? 11/16 Sunny AMPS 264 +3 255

Are you planning to follow one of the dosing methods used by many here on the boards?

With SLGS, you would hold the dose for seven full days before increasing (increases are always by .25u in SLGS), unless he drops below 90, in which case you would increase immediately.

I'm less familiar with TR because with his partly dry food diet, my cat isn't eligible for it (yet), but with that you hold your starting dose for 3-5 days; then, your increase (.25 or .5u) is determined by his nadirs.

My vet's advice is not to increase your dose more than once in a week, as according to her, that's how long it takes for a dose to really kick in. (In other words, her thinking is along the lines of SLGS, more or less.)

This is me just citing the post I've linked above (and a conversation with my vet) - I'm not in a position to give dosing advice. @Wendy&Neko, @tiffmaxee, maybe you can help out?
 
I believe most increase 0.25u at a time, unless the numbers are really bad. Plus with your saying he was feeling much better today and eating well, I wouldn't want to put a big shock to the system but going too fast. But that's just me, and I am new to all this too really.
@Allie & Gen , I wonder if they really have to be completely off the dry to make that work? I get the idea I suppose, that dry carbs last longer in their bodies. And for many foods I suppose that could cause issue. But if you feed Young Again Zero, that seriously has less than 1% carbs? I shouldn't think that would effect being able to use the TR method? That's less carbs than any wet foods unless feeding raw or home cooked. Just my thoughts on it anyhow.
 
Sunny is back from the Falls, so we want to take that into consideration, he’s not new. And he’s restarting insulin, not just dabbling a little with a few small doses and getting into greens, which is why I asked yesterday about Sunny’s weight. Initial starting dose weight based is often where you’d have wanted to start which is 0.25u per kg of ideal weight. If he’s around 15 lbs ideal weight that would be around 1.5 - 1.75u, if he’s not ideal weight, ie, he should be less, and if you want to ease in, you could bump him up to 1u, since I think 0.5u was too low to begin with.
 
Tyleete said:
I believe most increase 0.25u at a time, unless the numbers are really bad. Plus with your saying he was feeling much better today and eating well, I wouldn't want to put a big shock to the system but going too fast. But that's just me, and I am new to all this too really.
@Allie & Gen , I wonder if they really have to be completely off the dry to make that work? I get the idea I suppose, that dry carbs last longer in their bodies. And for many foods I suppose that could cause issue. But if you feed Young Again Zero, that seriously has less than 1% carbs? I shouldn't think that would effect being able to use the TR method? That's less carbs than any wet foods unless feeding raw or home cooked. Just my thoughts on it anyhow.
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I don't know, honestly. I take the dosing methods with a grain of salt, but I think the people who put together the TR protocols were working with data that involved a wet food diet only, and because it's such a "tight" protocol (with a higher risk/reward ratio), there were/are concerns that a cat with a dry or partly dry diet might respond in unexpected ways that the protocol wouldn't take into account, which could lead to higher risks or harder to predict outcomes. (I gleaned this from an old thread Christie shared with me about "common misunderstandings" around the dosing methods.)

To me, that means that it might well be fine to follow TR with a low-carb dry/partly dry diet, but you'd want to be really careful/able to monitor even more closely so you could adjust appropriately. (Which, obviously, is kind of a thing anyway, since every cat is different!) But I really don't feel equipped to offer actual advice or have a really decisive opinion without a better/more detailed background on how the protocol was developed, and/or more experience than I have at this point!
 
Allie & Gen said:
I don't know, honestly. I take the dosing methods with a grain of salt, but I think the people who put together the TR protocols were working with data that involved a wet food diet only, and because it's such a "tight" protocol (with a higher risk/reward ratio), there were/are concerns that a cat with a dry or partly dry diet might respond in unexpected ways that the protocol wouldn't take into account, which could lead to higher risks or harder to predict outcomes. (I gleaned this from an old thread Christie shared with me about "common misunderstandings" around the dosing methods.)

To me, that means that it might well be fine to follow TR with a low-carb dry/partly dry diet, but you'd want to be really careful/able to monitor even more closely so you could adjust appropriately. (Which, obviously, is kind of a thing anyway, since every cat is different!) But I really don't feel equipped to offer actual advice or have a really decisive opinion without a better/more detailed background on how the protocol was developed, and/or more experience than I have at this point!
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I've learned with a friend, sometimes you've just got to wing it and trust your gut. But I understand not everyone feels comfortable that way. Also, that cats (& occasionally wildlife) are my full time job, and I can stay with asthma monitor them 24/7 when need be. I know that's not the case with many. It was just a thought. Ever since learning most (myself included for the first few) aren't treating kidney cats the correct way, I've come to question a lot of things. I find just because it's believed to be old, tried, and true; doesn't mean there's not something else to be done or tried. ;)
 
Allie & Gen said:
To me, that means that it might well be fine to follow TR with a low-carb dry/partly dry diet, but you'd want to be really careful/able to monitor even more closely so you could adjust appropriately.
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Elise is correct. We’ve discussed this issue many times over the years. Dry food is dry food and if you feed any dry food at all, even YA, you should not use the TR Protocol. A prerequisite for using TR is feeding canned or balanced raw. If you feed any dry, you should be using SLGS.

New members should not do custom dosing. By the time someone has determined their cat needs custom dosing, they should need very little advice although we are here to support anyone at any stage.
 
tiffmaxee said:
If you elect to feed lc dry and follow TR it’s not really TR. It becomes custom dosing. Anyone can choose to do that but probably will not get dosing advice.
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Marje and Gracie said:
Elise is correct. We’ve discussed this issue many times over the years. Dry food is dry food and if you feed any dry food at all, even YA, you should not use the TR Protocol. A prerequisite for using TR is feeding canned or balanced raw. If you feed any dry, you should be using SLGS.

New members should not do custom dosing. By the time someone has determined their cat needs custom dosing, they should need very little advice although we are here to support anyone at any stage.
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I feel bad that we've hijacked Holly's thread for this conversation, when she's asking for advice about her own cat.

That said - this is well and good, but those of us who weren't around years ago could use a little bit more background on why the protocols work the way they do, how their guidelines were formulated, etc. It can be hard to feel that one is making an informed and careful choice about a beloved animal without more information than "this is how we do things," "this has been tried and tested and it works if you do it," or indeed, "we've discussed this issue many times over the years." (Personally, I get a detailed explanation from my vet for anything she prescribes or advises, and I am inclined to do the same with any source of medical advice.) I know that for TR, at least, there are quite a lot of background links, but even with all the time I've poured into this forum over the last month, I've barely had a chance to look at some of them. I might, at some point, not only read them, but try to use them to put together something short and digestible to share, for those who feel similarly. I'm sure that many of you who have been here for a long time and generously continue to offer advice and support may be tired of getting the same questions or misunderstandings - maybe something like that could help.
 
I agree with Christie on dosing. I'd go to at least 1 unit. I see that Sunny's break through dose first time on insulin was 2.5 units on Lantus. Second time around they typically have to go as high or a bit higher than they did the first time. Plus you have the possible impact of budesonide. The sooner you can get him regulated again, the better the odds for re remission.
 
For a bit of clarification....

The Tight Regulation Protocol was based on research and subsequently published in a leading veterinary journal. The link to the article is in the dosing method post. The authors were from well respected universities -- one is a vet and the other is a data analyst. The authors and their colleagues have continued to publish. The protocol has been in use for well over a decade. It has a strong track record of getting cats into remission or getting them well regulated. The "do what instinct tells you" method as was suggested above, is not unlike saying you would prefer to use a surgeon who takes your tonsils out via an abdominal incision. There is no research to support that approach. Over the years, the sciences have moved to evidence based approaches to treatment. This is not just in one specialty area. It's what is taught to any person pursing training in medicine or an allied field. I'm also saying this based on experience as I have spent my career on medical faculties. I opted to use TR with my cat because there was solid research to support the method. I don't intend this to be harsh or defensive but dismissing TR because you haven't had time to read the information is akin to saying, "Don't confuse me with the facts."

What is provided in the dosing method post with respect to TR is not a point by point excerpt from the article. A former moderator, Jill, who was coordinating with the authors, put together the information in our post to make sure the language was approachable rather than technical. Jill read the available research and worked closely with another moderator, Jojo, who was an incredibly knowledgeable vet tech.

None of the moderators or experienced members would tell anyone "this is how we do things." At the minimum, if anyone has a question, Marje, Wendy, or I will do our best to provide background. In addition, there are several members, including myself, who have access to university libraries or veterinary libraries. If you would like to read the research, you can always search via Google Scholar or PubMed and ask for an article. If a member opts to do something different than the methods we routinely discuss, we ask that you put a note to that effect in your signature. We also ask that you do not coach other members to do what you're doing since it is a dosing plan that is customized for your cat.
 
Taking it to a more personal level, I will also add that over my time here, I have appreciated the safety mechanisms that are built into the dosing methods used here on the forum. I have been here also long enough to have seen people come here desperately posting for help with their cat in hypo, and staying with them and guiding them as they deal with that because they couldn’t get their cat to emerg vet, and the circumstance was all because they had just been winging it with dosing. I’ll take the safety side every day of the week and twice on Sunday :)
 
I get that. But there are lots of times when none of the experienced people are either here or apparently willing to answer. We've seen some people ask questing and get no replies at all, and they're still asking the next day. So then some of us newbies try to give our input. I do always mention that I am new too. But this is also the 2nd cat that's gone into remission within 2 months of insulin. So while I definitely don't have the belts and accreditations to add to my name, when the protocols aren't working and I've had to just go by what my data is telling me to do (contrary to what all the sticky threads state) and my instincts tell me to do, I haven't much of a choice. My last little guy here was not "Following the guidelines", as one of the pros said, and everyone was confused with his results. Sometimes it has to be done. I consider that I took a leap of faith, and was rewarded for it.
And I don't think Allie meant anything bad with what she said. Only that sometimes the writings don't sound right to a newbie. There is SO much info we need to read and ASAP. It can be hard to decipher. And I've seen from my experience as well watching other posts, instead of having things explained in more simple terms, you're just pointed to those same sticky threads that didn't make sense the first 3 or 4x you read it. I for one, have asked questions about a the info in a sticky thread that I didn't understand. Asked if someone could explain it better to me. The response was.... 'It's all explained here (insert link), just read it. Then if you have any questions, ask'!
😑Which is exactly what I had done. I get the same questions are dull to the pros. Particularly asked over and over by each new person. But just essentially saying... 'Go read', after a person just said they read it and don't understand it? Not helpful. I could be wrong, but I think that's what she meant. I know it's how I've felt to where I stopped asking & started taking advice from another newbie till we figured my baby out.
We're all only trying to figure this out and dry the best we can for our little furballs. That's all we want.💕
 
Please consider sending a PM to a moderator or tagging a member/moderator who you've had a good experience with if there are questions or if you see someone who's question hasn't been answered. I know for me, if it's during the day, I'm at work. It's not often that I can get to the Board and if I do, I'm looking for what may be something urgent. If the question isn't obvious from the subject line or is embedded somewhere in what could be a long thread, I may not see it or skip to what appears to be an urgent question. Frankly, repeating a link isn't helpful if it's clear that the caregiver has read the material. Sometimes, it's not clear that the caregiver has done their homework. Also, I've been known to go on at length thinking that I'm answering the question and then the person posting tells me that I'm not targeting their question. Sometimes, asking a specific question helps!

I don't disagree that it can take getting over the initial sense of being overwhelmed and then multiple readings of instructions to get a feel for how to manage your cat's diabetes. It doesn't happen overnight. The challenge with a situation where a cat may not be responding to an established approach is that every cat is different and every caregiver's situation is different. What someone has customized may not be applicable to someone else's cat. In addition, for those of us who have been here for a while, we may have ideas about what to try if you need to customize. And even with that, in many instances, someone who may want to customize may not have given an established dosing method enough time to confidently state that it's not working for their cat.
 
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