11/27 Gus, AMPS 256, +234, PMPS 274, +2.5 306, +8 297

carfurby said:
Good luck with the new dose.
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Thank you!

Gonna head out and buy some fresh insulin today and try that later too, wondering if that will help his numbers along, it’s been opened going on 4 months now. Either way I think we might be due.

He kinda flinches after the poke while I’m injecting.. so want to rule that out, it’s more of a new thing - he’s never really been phased by his injections
 
Good Morning Kim,

If he's flinching with the injection, it might be stinging. Unfortunately Lantus can sometimes do that - you may want to try Levimer - if it's not too late before you go out to buy more Lantus.

Lantus doesn't usually wear out or expire as long as it's refrigerated. If it was frozen or left in a hot place then it's probably no good...sometimes the fresher the product the more the sting...I've used a single vial for a full year with Luci and it was good to the last drop.

And no, it won't help his numbers to buy new insulin. We hear that a lot and even I had looked suspiciously at the insulin when Luci seemed to be dragging it on and on with less than stellar numbers - it's usually the cat...

This stuff takes time...Looks like Gus kinda had a big liver dump yesterday...it takes time to get used to the insulin and time to get used to lower numbers...stay with the increase for 3 days and if you don't see any improvement increase again...

You're doing a great job on the testing!! Keep up the great work...you'll see the results...eventually.
 
Sue and Luci said:
Good Morning Kim,

If he's flinching with the injection, it might be stinging. Unfortunately Lantus can sometimes do that - you may want to try Levimer - if it's not too late before you go out to buy more Lantus.

Lantus doesn't usually wear out or expire as long as it's refrigerated. If it was frozen or left in a hot place then it's probably no good...sometimes the fresher the product the more the sting...I've used a single vial for a full year with Luci and it was good to the last drop.

And no, it won't help his numbers to buy new insulin. We hear that a lot and even I had looked suspiciously at the insulin when Luci seemed to be dragging it on and on with less than stellar numbers - it's usually the cat...

This stuff takes time...Looks like Gus kinda had a big liver dump yesterday...it takes time to get used to the insulin and time to get used to lower numbers...stay with the increase for 3 days and if you don't see any improvement increase again...

You're doing a great job on the testing!! Keep up the great work...you'll see the results...eventually.
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Thanks for that bit of info! I just thought it was strange that he was flinching since he’s has never done the in the last 3 months! It does make sense that it would sting more the fresher the vial. He mostly does it on his morning shots. He is developing a tougher skin too… despite rotating injections spots every day/shot.

The vial has been in the refrigerator the whole time, hasn’t been left out… I mean, I was pretty sure he wouldn’t have spiked all day out of nowhere from the vial having less effectiveness, as Chris said yesterday I would have figured it would be more gradual..

I think I will stay on course will Lantus for now but if it does become a bigger issue, thanks for the suggestion!

I know I’m starting to get a bit impatient… just want to get him regulated sooner than later! And I think Chris has talked me into trying TR… so, on that note, increasing in 3 days as you mentioned is definitely in the plans now..

I’m still trying to figure out what caused that liver dump… boy did that throw me off. And of course it was on a curve day!
 
Question. I’m guessing that on TR, since we’re doing it more often and and a little more testing throughout the day, no curves are needed? I’ll also assume that it wouldn’t hurt to do a curve if we are holding a good dose..?
 
Gus the Furminator said:
I’m guessing that on TR, since we’re doing it more often and and a little more testing throughout the day, no curves are needed? I’ll also assume that it wouldn’t hurt to do a curve if we are holding a good dose..?
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if you get tests sprinkled around at different points in the cycle, it's not necessary to do an "official" curve. If you look at China's spreadsheet, I never did an official curve in over 4 years. Now I was an admitted test-o-holic so you don't have to test as much as I did, but testing enough to know how YOUR cat responds to both insulin and food is important
 
Ok. Would love if someone can let me know if I understand what I’m up for with TR protocol, if I missed something or if you have anything extra to add, pls do. I know some has been explained to me already but I just feel better if I spin it around I my own words :)

So basically … and I know ECID :) but I need a basis to start from:

Hold the current dose for 3-5 days in Gus’ case we will start with 3 days on his current dose of 2.75u. Hold this dose for 8-10 cycles if under 200 (Q: Does this mean multiple drops under 200 or just one… or is that an up for discussion when the time comes, question?)

Increase the dose by .25 if nadirs are greater than 200 but less than 300 or increase by .5u if greater than 300.. (Q: I can still just do .25 no matter the number?)

Decrease the dose by .25 if Gus drops below 50 *If reduction fails, go back to the last dose that was working well for him. (Q: should I start with 50 or a higher number and work our way to 50?)

Testing:
AM/PM PS and at least one mid cycle per cycle… unless his numbers tell me otherwise or I just wanna see what he’s up to.

@Chris & China (GA) I get it! I could totally get hooked on testing (I always want to test - I literally walk around with him saying I want to test you… but I won’t or I’ll wait) but since Gus doesn’t love it, though he tolerates it… I think I’ll be making a compromise with him ;) we’ll get there I think

Stagger or ‘sprinkle’ test times. I’m currently doing PS tests of course. And trying for 1 mid AM cycle staggering and for PM I’m going with +2/3/4 (to see how his night will go), then I might start grabbing a before bed one since I’m generally up until his +6/7 on weekdays and later on weekends

I wish Gus would have more consistent nadirs/onset times, would make this easier but he’s all over.. and the worst one is when his nadir is his PS test. I think this is one of the reasons I was hesitant to start TR and upping his dose sooner - thought maybe a week would give me an idea of how that dose would treat him.

Keep forum updated.
Ask questions.
Don’t panic.
Have a hypo kit (md/hc/syrup).

Ok. Think that’s enough for now. TIA for your help
 
Gus the Furminator said:
Hold the current dose for 3-5 days in Gus’ case we will start with 3 days on his current dose of 2.75u. Hold this dose for 8-10 cycles if under 200 (Q: Does this mean multiple drops under 200 or just one… or is that an up for discussion when the time comes, question?)
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Yes, once you start seeing blue nadirs, you hold a dose 5 days/10 cycles. If nadirs are above 200, you increase every 3 days/6 cycles. This applies to whether it's a single nadir or multiple or long stretches of blue.

Gus the Furminator said:
Increase the dose by .25 if nadirs are greater than 200 but less than 300 or increase by .5u if greater than 300.. (Q: I can still just do .25 no matter the number?)
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Correct. You can still do 0.25U but the essence of TR is to get a cat to a good dose sooner. When a kiity stays in higher number longer, it tends to develop glucose toxicity. The term sounds a lot worse than it is. What this means is that your cat's body gets used to being in higher numbers and treats it as the "new normal." This makes it harder to get the numbers back to the real normal and may contribute to bouncing.

Gus the Furminator said:
Decrease the dose by .25 if Gus drops below 50 *If reduction fails, go back to the last dose that was working well for him. (Q: should I start with 50 or a higher number and work our way to 50?)
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By the time you get here, hopefully you will be comfortable enough with green. :-)

Gus the Furminator said:
Testing:
AM/PM PS and at least one mid cycle per cycle… unless his numbers tell me otherwise or I just wanna see what he’s up to.
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Correct. Usually a test at +2 will tell you whether it will be an active cycle or a pokie break. The idea of testing is to see how low the dose is taking him since Lantus dosing is based on nadirs.
 
Bandit's Mom said:
Yes, once you start seeing blue nadirs, you hold a dose 5 days/10 cycles. If nadirs are above 200, you increase every 3 days/6 cycles. This applies to whether it's a single nadir or multiple or long stretches of blue.


Correct. You can still do 0.25U but the essence of TR is to get a cat to a good dose sooner. When a kiity stays in higher number longer, it tends to develop glucose toxicity. The term sounds a lot worse than it is. What this means is that your cat's body gets used to being in higher numbers and treats it as the "new normal." This makes it harder to get the numbers back to the real normal and may contribute to bouncing.


By the time you get here, hopefully you will be comfortable enough with green. :)


Correct. Usually a test at +2 will tell you whether it will be an active cycle or a pokie break. The idea of testing is to see how low the dose is taking him since Lantus dosing is based on nadirs.
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Many thanks, Bhooma… I appreciate your feedback and confirmations. Looks like I’m about to change my spreadsheet to say TR!

Feeling a little more comfortable with the idea and honestly it was my first choice when choosing a protocol.. was just a bit nervous but I want to get him to a good place sooner than later. His curve on friday were mostly all pinks for whatever reason and one this evening - just when I thought he was going down… getting lower yellows and some blues even!

Understood about the .5 increase. I’ll follow the protocol, it’s tried and tested!
 
Gus the Furminator said:
Many thanks, Bhooma… I appreciate your feedback and confirmations. Looks like I’m about to change my spreadsheet to say TR!
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You are most welcome. :)
You are not the first person to have apprehensions about TR. All of us have been there! Like our cat's bodies, we too get so used to and comfortable in high numbers that normal numbers seem dangerously low to us! But once you get used to greens, they become addicitive and then it's the higher numbers that scare/upset us. LOL.

Good luck with TR. We are all here to help. :bighug: The reason we push TR, is that if you can test enough, it is a better protocol to achieve regulation and for some lucky cats remission. I am not saying that that's not possible with SLGS. Just that some cats do better on TR.
 
Bandit's Mom said:
You are most welcome. :)
You are not the first person to have apprehensions about TR. All of us have been there! Like our cat's bodies, we too get so used to and comfortable in high numbers that normal numbers seem dangerously low to us! But once you get used to greens, they become addicitive and then it's the higher numbers that scare/upset us. LOL.

Good luck with TR. We are all here to help. :bighug: The reason we push TR, is that if you can test enough, it is a better protocol to achieve regulation and for some lucky cats remission. I am not saying that that's not possible with SLGS. Just that some cats do better on TR.
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Back when I had the Libre on in the first two weeks on insulin… I was shooting 1 unit at lowish greens no problem… but that was 1 unit and I wasn’t too worried - I was also a newb and didn’t really know much about anything at that point it was all a blur. I’m sure I’ll get the hang of it

I can’t what for that addiction to set in, I’ve only had a little taste and I liked it! Lol. Those pinks these last two days were indeed upsetting.
 
Ignorance is indeed bliss. Till Bandit was diagnosed, I was feeding good old high carb kibble and getting on with my life! Now I think I spend more time, money and effort on their food and health than I do on mine! LOL.

He was indeed doing great initially. I wonder what happened. Did he get some infection etc that his numbers worsened subsequently?
It looks like glucose toxicity has set in subsequently and hopefully TR should help break that and get him back into those lovely flat blue and green cycles.
 
Bandit's Mom said:
You are most welcome. :)
You are not the first person to have apprehensions about TR. All of us have been there! Like our cat's bodies, we too get so used to and comfortable in high numbers that normal numbers seem dangerously low to us! But once you get used to greens, they become addicitive and then it's the higher numbers that scare/upset us. LOL.

Good luck with TR. We are all here to help. :bighug: The reason we push TR, is that if you can test enough, it is a better protocol to achieve regulation and for some lucky cats remission. I am not saying that that's not possible with SLGS. Just that some cats do better on TR.
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I really thought with his results in the first two weeks we would have had a diet remission… or a quick run at this….

But I changed his diet from high carb 2 wet meals breakfast/dinner and 1/4 cup dry throughout to a low carb all wet diet with 2 larger meals at insulin and small snacks throughout the day … there were a few week of no testing after the Libre but then was nervous blind shooting and bought/learned how to home testing - when I started testing again it all seemed to go backwards on us as his BG were up and the only change was his diet
 
Bandit's Mom said:
Ignorance is indeed bliss. Till Bandit was diagnosed, I was feeding good old high carb kibble and getting on with my life! Now I think I spend more time, money and effort on their food and health than I do on mine! LOL.

He was indeed doing great initially. I wonder what happened. Did he get some infection etc that his numbers worsened subsequently?
It looks like glucose toxicity has set in subsequently and hopefully TR should help break that and get him back into those lovely flat blue and green cycles.
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No kidding! Truth be told I thought I was already feeding a high quality, human grade food wet and dry… spending enough money… but here we are! I used to work at a high end pet store.. I went out of my way to learn pet nutrition outside of work hours… a lot of good that did … lol
 
Bandit's Mom said:
Ignorance is indeed bliss. Till Bandit was diagnosed, I was feeding good old high carb kibble and getting on with my life! Now I think I spend more time, money and effort on their food and health than I do on mine! LOL.

He was indeed doing great initially. I wonder what happened. Did he get some infection etc that his numbers worsened subsequently?
It looks like glucose toxicity has set in subsequently and hopefully TR should help break that and get him back into those lovely flat blue and green cycles.
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His initial, at home, vet visit he had a urinalysis and a wellness check, vet said he was a healthy boy other than the diabetes that his organs were all in good shape and that we caught the diabetes early.

There’s are no signs of any issues visually or behaviour changes… but that doesn’t always mean nothings wrong. He could have a hidden something happening
 
Bandit's Mom said:
Wow! He was doing that well before a switch to a low carb diet?! o_O

Let's see what TR does for him. It's probably a matter of getting to his breakthrough dose. Paws crossed!
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I know! I think some of the Pates I was feeding were ok for him but there were some ‘stews’ in the mix (performatrin ultra brand) and only 1/4 of dry … all meeting his daily kcals.

I think food is a strong factor in his numbers. He was going all day without food originally, wet breakfast at shot time, then at +7 I would toss kibbles for him and he’d run after them and he’d get the rest of the 1/4 cup to snack on, then a wet dinner with insulin and he’d snack on his kibble the rest of the night.

Ive often wondered if I should go back to that… there are some days he doesn’t get his snack cuz he slept through his time slot (2 hours before shot) and his numbers are lower.

I know it’s best to feed smaller meals and the reasons for this… and also Gus is allllllways hungry these days so I don’t think it would work anyhow. I feed him about 4 fancy feast pate cans a day now.
 
What times are you feeding now? If he will tolerate it, try feeding most (if not all) of the food in the first half of the cycle.
 
Bandit's Mom said:
What times are you feeding now? If he will tolerate it, try feeding most (if not all) of the food in the first half of the cycle.
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He gets bigger meals at shot time. Then at +3, 6 and 9. The 9 is because in the am he had a 2 or 3 vomits that I thought were from hunger.. when I started feeding him a snack at that time it stopped. And in the PM he will go bananas if I don’t feed him and he has to wait for dinner/shot time, he’s only ‘bad’ when he wants food… he’ll scratch anything and everything until he gets food and the meows are as if I’m starving him to death - he’s a bit dramatic.

He doesn’t always get his AM +9… if I feed him late enough before I go to bed he seems to be able to make it until AM shot/Breakfast

Just a note: I try hard to stick to a fixed schedule for consistency but some days he wants food earlier or life just happens.
 
Bandit's Mom said:
Totally understandable. They are the boss!

OK. Let's stick with this for now and make changes if necessary once he sees better numbers.
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Thoughts of buying raw have gone through my head … for the main meals and FF for snacks.. but they’re just thoughts for now.

Thanks a lot for the chat Bhooma, I’m excited to get started on TR and I hope that you will check in on us ;)
 
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