? 07/31 Grandpa. Third day complete. Next steps?

[Beck and Philly]

Grandpa just finished day 3 on Lantus. We started him at 1U every 12 hours. His numbers aren't making the huge swings they were doing on Vetsulin, but they're staying pretty high - mostly in the 400s.

I've been reading about tight regulation and SLGS. Since both seem to suggest 1U every 12 hours as a starting dose, I gotta admit that I'm having trouble understanding the differences. I see with TR you do multiple small meals and test at least once or twice per day in addition to the preshot tests. Is the difference that TR allows more frequent and faster dose increases?

I work from home and already feed Grandpa small meals. It sounds to me like TR might work, but I need your help.

My roommate just updated his spreadsheet since I can't make changes from my phone for some reason. She managed to make the updates despite Grandpa's "help" as he saved her from the invading laser light. He's good like that.

 

[Chris & China (GA)]

Is the difference that TR allows more frequent and faster dose increases?

Basically, yes

On SLGS, you only increase every 7 days so that can leave them in high numbers longer than ideal, but with TR, once you're through the "loading phase" (the first 5-7 days), you can increase as often as every 3 days

Leaving them at a dose that isn't getting them where we want them can lead to glucose toxicity setting in (where the body gets used to the high glucose despite the insulin and you can end up having to give more than you normally would have just to break the toxicity)

The other main difference is the point where you take reductions....on TR you don't reduce unless they drop below 50 on a human meter (68 on the AT).....on SLGS, you reduce when they drop below 90

 

[Beck and Philly]

Oh okay. Thanks! That helps a lot. So for now I leave him at the 1U for a week or so. That makes sense.

With his pancreatic masses, we aren't sure what his body is able to do, so I want to be careful while still helping him feel as good as possible. The vets have pretty much backed off and counted him out, so I really appreciate advice here.

 

[Chris & China (GA)]

The vets have pretty much backed off and counted him out

shows you what they know!!

Grandpa seems to have his own ideas!!!

 

[Susan&Felix(GA)]

on TR you don't reduce unless they drop below 50 on a human meter

Below 68 on Alpha Trak.

She managed to make the updates despite Grandpa's "help" as he saved her from the invading laser light. He's good like that.

She helps him, he helps her.

 

[Wendy&Neko]

Here is the link to your last post here: http://www.felinediabetes.com/FDMB/threads/grandpa-may-or-may-not-have-started-lantus-today.200293/ We include those so people can easily go back and see the history.

A couple other key differences between TR and SLGS. TR requires an all low carb wet food or raw diet. Any dry or HC and SLGS is the choice. Second, since TR has faster increases, it means enough testing to know what the dose is really doing so you can do safe increases. Both need preshot tests. TR suggests at least one other mid cycle test per cycle while SLGS does a weekly curve. Any additional spot checks are a good idea for both. And lastly, TR allows larger increases, 0.5 units, if the nadirs are all above 300 I keep remembering more things. Must be age. Anywho, with both SLGS and TR,meeting take the dose of the previous insulin into consideration and would have had you start closer to 2.0 units..

If you were doing TR, and had gotten more tests yesterday, you could have increased tomorrow.

 

[Beck and Philly]

A couple other key differences between TR and SLGS. TR requires an all low carb wet food or raw diet. Any dry or HC and SLGS is the choice. Second, since TR has faster increases, it means enough testing to know what the dose is really doing so you can do safe increases. Both need preshot tests. TR suggests at least one other mid cycle test per cycle while SLGS does a weekly curve. Any additional spot checks are a good idea for both. And lastly, TR allows larger increases, 0.5 units, if the nadirs are all above 300 I keep remembering more things. Must be age. Anywho, with both SLGS and TR,meeting take the dose of the previous insulin into consideration and would have had you start closer to 2.0 units..

If you were doing TR, and had gotten more tests yesterday, you could have increased tomorrow.

Thanks! I wondered if 1U seemed low. The prescribing vet made an effort to point out that we need to give a smaller amount of Lantus than we were dosing with Vetsulin. I then read a suggestion of how much to start with according to weight and it also came out to 1U. His numbers have seemed high, though.

We tested four times yesterday - the two pre- shots, a midcycle shot, and a pre-bedtime shot. All were in the same range. How many more would have been needed to make a dose increase decision?

Thanks again.

 

[Chris & China (GA)]

We tested four times yesterday

Wendy was referring to "yesterday", yesterday......so she was looking at the 30'th. Your spreadsheet only shows the AMPS and no other tests.

 

[Shawna & Davidson (GA)]

If you are working from home, then I'd suggest doing lots of test so that you can see the nadirs, and catch the lows and be able to decrease more often. Not testing more often most likely you'll miss the lows. Check out Davidson's SS and had I not done the tests I'd also miss the lower BG's. I'm testing often now as I want to catch him below 40 and when he's close, it means lots of tests..........he gets lots of treat, so he doesn't mind

 

[Beck and Philly]

Wendy was referring to "yesterday", yesterday......so she was looking at the 30'th. Your spreadsheet only shows the AMPS and no other tests.

Ahhh ok. I'l get tests throughout today. So far his AMPS is about where he's been for the past few days.

 

[Sue and Luci]

Good for you on the increased testing...soon you'll be able to see a pattern to his ups and downs.

As for the phone view of the spreadsheet - I cannot make changes to mine either...for whatever reason my I-Phone does not support Excel editing - only viewing. I have to be on my laptop to make any edits.

 

[Shawna & Davidson (GA)]

Good for you on the increased testing...soon you'll be able to see a pattern to his ups and downs.

As for the phone view of the spreadsheet - I cannot make changes to mine either...for whatever reason my I-Phone does not support Excel editing - only viewing. I have to be on my laptop to make any edits.

Strange, I can edit my SS on both my iPhone 5SE and iPad.....I go into google sheets and have full functions.

 

[Beck and Philly]

Good for you on the increased testing...soon you'll be able to see a pattern to his ups and downs.

As for the phone view of the spreadsheet - I cannot make changes to mine either...for whatever reason my I-Phone does not support Excel editing - only viewing. I have to be on my laptop to make any edits.

It's frustrating. I spent quite awhile researching how to edit by phone and downloaded the suggested apps, but no luck. I have a Galaxy S8. My roommate has an older Galaxy Note 4 and when she tried, it worked for her. She then spent quite awhile with my phone, trying to make it work. No luck. I can view, but not edit. I work on a government laptop so I haven't used it for updates. We have always kept a notebook with Grandpa's numbers written in it so she updates the spreadsheet from that.

 

[Amanda & Shmee]

Hi Beck welcome to the group, sorry I am late to the party You are doing so great already! It makes me sad that your vet has written Grandpa off. It happens a lot around here, or vets that just do not have the experience in this area. You are in good hands. Happy you were able to start Lantus! I work at home too and follow TR, but like both Chris and Wendy said it requires more testing and to be more vigilant since you could potentially be increasing every three days. There is science backing the TR procedure, so it is safe and has a better chance at remission. Although there have been cats that have also gone into remission from SLGS too. When I first started I heard a suggestion to look at your SS like a jigsaw puzzle - whatever is not filled in today try and get tomorrow or within the next few days (including PM tests when the numbers start to get lower). So you can get some good data and be able to recognize his patterns later. I know it is extremely overwhelming, you both will do great.

 

[Mandy & Rex (GA)]

Hi! I haven't posted in your condos before, but I saw that you said you have the Galaxy S8. That's what I have and I have always updated the spreadsheet from my phone. Do you use the Google Drive app?

I agree with the others about testing, testing, and more testing, within reason!

 

[Beck and Philly]

Thanks a

Hi! I haven't posted in your condos before, but I saw that you said you have the Galaxy S8. That's what I have and I have always updated the spreadsheet from my phone. Do you use the Google Drive app?

I agree with the others about testing, testing, and more testing, within reason!

These are the Google apps I have on my phone. I'm not sure what we're doing wrong.

 

[Mandy & Rex (GA)]

I'll try to help! When you open Sheets, what happens? Do you have your spreadsheet saved in there and also on Google Drive? Are you signed in with a Gmail email address? When I edit Rex's spreadsheet, I open Google Drive and click on Rex's spreadsheet, which is saved as a Google Sheet.

 

[Beck and Philly]

Thanks, Mandy! I just sat down after a busy day and thought I'd take another stab at figuring out how to edit from my phone. You asked if I'm signed in, and I don't think so. I don't use my gmail for email so I don't think I stay signed in. Let me take a look around

 

[Beck and Philly]

Thanks, Mandy! I just sat down after a busy day and thought I'd take another stab at figuring out how to edit from my phone. You asked if I'm signed in, and I don't think so. I don't use my gmail for email so I don't think I stay signed in. Let me take a look around

I think I may see the issue. The spreadsheet is marked view only and I'm signed into my Google account. I created it on a laptop. The owner name is my aol username. Not sure how I managed that. I tested creating a new Google sheets spreadsheet and that worked just fine. I don't think Grandpa's sheet knows who I am. Somehow we made it recognize my roommate, so maybe there's a way to make it see me.

 

[Mandy & Rex (GA)]

I think I may see the issue. The spreadsheet is marked view only and I'm signed into my Google account. I created it on a laptop. The owner name is my aol username. Not sure how I managed that. I tested creating a new Google sheets spreadsheet and that worked just fine. I don't think Grandpa's sheet knows who I am. Somehow we made it recognize my roommate, so maybe there's a way to make it see me.

Can you copy the old SS over to the new SS? If you are able to edit the new SS, then delete the old one and update the SS in your signature so it links to the new one. Good luck!

 

[Beck and Philly]

Brilliant suggestion! It took awhile and I had to fix some of the header that got messed up in the cut and paste process, but we have a spreadsheet that I can edit.

I've updated my signature to link to the new spreadsheet. I hope it works!

 

[Mandy & Rex (GA)]

Brilliant suggestion! It took awhile and I had to fix some of the header that got messed up in the cut and paste process, but we have a spreadsheet that I can edit.

I've updated my signature to link to the new spreadsheet. I hope it works!

I can see the spreadsheet. I can see where you had to edit some things. I could easily edit that for you, but I don't feel comfortable asking for editing rights to the SS. That usually falls to @Marje and Gracie .. that SS is her brain-child.

 

[Kris & Teasel]

I can see your SS.

 

[Beck and Philly]

I can see the spreadsheet. I can see where you had to edit some things. I could easily edit that for you, but I don't feel comfortable asking for editing rights to the SS. That usually falls to @Marje and Gracie .. that SS is her brain-child.

Thanks for all your help. I'm happy to let someone edit if needed. I don't think I changed any of the functionality when I fixed the top, though, so I'm okay with it like this. Does it still look jumbled up to you guys?

 

[Kris & Teasel]

Aside from the header and the compression of the colour code guide the rest is fine.

 

[Marje and Gracie]

Thanks for all your help. I'm happy to let someone edit if needed. I don't think I changed any of the functionality when I fixed the top, though, so I'm okay with it like this. Does it still look jumbled up to you guys?

I can easily fix all the issues for you. I’ll send you a private message so I can get editing rights.

Hi Beck welcome to the group, sorry I am late to the party You are doing so great already! It makes me sad that your vet has written Grandpa off. It happens a lot around here, or vets that just do not have the experience in this area. You are in good hands. Happy you were able to start Lantus! I work at home too and follow TR, but like both Chris and Wendy said it requires more testing and to be more vigilant since you could potentially be increasing every three days. There is science backing the TR procedure, so it is safe and has a better chance at remission. Although there have been cats that have also gone into remission from SLGS too. When I first started I heard a suggestion to look at your SS like a jigsaw puzzle - whatever is not filled in today try and get tomorrow or within the next few days (including PM tests when the numbers start to get lower). So you can get some good data and be able to recognize his patterns later. I know it is extremely overwhelming, you both will do great.

It’s not really “science” Members say that all the time but it was developed by Kirsten Roomp for her cat, Tilly, and also laypersons in the German equivalent of our board. Kirsten was able to partner with Jacquie Rand, a vet, to get the TR protocol published.

 

[Marje and Gracie]

SS is fixed.

IMHO, his lantus starting dose was too low. Regardless of whether you do SLGS or tight regulation protocol, if you previously used another insulin, you want to take the dose he was at on that insulin into consideration.

He wasn’t showing a lot of response on the 2u of Vetsulin. Granted, you didn’t have the tests you’ve been getting on lantus but Vetsulin doesn’t have the duration lantus typically does. His higher pre shots were likely due to the lack of duration.

I encourage you to take him up consistently and systematically per whichever method you decide to use.

 

[Beck and Philly]

Marje. Thanks for the spreadsheet help!

As far as the starting dose, I had read in several places that the starting Lantus dose should take into consideration his current dose of the insulin we're stopping. I don't know what "take into consideration" means, though. I had read that the starting Lantus dose should be less than a previous Vetsulin dose. I had also read how to calculate dose by cat weight. I figured we were on a good track with 1U. Sounds like I figured too low.

We started raising the dose today. We want to do TR, so it looks like a raise every three days is allowed. Our plan is to raise .25 at a time. If anyone has thoughts or suggestions, I'm very open.

 

[Noah & me (GA)]

The vets have pretty much backed off and counted him out,

Some dark humor for Grandpa / If cats could talk. "Thanks anyways doc but actually I'm not quite dead yet. You're not thinking of charging me for this are you?" Maybe medical schools could use a bit more Monty Python and a bit less textbook data.

 

[Beck and Philly]

Some dark humor for Grandpa / If cats could talk. "Thanks anyways doc but actually I'm not quite dead yet. You're not thinking of charging me for this are you?" Maybe medical schools could use a bit more Monty Python and a bit less textbook data.

No you didn't! You are so not right! Ha! I will be hearing that in my head all day. Thanks for the morning laugh.

 

[Amanda & Shmee]

It’s not really “science” Members say that all the time but it was developed by Kirsten Roomp for her cat, Tilly, and also laypersons in the German equivalent of our board. Kirsten was able to partner with Jacquie Rand, a vet, to get the TR protocol published.

Sounds like that is considered scientific to me since there was a study done to show it's benefits and the study was published by the Journal of Feline Medicine and Surgery.

 

[Marje and Gracie]

Sounds like that is considered scientific to me since there was a study done to show it's benefits and the study was published by the Journal of Feline Medicine and Surgery.

There wasn’t a study. I am a biologist and I can tell you there is a big difference between an actual scientific study and development of a protocol or method just based on anecdotal experience where observations were made and “tweaking” done.

There were no hypotheses developed and no controls used. Research ...which can include observations done on a population with minimal experimentation and no controls....is published in technical and professional journals all the time but even that, which is a higher level than this was, doesn’t always indicate that a true scientific study was conducted.

You might want to read Tilly’s website and you will have a better understanding as to the process. And it was published to give it wider dissemination, more credibility with vets, and because with researchers and even vets, it’s often about publishing.

 

[Noah & me (GA)]

You don't need a doctorate to understand "Publish or perish". Full disclaimer, I'm not in the sciences and I know the words anecdotal and science don't belong in the same sentence. Even a grade 10 science student learns the value of a double blind study, what's the use otherwise?