I’d like to address the interpretation of the TR protocol and the increases of late.
Let’s look at what the modified TR protocol states on increasing the dose:
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.
- if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
- when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
Regarding what I bolded and is in italics, if any cat is new to nadir
S under 200, the dose should be held 8-10 cycles but, honestly, most of us with experience will advise holding the dose a full ten, consecutive cycles and that is
after the first nadir below 200 assuming there are others. If there is one blue nadir and no more, increase after six cycles and any bounce has cleared.
Regarding the second part that I bolded and did not italicize, this refers to all cats, not just ones new to nadirs under 100. Even if you have been around awhile and your kitty has had several green nadirs on different doses, once a CG sees nadirS under 100, they should hold the dose ten cycles. Period. Not 6, not 8. Ten. Do not chase numbers!!!
I will say there is one caveat and that is for a
very, very experienced CG who has tons and tons of data and knows their cat’s onset, nadir, duration, how it responds to food.....the whole deal. That CG, who is likely no longer following TR because they know their cat so well and knows when it needs “tweaks", might very likely raise the dose after 6-8 consecutive cycles where they’ve seen high green nadirs because they know their cat has room to increase the dose. But that person is likely also not asking for advice.
I urge you, Debra, to slow down on the increases and let the doses settle a little bit. I would not raise Jill’s dose every 8 cycles; I’d give her a full ten consecutive cycles on each dose where she’s seeing nadirs below 100.
One of the most experienced members who trained me and was a moderator in the “old days” always said that a cat doesn’t have to be in nadirs of 50-60; 70s and 80s are just fine. The cat’s body does not know the difference between a nadir of 65 and a nadir of 90, for example. The CG does not need to push. I understand you might not like those BGs between 100-200 at night but let the dose settle in and remember that it would not be incorrect to hold her dose even longer than ten cycles with the nadirs she’s getting at least until you start to see a trend upwards.
Questions or thoughts?
Though, Templeton misses his pretzels (dry food) so much, he'd jump on a wheel for pretzel crack at this point.
