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Time to follow Roomp and Rand's 4th step?
- Thread starter joanngold
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Jo Ann
with all due respect, I'm really not sure what protocol you are following. By step 4, if you mean, "reducing the dose" as described on Tilly's webpage, Big Shot hasn't earned a dose reduction. His numbers, as far as we can see, still appear to be high.
We would love to help you but it's difficult for us to make sound suggestions with no nighttime tests. I hope you will go back and read our responses to your last post.
with all due respect, I'm really not sure what protocol you are following. By step 4, if you mean, "reducing the dose" as described on Tilly's webpage, Big Shot hasn't earned a dose reduction. His numbers, as far as we can see, still appear to be high.
We would love to help you but it's difficult for us to make sound suggestions with no nighttime tests. I hope you will go back and read our responses to your last post.
Amy&TrixieCat
Member Since 2011
Hi Jo Ann-
Here's the link to the sticky of the Tight Regulation Protocol
Specifically, here's the info about reducing a dose:
Big Shot sounds like he's feeling better from being on insulin, but given the information/data you have his BG numbers do not indicate that he is ready for a lower dose.
However, as Marje said, you are missing a lot of information by not having any nighttime tests, and it really is impossible to truly evaluate dose without that information. Without those tests, we don't know if he is dropping dangerously low during the night, or if he's bouncing high during the night, or if he's just staying flat. This information is definitely vital in determining where to go next, and it is important for making sure Big Shot is safe.
We hope you'll stick around, ask questions, and check out the spreadsheets of other cats here so you can see how they are responding and how dose adjustments are being made. We would love to help you help Big Shot, but we do need more information in order to do so.
Here's the link to the sticky of the Tight Regulation Protocol
Specifically, here's the info about reducing a dose:
Big Shot sounds like he's feeling better from being on insulin, but given the information/data you have his BG numbers do not indicate that he is ready for a lower dose.
However, as Marje said, you are missing a lot of information by not having any nighttime tests, and it really is impossible to truly evaluate dose without that information. Without those tests, we don't know if he is dropping dangerously low during the night, or if he's bouncing high during the night, or if he's just staying flat. This information is definitely vital in determining where to go next, and it is important for making sure Big Shot is safe.
We hope you'll stick around, ask questions, and check out the spreadsheets of other cats here so you can see how they are responding and how dose adjustments are being made. We would love to help you help Big Shot, but we do need more information in order to do so.
Melanie and Smokey
Member Since 2010
What was the prompting for lowering the dose? It seems like numbers were consistently going up when you reduced the dose. When I look at the protocol, you would likely go back step 2, raising the dose, though I agree than never having a single test after the PMPS test makes it a little more difficult to know whats going on. Its great that he's feeling and acting better! I just don't think you'd want to start pulling the insulin support away while he's still so far from normal numbers.
I am referring to the Roomp and Rand's protocol and the numbers beginning on December 1st through December 9th. They say that the goal is to keep the blood glucose concentration between 70 to 220. (These numbers for AlphaTrak are probably off some.) But it looks to me that the spreadsheet correspond to the goals for step 3. The nadars all fall into the recommended range for the dates I mentioned. And so I reduced the dose by .25 u. For that reason I would think that I should move onto Roomp and Rand's step 4 with their own set of instructions. And I'm asking if I am interpreting the protocol in the appropriate way?
We all would rather I be in a position to collect at least an additional night measure. And, I would do so if it were at all possible. I'm not comfortable with explaining why this is not possible. It is an undesirable circumstance I live with.
We all would rather I be in a position to collect at least an additional night measure. And, I would do so if it were at all possible. I'm not comfortable with explaining why this is not possible. It is an undesirable circumstance I live with.
Melanie,
You touch on an area that has been difficult for me to follow. The instructions are very clear and detailed for increasing the dose. But I wish I could find instructions that are similarly detailed for reducing the dose. Perhaps I am missing the instructions.
Jo Ann
You touch on an area that has been difficult for me to follow. The instructions are very clear and detailed for increasing the dose. But I wish I could find instructions that are similarly detailed for reducing the dose. Perhaps I am missing the instructions.
Jo Ann
BJM
Member Since 2010
If you try it, you will find out if it works OK for your cat. Maybe you'll be lucky and it'll work OK. The others raise valid concerns, though.
You'll want to be testing for ketones, monitoring for dehydration, and measuring the food and water intake and elimination. See my signature link Secondary Monitoring Tools for some ways to do those and other monitoring ideas.
You'll want to be testing for ketones, monitoring for dehydration, and measuring the food and water intake and elimination. See my signature link Secondary Monitoring Tools for some ways to do those and other monitoring ideas.
Phase 3 states of the R/R TR protocol:
A dose reduction is earned:
Big Shot did get to 83 but 83 is not below 80. Of course, with him going so high at AMPS some days, I wouldn't be surprised if he is going low at night.
If you feel safer giving him 1u due to your circumstances, that is definitely something to consider. While those of us actually doing TR would not reduce the dose (if we were using the AT) at 83, your circumstances may dictate that it is the safer way to go.
A dose reduction is earned:
Big Shot did get to 83 but 83 is not below 80. Of course, with him going so high at AMPS some days, I wouldn't be surprised if he is going low at night.
If you feel safer giving him 1u due to your circumstances, that is definitely something to consider. While those of us actually doing TR would not reduce the dose (if we were using the AT) at 83, your circumstances may dictate that it is the safer way to go.
Amy&TrixieCat
Member Since 2011
Since you are not able to do any nighttime testing, it will be challenging/virtually impossible to truly follow the protocol. So your goal should be to keep Big Shot in the best numbers possible while not risking him going too low when you're unable to test. This would mean running him a tad higher than that target range set by the protocol, while still keeping him below the renal threshold. As Marje said, the inability to get nighttime tests would certainly be an appropriate reason to lower Big Shot's dose, even though he "technically" has not earned a reduction. Whether or not you are following the protocol, safety has to come first. So if you do find that Big Shot falls under 80 at any point, you absolutely do want to reduce the dose immediately. Since you aren't able to get those nighttime tests, I would aim to keep him a little further away from that 80 in general, in hopes that he won't dive too low during the night.
BJM
Member Since 2010
Would you feel more comfortable following the Start Low, Go Slow protocol?
julie & punkin (ga)
Member Since 2011
there are others that aren't able to get pm cycle tests in - you don't have to explain your circumstances but it really helps us to know that is your situation. Sometimes people just think if they get day tests in that is good enough and they don't understand that it's common for cats to go lower at night.
I would do 2 things if I were in your shoes. I would make sure that food (low carb canned) is available at night. If he'll graze, that's ideal. But if he's not a grazer, a timed feeder becomes very helpful. Train Big Shot when you are home that food will be coming from the timed feeder. Many but not all cats will eat if their blood sugar goes low. If you can train him to eat from it, then I would set it to open a few times during the night. There is a discussion on timed feeders in the links at the bottom of this post that you might find helpful. That's a little bit of insurance to protect him.
The second thing I would do is to probably let him run a little bit higher, as Amy is suggesting. The Tight Reg Protocol is designed to get a cat into normal numbers and keep them there so that hopefully, their pancreas can heal but if not, their body is still protected from the damage of high blood sugar. An essential component of doing Tight Reg, however, is the testing. It wouldn't be safe to push a cat into lower numbers (just above hypoglycemic numbers) if the testing isn't possible. Those two things go hand-in-hand. That's why everywhere on the yellow starred stickies it says that the guidelines provided there are for those following Tight Regulation.
The FDMB guidelines that are on the Tight Regulation Protocol yellow starred sticky are very clear. These were written interpretations of the AT page that you are referring to.
You're doing a great job of testing during the day, but if the night cycle testing just isn't possible, consider letting him run a little higher instead of trying for remission.
I would do 2 things if I were in your shoes. I would make sure that food (low carb canned) is available at night. If he'll graze, that's ideal. But if he's not a grazer, a timed feeder becomes very helpful. Train Big Shot when you are home that food will be coming from the timed feeder. Many but not all cats will eat if their blood sugar goes low. If you can train him to eat from it, then I would set it to open a few times during the night. There is a discussion on timed feeders in the links at the bottom of this post that you might find helpful. That's a little bit of insurance to protect him.
The second thing I would do is to probably let him run a little bit higher, as Amy is suggesting. The Tight Reg Protocol is designed to get a cat into normal numbers and keep them there so that hopefully, their pancreas can heal but if not, their body is still protected from the damage of high blood sugar. An essential component of doing Tight Reg, however, is the testing. It wouldn't be safe to push a cat into lower numbers (just above hypoglycemic numbers) if the testing isn't possible. Those two things go hand-in-hand. That's why everywhere on the yellow starred stickies it says that the guidelines provided there are for those following Tight Regulation.
The FDMB guidelines that are on the Tight Regulation Protocol yellow starred sticky are very clear. These were written interpretations of the AT page that you are referring to.
So those following TR wouldn't reduce a dose until the cat went below 50 on a human glucometer or 80 on an alphatrak. But in your circumstance, reducing because you are anticipating low numbers might make some sense.
You're doing a great job of testing during the day, but if the night cycle testing just isn't possible, consider letting him run a little higher instead of trying for remission.
Paula: it's in the original R/R TR Protocol. The 68 is referenced in the Management of Diabetic Cats pdf linked on the TR Protocol Sticky. You are correct that in that document, it identifies a 68 on an AT as being more "equivalent" to a 50 on a human glucometer.
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