new member 05/16/22 - looking for clarification with TR protocol

Hello!

I'm taking care of my elderly mother's recently diagnosed diabetic cat, Bro, because she felt too overwhelmed by the idea.

I have read so much here and learned a ton, thank you!

Her vet feels confident that Bro is likely to go into remission because the disease was caught early on routine blood work. His previous diet was already exclusively canned food with a fairly low carb content (10-15%) but he has been taking large doses of lactulose for constipation for many years, and I wonder if that hasn't contributed to the situation (even though what limited available medical knowledge there is says it's unlikely...). So, we removed the lactulose and switched him to even lower carb wet foods right away (<2% carbs). Magically, he is having no problems pooping, so that's a pleasant surprise!

Anyway, Vet started him out on 1 unit of Lantus twice a day, of which I have now finished 5 full days (10 cycles). Vet's original instruction was to continue on this regimen for 12 days, at which time I should take a +6 BG measurement and see if the dose needs to be adjusted.

However, I'm doing a fair amount of home testing (using an AlphaTrak2 meter since that is also what our vet uses and I wanted to be consistent). His numbers are still pretty high, and although they do drop a bit during the cycle, it's not a ton; his AM and PM PS numbers are still pretty much always in the 400s and even the nadirs appear to only dip into the mid 300s.

So, I'm looking at the TR protocol on Tilly's Diabetes page, which is what I've been using as a guide, and I'm thinking I want to increase his dose, but my question is, does it seem OK to go right to 1.5 units? Or is there some reason I should try a smaller increase first (to 1.25)? It's pretty tricky because my syringes are 0.3 cc with half units being the smallest marked increments, so I'd have to eyeball it for quarter unit changes and they're so TINY. But I'm not sure how safe it might be to increase him straight to 1.5, which is a 50% increase from his current dose. The TR protocol seems to allow for it though, where it says "if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU."

Does anyone have any experience with this or advice they could offer?

Thank you thank you!

 

I can't really advise you on the dose increases bit I can tell you that many people here use calipers to deal with the 0.25u increments. I have even done half that, 0.125 unit increments .
Here is some information about that.

Also if you like you can post on the Lantus page, with Bro's daily numbers and get advice and feedback from experienced members.

https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

 

First of all, THANK YOU for stepping up to help your mother's cat. Not all family members are that supportive.

Since he has gotten that 200 in there, you'd only want to increase by .25. Most of us eyeball it which is fine to do. What's important is to make it as consistent as possible, not necessarily that it's exactly .25. Many people use an old syringe and draw up some kind of colored liquid to where they decide 1.25 is and then when they draw up the insulin, they have a template to compare with.

One thing though....you're not getting any testing on the PM cycle. Most cats go lower at night so it's very important to get at least a "before bed" test on the PM cycle so if he's dropping too much you can set an alarm to get tests later in the cycle.

Think of your spreadsheet like it's a puzzle. If the only pieces you have are on the left side, you have no idea if there's a puppy, a kitten or a flower on the right. The PM cycle is half the data so it's important not to skip it. (Welcome to the wonderful world of sleep deprivation otherwise known as Feline Diabetes....LOL)

You might want to read up on the 2 dosing methods we use here as well as the guidelines for each when it comes to increasing the dose. You don't need to choose one right now, but you will want to decide on one to start with soon because the advice we'll give depends on the dosing method you choose. If you choose one and it doesn't work for you, you can always switch. It's not like you're locked into one forever.

 

@Meredith (& Bro) welcome to the club, glad you found us.

yes there are many folks here who are experts in TR and can offer dosing advice (or SLGS). This advice is dolled out over on the Lantus/Levemir/Biosimilars forum where folks like us are asked to post a daily thread with the kitty's BG readings, link the previous thread, and then experts scanning the forums can jump in and offer guidance in line with TR or SLGS.