DOUBT ABOUT DOSIS REDUCTION-SUSI-HELP!

MariaSpain

MariaSpain

Member Since 2023
Hi,

I am lost about the reduction instructions in the TR protocol which I started 6 days ago

In the TR protocol I see the following (copying below), each reduction is of 0.25iU per shooting

So, I have a doubt: my cat fullfills 2 criteria for reduction, yesterday it had a 48 nadir, and now it has a 102 PS value. So, should I reduce the shot now (I am shooting 0,25iu per kg BID), and reduce from 1,75 to 1,5? Or even to 1,25 in case that 0.25 should be applied to EACH reduction criterium?

Pls help!

Thanks

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.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
  • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
  • If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
  • We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall.
 
If your cat goes under 50 and you are following TR, a cat that is newly diagnosed has it's dose reduced by 0.25 units. A newly diagnosed cat is one that has been diagnosed with diabetes less than 1 year ago.

This post tells you a few things you can do to help us help you better, including information to put in your signature:
New? How You Can Help Us Help You!

Are you giving insulin twice a day? The spreadsheet shows just one shot a day. If you are giving 1.75 units twice a day, that means reducing to 1.5 units since he went under 50.
 
Wendy&Neko said:
If your cat goes under 50 and you are following TR, a cat that is newly diagnosed has it's dose reduced by 0.25 units. A newly diagnosed cat is one that has been diagnosed with diabetes less than 1 year ago.

This post tells you a few things you can do to help us help you better, including information to put in your signature:
New? How You Can Help Us Help You!

Are you giving insulin twice a day? The spreadsheet shows just one shot a day. If you are giving 1.75 units twice a day, that means reducing to 1.5 units since he went under 50.
Click to expand...


Thanks!

Yes I shoot 1,75 BID
I filled imcorrectly the sheet today because I was in a hurry
I shot 1,5 U a couple of hours ago and he has now lower BG than PD
PS was 102 and now 70-80

I will fill in the sheet tomorrow

I am afraid to go sleep (I am in Spain Europe) because he ate several times and still no BG rise,:(
 
Susi is doing great for a newly diagnosed cat! The normal range is 50-100 mg/dl on a human meter so it's good for him to spend as much time as possible in those numbers.

Could you please update the SS with the PM dose and last night's numbers? In addition to updating your Spreadsheet, it would be a big help to us if you can set-up your signature? It's basically a summary of the information we need about your cat to give you advice. The spreadsheet and signature are the things we look at when asked for advice. It saves us asking you the same questions again and again especially when the question is time critical like stalling or low numbers. It also saves you the effort of giving us the information every time you post!

Here's how you can set-up your Signature:
  • In the Menu, under your user name, click on Signature.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • There is a limit of two lines. You may separate info with commas, dashes, | etc.
  • Be sure to click the 'Save Changes' button at the bottom.
 
Thanks for the replies, it is so very helpful to receive support from experienced forum members!

I updated the spreadsheet and signature as per your advise

I still do not have it very clear, if for example, yesterday Susi had a 48 low, I reduced the night dosis by 0,25 U and shoot 1,50
Today should I continue with this new reduced dose 1,50, or it needed to be reduced only for yesterday, and today I should return to the original dosis 1,75 I started several days ago?

Today Susi had PS 139, then 125, and now I cannot measure it till +9 because I am at work
My husband is taking care of him now, but cannot measure. He told me Susi has been eating quite ravenously at (+3) so I guess he had a lowish number

Thanks for your help once again!
 
MariaSpain said:
I still do not have it very clear, if for example, yesterday Susi had a 48 low, I reduced the night dosis by 0,25 U and shoot 1,50
Today should I continue with this new reduced dose 1,50, or it needed to be reduced only for yesterday, and today I should return to the original dosis 1,75 I started several days ago?
Click to expand...
Once a reduction is earned by the BG dropping below 50, you would continue with the reduced dose going forward - unless he drops below 50 again and another reduction is earned. One caveat - the Lantus depot takes at least 4 cycles to adjust to a reduction - so if he dropped below 50 yesterday and you took a reduction, you would not reduce again if he drops below 50 again today. You don't take back-to-back reductions with TR. I am sorry if I am confusing you. Hopefully it will become clearer with time! If you post regularly we can help with dosing. Let's see what he does on 1.5U for the next 3-4 days.

Are you not able to get tests in the PM cycle? A test before bed would be good. Many cats go lower at night.
 
Bandit's Mom said:
Once a reduction is earned by the BG dropping below 50, you would continue with the reduced dose going forward - unless he drops below 50 again and another reduction is earned. One caveat - the Lantus depot takes at least 4 cycles to adjust to a reduction - so if he dropped below 50 yesterday and you took a reduction, you would not reduce again if he drops below 50 again today. You don't take back-to-back reductions with TR. I am sorry if I am confusing you. Hopefully it will become clearer with time! If you post regularly we can help with dosing. Let's see what he does on 1.5U for the next 3-4 days.

Are you not able to get tests in the PM cycle? A test before bed would be good. Many cats go lower at night.
Click to expand...

@Bandit's Mom Thanks so much for your help and patience!

I just saw I had filled in some BG values in the wrong hours for yesterday and amended it,

What I do notice is that Susi gets the lowest in between +2 and +4 (especially around +3). The same happened to him when he had the diabetes in 2016, it seems to be his danger zone

From your last reply I understand that, once I start a reduction (yesterday night), I must wait for 2 days (or 4 cycles), before I make a new redcution, even though he gets a low today, is this correct?

Thanks
 
@Bandit's Mom

Me again:-(

I just observed another detail that puzzled me: Dearling with a PS number below 200!
But, Susi's PS numbers are all below 200...so?

Sorry if I am asking too much:-(...


Maria


Read the yellow stickies at the top of the Insulin Specific Group pages you are using to familiarize yourself with the insulin you use.

Dealing with a lower than usual preshot number: Initially we encourage using a ‘no shoot number’ of 200 mg/dL (11 mmol/L) on the Main Health page and
  • For newbies in the Lantus, Levemir, and Biosimilars Group, if you get a blood glucose of 150mg/dL (8.3 mmol/L) or below, while you are gathering data and experience, stall without feeding, post and ask for assistance. This applies to both the Tight Regulation and the Start Low Go Slow methods
  • For people in the other Insulin Specific Groups, 200 mg/dL (11 mmol/L) is used as the ‘no shoot number’ while you gather data and experience.
 
MariaSpain said:
Me again:-(
Sorry if I am asking too much:-(...
Click to expand...
Feel free to ask as many questions as you want :) No need to apologize. We have all been new to this and full of questions and doubts!

MariaSpain said:
I just observed another detail that puzzled me: Dearling with a PS number below 200!
But, Susi's PS numbers are all below 200...so?
Click to expand...
Yes. For newer members we advise not shooting below 200 or 150 till they gather data on how their cat responds to insulin. With data and experience you can shoot any number over 50 with TR. Usually newly diagnosed cats have pretty high BGs - over 300. Sometimes it takes weeks before they see green nadirs. Susi is a lucky boy who has become regulated almost immediately on starting insulin. So these no-shot numbers do not apply to him.
 
Bandit's Mom said:
Feel free to ask as many questions as you want :) No need to apologize. We have all been new to this and full of questions and doubts!


Yes. For newer members we advise not shooting below 200 or 150 till they gather data on how their cat responds to insulin. With data and experience you can shoot any number over 50 with TR. Usually newly diagnosed cats have pretty high BGs - over 300. Sometimes it takes weeks before they see green nadirs. Susi is a lucky boy who has become regulated almost immediately on starting insulin. So these no-shot numbers do not apply to him.
Click to expand...

Thanks for your quick reply and kindness:-)
 
MariaSpain said:
Thanks for your quick reply and kindness:)
Click to expand...
Most welcome! :-)

Btw, a small housekeeping note, we request members to post a new thread every day. This ensures that the thread doesn't get too long to read. Especially in time-critical situations like low numbers or a member stalling a shot.

The thread title nomenclature is:
<Date> - <Kitty's Name> - <AMPS/PMPS number and any other BG numbers you may have for the day> - <Question, if any>

Use the the '?' prefix in the thread title if you have a question, so people know that it's not just an update.

For e.g.
"? 2/23 - Susi - AMPS 176 - Dosing Advice Requested"
 
Bandit's Mom said:
Most welcome! :)

Btw, a small housekeeping note, we request members to post a new thread every day. This ensures that the thread doesn't get too long to read. Especially in time-critical situations like low numbers or a member stalling a shot.

The thread title nomenclature is:
<Date> - <Kitty's Name> - <AMPS/PMPS number and any other BG numbers you may have for the day> - <Question, if any>

Use the the '?' prefix in the thread title if you have a question, so people know that it's not just an update.

For e.g.
"? 2/23 - Susi - AMPS 176 - Dosing Advice Requested"
Click to expand...

Thanks, surely I will most willingly post everyday the updates on Susi's progress and welcome advice and suggestions!:-)

I had noticed the strange "calculus-like" post titles ;-), and I was going to investigate later about the meaning of them, but your kind indication saves me the homework:-)

It is such a great help to have found this forum! I have learned more here in a couple of days than during all the years visiting the vet...

Thanks for everything!
 
MariaSpain said:
It is such a great help to have found this forum! I have learned more here in a couple of days than during all the years visiting the vet...
Click to expand...
I know what you mean. This forum has been of tremendous help to me in navigating Bandit's diabetes and I have learnt a lot about feline health, in general. Thank God for these forums/support groups - you realize how little most vets know about feline diabetes or chronic kidney disease etc.
 
Bandit's Mom said:
I know what you mean. This forum has been of tremendous help to me in navigating Bandit's diabetes and I have learnt a lot about feline health, in general. Thank God for these forums/support groups - you realize how little most vets know about feline diabetes or chronic kidney disease etc.
Click to expand...

@Bandit's Mom
Yes, exactly so...during Susi's previous experience in 2016 the vet tried to convince me that I had to give him dry food because it was the very best for all cats, go figure! Luckily I did not listen and searched for info in the internet, thanks to this Susi got such a quick remission in about 2-months time, with wet food and Lantus TR (with a modification at the end)

Yet, this time I am searching for the modification of approach I used back then in the last couple of weeks before the remission, and I am uncapable of finding it or remembering it. I posted yesterday this in my presentation post in Feline Health, in case you might be albe to spare a minute and look. I have been searching for it in the last couple fo days but no luck so far..
 
MariaSpain said:
Yet, this time I am searching for the modification of approach I used back then in the last couple of weeks before the remission, and I am uncapable of finding it or remembering it. I posted yesterday this in my presentation post in Feline Health, in case you might be albe to spare a minute and look. I have been searching for it in the last couple fo days but no luck so far..
Click to expand...
Do you mean Dr. Hodgkins protocol that you have posted about in your first post in Main? The sliding scale does not work with Lantus which is a depot insulin. It works best when dosed consistently and dosing is based on nadirs and not preshots. Susi is already responding very well to Lantus. Just follow the TR protocol and see how it goes. :-)
 
Bandit's Mom said:
Do you mean Dr. Hodgkins protocol that you have posted about in your first post in Main? The sliding scale does not work with Lantus which is a depot insulin. It works best when dosed consistently and dosing is based on nadirs and not preshots. Susi is already responding very well to Lantus. Just follow the TR protocol and see how it goes. :)
Click to expand...


Thanks again for dedicating time to Susi's story!
Yes, as I posted in Main, in 2016 I followed the TR at the beginning, but past about 2 months with numbers basically between 200 and 300 I made a modification (but now I do not remember where I got the info about it, or the exact protocol it was, and by searching now I deducted it was something similar to Dr. Hodgkins approach, but I am not completely sure if it was this or something else). The matter is that, what lead Susi to remission in 2016 was not the exact TR but precisely this "modification", of which now I am trying to find out what was it exactly
All I have is my diary with daily values from 2016, in which I see that I had been giving a consistent 3.5 and then 3 U dose BID of Lantus for about 2 months with little change of BG values, then, I made this modification and started to NOT give shots when 150 or less, give 0,5 or 1 U when 200 or around, and not at regular times but depending on BG values..but unfortunately I did not write down what was the exact protocol and now I cannot remember what it was or where I found it. I only have the diary with values of BG and some of the shots (al this with Lantus)
So I would be very grateful if someone could tell me what this amended protocol might have been, because it took Susi to remission in less than 2 weeks

Thanks again!
 
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