Protocol -- clarification requested

Status
Not open for further replies.
Vidya & Boo

Vidya & Boo

Member Since 2012
We're still only on day 6 of Boo's Lantus treatment (2 units, twice daily), and watching BG begin to stabilize. But I'm thinking ahead to the next few days, and I'm unsure of something re: the tight-regulation protocol.

The guidelines say to hold the dose for 5-7 days initially (as we are now).

They then say to hold the dose for 3-5 days more if nadirs are less than 200. (Boo is currently registering most nadirs a little above 100, and his PS values are most often just under 150 now.)

So, if these BG readings stay the same, we'll hold the dose for 3-5 days more . . . but then what? The 'reducing the dose' guidelines seem to only apply if the nadirs drop below 50 (which they haven't), and the 'increasing the dose' guidelines only apply for nadirs greater than 200 (which are higher than he's registering). If Boo's numbers were to hold steady in the 100-150 range overall, would we just continue to hold the dose?

Yet other material posted/linked on the FDMB seems to suggest we should be aiming for stability in the non-diabetic 50-80 range (which could require a small dose increase to achieve) before attempting any dose reduction.

Could someone please clarify this for me? We obviously want to avoid any danger of hypoglycemia, yet we want to get Boo's numbers stabilized in a range where pancreatic healing is more probable. Thanks!
 
wow, vidya, i think it sounds like Boo is having a great response to the lantus. newly diagnosed kitties who get on the TR protocol often do. so congratulations!

are you saying in a 12 hour cycle (between one shot and the next, the preshot numbers are usually under 150, and the low point (nadir) of the cycle is above 100? just want to make sure i understand what you're saying.

lantus has a cumulative effect, ie, it builds in the system and sorta slow-releases. the reason that the instructions say to hold the dose for 5-7 days when you're beginning is to allow that action to happen so you see what the dose is doing in the cat's body.

i need to ask you a few questions - first, what is Boo eating? does he have any other medical issues? has he had ketones or diabetic ketoacidosis (DKA)? those things can influence decisions around dosing.

sounds like you've already been doing some reading - good job!

yes, you've got the basic idea down. we start with a dose, hold it for several days to let it build and see what it does, then we tinker with the dose based upon the low point in the cycle. to follow the TR dosing protocol, the cat must be on low-carb canned food or a raw diet. that eliminates excess carbs from the cat's diet and gives the best possible chance for the cat's pancreas to recover and the cat to go off of insulin.

once we see what the dose does, based upon the nadirs we are seeing, we will hold the dose longer or increase the dose. anytime a cat gets below 50 we decrease the dose by .25u.

there are some things that can happen that complicate matters - sometimes when a cat's BG drops too quickly or into a range they're not used to, their liver can release sugars & hormones causing the BG to go high. when a dose is increased, sometimes the BG will go higher as well. both of those things can last up to 3 days.

because it's all kinda complicated to learn, we encourage people to post regularly/daily and we're glad to teach you how to read what's going on in your cat, because every cat is different, and know how to adjust the dose for the best results.

so welcome to Lantus Land! ask away and people will be happy to answer a zillion questions and help you help Boo!
 
i'm not avoiding your question about what to do if the nadirs remain around 100 - but i don't want to give dosing advice without knowing more.
 
Hi Vidya and Boo,

Julie always gives good advice and great summaries of Lantus action. Welcome to Lantus Land and keep asking questions!

Ella & Rusty
 
It will be really helpful to people trying to assist you if you would set up a spreadsheet for Boo. Here is the link to help you do that http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 The spreadsheet is also really useful for yourself to help visualise what Boo is doing over time, something you can't do easily just with a notebook.

Sounds like Boo is doing really really well for a begginer, and so are you, welcome to Lantus Land :-D

Serryn
 
Thanks!

Yes, Boo's PS numbers have been around 150 or slightly lower for the last couple days, and his nadirs are anywhere in the 150 to 100 range (besides PS numbers, we're testing at least once somewhere between +4 and +8, varying the times daily; we'll likely be doing our first full curve in a couple of days to get a clearer sense of Boo's personal nadir time(s)).

Upon diagnosis last week, we switched him immediately to a low-carb wet/dry diet, and he has now been fully transitioned to only wet low-carb food for several days now. We're also *very* slowly introducing BG-regulating herbs and we will be starting homeopathic treatment (I'm a non-professional homeopath) soon to help with organ regeneration and healing. He also gets a little chromium with his food for glucose regulation, and right now some psyllium for moderate constipation from the quick diet change.

He doesn't have any other medical problems that would be relevant to diabetes control. He's never had issues with ketones/DKA (he was negative for ketones even at diagnosis). He's about 8 or 9 years old, and has always naturally been an enormous -- muscular and fat -- cat, so we think he could tend constitutionally toward insulin resistance -- but, as you note, his reaction to the Lantus has so far been excellent.
 
do you have any idea what triggered the diabetes? was he given any steroids? any medical condition can be related - does he have asthma? eye weeping that might indicate herpes?

yay for getting him onto the wet food.

punkin's been taking the chinese herbs for the past several months, but i haven't seen any help from it and it upsets his stomach, so i just stopped them this week.

about how big is he - weight?
 
We're not sure about the diabetes trigger. For a couple of weeks before, I had him on a cat/dog digestive-enzymes supplement which, it turns out, had lactose as its first ingredient, so I wonder about that. He's also had a lifetime of high-carb dry-food feeding, which was certainly no help.

No, his only other known health issue is a little minor impairment from an ACL (ligament) injury years ago.

We're not sure about his weight -- our vet is a mobile one who makes housecalls and so she couldn't weigh him, and in our household we practice HAES (Health At Every Size) so we don't have a scale for ourselves either. I'd estimate Boo's at least 20 pounds, maybe even a little more -- he's like a little grizzly bear. :-)
 
Just stoppin' by to say "Welcome," and what a cutie pie Boo is - love his avatar!!! I hope we see more of you guys around here!

Amy
 
ok, thanks for answering all of those questions.

the spreadsheet that serryn referred to is an essential tool around here. once you get the hang of it, you can "read" patterns in the numbers when they are laid out in the spreadsheet. as test numbers go in, it's just like a jigsaw puzzle and we can see more about what's going on and what needs to be changed. we'll be able to give you better and more specific advice when we see actual numbers.

but the phases of the protocol that you're asking about - in general, yes, the goal is to get the cat's BG into the same BG range as a non-diabetic cat, basically 50-100 if you are using a human glucometer. so if the range is 100+, we would increase the dose to push it down a little bit farther. we stay in the "increasing the dose" phase unless the cat goes below 50, then we decrease the dose. sometimes the decreases don't hold and we have to go back into the increasing phase. it's a bit of a dance.

but this is tricky enough to interpret that i don't want to give you dosing advice without seeing actual numbers and the time they occur in relation to the shots. that part matters a lot. so i'm just speaking generally. when you have the spreadsheet up we'll be able to be more specific to Boo.

keep posting your questions! do you need help with where to buy supplies, what to get, food, syringes, getting tests? oh - and do you have syringes that have .5u (half unit) markings on them?

one more question - what are Boo's teeth like? does he have bad breath? has he ever had them cleaned?
 
I agree that I would be uncomfortable making any suggestions without seeing a spreadsheet. No one wants to inadvertently cause harm to Boo and the best way for us to keep him safe is to see his numbers.

Just to clarify, the normal BG range is 50 - 120. A drop below 50 is reason for a dose reduction. The other way to reduce dose is numbers in the normal range for a week.

If you are going to give Boo any homeopathic supplements, please speak to your vet or a holistic vet in your area. Even something we think may be innocuous can be problematic for a cat (e.g., soy).
 
Thanks, we'll work on the spreadsheet.

The info on the ideal range and procedure for getting there is exactly what I was wondering about; thanks for this.

No, we've had no problem getting the supplies; yes, we have the 0.5-marked syringes.

The vet mentioned some tooth issues when she examined Boo, and she showed me some gum inflammation. The blood and urine tests didn't suggest active infection, but I've been adding a little vitamin C to his food now and then -- it's an absolutely brilliant 'antibiotic' for feline infections, dental and otherwise.

Homeopathic medicines, unlike herbal supplements, have no remaining substance of the material(s) from which they are made (they are highly diluted and potentized), so they are safe to give to animals of any species without toxicity concerns. The herbal supplement Boo is starting is 'Mellit', which is a mixture of extracts formulated specifically for diabetic cats.
 
Status
Not open for further replies.
Back
Top