. I know that the experienced folks on this site are bound and determined to get kitties into remission - understandably. I am not one of them. I am not that comfortable. Nor do I have help deep in the night to test. I love my cat but I need to sleep too. I am in this all by myself with no DH or kids to help and if I am not comfortable with TR then I will stay with SLGS. I want some control. I will do everything I can to keep Susie below the renal threshold but I am not going to stay up night after night testing every hour on the hour like I see so many folks doing. I read #37 of your link and printed the rest of the article to read latter.

#37. "While remission is possible using Start Low, Go Slow, there is less emphasis on remission as a goal with this approach". I will accept this and work with it.

I also understand that the protocols are put in place for a cats safety and I will adhere to them.

 

I think Susie's onset is about +2 to +3. If you are going to modify the reduction number, you'll need to add it to your signature. See how I did mine for Furball.

 

I don't know how to get to your signature. I found it. It says "reductions at 60". Thanks, Carla. I'm glad I am in this with you

 

Hi!

We also do modified SLGS and take reductions at 70 for Cosmo

Nice to see all those blues!

 

No. Nothing special. Just change your signature and if you will reduce at a lower number add that as well.

 

Thanks for letting me know that, Tanya. I like your reductions at 70 better than 60 but I shot a full dose at 64 a few days ago so I guess I will stick with 60 unless I can't monitor or Susie won't eat.