So, what is TR, and why is it bad with PZI kitties?...

[Bowie S. B. Otch]

Just curious, I saw something on another thread, and I didn't want to hijack it with my question. I have seen references to TR, aka "Tight Regulation" protocol, but I am not sure what that means. I also saw that it isn't something you want to do with a kitty on prozinc.

Anybody care to explain?

 

[Kris & Teasel]

TR protocol is not "bad" per se but there are few, if any, people on the forum who are experienced in it. It's a protocol from a feline diabetes vet, Dr. Hodgkins. There's a group of people on the "Your Diabetic Cat" website's forum that use it in one form or another. The general consensus of people who are active on this forum is that it promotes some techniques that are risky and makes claims that are disputed based on owners' direct experience. One such claim is that if this protocol is followed carefully a kitty won't have a hypo episode.

If you post in the main health forum and ask about it you might get more info than I can provide.

 

[Sue and Oliver (GA)]

TR is two things - one, a protocol espoused by Dr. Hodgkins. There is a website that promotes it but she is no longer associated with it. One of my issues is that it says "if your cat is in this range, shoot this." We believe every cat is different and no one dose fits all. To see that in real life, just check out the spreadsheets here and see what different cats get for a number in the 200-250 range and how it impacts their levels during the cycle. We use past data in each cat to decide how to dose. Their protocol also says that if a cat is on a wet low carb diet and is monitored, they can't hypo. I have seen that happen too many times to believe that. We are very careful monitoring kitties who drop in lower ranges. I personally would never say that a cat won't hypo. You can bring a kitty up from low levels with food often, but I have also seen instances when a cat doesn't come up with food but continues to drop, meaning a trip to the ER.

TR is also a protocol for depot insulins like Lantus and Levemir that is promoted on their forums within FDMB. It seems to work well with many cats on depot insulins, which have longer flatter cycles than ProZinc and have a carry over effect. PRoZinc is an "in and out" insulin which, most often, affects a cat within a 12 hour time period and is gone after 12 hours. It's onset is faster than a 12 hour insulin and has a smile shaped curve, not a flatter one. Because the insulins have different patterns and work differently, they have different protocols. There is also a Start Slow, Go Slow protocol for depot insulins which is more similar to the protocol we tend to use for ProZinc.

Complicated, but hope that helps.

 

[Rachel]

Here on FDMB, we have a saying "First, do no harm". That's pretty much the basis of what we do. Dr. Hodgkins protocol seems dangerous to me, and it's not something I could advocate. We've had people drop by here who were using it, but since we can't advise on it or support it, we weren't really able to help much. We are more conservative with our advice and prefer to get the kitty to regulation and remission slowly and carefully.

 

[Bowie S. B. Otch]

Thanks Rachel and Sue and Oliver. Those explanations make sense. I am currently uncomfortable with idea of tinkering around with Bowie's dosages without consulting his vet, but I do want to know what others are talking about on the topics.
I am way to new to this, including figuring out what his dose should be with the vet, to be deviating from the course or adjusting meds on my own. We just bumped his dose up to 4U last week, and based on his latest curve on Sat, the vet would like me to redo one in a couple of days to see if we can bump it back down. We are getting better about stopping him from getting contraband food. I think I am also getting better at the insulin shots; I make sure he is lying down, and while I let go of the skin ASAP, I leave the needle in for a few more seconds. He had shifted on me a few times in the first week and he may have gotten a few "mostly fur shots" back then. Plus, he had to come down from a HUGE high when he was diagnosed (he was 500 when he was diagnosed on the 19th). Even when his levels were in the 300s for the first curve, he was looking and feeling better. His latest curve had him in yellows and blues. His excessive drinking and urinating is gone, he is bright-eyed, with shinny healthy fur, playing in paper bags again and getting rowdy sometimes, and being a cuddle boy before naps instead of sulking off to the bathroom rug to collapse on it. It's like night and day. We may not have this perfectly down, but I he is feeling much better, and I am learning a lot.

 

[Jill & Alex (GA)]

At one time PZI was the #1 insulin choice for those wishing to practice TR on the FDMB. However, I don't think there's anyone left on the FDMB anymore who practices TR by using a sliding scale and shooting on the rise after nadir... and hasn't been for many years.

If you're interested in finding out more about practicing TR with PZI/Prozinc, you might want to check out Diabetic Cat Help. I understand they offer a lot of help and have been successful when it comes to practicing TR with PZI or Prozinc.

 

[Sue and Oliver (GA)]

Some members here do use sliding scales, and shooting every 8 hours is one of the advanced dosing protocols that can be used. We just find very few people who can be around every 8 hours and do all the monitoring that requires.

I have certainly heard very mixed reviews about YDC.

 

[Jill & Alex (GA)]

Some members here do use sliding scales, and shooting every 8 hours is one of the advanced dosing protocols that can be used. We just find very few people who can be around every 8 hours and do all the monitoring that requires.

Yes, I'm aware of some here using sliding scales. I'm also aware shooting TID (every 8 hours) is a technique which has been used for just about every insulin ever used when treating feline diabetes. The schedule is extremely rough and for that reason, among a few others, is usually not the best choice for most caregivers.

However, shooting on the rise after nadir combined with or without the use of a sliding scale is another method used to achieve tight regulation which I haven't seen members here using in many years. Honestly, I don't think there's anyone left on the FDMB who has the knowledge, understanding, and experience to share the method with others... but that doesn't mean the technique doesn't exist or is dangerous.

The technique was so popular prior to the Lantus boom that our webmaster even created a separate forum for those practicing TR. IIRC, about 99% of the caregivers posting in the forum were PZI users. The separate TR forum became defunct when members became comfortable practicing TR within the ISGs themselves. It's a shame TR with PZI/Prozinc has become a lost art on the FDMB. As Lantus use became more popular, PZI use declined. Between the normal turnover we usually see, life changes, burn out, and the inevitable loss of cats... those experienced with PZI and TR have moved on.

I have certainly heard very mixed reviews about YDC.

Yes, I have, too. I've also experienced horror stories first-hand which occurred on the YDC web site... fatal stories. However, it should be noted, YDC and Diabetic Cat Help are two different websites. Yes, they're both based on Dr. Hodgkins TR Protocol, but the websites are different for a multitude of reasons. You mentioned Dr. H is no longer associated with YDC. Given all that went on with YDC at the time, I would have to think there's a reason for that, too.

We're here to help people. If someone is interested in practicing TR with PZI or Prozinc and they can't find the help they need here or another method may prove beneficial... I can't help but feel we should point them in the right direction... allowing them to explore options which may work for them and help their cats.

Just my thoughts...

 

[Bowie S. B. Otch]

Thanks for the further input. Every 8 hours is not going to work for our family. We will do our best on a 12 hour. I'm nervous about Wednesday when the kids go back to school and both me and my husband will be busy with work. Eek!

 

[Jill & Alex (GA)]

Thanks for the further input. Every 8 hours is not going to work for our family. We will do our best on a 12 hour.

You're welcome!
I've read your posts. I agree, shooting every 8 hours does not seem like the right fit for your family.
Wishing you the best!

I think some clarification may be needed for the benefit of the group...
"Shooting every 8 hours" is not synonymous with "shooting on the rise after nadir" and shooting every 8 hours is not what Dr. H's TR Protocol is all about.