Questions on TR and start low go slow methods

[Summers Mom]

Hi, I have been reading here on the forum as much as possible. My Summer was diagnosed with 3 different vets last week but she was super stressed at all the vets. She had to stay overnight at one. She read at 365 at one and 345 at the other. Her furtosemine was 245. Vets said No insulin except for one but didn't seem too concerned So as you most know, we must take this into our own hands to protect our furkids. I have first started just doing bg testing at home to see if her numbers are lower. Summer, my cat seems fine other than her skin being thin and it ripped from an injury from another one of my cats so now she has stitches from shoulder to shoulder. She also is peeing more and sometimes out of the box. She acts as if she is starving although I feed her 3 meals a day. And I did notice her shivering the other morning as she was eating her breakfast. I couldn't see her shivering but I felt it. Her coat feel dirty greasy and she has some hair loss on her liwer belly. She has always been very clean but not here lately.Her numbers yesterday were 292 mid day and 204 last night. I make sure I don't feed her before testing and I don't test for 3 hrs afterwards. This morning she was 199 and at lunch she was 227. She just tested at 258. I thought I was going to do TR method but as I was reading I read that too much insulin in the beginning can be dangerous and make them hypoglycemic. I was told by the one vet that said she needed insulin to start her on 1 unit 2x day. But now I am wondering if I need to start even lower. Say 1/2 unit 2 x daily. And if she ever shows signs of being hypoglycemic, how much of the ff gravy lovers do yall feed along with honey or syrup? And how many meals do you all feed? Summer eats an only raw diet other than having a bite of boiled chicken after her bg test. I also want to know how long I should test her before actually starting her on insulin? Thank you all for your support. I have no idea what I would do without you all!!!!!

 

[Chris & China (GA)]

Hi Debra!!

It looks like Summer may need a little support with some insulin, but her numbers are really not bad for a newly diagnosed kitty so hopefully she is a good candidate for remission!! It's been several days and she's still running a little higher than we'd like to see

On TR, the starting dose is based on weight....do you have a recent weight on her? ......as long as you're able to test, you really don't have to worry so much about hypos. I know vets scare the bejeebers out of us talking about hypos, and yes, they can be very serious, but that's why we are so big on home testing here!

1U is a pretty standard starting dose, but (depending on weight and your comfort level) she can be started at a lower dose. It's important to have syringes with half unit markings so you can do dose changes in .25 unit increments.

If you test, you will know what's going on and can intervene early if you need to and prevent any crisis!

On TR, if she drops under 50 on a human meter, that's your "time to act" ....what I usually do is open a can of Fancy Feast Gravy Lovers, put it back down and "squeeze" the gravy part into another bowl....most of the carbs are in the gravy anyway. It's messy but it works!! Feed a teaspoon or two of the gravy and plan on testing again in 20-30 minutes to make sure she's coming up.

As for feeding, most of us feed multiple meals throughout the day....China gets food about every 3-4 hours. As with everything here though, ECID (Every Cat Is Different) so it's a matter of seeing what works best for Summer!! It's actually easier on the pancreas to deal with multiple small meals instead of fewer big ones. Some cats do best if they get most of their food before the "nadir"....some do OK eating all the way through the cycle.

The only time you really don't feed is the 2 hours immediately before Pre-shot tests so you get a number that's not influenced by food.

With Lantus, you Test/Feed/Shoot....all in 5-10 minutes....TEST to make sure she's high enough for insulin at all, FEED to make sure she's at least willing to eat and SHOOT....it's not as important that she eats a certain amount before shooting, as long as she's willing to eat and not sick ......Lantus doesn't usually start to "kick in" for 2-3 hours, so you have some time to get more food into her if she doesn't eat a "normal" meal at shot times.

It will help to go ahead and start our spreadsheet on Summer. We are very data driven here and the more data you have, the easier it will be for us to help advise you.

Take a look at China's Profile pictures in my signature....she was SO skinny and scruffy looking when she was first diagnosed.....Look at her a few months later!!! (with the help of the great people here!)

 

[Tuxedo Mom]

You have been testing at home for a couple of days now and the readings are higher than you want them to be.

When Summer went to the vet I think I remember you saying she had a CBC done which showed no other problems. Do you have a copy of the tests...if not you can ask the vet to give you one. There are people on here who are very good and intuitive about reading lab reports.

The difference between TR and SLGS methods is not the amount of insulin but how quickly dosing is increased. With TR you would want to be able to do both preshots and AT LEAST once other test...if not more...in between shots. SLGS is used by people who either are still using some dry food or HC food or are not able to get as many tests in each day and dose increases are done more slowly. That's sort of a quickie explanation but it gives you an idea.

Lantus is a good insulin and most kitties do well with it. The usual starting dose is 1 unit and Summer should be okay with that depending on her weight. By posting daily here with the readings you can get advice and support and regular testing will help to catch low numbers before they reach the hypo stage.

 

[Summers Mom]

Thank you all for your help and support.

Hi Debra!!

It looks like Summer may need a little support with some insulin, but her numbers are really not bad for a newly diagnosed kitty so hopefully she is a good candidate for remission!! It's been several days and she's still running a little higher than we'd like to see

On TR, the starting dose is based on weight....do you have a recent weight on her? ......as long as you're able to test, you really don't have to worry so much about hypos. I know vets scare the bejeebers out of us talking about hypos, and yes, they can be very serious, but that's why we are so big on home testing here!

1U is a pretty standard starting dose, but (depending on weight and your comfort level) she can be started at a lower dose. It's important to have syringes with half unit markings so you can do dose changes in .25 unit increments.

If you test, you will know what's going on and can intervene early if you need to and prevent any crisis!

On TR, if she drops under 50 on a human meter, that's your "time to act" ....what I usually do is open a can of Fancy Feast Gravy Lovers, put it back down and "squeeze" the gravy part into another bowl....most of the carbs are in the gravy anyway. It's messy but it works!! Feed a teaspoon or two of the gravy and plan on testing again in 20-30 minutes to make sure she's coming up.

As for feeding, most of us feed multiple meals throughout the day....China gets food about every 3-4 hours. As with everything here though, ECID (Every Cat Is Different) so it's a matter of seeing what works best for Summer!! It's actually easier on the pancreas to deal with multiple small meals instead of fewer big ones. Some cats do best if they get most of their food before the "nadir"....some do OK eating all the way through the cycle.

The only time you really don't feed is the 2 hours immediately before Pre-shot tests so you get a number that's not influenced by food.

With Lantus, you Test/Feed/Shoot....all in 5-10 minutes....TEST to make sure she's high enough for insulin at all, FEED to make sure she's at least willing to eat and SHOOT....it's not as important that she eats a certain amount before shooting, as long as she's willing to eat and not sick ......Lantus doesn't usually start to "kick in" for 2-3 hours, so you have some time to get more food into her if she doesn't eat a "normal" meal at shot times.

It will help to go ahead and start our spreadsheet on Summer. We are very data driven here and the more data you have, the easier it will be for us to help advise you.

Take a look at China's Profile pictures in my signature....she was SO skinny and scruffy looking when she was first diagnosed.....Look at her a few months later!!! (with the help of the great people here!)

Thank you so much for your help! Summer I believe is close to 9 lbs. 8.8lbs. Should I go ahead and start her like this weekend on insulin?? I will be using Lantus so I have to go to my Dad's and pick up a bottle. He us willing to help me out. And I have no idea how to do the spreadsheet. I have been writing all the test times and bg numbers down in a little book that came with the relion tester.

 

[Chris & China (GA)]

Should I go ahead and start her like this weekend on insulin??

I think I would go ahead and start as soon as possible....the sooner you can get her numbers back down, the better her chances of having her pancreas heal and possibly resume working again

Here are the instructions on getting the FDMB spreadsheet

If you can't figure it out, feel free to send me a private message...I would be happy to set it up for you....takes me about 30 seconds once I have some information from you. To send a PM, click on my name and then "Start Conversation"

 

[Summers Mom]

You have been testing at home for a couple of days now and the readings are higher than you want them to be.

When Summer went to the vet I think I remember you saying she had a CBC done which showed no other problems. Do you have a copy of the tests...if not you can ask the vet to give you one. There are people on here who are very good and intuitive about reading lab reports.

The difference between TR and SLGS methods is not the amount of insulin but how quickly dosing is increased. With TR you would want to be able to do both preshots and AT LEAST once other test...if not more...in between shots. SLGS is used by people who either are still using some dry food or HC food or are not able to get as many tests in each day and dose increases are done more slowly. That's sort of a quickie explanation but it gives you an idea.

Lantus is a good insulin and most kitties do well with it. The usual starting dose is 1 unit and Summer should be okay with that depending on her weight. By posting daily here with the readings you can get advice and support and regular testing will help to catch low numbers before they reach the hypo stage.

Hi, yes I did get a CBC on Summer and will be going to get a copy of that in the morning. I am good with the testing. I can test as often as possible. I am so thankful that Summer is such a good patient and such a good girl!!! Each time I do the testing I feel better about it and not nervous. Summer jumps up on her table and it's as if she knows I am trying to help her. They are so smart! I am though a bit nervous on starting her on the insulin because I don't know what to expect. I can only pray she will do fine. Do you think I should start her lower than 1 unit 2x day? I just don't want to give too much in the beginning. I haven't slept well since I found out her diagnosis of diabetes and I have read as much as I can on here. It's just so scary and overwhelming. I know you understand that. Thank you for helping me and Summer.

 

[Chris & China (GA)]

at 8.8lbs, the starting dose for TR would be 1U but we do usually suggest starting a little lower because TR is already an aggressive dosing protocol

Do you have syringes with half unit markings? If so, you could start at .75....it's "between the lines" and nobody can get it perfect, but the important part is to get it to where you decide .75 is and keep it as consistent as possible

Have you read through and decided for sure if you're going to do TR or SLGS? TR offers the best chance at remission but requires a little more testing....but it also allows you to adjust the dose as often as every 3 days if it's not getting them where we want them to be. On SLGS, you hold the dose for a week which can be hard if you're getting those higher numbers.

 

[Summers Mom]

at 8.8lbs, the starting dose for TR would be 1U but we do usually suggest starting a little lower because TR is already an aggressive dosing protocol

Do you have syringes with half unit markings? If so, you could start at .75....it's "between the lines" and nobody can get it perfect, but the important part is to get it to where you decide .75 is and keep it as consistent as possible

Have you read through and decided for sure if you're going to do TR or SLGS? TR offers the best chance at remission but requires a little more testing....but it also allows you to adjust the dose as often as every 3 days if it's not getting them where we want them to be. On SLGS, you hold the dose for a week which can be hard if you're getting those higher numbers.

Yes I has the relion syringes with the half unit markings. I am going to do the TR method. I will go to my Dad's tomorrow to pick up the Lantus as he is diabetic and will be giving me a bottle. So .75?? Do you think it would be too low to give 1/2 unit? What can I expect to happen when I start her on insulin? My stomach is in knots thinking about it. I appreciate you and everyone else that has helped me.

 

[Chris & China (GA)]

If she's below 200, stall, don't feed and post for help...make sure your subject line says something like "STALLING...NEED HELP" to get some attention

At first, we would suggest waiting 20-30 minutes and retesting to see if the number comes up without food

As you gather more data, that "stall" number comes down.....those of us with enough experience will shoot anything over 50 but that's only after we have enough data to truly understand how our cats respond to both food and insulin

If you would feel better starting at .5, there's nothing that says you can't!! For the first 5-7 days you're "filling the depot" so you probably won't see the full effect of the dose for several days at least anyway (but some cats respond sooner)

 

[Summers Mom]

If she's below 200, stall, don't feed and post for help...make sure your subject line says something like "STALLING...NEED HELP" to get some attention

At first, we would suggest waiting 20-30 minutes and retesting to see if the number comes up without food

As you gather more data, that "stall" number comes down.....those of us with enough experience will shoot anything over 50 but that's only after we have enough data to truly understand how our cats respond to both food and insulin

If you would feel better starting at .5, there's nothing that says you can't!! For the first 5-7 days you're "filling the depot" so you probably won't see the full effect of the dose for several days at least anyway (but some cats respond sooner)

If Summer is below 200 I don't do anyting? No insulin or food? I don't really understand what you were saying about stalling to see if the numbers come up without food. I am confused. Wouldn't I want her numbers to go down?

 

[Tuxedo Mom]

If you do a preshot test and the numbers are lower than 200, you would "stall"...do not give food at that time and retest again in 20 minutes. By not giving food before you retest, you know that if the numbers are going up it is not because of food. When a person is new to shooting "200" is used as a safety number. If the retest shows above 200 then you can give the shot. If it is still below 200 then the suggestion is to skip the shot and go ahead and feed and wait until the next usual shot time. As a person becomes more experienced and more data is gathered then shooting at less than 200 can be done. The main emphasis is to make sure Summer stays safe.

Hope I have explained that ok.

 

[Tuxedo Mom]

Getting the spreadsheet up will be very helpful .I had lots of trouble doing mine when I started and had someone help me get it going. I am going to tag a couple of people on here that can help you with that @Yong @Marje and Gracie


Just keep gathering as much data as you can. Every bit is helpful!

 

[Summers Mom]

If you do a preshot test and the numbers are lower than 200, you would "stall"...do not give food at that time and retest again in 20 minutes. By not giving food before you retest, you know that if the numbers are going up it is not because of food. When a person is new to shooting "200" is used as a safety number. If the retest shows above 200 then you can give the shot. If it is still below 200 then the suggestion is to skip the shot and go ahead and feed and wait until the next usual shot time. As a person becomes more experienced and more data is gathered then shooting at less than 200 can be done. The main emphasis is to make sure Summer stays safe.

Hope I have explained that ok.

Yes, I understand now. I remember the vet that diagnosed Summer (the vet that recommended the insulin), said that normally you would want cats to test under 200. I just recall her saying that. But I know that the range should be from 50 -120 once she is balanced out. I have the copy of Summers bloodvwork. I picked it up this morning along with a bottle of Lantus from my dad. I have something to ask.
Summer goes Wednesday to get her stitches taken out. She also at the time of her surgery which was 8/23/17 was given a convenia. shot. I am thinking it may be best Not to start her on the insulin until after the stitches are taken out and the convenia runs it's course. She will be stressed at the vet and I just think it may be best to wait until that's behind her. What do you think?

 

[Tuxedo Mom]

Are you still doing some glucose testing? What sort of numbers are you getting? If she is still running high then starting her on a low dose of insulin might be a good idea especially if you are around on the weekend to do extra testing.

What was the convenia given for...what type of infection did she have? She will of course be stressed at the vet but if the numbers are running too high it is better not to wait to start insulin.

 

[Summers Mom]

Are you still doing some glucose testing? What sort of numbers are you getting? If she is still running high then starting her on a low dose of insulin might be a good idea especially if you are around on the weekend to do extra testing.

What was the convenia given for...what type of infection did she have? She will of course be stressed at the vet but if the numbers are running too high it is better not to wait to start insulin.

Yes, I am still test her bg here at home. I stay home so I am here with her at all times. The convenia shot was given to her when got stitches to keep it from getting infection. Will the convenia interfere with causing problems as the insulin is injected?? And her being stressed going to the vet, will that cause any problems with her while having the insulin in her system before she is regulated?? I just want to be safe.

 

[Summers Mom]

Summer was 191 this morning and 220 at 2:00 today. I pm'd Chris to help me with the spreadsheet.
Oops!!!! I just saw where you have tagged someone to help me with the spreadsheet!!!

 

[Tuxedo Mom]

Summer was 191 this morning and 220 at 2:00 today. I pm'd Chris to help me with the spreadsheet.
Oops!!!! I just saw where you have tagged someone to help me with the spreadsheet!!!

Chris can help or either of the 2 people I tagged, so no problem. Whoever is in and has the time can help you

The convenia was given as a precaution rather than addressing an existing infection so it should have no effect on the glucose levels or giving insulin. Of course you would want to give the shot away from the area that was stitched. These are the areas used to give shots:

If you are nervous or worried about doing your first shot you could measure up some water and try injecting that as a practise run. It is always scary the first few times when you first start injecting.

 

[Tuxedo Mom]

Summer was 191 this morning and 220 at 2:00 today. I pm'd Chris to help me with the spreadsheet.
Oops!!!! I just saw where you have tagged someone to help me with the spreadsheet!!!

With the numbers you are getting right now you can hold off with starting insulin. Summer is still a bit higher than she should be but not really at the point where we advise a "newbie" to shoot yet. It is right on the borderline of when you should shoot, but not in such high numbers that there is a major worry right now. Keep doing some more tests and recording and posting the numbers. Try to do one when she hasn't eaten for a while then another one 3-4 hours after she has eatne and keep track when the tests were done.

 

[Summers Mom]

Simmer was 191 this morning and 220 at 2:00 today. I pm'd Chris to help me with the spreadsheet[/QUOTE

Chris can help or either of the 2 people I tagged, so no problem. Whoever is in and has the time can help you

The convenia was given as a precaution rather than addressing an existing infection so it should have no effect on the glucose levels or giving insulin. Of course you would want to give the shot away from the area that was stitched. These are the areas used to give shots:

If you are nervous or worried about doing your first shot you could measure up some water and try injecting that as a practise run. It is always scary the first few times when you first start injecting.

Inject water into Summer?

 

[Tuxedo Mom]

Inject water into Summer?

If you are nervous about when you may have to inject insulin you could do a "trial run" by injecting a small amount of distilled water. I did my first "practice injection" with my first FD kitty doing this. However if the numbers are staying low enough that you do not have to give any insulin you can wait until you are at the vets and have them show you how to do injections. As long as she is staying in these sort of numbers you do not have to worry about that at this point.

It was just a thought but not something you need to do.

 

[Chris & China (GA)]

Inject water into Summer?

I'd suggest shooting into an orange instead of Summer....it has a similar "feel" to it.....but really....the needles are so thin and tiny that most cats truly never even notice the insulin shot

Oops!!!! I just saw where you have tagged someone to help me with the spreadsheet!!!

I had offered earlier to set it up for you...once you send me the information I asked for, I'll get it set up for you...it's really simple (especially once you've done it a few hundred times....LOL)

As far as Convenia goes, it shouldn't effect the glucose numbers.....but you may want to read the information on "Convenia, Worth the Risk"? .....most of us have our cats records marked with "No Convenia, No Metacam" because of some of the problems associated with those drugs.

As long as she's staying close to 200, try making sure she's had no food for at least 2 hours and getting a test in.....then test again in 3 hours.....let's see what happens.

 

[Yong & Maury GA]

Glad Chris is helping. I'm out of town for a family event.