7/21 Sugar AMPS 161 |+5 110 |+9.6 116 |PMPS 115 |+4.5 137

[Sugar’s Mama]

Yesterday

161 @ AMPS

Looks like he may be done bouncing. We’ll see what today brings!

 

[Sugar’s Mama]

110 @ +5

@Bandit's Mom - when should we consider an increase?

 

[Bandit's Mom]

The depot will take 6-8 cycles to rebuild after a skip/token dose. I would wait till 7/23 to consider an increase.
Try and get a test at +9 and if lower, feed? He likes to dip into green at the end of the cycle and spook you.

 

[Sugar’s Mama]

Thanks! We will test at +9 today. He does like to have those sneaky, end of cycle greens!

 

[Bandit's Mom]

He does like to have those sneaky, end of cycle greens!

And if he does give you green, shoot! Assuming you can monitor. That's the only way to progress. He might earn a reduction. You will not know without shooting.

 

[Sugar’s Mama]

Of course we have plans this evening so he probably will be green! We'll only be out for a few hours (till +3/4), so we'll see what the numbers are and can hopefully feel confident to shoot. I'm thinking, if he is 90 and above we will give the full dose; 70-90 token dose and below 70 skip. Does that sound right? I want to have it planned out so I'm not feeling frantic in the moment.

I will be home most of Fri-Mon so if we do decide to increase or shoot low I'll be around.

 

[Sugar’s Mama]

116 @ +9.5

Eating a good snack so fingers crossed that he’ll be good for PM shots.

 

[Sugar’s Mama]

115 @ PMPS so getting his full .75 dose!

Leaving out his fav food and will check again when we return home.

 

[Bandit's Mom]

Got any tests in the PM cycle?

I'm thinking, if he is 90 and above we will give the full dose; 70-90 token dose and below 70 skip. Does that sound right? I want to have it planned out so I'm not feeling frantic in the moment.

A preshot is no guarantee of how the cycle will play out. Usually, shooting low gives beautiful flat cycles. And the depot continues to affect the first part of the cycle even if you skip or give a token dose. You can always feed him high carbs with the shot and leave out some for him on nights like this. Do you have an autofeeder that you can use to feed when you aren't at home?

 

[Sugar’s Mama]

137 @ +4.5

Is it your morning, Bhooma? Good morning!

We don’t have an auto-feeder but Sugar seems to free-feed OK. We give him a full Weruva pouch at each shot time and portion out two more throughout the day that he sometimes finishes but sometimes it’s goes wasted. His sister sometimes cleans the plate, but that’s a new development.

 

[Sugar’s Mama]

A preshot is no guarantee of how the cycle will play out. Usually, shooting low gives beautiful flat cycles. And the depot continues to affect the first part of the cycle even if you skip or give a token dose.

I understand this on an intellectual level. But, I think that’s the part of TR that is scary for me. With SLGS, there are clear ‘rules.’ With TR it seems like more of a ‘try to push the envelope until it’s too much and then back off.’

 

[Bandit's Mom]

But, I think that’s the part of TR that is scary for me. With SLGS, there are clear ‘rules.’ With TR it seems like more of a ‘try to push the envelope until it’s too much and then back off.’

Why do you say that there are no rules for TR? In fact it is a scientifically developed and published protocol.

"Tight Regulation with Lantus or Levemir for Diabetic Cats
Management of Diabetic Cats with Long-acting Insulin - summary published in 2013

The Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats was developed by laypersons from the German Diabetes-Katzen Forum. The protocol was eventually published in the Journal of Feline Medicine and Surgery. Note: Basaglar is a new brand of insulin glargine developed and made available since the TR protocol was written.

The tight regulation protocol was tested in 55 diabetic cats for Lantus/glargine and in 18 diabetic cats for Levemir/detemir from the German Diabetes-Katzen Forum. Owners measured blood glucose an average of 5 times daily and adjusted insulin dose based on the protocol. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis."

 

[Sugar’s Mama]

I suppose I mean easy rules. I have no idea at this time when to increase or decrease, it all seems arbitrary at the moment while I’m still trying to learn. So, I feel dependent on this forum and especially you to help me along. It felt easier to know numbers that triggered increases/decrease/NS with SLGS. Does that make sense?

 

[Bandit's Mom]

I think you will get the hang of TR soon. I can understand your fear of lower numbers and shooting low. Believe me, we have ALL been there. Every one of us (me included) have panicked at our first green and skipped our first green preshot (or even blue preshot!). Yes, TR is more aggressive than SLGS, but it is also very structured.

Let me see if I can clarify some of the rules:

1. Easiest is the decrease. Since he is a newly diagnosed diabetic, a drop below 50 on the human meter would earn a dose reduction. The difference between SLGS and TR (besides the reduction point) is that for SLGS, every drop below the reduction point is a decrease. There is no concept of not taking back-to-back reductions. With TR, you provide for the depot taking 4-6 cycles to adjust to a lower dose and therefore wait 4 cycles to reduce again.
   
   For example, if Sugar were to drop below 50 tonight, he would earn a reduction to 0.5U from tomorrow morning. However, if he were to drop below 50 again tomorrow, you would not reduce again because it is still the 0.75U depot affecting his numbers.
   
   
2. With TR, the no shoot number is 50 (on a human meter). Just like with SLGS, you stall without food and test again in 20 mins to see if the number rises over 50 to shoot. This is a sticky detailing how to handle preshots below 50: Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers
   
   
3. As far as increases go, once a cat starts seeing nadirs below 100, you hold a dose 8-10 cycles. Every time you skip or give a token dose, the depot is disrupted and the cycle count resets. So after a skip/token, you give the depot 8-10 cycles to rebuild before evaluating whether he needs a dose increase. With TR you want them to spend as much time in greens as possible. If they are seeing higher greens on a dose, you want to increase the dose to bring down nadirs and increase the amount of time spent in green.

I probably have not covered everything, but you will get the hang of it with time. There is absolutely nothing in TR that is not structured and clear. I think what is spooking you is handling and shooting lower numbers. That will come with time and experience. Till you shoot a green preshot, you will not get comfortable shooting them. Your fear is not unreasonable. Like I said, we have ALL been there. It's not insurmountable. We are here to help with that!

 

[Sugar’s Mama]

Thank you so much for this reply. Your point one is already more clear then what I keep re-reading! Will read through again properly in my morning! And will add this info into my ‘cheat sheet’ tab on my SS.

You are right about what scares me. But, I am looking forward to being home the next couple days in case I can experience a green PS and monitor how it plays out.