Question on TR protocol re dose increases

nslade001

nslade001

Member Since 2018
Hi everyone, I wasn't sure if I should just ask this under my usual thread which is here or start a new thread, hope this is ok.

First, my question:

Is Tight Regulation supposed to put cats in a safe green healing zone, where their body may or may not heal into remission but at least is as healthy as they can be?

Or is TR supposed to be constantly "nudging" them to the edge of hypos with slight dose increases which frequently stimulate the pancreas to react (if it can) and thus earn reductions which can possibly "drive" them into remission?

Quick history:

Willow was diagnosed and put on caninsulin on November 12 2018; I switched her to Lantus on December 18, and we did a few increases as per TR protocol (which I really want to follow). She's been on the current dose of 1.25U since December 28 and I haven't increased.

From the protocol:

"Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing."
So, I held the dose, and I continue to hold it because I don't know what to do.

She has dropped once to 50 on this dose, but is usually a bit higher.Her cycle has *always* been low and flat, even on caninsulin; she has been "regulated" I guess since we started insulin, if regulated is under 200. Regulation isn't (yet) an issue for her.

Shortly after she hit that 50, I asked what I should be doing, and responses indicated I should hold the dose. But she hasn't dropped lower since, and someone did mention the possibility of glucose toxicity (which I understand is when they stop responding to a dose of insulin, and as my hubby says is a hard thing to gauge when you're flat lol.)

I haven't seen another SS similar to Willow's. Most cats seem to be in such high numbers that an increase *may* drop them to a reduction, but it is safe to increase; with Willow, I'm pretty confident that any increase *will* cause a reduction and that makes me feel like I'd be deliberately driving her into borderline hypo numbers.
The spreadsheets that I see that *are* similar (all greens and blues) seem to be actually in a reducing cycle, with regular earned reductions. Willow is too stable lol.

I'm quite comfortable keeping her on this dose if that is what I should be doing. Am I waiting it out to see if she will go into remission this way? My fear is, am I holding too long and ruining any chance of remission, or making it harder to do so?

Thanks so much, with love, Nikki
 
This dose is looking really good for Willow! I would hold this dose for now as she is getting some nice greens and last night the nadir was a nice 61 which doesn't give a lot of wiggle room. It looks as though she is an early nadir kitty. And, her pre shot numbers the last few days are lowering which is nice.

If she starts to creep up in higher greens then you might want to revisit whether to increase or not.



nslade001 said:
Is Tight Regulation supposed to put cats in a safe green healing zone, where their body may or may not heal into remission but at least is as healthy as they can be?

That is a goal for TR.

Or is TR supposed to be constantly "nudging" them to the edge of hypos with slight dose increases which frequently stimulate the pancreas to react (if it can) and thus earn reductions which can possibly "drive" them into remission?
Click to expand...

When kitties go under 50 with a human meter it is one way for them to earn a reduction. Another way for them to earn a reduction is to be in all green numbers for 1 week.

Keep on keeping on!
 
Thank you to everybody! I will go with the general consensus to hold the dose as long as her numbers don't start climbing (or dropping I guess). I will probably also keep with the BD syringes, since apparently it's hard to find others in Canada...which sort of sucks because I've had a lot in this box with too much lube. What I will also do is figure out what dose she is actually on (since I've learned that BD syringes are also quite inaccurate, and looking at the placement of the zero line in mine, I'd hazard a guess that what I've been dosing as 1.25U is actually a higher dose) by getting some calipers.

I'm going to tag @Wendy&Neko about *how* to use calipers with BD syringes, as well as ask on my usual daily thread. I've spent a long time googling youtube etc and simply don't know how to adjust for the little ridge on BD syringes...the small arms are "supposed" to be used for inside measurements, and I don't see how to use them otherwise. Even a pic of the calipers held on the syringe might help lol.

Sorry for starting this post outside my daily thread, next time I'll just add any question in there.

Thanks so much, with love, Nikki
 
Here is a great link all about Calipers. There is also a great video. All syringes are subjected to inaccurate markings. Some can be off as much as .25 unit. Bubba is on .75 of a unit and on the Relion syringes tonight with caliper it was actually at the .50 unit mark. Had I not been using calipers, he would have been shortchanged by .25 of a unit.
 
I know that Wendy (@Wendy&Neko ) has a technique for dealing with BD syringes using calipers.
The inaccuracy of all brands of syringes is legend here. Calipers are the only solution because you can totally disregard the "zero" line. The link that Bobbie gave you is really good.

I agree with the others: hold Willow's present dose. His numbers look great.
 
Ella & Rusty & Stu(GA) said:
I know that Wendy (@Wendy&Neko ) has a technique for dealing with BD syringes using calipers.
The inaccuracy of all brands of syringes is legend here. Calipers are the only solution because you can totally disregard the "zero" line. The link that Bobbie gave you is really good.

I agree with the others: hold Willow's present dose. His numbers look great.
Click to expand...

Thank you Ella, and @Bobbie And Bubba . It will be interesting to see what dose Willow is actually getting when I get calipers, as some of my syringes have the bottom of the plunger coming up to the zero line.
Also, I think Willow heard all the talk on a dose change; her PMPS is my second green shot at 97.
 
I personally think it's better to do your own measurements on the syringes when using the calipers. We all measure a little differently from a slightly different spot on the syringe. It's better to be consistent than 100% accurate. My measure on the BD syringes differed from Wendy's. Neither is right or wrong because we obviously didn't measure from exactly the same point on the syringe.
Loving that PMPS of 97! :joyful:
 
MrWorfMen's Mom said:
I personally think it's better to do your own measurements on the syringes when using the calipers. We all measure a little differently from a slightly different spot on the syringe. It's better to be consistent than 100% accurate. My measure on the BD syringes differed from Wendy's. Neither is right or wrong because we obviously didn't measure from exactly the same point on the syringe.
Loving that PMPS of 97! :joyful:
Click to expand...
I agree about using your own measurements for consistency! I just don't know how I'd use the calipers under the ridge on the BD syringes(how to use the small arms)...maybe once I'm holding the calipers I'd be able to figure it out.
Which calipers do you use, Linda? (I see you're also in canada, as far as I know we don't have harbour freight and I know many use their brand).
Thanks so much! With love, Nikki
 
nslade001 said:
I just don't cleknow how I'd use the calipers under the ridge on the BD syringes(how to use the small arms)...maybe once I'm holding the calipers I'd be able to figure it out.
Click to expand...
I think you look at the link and the video, it will be more clear to you on how to use the calipers. The link also gives info on the best calipers to get from Harbor Freight.
 
I used the iGaging EZ Digital Caliper. I purchased it at Lee Valley Tools.
That lip (ridge) on the BD syringes is nothing short of a pain so when I measured, I used the bigger outside arms and measured from the lip down to the 1 unit line. I measured on several syringes that by eye looked to have the markings pretty consistent but to measure from the zero line proved impossible for me. The other thing I did was invest a few bucks in a light box (got a cheap one at Giant Tiger) so I could lay the syringe and caliper side by side when checking measurements.
 
MrWorfMen's Mom said:
I used the iGaging EZ Digital Caliper. I purchased it at Lee Valley Tools.
That lip (ridge) on the BD syringes is nothing short of a pain so when I measured, I used the bigger outside arms and measured from the lip down to the 1 unit line. I measured on several syringes that by eye looked to have the markings pretty consistent but to measure from the zero line proved impossible for me. The other thing I did was invest a few bucks in a light box (got a cheap one at Giant Tiger) so I could lay the syringe and caliper side by side when checking measurements.
Click to expand...
Thank you!
 
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