Eva & Butters & 5 Others said:
And please don't shoot me, everyone, but I'd like to respectfully and gently suggest that either a modified version of Tight Regulation Protocol or the Start Low Go Slow Approach can work well for us if we're not following Tight Regulation to the letter. I like the guidelines that Tight Regulation provides even if you need to stay with a dose longer to keep your cat safe and to have more time to test for nadirs. With Lantus or any other insulin and the protocol that goes with it, we need to make it work for our cats, ourselves, our schedules, our work, our lives.
yes, we need to make things work for us, but we have a responsibility to do it safely.
the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats comes with
requisites:
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
- Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
- It will be necessary to test kitty's blood glucose levels multiple times per day.
- Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
- Feed a high quality low carb canned or raw food diet.
- Feed small meals throughout the day. Some kitties adapt well to free feeding.
these are not my requisites. they (and more) come from the protocol itself:
http://www.tillydiabetes.net/en_6_protocol2.htm. these requisites serve as built-in safeguards for the cat. failure to adhere to these requisites results in creating a potential risk. recommending dose adjustments based on the guidelines in the TR Protocol when a caregiver has chosen to not follow the protocol... well, let's just say it could be dangerous.
practicing TR
safely involves a commitment to the requisites listed above. not everyone can or wants to commit themselves to this kind of regiment. that's fine. it doesn't mean they can't have a healthy and regulated cat. it doesn't mean their kitty will never go OTJ. there have been many Lantus kitties who have gone OTJ following the SLGS Approach. many.
here's a little "
SLGS Dosing Guidelines Cheat Sheet for Lantus Users" i recently prepared for a few others:
Starting Dose
- 1u – 2u twice per day if kitty’s glucose was higher than 400mg/dL at diagnosis OR if cat is not on a wet low carb diet
- 0.5u – 1u twice per day if kitty’s glucose was less than 400mg/dL at diagnosis OR if the cat has been switched to a wet low carb diet
Hold the dose for at least a week
- unless your cat won’t eat or you suspect hypoglycemia
- be consistent in timing and type of food
After 1 – 2 weeks at a given dose perform a 12 hour curve, testing every 2 hours
- if nadirs are more than 150, increase by 0.25 unit
- if nadirs are between 90 and 149, maintain the same dose
- if nadirs are below 90, decrease the dose by 0.25 unit
Lather, Rinse, and Repeat!
as you can see, SLGS is similar to the TR Protocol in that it recommends
Lantus dose adjustments be made in small increments. the biggest difference is in holding the dose longer (as you mentioned above)... which takes those who don't want to/can't test as frequently as the TR Protocol requires into consideration. seems like a win - win to me! :mrgreen:
