Tight Vs. Relaxed Insulin Regulation?

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oreosmom

Member Since 2012
Hello,

I posted in the Lantis site, but realized I was a novice and should have posted here. I want to know what is tight regulation and what is relaxed regulation?
I cannot test my cat 3-4 times a day due to my job. Can somebody please let me know if relaxed regulation isn't quite as restrictive? I don't know how to track any of this either. I looked at the spreadsheet data, and have no clue to what the terminology is. I would appreciate help on this.

Sincerely,

Oreo's Mom
 
Tight regulation (TR) is the recommended dosing protocol for cats on Lantus. It is the protocol that is associated with the very high remission rates for Lantus, and produces the best results in getting blood sugar under control in diabetic cats on Lantus or Levemir.

A "relaxed" approach means that the Lantus dosing protocol is not being followed for whatever reason--either because people were unable or unwilling to test at least 3 times a day, or because their schedule wouldn't allow them to shoot on a 12/12 schedule, or that they felt that tight regulation just wasn't working for their cat and chose to use a different protocol.

This thread gives a good overview of what exactly TR is: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

I would always recommend newbies try to start with TR first, and then go to something more relaxed if it's just impossible for TR to work for them. That's because the 86% remission rate with Lantus is only associated with TR, so it offers you the best chance of getting to remission. But there's a window on remission and TR, so the sooner you start it, the better your chances. What is your work schedule like? Is a way to schedule in the test at night? Or is there someone you can get to help you test on work days? Are you able to go home for lunch breaks? Could your shot times be adjusted to let you get that third test? Perhaps we can give you some advice on how to manage the testing with your work schedule--it seems overwhelming and stressful at first but I found that things were far LESS stressful once we got into a routine with TR.

When Bandit was on insulin, I was working two jobs and going to grad school, so I'm not someone who was home all the time to test. To give you an idea of how I managed it, here's what I did. Bandit's shots were at 7am and 7pm, and his nadirs (lowest number of the cycle) were typically 6hrs after each shot (1pm/1am). I tested and gave him his morning shot and food, and then I had to leave for work for nearly 12 hours (I have an hr commute both ways). So I set the autofeeder with frozen food and to go off at his nadir (1pm) so that he had food available if he dropped a little low. I got home just before 7pm and tested and gave him his PM shot. Then I got a test before bed at around 9-11pm (+2-+4), and I set an alarm to get up at 1am and get his nadir test every day (+6) and went right back to sleep. That seems like a pain, but after a week or two I adjusted and it was fine. On the weekends when I was home to test, I would do a curve in his AM cycle and get some extra tests in when I could.

It is a little bit more work, but it actually SAVES you a lot of work and stress in the long run. A cat in remission is far easier to care for than a cat on insulin, and it's the healthiest place for a diabetic cat to be, so it's win/win for both of you. If there's no secondary health condition that might throw off his BG, it's very likely your cat will reach remission with TR. Also, it's safer because you'll have a better idea of how the insulin is working in your cat, and if the dose is too high or too low. Without a daily mid-cycle test, it's really hard to tell if the dose is too high because too much insulin will keep blood glucose just as high as too little insulin.

EDIT: I just went back and saw that Oreo does have secondary health conditions, and he's not newly diagnosed, so the remission rates with TR wouldn't be applicable to him (although not impossible). However, TR would still offer better control over his blood sugar, so if you can manage it, I would still urge you to give it a shot.
 
As for the spreadsheet terminology:

AMPS=AM Pre-shot
PMPS= PM Pre-shot
U= number of units given
+1, +2, +3, etc.--the number of hours after the shot the test was performed.

Does that explain everything for you? If you have any more questions, please ask!

Oh, and one more thing--what food are you feeding? Diabetic cats should be on a low carb (less than 10%), canned diet only. I saw in another thread that you are feeding Fancy Feast Mornings? That's not a low carb food. The diabetic safe flavors of Fancy Feast are the ones that say "classic" on the label. Check out the cat food nutrition charts for the carb values for many cat foods: http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf
 
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