Protocall

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Mary and Stella

Mary and Stella

Member Since 2011
Hello all!

I am not understanding the protocall. I thought if you changed a dose by .25 you held it for 6 cycles to see if it worked, and if it isn't you bump it back up to the last working dose. Someone was trying to help me, and asked me why I dropped the dose since Stella hadn't dropped below 50. I am confused. If Stella is getting 3.25U is that what Stella gets forever until it goes to green at some point using 3.25U? I thought we brought it down .25 at a time until Stella never needed any.

Please advise. I have read the Protocall numerous times and it isn't clear. :oops:
 
Re: Protocall???

im linking your previous thread so that others can look back at that conversation: viewtopic.php?f=9&t=48709&p=523880#p523880

Im not very good at explaining things like this, but there are some here who do a good job at explaining it.

one little point, this is where the patience comes in , you won't be at the same dose forever, you're getting good data to fill up your ss, you will see changes over time, and you're seeing some now too.
hang in there, it will hopefully be more clearer for you soon.
 
Re: Protocall???

Here is the section of the protocol:

Increasing the dose...
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
    After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
    After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
  • If kitty drops below 40 (long termdiabetic) 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, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
    If an attempted reduction fails, go right back up to the last good dose.
    Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...

Reductions are only given if a cat's nadir is below 50 or has been in the normal range for a week. That is why you were questioned about it. Stella's nadirs were barely under 200 , according to the protocol her dose should have been increased after 5 to 7 days, not decreased. Our goal w/ the protocol is to get a cat's numbers consistently below the renal threshold (200). Being below 200 give the pancreas a chance to start healing. Eventually as the pancreas heals she will drop into the normal range (60 to 100, generally although there are a lot of different limits quoted). Once they start staying in the normal range we can start decreasing.
 
Re: Protocall???

I just want to second what Ann said. The protocol posted in the Tight Regulation Protocol Sticky is more generalized so that it's easier to understand, but here's a link to the detailed protocol found in the sticky: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

You'll see that there are more details, but it's a bit intimidating, especially when you're first starting out which is why the general guidelines are listed for people to refer to in the TR sticky.

As for holding the dose, sometimes you can be holding it for a while and have to be patient. The first time around that Bandit needed insulin, I held his doses for nearly a month at a time once he regulated. Your aim is to keep the numbers in a normal range (60-100 for most cats--Bandit is a bit unusual because his normal BG range is a little high, 80-140)as long as possible so the pancreas will heal. Stella hasn't reached any normal numbers yet, so you're still in the process of increasing. Once she starts getting normal numbers, you'll hold the dose, and once those normal numbers start gradually lowering, you'll decrease. Each of these steps can take weeks, or months, or sometimes even years depending on the cat.
 
Re: Protocall???

Ann did a good job of clarifying. Sorry if I confused you. The quick explanation is that unless a dose reduction is earned (i.e., a drop below 50 or a week in normal BG numbers), the dose is increased.
 
Re: Protocall???

Thanks to everyone who replied. This is slowly getting to where the light is turning on. :lol:

I am confused as to increase by .25 or .50 because I interfered with her dose by reducing it. :oops: I will increase tonight's dose by .25 hold for six cycles and see if I have to add another .25 according to:

Increasing the dose...
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

I think the punctuation of the first line tripped me up. If (before increasing dose) was in parentheses my brain might have soaked it in. Also, why would you hold it only for 3-5 days? Wouldn't you just hold it indefinitely if the nadirs are below 200? I think it left me confused and I must have been trying to sort that out while I continued to read the next two lines. Maybe I am still confused. My brain is starting to hurt. :lol:

Please just watch out for Stella and make sure I don't do this again. I will keep re-reading all of this great info until it is clearer to myself....
 
Re: Protocall???

Mary, I suggest all newbies print out the stickies and put them in a binder... I know it took me what felt like FOREVER to feel like I understood what was going on.

The protocol we follow has tight regulation as it's ultimate goal (note that while it is called the "tight regulation protcol," tight regulation is an outcome, not a method):

These are the categories of regulation taken from the stickies:

Not treated --[blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
Treated but not regulated --[often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
Regulated --[generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
Well regulated --[generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
Tightly regulated--[generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
Normalized --[60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

Cats have a unique ability compared to other animals (including humans!) in that their pancreas can heal and they can go into remission. For the pancreas to do so, numbers need to be in the normal range of 50-120 on a human meter, so while the initial goal is to get nadirs under 200 (the point at which sugar is spilling into the kidneys and damaging them... what we refer to as the renal threshhold, which also happens to be the point at which risk of DKA goes down pretty dramatically), the ultimate goal is for a cat to spend as much time per day as possible in the "normal" range of 50-120, or to use the lingo, to be "tightly regulated." You want to be aggressive as your schedule and lifestyle allow early in the game, as the chances are much higher for kitties the closer they are to diagnosis. Though, we have had our share of longtimers here achieve remission!

Even if remission never happens, keeping your cat in the "normal" range by regulating with insulin allows their bodies to function as normally as possible, and is a healthy place for a cat to be!

The key is having as much data as possible. We want to be able to predict, to the best of our ability, how our cats will react to the insulin. Without data to support our dosing decisions, we could be putting our cats in danger. As you get more data, you then have the information you need to shoot progressively lower numbers. For example, I will routinely shoot a 60 for Willie because I know that, in general, he's going to rise a bit and we won't go into dangerous numbers. I would never recommend a newbie do that. Even with a great deal of data, I still have a "do not shoot" threshhold. You'll get there as well!

Please keep asking questions as you have them! We've all been through the steep learning curve here!
 
Re: Protocall???

We love questions!! If you're not sure what to do, just ask. There's a huge amount of experience here and we've all be new at this and overwhelmed by the amount there is to learn.
 
Re: Protocall???

Thanks Sienne and Gabby. Watch out...you may get tired of my questions! ;-) But I will always ask. Stella is what is important here. :smile:
 
Re: Protocall???

seriously - just as confused as you are, everyone here has been that confused too at one point. it is confusing. seemed to me that i didn't understand points until they were actually relevant. there's a lot to take in - so we all understand questions.

one of the things that is helpful is if you are posting your daily numbers in the subject line (leave a string of them) then if people don't see progress, or see something that's concerning, they will look and tell you. after a while you know about where in the game each cat is (if the bean is posting regularly) and what is unusual for a kitty. it's just a quick and easy way to help each other out.
 
Re: Protocall???

You'll see results over time. It DOES take a lot of patience (believe me, I know... and I'm not as patient as I need to be sometimes). I, too, was confused (and still am on occasion) about the protocol, but you'll understand most, if not all, of it soon. Just hang in there. :) You're doing great!
 
Re: Protocall???

Thanks Angela! Stella's numbers are already dropping since going back to 3.25. We are back on track. :smile:
 
Re: Protocall???

:lol: :lol: it's so easy to get confused...

i'm the person who read "early shot=an increase; late shot=a decrease"

and took that to mean i could only increase his dose at the am shot...and decreases had to wait for the pm shot... :?

you are not alone in needing clarification at times!
thank goodness we have folks to guide us!

celi & binks
 
Re: Protocall???

Thanks mybuddybinks (and everyone else who has made a mistake) for making me really feel, I am not alone!

As you see in Stella's SS... the 3.25U has put us in a solid Blue for her nadir this pleasant day. Thanks Sienne for so politely pointing out that I um... was on the wrong path.... :lol:
 
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