Trying tight regulation after 9mo...great results.

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Barb M

Barb M

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9.5 months ago we started 4yr old Tigger on Prozinc and he not regulated after 39 weeks.
http://catinfo.org and FDMB has been very helpful for us especially since so few vets seem to have solid strategies and info about beating FD into remission.

I believe we were not aggressive enough with our dosages to get him down under 100 all the time, and I found a reference to YourDiabeticCat.com in a cat care blog post about diabetes.

yourdiabeticcat.com/protocol.html
We've been following this protocol, and Tigger seems to be doing better than with the standard 2 shots per day.

Our life is not as simple as AMPS/PMPS so I made another chart to track times for readings, dosages and feedings.
https://docs.google.com/spreadsheets/d/1KAZC1wtcxDQ8fvbJCl1eTAdMFWHDIf-PIl7DZRXjk5g/pubhtml
The original chart is in the FDMB tab of the sheet.
The first tab is TightRegulation if anyone is curious.

I'll update this thread as we get more results in the hopes that it may benefit the community that was such a wonderful source of guidance when we first started this process with Tigger.
 
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Hi Barb and Tigger,

I am glad Tigger is doing well. I tried to understand the charts you posted but can't figure out how you are dosing him. One chart looks like you use a sliding scale, dosing a different amount for different levels. Is that correct? Lots of beans here use sliding scales and they do seem to work well for lots of cats, but some don't do as well with them.

We also have had beans dose every 8 hours, three times a day, although no one currently posting now is doing that. Our biggest caution for that protocol is to be sure the number is rising, not falling. And we usually suggest that method after twice daily dosing has not produced results, in part because it requires a lot more testing and time commitment on the part of the care giver.

I am not a fan of the your diabetic cat site but am glad you have found help there. Over the years, we've had people come here after using their methods, with cats crashing and bouncing high because of overdosing and cats going hypo (although they maintain that can't happen to cats who are on wet low carb diets.)

However you have gotten him into lower ranges, congratulations!
 
Thank you very much for your response and taking the time to try to interpret our chart.
Our new chart is a work in progress, and I apologize if it was confusing.
It shows three rows per day at half hour increments for BG, dose and food.

We're trying the dosage recommendations from YourDiabeticCat to see how things go.

Blood Glucose mg/dl = Units of Insulin to Inject
151-170 = .5
171-185 = 1
186-200 = 1.5
201-220 = 2
221-250 = 2.5
251-290 = 3
291-350 = 3.5
351-410 = 4
 
Again, I am thrilled that Tigger is doing well. But I don't like the protocol YDC uses.

My problems with it include

The sliding scale is the same for every cat. We try to develop a scale that is based on that particular cat's history of dosing. Giving .5 to one cat who is at 150 might be okay, but might not for another one. And I think it is incredibly important to know that the 150 is a rising number, not a falling one. Adding more insulin when the previous dose is still working can really mess things up for a non depot insulin.

Tigger looks like he has been in the 30s several times. You may have been able to being that number up with food and he may have been fine, but it is nothing I could ever advise someone else to do with their cat.

I think the only constant for a diabetic cat is that every one is different. And what works well for one could mean seizures for another. Some cats might be fine at 30; others could be seizing and going blind.

Barb, I am incredibly happy that this protocol is working for Tigger and that you are able to shoot at lower numbers at different times and watch carefully for low levels and bring them back up. Not everyone can or is willing to do that. That's why there are two different websites with very different philosophies. Here, IMHO, I think our philosophy is ECID, first do no harm, and that there are no absolutes. Others may not agree, but those are my thoughts.
 
Hello Barb,
Just looked at your SS and had a couple of questions.
1. The first date in it, is that when you switched to the TR protocol?
2. The only "problem" I have with it, with my old eyes, is trying to quickly determine the elapsed time from one shot to the next. Would it be a pain if you used the far right column to make a note like "shot at +7.5"?

I understand some of the hesitation to advocate the protocol here on FDMB. But IMHO, there doesn't need to be two messages boards that are " protocol specific". I don't imagine people at YDC follow multiple protocols for PZI, do they? We have many Lantus and Levemir folks who use TR, SLGS, and maybe modified versions of each, and they all post in one forum.

We actually have a new member, @jayla who is using a modified version of the Hodgkins TR with direction and help from her vet with her cat, Drevon.

I didn't do TR, but I did use PZI and a fairly aggressive sliding dose scale with my cat, Bob. So while I can't tell you I did what you're doing, I'll be happy to look at your numbers and help as much as I'm able to.

I'm glad things are improving for you and especially for Tigger.
 
Barb,
You didn't mean to put the GA tag on your first thread, right?
That indicates a kitty who has "Gone Ahead" or "Guardian Angel".
 
Sue and Oliver (GA) said:
Barb, I am incredibly happy that this protocol is working for Tigger and that you are able to shoot at lower numbers at different times and watch carefully for low levels and bring them back up. Not everyone can or is willing to do that. That's why there are two different websites with very different philosophies. Here, IMHO, I think our philosophy is ECID, first do no harm, and that there are no absolutes. Others may not agree, but those are my thoughts.
Click to expand...
I agree with Sue on this. As for Dr. H's views on hypoglycemia, I must disagree. One can pull any number of veterinary references - from the Merck Veterinary Manual to many, many other reputable sources - and all say that when insulin is being injected into a cat, hypoglycemia is to be avoided. I don't think those warnings are written just for grins.

Yet Dr. Hodgkins writes in her protocol: Most normal cats operate when relaxed between 60-100. As long as you feed low carbohydrate wet foods, you will not cause seizures in your pet. In hundreds of cats that I have put through this protocol using low carbohydrate foods, I have never caused a single one to seizure, despite taking many well below 100 mg/dl.

The above statement from that protocol - as written - can too easily be misinterpreted by someone brand-new to feline diabetes - as diabetic cats are not "most normal cats!" While Dr. H herself may not have seen a serious hypoglycemic event in "hundreds of cats that I have put through this protocol using low carbohydrate foods," once you add insulin injections to the mix, there is always going to be the possibility of hypoglycemia - which is why we don't recommend that beginners shoot insulin at levels below 200 mg/dl.

As for the sliding scale shown in the protocol link you provided, I'd have to echo Sue's words above: Every cat is different, and that especially applies to every diabetic cat. Some cats do beautifully on a sliding scale; others just don't. (My cat, for example, has shown me - repeatedly - that she is extremely sensitive to dose changes - even very tiny doses. I've learned that I need to be very careful about that with this cat.)

While some cats may tolerate dropping well below 50 (on a human meter) or well below 69 (on an AlphaTrak meter); for others a drop to extremely low BG levels can mean a seizure, a coma, and a trip to the emergency room. And for some cats, unfortunately, too much of a drop has even meant a journey to eternal rest. This is why we don't recommend newbies shoot below 200, and when anyone elects to shoot at 150, we always caution that close monitoring is essential, as is plenty of data to support such decisions.

The only other thing I have to add is what Sue, Carl and others have said here at FDMB repeatedly: A diabetic cat is more than a blood glucose number. While most normal cats may indeed "operate between 60-100 mg/dl when relaxed," there are diabetic cats who operate quite nicely at even higher #s - even though they may even cross the dreaded renal threshold every now and then (as indicated by a quick BG check). While remission is possible for a good number of cats when diabetes is caught early on (heck, it's what we all hope for), sometimes it's just not going to happen - but that doesn't mean that a diabetic cat can't have a long and happy life on-insulin. Personally - and this is just my own view - I don't want to spend much time pushing the limits of my cat's tolerance of a near-hypoglycemic state anymore. She's 11 years old now; she's well-regulated; she drinks only a fraction of an ounce of water daily, she's at a good weight with a beautiful, glossy coat ... and aside from a little diabetes, she's quite healthy and happy!:)

I hope the new approach you're trying with Tigger works out well, though; will keep fingers, toes and paws crossed for you.:bighug:
 
For what it's worth...
The scale Barb posted is about the same as the scale Bob was on. The only difference is that I didn't shoot as often. Bob's doses were 11-13 hours apart, and that 100% determined by my work schedule. I was treating Bob on my own, and my work schedule does not allow for 12 hours apart most days. But he did get 4u doses on BGs above 400. Several times.

Another difference is I actually gave him shots when his numbers were even lower than Barb's scale shows. Bob got shots when he was below 100 a couple of times. Because, yes, ECID. The key was "know thy cat". And I knew Bob.

Whether you agree with the Hodgkins protocol or not, whether you agree with Dr. Hodgkins theories and claims or not, that's what Barb has chosen to do. She already tried the " FDMB" way, and it didn't work for Tigger.

I used to think that the Lantus TR protocol was insane. Worse than the Hodgkins TR protocol. But over the past 3 years after spending a lot of time in the L forum, and seeing the results, I now believe cit is the "best way to go" whether you achieve remission or not.

I don't know about the rest of you, but I'm interested in watching the protocol that Barb has chose "in action". I'm sure I'll learn from it. Everyone here can.

I'm quite confident the Barb, and that Jayla, have put a lot of thought into their choices, and have their kitties best interests at the forefront of their minds. And they understand the aggressive approach, and the risks involved. I might not do it myself, but I guess I sort of did to some degree.
 
Thank you all for you input and help.
I respect the concerns about a one-dose-fits-all method.
We're cautiously moving forward, and I'm able to monitor him around the clock.
We have a hypo kit handy.
We'll post the results of our experiment.

Carl & Polly & Bob (GA) said:
Hello Barb,
Just looked at your SS and had a couple of questions.
1. The first date in it, is that when you switched to the TR protocol?
2. The only "problem" I have with it, with my old eyes, is trying to quickly determine the elapsed time from one shot to the next. Would it be a pain if you used the far right column to make a note like "shot at +7.5"?
Click to expand...

Yes. The first date on the first tab is when we switched.
The second tab shows the prior nine+ months.
I'll add dosage interval notes.
 
Personally, I'm with Sue and Robin on this one. I'm glad that this is working for you, Barb, and I hope it continues to do so. But personally, I could never advise someone to follow it....first do no harm. I take that very seriously, which is why sometimes my advice is extremely conservative. I'm not saying that people shouldn't be more aggressive at times, but I wouldn't advise it usually since I can't live with myself if I suggest that and a cat doesn't make it because of what I said.

Barb, if it works for you, I'm so happy. I mean it. I'm glad you're being cautious..but I felt like I needed to register how I feel. :)
 
Y'all do realize that TR with PZI is not "new" here, right? Back in the day, before any of us joined, before Lantus became the insulin of choice, the first TR Forum was for users of PZI. And quite a few people who are no longer around followed it, with good results.

The thing that caught my eye when I came to the forum tonight, was Barb's subject line. Especially the "great results" part. I'm psyched for her and Tigger.
 
Barb M said:
Thank you very much for your response and taking the time to try to interpret our chart.
Our new chart is a work in progress, and I apologize if it was confusing.
It shows three rows per day at half hour increments for BG, dose and food.

We're trying the dosage recommendations from YourDiabeticCat to see how things go.

Blood Glucose mg/dl = Units of Insulin to Inject
151-170 = .5
171-185 = 1
186-200 = 1.5
201-220 = 2
221-250 = 2.5
251-290 = 3
291-350 = 3.5
351-410 = 4
Click to expand...
Hi Barb…
I am also using a modified version of TP--I have put a enormous amount of thought into it and with the help of my vet we have a protocol as follows for Drevon.
120-160--1/4
161-185-1/2
186-210-3/4
211-230-1
231-250-1+1/4
251-275-1.5
276-315-2
315-365-2.5
We came to this dosage chart based on his numbers and his "drops" and when he his numbers raise. Drevon is 15 and we know we have a small window to get him in remission.
I try to test and dose 6-8 hours apart but am not always able to--I know Drevon drops at about 3-4 hours and begins to rise after that but I always recheck if has only been 6 hours just to make sure he is rising before dosing. For us this is going along pretty good. I was so excited when I started the protocol and then I started to doubt myself which I now regret because I lost almost a week of possibly getting him healthier but live and learn. I know my boy so I am no longer afraid to continue with the protocol designed for him. Trust your gut it is always right ;)) I do have a hypo kit in place if ever it is needed as caution never hurts but in my heart I really believe we will beat this disease and Drevon will be insulin free :) Best to you and your baby….
 
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