Improving Clarity for Diabetic Cat Care Guides

[Kosmo]

Hello everyone,

I believe that the current explanations including those found on FDMB, can sometimes be overwhelming and difficult to understand for newcomers.

Many caregivers with newly diagnosed diabetic cats may find themselves confused by complex terminology, unclear instructions, or walls of text without clear structure.

I want to change that.

My goal is to make feline diabetes management as clear, accessible, and user-friendly as possible for every cat owner who visits SugarCatCentral.

This means:

• Clarity and Simplicity: Rewriting all explanations in a clear, beginner-friendly manner, avoiding unnecessary jargon, and ensuring that all terms (like "pre-shot," "AMPS," "PMPS", ''Nadir'', and more) are clearly defined the first time they are mentioned.
• Visual Tutorials: Providing visual guides with images for complex concepts (e.g., how a U100 syringe looks, what a hypo kit should contain).
• Logical Structure: Organizing information so that each page connects logically to the next, making it easy for users to navigate without getting lost.
• Hyperlinked Content: Interconnecting related pages for quick access (e.g., a section on hypoglycemia can link directly to a detailed "Hypoglycemia Management" page).
• Accurate, Fact-Checked Content: Ensuring all information is accurate, up-to-date, and supported by the latest guidelines for feline diabetes care.

As someone who has personally struggled to understand the complexities of feline diabetes management, especially as a European dealing with different measurement units (mmol/L vs mg/dL), complex jargon, I know how important it is for this information to be presented clearly.

My aim is not to criticize the incredible help and support already available, but to build on it by making it even more accessible for newcomers.

I look forward to collaborating with anyone who is interested in making this information better for everyone.

Thank you for your support and for everything you have already done to help cats and their caregivers.

Information may be inaccurate! - This text is just the structure I'm building!

Example page: (Done for 70 %)​

Tight Regulation Protocol for Diabetic Cats​

Introduction​

This protocol provides clear, step-by-step guidelines for managing diabetic cats using long-acting insulins such as Lantus (glargine) or Levemir (detemir).

The focus is on frequent monitoring, consistent dosing, and careful adjustments.

Key Requirements​

• Insulin Type: Lantus (glargine), Levemir (detemir), or their biosimilars.
• Syringes: U100, 3/10cc (0.3 ml) with half-unit markings.
• Glucometer: Human glucose meter (0.6 µL or less per test).
• Diet: High-quality, low-carb canned or raw food. (No dry food if possible.)
• Feeding: Multiple small meals or free-feeding low-carb food.
• Blood Glucose Monitoring: Multiple tests daily, including pre-shot and key points (+3, +6, +9).
• Hypoglycemia Management: Keep a hypo kit ready (syrup, high-carb food).
• Ketone Monitoring: Regularly test for ketones, especially in the early stages.
• Spreadsheet: Use our spreadsheet to track all measurements for accurate treatment decisions.

Jargon used:​

1. Hypo
2. Pre-shot
3. Nadir
4. +t
5. Cycles
(still working on this part)

If switching insulin:
Reduce dose by 30% if switching between long-acting insulins (Lantus to Levemir or vice versa).
Maintain the same dose if switching from short-acting insulin such as ProZinc or Caninsulin.

Phase 1: Starting Dose​

• Insulin Type: Long-acting insulin of your choice.
• Calculation: 0.25 IU/kg of the cat's ideal weight.
• When: Administered every 12 hours at the same times.
• Monitoring: Test blood glucose at pre-shot, +3, +6, and +9 for the first 3 days.
• First time treatment: Hold the dose for 5 to 7 days.
• Important: Add all new data to your spreadsheet.

Phase 2: Dose Adjustment​

• Increase:
• If nadirs are over 200 mg/dL / 11.1 mmol/L but below 300 mg/dL / 16.7 mmol/L, increase by: 0.25 IU (After 3 days, 6 cycles.)
• If nadirs are over 300 mg/dL / 16.7 mmol/L, increase by: 0.5 IU (After 3 days, 6 cycles.)
• Hold: If nadirs are between 100 - 200 mg/dL / 5.6 - 11.1 mmol/L.
• If nadirs are under 100 mg/dL / 5.6 mmol/L, hold for at least 10 cycles.
• Reduce: If nadirs are below 50 mg/dL / 2.8 mmol/L, reduce by: 0.25 IU immediately.

• For Cats New to Certain Numbers:​

• If your cat is new to numbers under 200 mg/dL / 11.1 mmol/L, hold for at least 8-10 cycles.
• Important: This should be based on your spreadsheet data.

Phase 3: Holding the Dose​

• Target Range: 50-200 mg/dL / 2.8-11.1 mmol/L for most of the day.
• Consistency: Avoid skipping doses.
• Important: This should be based on your spreadsheet data.

Phase 4: Reducing the Dose​

• Criteria: If nadirs are consistently in the 50 - 100 mg/dL / 2.8 - 5.6 mmol/L
• range for one week.
• Method: Reduce by 0.25 IU.
• Important: This should be based on your spreadsheet data.

Phase 5: Remission​

• Signs of Remission: If your cat's blood glucose remains in the healthy range (2.8-5.6 mmol/L) even after reducing multiple doses over the weeks, this may indicate that your cat is approaching remission.
• Criteria: 14 days without insulin, with stable blood glucose (2.8-5.6 mmol/L or 50-100 mg/dL).
• Important: This should be based on your spreadsheet data.
• Keep Track: Continue monitoring closely to ensure your cat stays in remission.

Quick Reference Table​

Blood Glucose (mmol/L)​	Action​
>11.1​	Increase dose by 0.25 IU after 3 days​
5.6 - 11.1​	Maintain dose (no change)​
2.8 - 5.6​	Monitor, prepare for reduction if stable​
<2.8​	Reduce dose by 0.25 IU immediately​

Blood Glucose (mg/dL)​	Action​
>200​	Increase dose by 0.25 IU after 3 days​
100 - 200​	Maintain dose (no change)​
50 - 100​	Monitor, prepare for reduction if stable​
<50​	Reduce dose by 0.25 IU immediately​

Final Notes​

• This protocol is data-driven and should be adjusted based on your cat’s specific response.
• Always consult with your veterinarian for guidance.
• Regularly test for ketones and maintain a low-carb diet throughout.

Maybe it's better to have 1 page that shows mg/dL and one page that shows only mmol/L for cleaner and shorter texts without getting a headache reading.​

test:

 

[Kosmo]

mg/dL only:​

Tight Regulation Protocol for Diabetic Cats​

Introduction​

This protocol provides clear, step-by-step guidelines for managing diabetic cats using long-acting insulins such as Lantus (glargine) or Levemir (detemir).

The focus is on frequent monitoring, consistent dosing, and careful adjustments.

Key Requirements​

• Insulin Type: Lantus (glargine), Levemir (detemir), or their biosimilars.
• Syringes: U100, 3/10cc (0.3 ml) with half-unit markings.
• Glucometer: Human glucose meter (0.6 µL or less per test).
• Diet: High-quality, low-carb canned or raw food. (No dry food if possible.)
• Feeding: Multiple small meals or free-feeding low-carb food.
• Blood Glucose Monitoring: Multiple tests daily, including pre-shot and key points (+3, +6, +9). More frequent monitoring may be needed, especially at the start.
• Hypoglycemia Management: Keep a hypo kit ready (syrup, high-carb food).
• Ketone Monitoring: Regularly test for ketones, especially in the early stages.
• Spreadsheet: Use our spreadsheet to track all measurements for accurate treatment decisions.

Jargon used:​

1. Hypo
2. Pre-shot
3. Nadir
4. +t
5. Cycles
(still working on this part)

If switching insulin:
Reduce dose by 30% if switching between long-acting insulins (Lantus to Levemir or vice versa).
Maintain the same dose if switching from short-acting insulin such as ProZinc or Caninsulin.

Phase 1: Starting Dose​

• Insulin Type: Long-acting insulin of your choice.
• Calculation: 0.25 IU/kg of the cat's ideal weight. If the cat is underweight, use the actual weight instead.
• When: Administered every 12 hours at the same times.
• Monitoring: Test blood glucose at pre-shot, +3, +6, and +9 for the first 3 days. (More frequent tests may be needed.)
• First time treatment: Hold the dose for 5 to 7 days.
• Important: Add all new data to your spreadsheet.

Phase 2: Dose Adjustment​

• Increase:
• If nadirs are over 200 mg/dL but below 300 mg/dL, increase by: 0.25 IU (After 3 days, 6 cycles.)
• If nadirs are over 300 mg/dL, increase by: 0.5 IU (After 3 days, 6 cycles.)
• Maintain: If nadirs are between 100 - 200 mg/dL
• If nadirs are under 100 mg/dL, hold for at least 10 cycles.
• Reduce: If nadirs are below 50 mg/dL, reduce by: 0.25 IU immediately.
• Special Cases for Dose Adjustments: (For Cats New to Lower Numbers
• If your cat is new to numbers under 200 mg/dL, hold for at least 8-10 cycles before increasing.
• If nadirs are under 100 mg/dL, hold for at least 10 cycles.
• Important: This should be based on your spreadsheet data.

• Special Cases for Dose Adjustments​

  • For Cats New to Lower Numbers:
    • If your cat is new to numbers under 200 mg/dL, hold for at least 8-10 cycles before increasing.
    • If nadirs are under 100 mg/dL, hold for at least 10 cycles.
  • For Cats Prone to Ketones or High Flat Curves:
    • Dose adjustments may need to be made after 3 days (6 cycles) instead of 5-7 days.

Phase 3: Holding the Dose​

• Target Range:50-200 mg/dL for most of the day.
• Consistency: Avoid skipping doses.
• Important: This should be based on your spreadsheet data.

Phase 4: Reducing the Dose​

• Criteria: If nadirs are consistently in the 50 - 80 mg/dL
• range for one week.
• Method: Reduce by 0.25 IU.
• If a Reduction Fails: Immediately return to the last effective dose without delay.
• Shaving the Dose: If your cat struggles to maintain reductions, consider reducing by slightly less than 0.25 IU.
• Important: This should be based on your spreadsheet data.

Phase 5: Remission​

• Signs of Remission: If your cat's blood glucose remains in the healthy range (50 - 80 mg/dL) even after reducing multiple doses over the weeks, this may indicate remission.
• Criteria: 14 days without insulin, with stable blood glucose 50-80 mg/dL
• Important: This should be based on your spreadsheet data.
• Keep Track: Continue monitoring closely to ensure your cat stays in remission.

Special Situations: Shooting Early or Late​

• Shooting an hour or two early may act like a slight dose increase.
• Shooting an hour or two late may act like a slight dose reduction.
• Monitor carefully if you must adjust timing.

Quick Reference Table​

Blood Glucose (mg/dL)​	Action​
>200​	Increase dose by 0.25 IU after 3 days​
100 - 200​	Maintain dose (no change)​
50 - 80​	Monitor, prepare for reduction if stable​
<50​	Reduce dose by 0.25 IU immediately​

Final Notes​

• This protocol is data-driven and should be adjusted based on your cat’s specific response.
• Always consult with your veterinarian for guidance.
• Regularly test for ketones and maintain a low-carb diet throughout.

 

[Marje and Gracie]

Thank you for your work on this.

We Moderators will need to discuss it but I doubt you will see us switching from mg/dL. One of the Mods is in Canada and she has not pushed for that in all the years she’s been here.

Our guidelines were written by our former Moderator, Jill, who, very sadly passed away several years ago. She was very precise in the way she wrote them working with Kirsten, the original author of the TR protocol and Tilly’s website. Many thousands of members have used them successfully, as written so there will be reticence in changing them. But we can discuss it.

We appreciate your suggestions.

 

[Sienne & Gabby (GA)]

I am in complete agreement with Marje. Recommendations for changes such as you're proposing should first be directed to the moderators. The TR protocol is a peer reviewed document that was published in a leading veterinary journal. I would be reticent to make changes that have not been similarly researched.

Likewise, we do our best to make sure that we are attentive to the measurements that are referred to are accessible to everyone who is on the board. Our membership is international. I would not want those who are outside of the US to feel excluded.

 

[Kosmo]

Ah, I now understand the history behind the guidelines and why they are valued.

But to be honest, I think the text is objectively chaotic and hard to understand, especially for people new to this information.

I think those of you who are familiar with the subject find it clear because you already have a solid understanding, but for someone new, it can feel like trying to understand advanced math without learning the basics first.

For example, what a ''Nadir'' is, is not even explained one time, how would people understand the document at all?

Also, almost everything is explained in mg/dL, not mmol/L, which would be the same as a fitness instructor explaining things in pounds to someone who only understands kilograms.

and much more.

The problem is that many people who get overwhelmed with unstructured information may just give up, especially if they do not care as much about their cat’s health as we do.

They might skip Tight Regulation entirely, rely on short-acting insulin, listen to their vet, and just hope it works out because they do not fully understand the protocol.

My goal is not to disrespect Jill or Kirsten’s work but to make the protocol clearer so that more cats can benefit from it. (Not to change the protocol itself.)

Let's then hope you people are right, and I was just the only person who did struggle to understand it, so people who do not care as much about their cats do not end up abandoning their cat when they find it too difficult to understand.

 

[Sienne & Gabby (GA)]

To be honest, the text that describes TR that is on the German Lantus forum and is linked is not terribly straight forward. We've kept the original text as authored by Kristen. It drives me crazy when people copy our information and materials (e.g., spreadsheets), and then edit what our members or moderators have put extensive time and energy into and essentially butcher the content. (I'm not suggesting that you're doing this.) But, we need to be fair and reasonable to all of our members. What one person finds to be a "difficult" read, may not be to someone else. We want to keep the content of what we're telling people consistent. We also want to make sure the information is accurate. If multiple people rewrote informational posts, it would quickly be more than what we could handle and the lack of clarity could become a nightmare.

If you are serious about this kind of project, once we know what's going on with FDMB, Marje, Wendy, and I would be happy to discuss this further. Right now, with the uncertainty over what's going on with the Board, we're a bit frazzled.

 

[Kosmo]

@Sienne & Gabby (GA)

I completely understand.

And I clearly stated the reasons why I suggested this and why I made a sketch version of how it could be done better.

It is nothing personal.

And I am serious about this, of course.

But if you are objectively honest, do you think someone who reads a set of instructions that is not structured in a correct way will be able to follow it easily?

Imagine receiving a set of instructions for assembling a piece of furniture.

The instructions tell you to screw in part A to part B, but then, halfway down the page, it suddenly mentions that you should have applied glue before attaching the parts. To make it worse, the measurements for the different parts are given in inches, but you only understand centimeters.

But honestly if you think that people will understand and I'm one of the: ''What one person finds to be a "difficult" read, may not be to someone else.''

I dot not care, and I will not take that personally, and that is fine because I care enough about cats to be critical of something that is clearly not clear enough.

It is not my responsibility or on my conscience if there is a possibility that many people might give up on helping their cats, leaving them to their fate, because they find the TR concept too difficult to understand, because it will require 100% additional research that they are unwilling to do.

 

[Wendy&Neko]

One of the Mods is in Canada and she has not pushed for that in all the years she’s been here.

That's me. It's pretty easy to become "bilingual" with measurements. In our country we also did the imperial to metric switch for temperature, distance/length and weight and I still can understand the general concepts of imperial, though I use the metric. The spreadsheet converts blood sugar values for you. The truth is that the majority of people here who help with dosing are from the US and mg/dL is their language. I've seen many a person post using mmol/L and ask using for help and not get much attention. For their sake, especially in a low numbers situation which is urgent, it's best if they can "speak" mg/dL.

I do agree with Marje and Sienne that it's worth a periodic review of documents, especially dosing methods, to try to make them easier for people to use on their own, without diluting the meaning behind them.

 

[Kosmo]

That's me. It's pretty easy to become "bilingual" with measurements. In our country we also did the imperial to metric switch for temperature, distance/length and weight and I still can understand the general concepts of imperial, though I use the metric. The spreadsheet converts blood sugar values for you. The truth is that the majority of people here who help with dosing are from the US and mg/dL is their language. I've seen many a person post using mmol/L and ask using for help and not get much attention. For their sake, especially in a low numbers situation which is urgent, it's best if they can "speak" mg/dL.

I do agree with Marje and Sienne that it's worth a periodic review of documents, especially dosing methods, to try to make them easier for people to use on their own, without diluting the meaning behind them.

I actually did not push for changing the mg/dL metric to mmol/L internally.

I suggested adding it to the protocol document or creating a variation that is also available in mmol/L, allowing European users to understand it.

Additionally, the protocol should be clearer so that any newcomer can easily understand and apply it. (Including a clear structure and explanations of jargon used.)

The sketch I made (second post in this thread, not finished) is based on Jill’s original protocol, so it does not deviate from the original work. (And I obviously need help to complete this.)

This is not an ego thing for me, where I am trying to rewrite the protocol without any consideration. (I understand the emotional connection to the original written protocol.)

But I still genuinely believe it is important to make the protocol accessible to as many people as possible.

This way, they can understand and confidently treat their cats using the Tight Regulation protocol, rather than feeling overwhelmed and giving up.

Millions of cats worldwide suffer from diabetes, and given the protocol’s success, it should be exceptionally well-documented.

 

[Marje and Gracie]

I actually did not push for changing the mg/dL metric to mmol/L internally.

I suggested adding it to the protocol document or creating a variation that is also available in mmol/L, allowing European users to understand it.

Additionally, the protocol should be clearer so that any newcomer can easily understand and apply it. (Including a clear structure and explanations of jargon used.)

The sketch I made (second post in this thread, not finished) is based on Jill’s original protocol, so it does not deviate from the original work. (And I obviously need help to complete this.)

This is not an ego thing for me, where I am trying to rewrite the protocol without any consideration. (I understand the emotional connection to the original written protocol.)

But I still genuinely believe it is important to make the protocol accessible to as many people as possible.

This way, they can understand and confidently treat their cats using the Tight Regulation protocol, rather than feeling overwhelmed and giving up.

Millions of cats worldwide suffer from diabetes, and given the protocol’s success, it should be exceptionally well-documented.

Let me just say that thousands of people have done TR successfully using those documents including the three of us In fact, I can’t think of a time when someone said it was unclear. There are several up-to-date documents on FDMB with definitions but ones such as “nadir” are defined in the stickys.

But, as we’ve said, let us figure out this while board issue and we can take a look at your suggestions.

Thank you.