9/13 Mia 171; +2.5 96; +3.75 89; PMPS 124

Hi Janet, I don't see that it's necessarily climbing. It's higher today than yesterday and the past few days, so it seems like it's climbing, but if you'll look back, she's often had higher preshot numbers. It would be nice to get those preshot numbers down a bit, and to also get her down into the greens a bit more. I know that you are reluctant to try TR, even though you are currently testing enough for it. If you switch to TR, I'm wondering if, by taking her dose up a little and holding it there (TR takes reductions at 50 for a newly diagnosed kitty; SLGS requires reductions when they fall below 90), you can get those preshot numbers AND her overall cycle numbers down some. Let's check with @Christie & Maverick to see what she thinks. The decision is yours, of course, no one will force you, but getting some more experienced eyes on her numbers might give you some insight.
 
Mary & Jude said:
Hi Janet, I don't see that it's necessarily climbing. It's higher today than yesterday and the past few days, so it seems like it's climbing, but if you'll look back, she's often had higher preshot numbers. It would be nice to get those preshot numbers down a bit, and to also get her down into the greens a bit more. I know that you are reluctant to try TR, even though you are currently testing enough for it. If you switch to TR, I'm wondering if, by taking her dose up a little and holding it there (TR takes reductions at 50 for a newly diagnosed kitty; SLGS requires reductions when they fall below 90), you can get those preshot numbers AND her overall cycle numbers down some. Let's check with @Christie & Maverick to see what she thinks. The decision is yours, of course, no one will force you, but getting some more experienced eyes on her numbers might give you some insight.
Click to expand...
Thanks, Mary. I will certainly consider any advice. A lot will depend upon the protocol for TR, as I don’t have a thorough understanding of that. I’m dealing with three special needs cats currently, and just can’t take on more intense treatment on this front. What is it that causes the AM pre shot number to be so high comparatively? The PM pre shot numbers are lower. Ideally, I’d feel comfortable keeping her around the 90’s.
 
Janet & Mia said:
Thanks, Mary. I will certainly consider any advice. A lot will depend upon the protocol for TR, as I don’t have a thorough understanding of that. I’m dealing with three special needs cats currently, and just can’t take on more intense treatment on this front. What is it that causes the AM pre shot number to be so high comparatively? The PM pre shot numbers are lower. Ideally, I’d feel comfortable keeping her around the 90’s.
Click to expand...
90 is a good goal. Also, did you know that cats can go into remission? They become food controlled diabetics, but don't require insulin. The TR method is one that has been scientifically proven to get kitties into remission. If you decide to switch, you can always go back to SLGS if you don't like TR.

In terms of the "protocol for TR," basically, TR requires that they don't eat kibble, only wet food. In addition to the preshots, you should also grab at least one other test per cycle, but more is preferable. You are currently testing enough for TR.

The main difference in the dosing methods is when increases/decreases are taken.

I'm going to use excerpted language from this dosing sticky, but I'll highlight in red certain aspects for you; also, my language is italicized:

With TR,

You hold the dose for a shorter period of time before each increase:

General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Reductions are taken at a lower number:

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.

  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
With SLGS,

You hold the dose longer (for one week), and you take reductions at a higher number:

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

TR allows a kitty to get to a specific dose more quickly and to stay there longer, which can SOMETIMES get them into better numbers and can SOMETIMES lead to remission.

I don't know why Mia is having higher preshot numbers. Some kitties just do, and some never are able to get those numbers down. It's something to try focusing on early on in treatment because you might be able to make some dosing tweaks that help lower those numbers.
 
Mary & Jude said:
90 is a good goal. Also, did you know that cats can go into remission? They become food controlled diabetics, but don't require insulin. The TR method is one that has been scientifically proven to get kitties into remission. If you decide to switch, you can always go back to SLGS if you don't like TR.

In terms of the "protocol for TR," basically, TR requires that they don't eat kibble, only wet food. In addition to the preshots, you should also grab at least one other test per cycle, but more is preferable. You are currently testing enough for TR.

The main difference in the dosing methods is when increases/decreases are taken.

I'm going to use excerpted language from this dosing sticky, but I'll highlight in red certain aspects for you; also, my language is italicized:

With TR,

You hold the dose for a shorter period of time before each increase:

General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Reductions are taken at a lower number:

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.

  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
With SLGS,

You hold the dose longer (for one week), and you take reductions at a higher number:

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

TR allows a kitty to get to a specific dose more quickly and to stay there longer, which can SOMETIMES get them into better numbers and can SOMETIMES lead to remission.

I don't know why Mia is having higher preshot numbers. Some kitties just do, and some never are able to get those numbers down. It's something to try focusing on early on in treatment because you might be able to make some dosing tweaks that help lower those numbers.
Click to expand...
Thank you. I have some questions, but I have to run take care of some other cat issues at the moment.
 
How is Mia acting today? I see the comment about still seeming in pain, is she still getting bupe?

Nice to see her still get some higher greens today.

The morning AMPS are usually the last numbers to come down. Are you giving her a small snack at AM+9? Her PMPS seems to be pretty good. I know it's hard to feed the PM+9 snack, that might help.
 
Wendy&Neko said:
How is Mia acting today? I see the comment about still seeming in pain, is she still getting bupe?

Nice to see her still get some higher greens today.

The morning AMPS are usually the last numbers to come down. Are you giving her a small snack at AM+9? Her PMPS seems to be pretty good. I know it's hard to feed the PM+9 snack, that might help.
Click to expand...
Hi, Wendy. I ceased the AM+9, because I have to give her a snack with her AB around AM+4. Is it best to still give another snack at +9? She is totally off bupie as of 9/4. Still receiving GABA b.i.d. Unfortunately, the PM+9 isn’t a time I can accommodate. Thank you.
 
At her size of dose (tiny), you can still give her a small snack, 1-2 tsp, at AM+9. Multiple snacks in a cycle is fine.
 
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