? Vet says tight regulation sounds unsafe. Opinions on what I should do?

Status
Not open for further replies.
Amanda & Shmee

Amanda & Shmee

Member Since 2018
My Shmee was on 1U 2x a day, then my vet upped him to 2U 2x a day. After this curve she wants me to go up to 3U 2x a day. I told her I would like to start tight regulation protocol on Monday, and sent her the links to the veterinary medicine journal study supporting it and the website explaining it. This was her response;

“Since he is still running in the 300s, as long as he is eating well, I would advise increasing his insulin to 3 units every 12 hours and doing another curve after 1 week.

I have never done that particular tight regulation protocol. Since it takes a week for the body to adjust to an insulin change I'm not sure about changing the insulin amount that often. I will have to do more research and see what veterinary endocrinologists are saying. It may be an option. Overall if a cat is on a low carb diet and is on Lantus there is a much better chance of remission overall. I have heard of protocols that start with a much higher dose of Lantus and work down the dose but I generally don't use that as the risk of hypoglycemia is so high. I will research it and let you know what I think. For now I'd advise increasing to 3 units and if his glucose started to drop much below 100 or suddenly gets super high, go back to 2 units and let me know.”

I understand her points about changing the insulin often, but since the changes aren’t by that much (like increasing by .25), I don’t see this being unsafe.

**addition - he’s been losing weight. I don’t know if I should consider this fact before making the decision of raising him to 2.25 or to 3. Early this month he was 15.5 and now he is 14.6. I want his blood sugar numbers to go down quickly so he can start to properly digest his food and gain weight... but I want to do it the safest way.

Please let me know your opinions!!
Thank you
 
Last edited:
Hmmm... reading through what she wrote, it sounds like she might end up on board if she gets a chance to think about it. TR is aggressive, but not in the way she is saying (starting too high), in fact it's far less aggressive than the 1U dose increases she's suggesting. I wonder if she has run across some of the other "internet protocols" out there, some of which may recommend starting on a high dose.

I'm interested in what others have to say about this, but that's my first impression of the situation.
 
Nan & Amber said:
Hmmm... reading through what she wrote, it sounds like she might end up on board if she gets a chance to think about it. TR is aggressive, but not in the way she is saying (starting too high), in fact it's far less aggressive than the 1U dose increases she's suggesting. I wonder if she has run across some of the other "internet protocols" out there, some of which may recommend starting on a high dose.

I'm interested in what others have to say about this, but that's my first impression of the situation.
Click to expand...

Yes I was thinking the same thing, if she’s worried about being too aggressive, wouldn’t a full unit increase be much more worrisome? Im not sure why she brought up the comments towards the end about starting on a high dose.. I am wondering if she understands it’s only a .25 increase at a time (for Shmee at least, since his nadir is in the 200’s).
 
I agree with Nan that the TR protocol is an aggressive protocol , but it is assuming that the caregiver is able to get the required testing in each cycle. And also, as Nan said, raising in increments of 1 unit is not recommended for safety reasons and also so that you don't go over the right dose. We recommend to raise and lower in increments of .25 of a unit.


A lot of vets are happy if you can keep a cat below the renal threshold , but a lot of us here are shooting for remission ( Bubba has been in remission 3 times and we are working on # 4) Ask your vet how many kitties she has treated that have gone into remission. My guess is a few to none.

How much does Shmee weigh because that influences the amount of insulin that kitties start on ? Most are somewhere around 1 to 1/2 units twice a day.

Oh and Welcome! To the best place you never wanted to be. I don't think I have ever posted on your thread before. :cat:
 
A good compromise for you and your vet would be to tell her you'd feel better about increasing with smaller increments more frequently ( according to TR) than in large increments of 1 unit as she proposed. Hopefully, she will support you with your decision to follow a tried an true protocol that works.
 
Bobbie And Bubba said:
A good compromise for you and your vet would be to tell her you'd feel better about increasing with smaller increments more frequently ( according to TR) than in large increments of 1 unit as she proposed. Hopefully, she will support you with your decision to follow a tried an true protocol that works.
Click to expand...

Thank you so much Bobbie. Yes I think that is a good compromise. I am about to write her back but I’m curious about your comment “going over the right dose”. I have heard people mention this before, but some of his numbers are still over 400, so do you really think we could’ve skipped over a right dose with some numbers still being so high? That is kind of confusing to me. Which is also why I understand the vet wanting to increase to 3, since some of his numbers are so high. But I also know we have to go by nadir and not the highest numbers.... it’s so confusing with the conflicting information!
 
Here is my reply to my vet;

“Thank you for looking it over. I am also worried about the increasing number of units like you were saying, that is why I thought this protocol sounded safe because the increases are only by .25 instead of a full unit, so if I increase him by .25 every three days (that’s at the very least - I am thinking I would like it would be more like 5 days), thats a gradual increase of one unit over a 12 day total. I appreciate you saying you will look into it more because I only want what’s best for Shmee. He’s everything to me. Just to gauge the online information and your advice, I am curious how many cats you’ve treated that have gone into remission? That link in the first email to the veterinary journal has a study that was completed where 86% of the cats that started this protocol within six months of their diagnoses went into remission. I have also found an online community that has lots of information, health articles, and experiences of other members. They explain two kinds these protocols that are out there, one is the “start low go slow” method that seems to be what we are on right now, adjusting doses weekly, except those increases are only by .25. They also have lots of information about the tight regulation method, and lots of cats have been put into remission with it. This is the study that was done with the instructions used in the study that led to the veterinary journal being published; http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

As of right now, I’m getting more blood sugar tests throughout the weekend and will probably increase by .25 per tight regulation on Monday because I don’t think I feel comfortable increasing by a full unit again yet. I’m curious how he will do if I increase him gradually. That’s at least as of right now.. if he doesn’t do well I of course will do whatever I can to make him better. I am trying to research as much as I can still, thank you for looking into it more, I value your help and advice and am looking forward to what you think after your research as well.”
 
I like your email to your vet. It was straight forward and respectful yet let her know your position.

What we mean by going over the best dose: Lantus is dosed on the lowest number you get in a cycle or the nadir not the pre shot numbers. So, you are correct about looking at the nadir ( lowest number and not the other numbers) . When the kitties hit these lower numbers their bodies could react with bouncing up as they are not used to being in lower numbers. We have to get them used to them again in a systemically way of increases. A bounce can last up to 3 days or 6 cycles so the TR protocol accounts for that. Here is an explanation of bouncing.

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

We will help you every step of the way. I am so glad you found us!
 
Last edited:
Hi....I won’t comment on your vets reply, but I will say when Davidson was initially diagnosed in 2014 the vet also had him on 3 units and it was quickly reduced and after 3 months of following the TR, Davidson went into remission. It’s been 4 yrs and due to several infections and teeth having to be extracted his blood levels rose and I made the decision writhe help of people on here to put him back on insulin. The vet wanted to start him on 2u, and if you look at his SS from today (his first day on the juice) and starting at .25u - if he was at 2u he would be in trouble.

Your friends on here know what they are doing since everyone here has gone thru what you have, some longer then others, but the experience on here is for the benefit of our kitties. I would hear what your vet says, but heed more to what is said here as you’re getting hands on advise. Run what is said on here by your vet, they should listen and they too can learn. My vet sends me their clients who have been diagnosed as they have no clue about TR and sees it works. Keep in mind ECID but I fully support what’s suggested on here as a great place to learn and work with. Besides, you have 24/7 support and somewhere there is someone on here to help.

Just sayin,
Shawna
 
First, let of offer some clarification. I'm not sure what your vet read about TR. The first version of TR had the starting dose calibrated at 0.5 x ideal weight in kilograms. So the starting dose for a 10 lb cat would have been 2.25u. This was considered safe IF the cat was hospitalized and being monitored 24/7. The calculation for starting dose was revised to 0.25 x ideal weight in kilograms so this would be roughly 1.0u. This is obviously much safer unless you are able to be at home with your cat all the time.

The TR protocol was published in one of the top veterinary journals -- the Journal of Feline Medicine & Surgery. In order for a study to be published, it has to meet the criteria for institutional safety -- this is the same as with humans. An institutional review board MUST review any research to insure no animals are unduly harmed, the research meets ethical standards, and subjects are treated with care. A study can't be conducted, let alone published, if it has not met the standards of review. Not only did the original study meet these criteria, so have other published studies from Roomp & Rand. I've attached the original journal article if you want to send it to your vet.

I don't know what insulin your vet is most familiar with. Most vets have considerable experience with the types of insulin that were popular before Lantus came on the market. Shorter acting insulin does not need a week for a cat's body to adjust. Short acting insulin is just that -- it is metabolized in just a few hours. Insulin like Novolin/Humulin N has a duration of about 8 hours and then it's gone. Lantus differs in that it forms a depot. It takes 3 - 5 days for the depot to stabilize when a dose is changed. This may be a subtle difference but it is a difference nonetheless.

FWIW, I worked with several vets both in Chicago and now in Columbus, OH. They were all trained at OSU. My vet is a feline specialist -- it's a cats only practice. She was thoroughly familiar with TR, supposed home testing, and basically was very happy to let me manage Gabby's FD. (I'm sort of assuming your vet also trained at OSU since you're in the Cleveland area.)

Just an observation -- SLGS is not a protocol. It doesn't have scientific research to support it's use. The only place where this method is used is here. It was the method that was developed when FDMB started and was used for any and all types of insulin. It has been successful at getting cats into remission but my impression is that it's not as successful as TR. (No data to support that impression, though.) In fact, when several members (e.g., Jill and Alex) began using TR, there was considerable alarm over how aggressive the dosing method was. The German Lantus board (which is where Kirsten Roomp is affiliated) was way ahead of us.

 

Attachments

GECKO said:
Hi....I won’t comment on your vets reply, but I will say when Davidson was initially diagnosed in 2014 the vet also had him on 3 units and it was quickly reduced and after 3 months of following the TR, Davidson went into remission. It’s been 4 yrs and due to several infections and teeth having to be extracted his blood levels rose and I made the decision writhe help of people on here to put him back on insulin. The vet wanted to start him on 2u, and if you look at his SS from today (his first day on the juice) and starting at .25u - if he was at 2u he would be in trouble.

Your friends on here know what they are doing since everyone here has gone thru what you have, some longer then others, but the experience on here is for the benefit of our kitties. I would hear what your vet says, but heed more to what is said here as you’re getting hands on advise. Run what is said on here by your vet, they should listen and they too can learn. My vet sends me their clients who have been diagnosed as they have no clue about TR and sees it works. Keep in mind ECID but I fully support what’s suggested on here as a great place to learn and work with. Besides, you have 24/7 support and somewhere there is someone on here to help.

Just sayin,
Shawna
Click to expand...

Thank you Shawna (and everyone!), I appreciate it. I see that your 3units only lasted one day in 2014 and then you decided to start over from scratch back at zero for a week before starting fresh. This is what I am also struggling with - I don’t know if I should move him up to 2.25 on Monday, because I don’t want to miss his “match”. But since he’s been on insulin for weeks now I think doing the 2.25 would be safer? It’s so frustrating to not know what to do.
 
Amanda, when Davidson was diagnosed the vet at that time gave him 3u canninsulin while her was there. At that time I was at home and reading the FD forum and inquiring like every other newbie what I should do. First respons was get him off dry food and put him on FF. I picked up Davidson with and told the vet I didn’t want his insulin and would look after things myself, they also sent me goes with vet prescribed diabetic food, which as I found it here was 26% carbs.....that vet never saw me again and didn’t want to know that dry food is not recommended, nor did he want to hear about human insulin.

I fed Davidson FF for close to 2 months and his levels dropped in half right away, and since. Was going on holidays mid Dec. I decided to keep him on the FF and when I got home I’d put him on insulin where I could monitor him. Luckily I worked from home and that’s why you see all the testing. On Jan 15/14 I started following the TR and gave an initial dose of 1.5u and monitoring it to see how he did. With the help here, I increased he dose until we found a workable unit and when he started showing signs of stabilizing it was then that numerous test were done to insure I could see when he earned a reduction and after about 3 weeks or so he earned a reduction, and then dropped .25 every week. It was a total of 3 months on insulin and he went into remission.

It’s better to give less of a dose to see how he reacts then to do too much and he goes into hypo mode....

My personal motto for injuries (I was a pro athlete in extreme sports) is that you only have one chance to heal right the first time, after that you’re just recovering. I used that with Davidson and took it slow, listened to those who have direct experience and for that reason I have supported this sight as I have the utmost respect for those who provide the information for all of us, and who are continually there to assist us all.

When in doubt.....ask questions

Shawna
 
Hi Amanda, and welcome!

I think your vet sounds like she might be willing to work with you on this. Your response was very good - informative and respectful, but you made your point about what you would like to do.

Some vets don't encourage smaller doses because they can be hard to measure accurately. She's probably be shocked to see we have cats here on .1 units! What we have to remember is that a cat is much smaller than a human, so .25 unit is actually a lot! I hope your vets sees the sense in the approach you want to take and plays along. It is so much easier to do this when one has a supportive vet.

As others have mentioned, you have us now, too. We aren't vets (although there are some members with veterinary experience), but many of us have been doing this for years, and some of us with multiple cats. We've lived it 24/7, 365. We aren't just crazy cat ladies and gentlemen - we're people that love our cats and are willing to do whatever we have to do to keep them healthy and happy. Clearly, you feel the same.
 
I just weighed him so I feel like I need to add that he is losing weight. He’s 14.6 and at the beginning of the month he was 15.5. He’s moving around more but I know his body isn’t properly breaking down the food since his numbers are so high. I’m thinking of adding Young Again Zero to his diet as well as the FF classics and chunkys he’s eating now for some more calories. My vets main concern has been him gaining his weight back but it just keeps falling :(
 
If you add dry food to the picture, that means using SLGS instead of TR. One of the safety mechanisms built into TR is using only low carb wet food or raw, which is better for them than any dry. Dry is metabolized at a different rate than wet or raw. There are other options out there that are higher calories canned food, but still low carb. How many calories are you feeding now?
 
Wendy&Neko said:
If you add dry food to the picture, that means using SLGS instead of TR. One of the safety mechanisms built into TR is using only low carb wet food or raw, which is better for them than any dry. Dry is metabolized at a different rate than wet or raw. There are other options out there that are higher calories canned food, but still low carb. How many calories are you feeding now?
Click to expand...

Thank you for pointing that out Wendy, I didn’t even realize that. I have a binder of information and it’s hard to keep everything straight. I already bought the dry food and a food puzzle earlier online :/ ugh!! I’ll have to look into higher calorie wet foods or something
 
Amanda & Shmee said:
Thank you for pointing that out Wendy, I didn’t even realize that. I have a binder of information and it’s hard to keep everything straight. I already bought the dry food and a food puzzle earlier online :/ ugh!! I’ll have to look into higher calorie wet foods or something
Click to expand...
Fancy Feast gravy is high carb.
 
It sounds as if your vet is willing to work with you,that's a big plus. There are so many things to take into consideration when deciding how you are going to treat. ECID and every cat will respond differently to different insulin. My 2 diabetics are so totally different.

Smokey (GA) was the 1st and I knew nothing. He was on 3 different insulin. I just followed vets instructions. He had a hypo, I found fdmb and things changed. He was long term so remission was never an option. He had multiple medical issues where I thought TR was to risky. Yet he didn't fit the slgs method either. Smokey did his own protocol.

Now Olive, is totally different. Lantus is not helping much. Doing slgs was not working even holding for just 5 days instead of the 7 days. I bite the bullet and do TR since I'm home all the time. However, even TR isn't helping. So with advice and help we are even more aggressive (DO NOT COPY US). Now just found out she has a mass that is probably the cause of diabetes and affecting her glucose. On top of it she also has mild heart disease. Remission is highly unlikely and she most likely will be a high dose kitty. I am going to switch insulin on her as soon as the weather warms up and it's safe to ship. My vet is not agreeable to the new insulin but as I told him "you have to trust me on this that I know how to keep her safe" and know if I need to stop it immediately and if it helps then you have a new type to offer other clients. Even if he was totally against it (he was with Smokey) I would do it anyway. I did with Smokey and Lantus, now Lantus is his preferred insulin.

Every cat, insulin, other meds cat might be on, humans schedule, food they are on and changes in food by manufacturers must all be taken into consideration. Even then it can change at any time. You decide on a method, follow it very closely, give it time to work and then if it doesn't you tweak one thing at a time.
 
If you are looking for a higher calorie, low carb food, look at Wellness. The pate styles are about 4 - 5% carb and higher in calories than FF. Take a look at Dr. Lisa's food chart for the calories if you don't want to search on the web.
 
Status
Not open for further replies.
Back
Top