TR Question

[Jordenne/Barb and Jospeh]

So I'm a new member just want to make sure I understand the general idea with TR.

Basically it's like playing chicken with driving the numbers as low as you can without getting lower than 2.7 so you start at a safe level and once you prove that's safe though data over a number of cycles you increase the dose and so on.

The idea is that as you get the BG levels lowers the difference between the peaks and the nadir will lower and jump start the Kitty's pancreas to heal and start producing insulin on its own.

Once this process begins you'll see the levels start to get lower without increasing the dose which will triggers dose reductions and with luck eventually youll earn a reduction to zero and thus start a OJT trial where we see if kitty will regulate on their own.

This is quite the difference from SLGS which if I understand correctly is just interested in getting a dose established that will keep the numbers low enough to prevent any clinical symptoms from developing but high enough to have a very low risk of hypo and a much reduced testing regime needed. The problem with doing this method is that it makes it much harder for the pancreas to jump start and start producing on its own

If I've made a mistake please let me know. It's difficult to wrap my head around it all and I want to make sure I've distilled the information properly

 

[Waheeda]

So I'm a new member just want to make sure I understand the general idea with TR.

Basically it's like playing chicken with driving the numbers as low as you can without getting lower than 2.7 so you start at a safe level and once you prove that's safe though data over a number of cycles you increase the dose and so on.

The idea is that as you get the BG levels lowers the difference between the peaks and the nadir will lower and jump start the Kitty's pancreas to heal and start producing insulin on its own.

Once this process begins you'll see the levels start to get lower without increasing the dose which will triggers dose reductions and with luck eventually youll earn a reduction to zero and thus start a OJT trial where we see if kitty will regulate on their own.

This is quite the difference from SLGS which if I understand correctly is just interested in getting a dose established that will keep the numbers low enough to prevent any clinical symptoms from developing but high enough to have a very low risk of hypo and a much reduced testing regime needed. The problem with doing this method is that it makes it much harder for the pancreas to jump start and start producing on its own

If I've made a mistake please let me know. It's difficult to wrap my head around it all and I want to make sure I've distilled the information properly

Wonder if anyone has statistics on remission from TR and SLGS.

 

[Sienne and Gabby (GA)]

I'm not sure I fully understand how you're conceptualizing TR. The method is a means of getting numbers into normal range as quickly as possible. No one knows how long a cat has been diabetic at the time of diagnosis. Many of the cats we see here have become acclimated to having their blood glucose (BG) numbers sitting in a high range (i.e., glucose toxicity). TR is meant to break through that by getting the numbers as low as safely possible in order to warrant a dose reduction. Not every cat has a dramatic response with their pancreas kicking in. Some cats take more time, some less, and some can be tightly regulated but don't go into remission. It's not so much TR that flattens the curve. It's the nature of Lantus and Levemir. They are long acting, depot-type of insulins and the "flat" curve is the pharmacology of the insulin. The more time the cat is in normal numbers, the greater the chance the pancreas is healing and can support itself without benefit of exogenous insulin because the pancreas is producing its own insulin.

I think your impression of SLGS is closer to what we see. However, it doesn't mean that numbers can't drop unexpectedly low. Even with TR, some cats need a slower approach. We've seen cats take 2+ years to go into remission with TR. Keep in mind, it's the cat who's dictating dose increases and reductions with either method.

@Waheeda - we know which cats have gone into remission (see an OTJ celebration thread -- all the cats we know of are listed) but don't know which dosing method was used. The records aren't that detailed.

 

[Si am cat mom]

Wonder if anyone has statistics on remission from TR and SLGS.

I think the TR stats are listes in the guidelines. I know they are on the page it was " borrowed from" .
The other stats I've seen were from specific insulins ( Lantus vs PZI etc. )

It seems to me that some folks start with SLGS and then switch to TR - possibly to lower the number for reductions....

 

[Waheeda]

Tha

I think the TR stats are listes in the guidelines. I know they are on the page it was " borrowed from" .
The other stats I've seen were from specific insulins ( Lantus vs PZI etc. )

It seems to me that some folks start with SLGS and then switch to TR - possibly to lower the number for reductions....

nks @Sienne and Gabby (GA) and @Si am cat mom
I am tempted to try TR. he’s doing fine with SLGS but I feel I want to be more aggressive and push lower than 90. At the same time, I’m also nervous cos he usually goes lower during morning cycle when I’m at work. I can run home every 2/3 hours like what I do now sometimes but tight monitoring is not possible.
Is it possible to do SLGS but instead of 90 being the cut-off point for reduction, I push it down to 70? Cos 90 doesn’t work for him.

 

[Olive & Paula]

It would be hard to determine which cats gain remission with TR or SLGS. People switch back and forth.

 

[Sienne and Gabby (GA)]

FWIW, I worked full time and did TR. Take a look at this post on working and using TR. Some of the suggestions may be helpful.

 

[Jordenne/Barb and Jospeh]

FWIW, I worked full time and did TR. Take a look at this post on working and using TR. Some of the suggestions may be helpful.

I actually read that a couple days ago, it was very helpful. Our work schedules are such that my spouse does the preshoot checks and injections and I manage the nadir checks and monitoring. Works out well for getting the tests done but has its problems with both of us being on the same page because we only get face to face communication on the weekends.

Typical plan for our days involve her waking up and doing the AMPS and injection before leaving for work. She texts the number to me so I'll see it when I wake up around the +2.5 point. If we shoot a low number then I get woken up so I can get a +1 and +2 and be prepared to deal with a low drop.

I leave for work around the +8 mark so he is well passed nadir. For the PM cycle if we shoot low then she stays up and gets a +1 and +2 to get a better idea of what to expect. If those numbers are troublesome then I'll come home for a +4 check and feeding to soften the drop to nadir. I'm home like clockwork at +6 for a PM nadir check and monitoring if needed until we get a rise.

So far the plan has worked well. I think we are being too pre-emptive when we encounter a new "low preshoot" number by feeding the gravy food and unlocking the treat vault but other than that we are doing good so far

 

[Bobbie And Bubba]

Tha

nks @Sienne and Gabby (GA) and @Si am cat mom
I am tempted to try TR. he’s doing fine with SLGS but I feel I want to be more aggressive and push lower than 90. At the same time, I’m also nervous cos he usually goes lower during morning cycle when I’m at work. I can run home every 2/3 hours like what I do now sometimes but tight monitoring is not possible.
Is it possible to do SLGS but instead of 90 being the cut-off point for reduction, I push it down to 70? Cos 90 doesn’t work for him.

Sorry for highjacking your thread @Jordenne/Barb and Jospeh but I wanted to answer Waheeds’s question.

Since you have lots of data on your kitty, you can lower your reduction number . The SLGS method are guidelines and once you Know Thy Kitty , you can customize it. There are many here that have lowered the reduction number to allow their cat to be in green numbers longer and allowing more healing to occur.

And all that said, there are many that follow TR and work full time. An automatic timed feeder will be your best friend. See this http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

 

[Waheeda]

Sorry for highjacking your thread @Jordenne/Barb and Jospeh but I wanted to answer Waheeds’s question.

Since you have lots of data on your kitty, you can lower your reduction number . The SLGS method are guidelines and once you Know Thy Kitty , you can customize it. There are many here that have lowered the reduction number to allow their cat to be in green numbers longer and allowing more healing to occur.

And all that said, there are many that follow TR and work full time. An automatic timed feeder will be your best friend. See this http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

Thanks!
I have 2 other civvies besides him. Auto-feeder won’t tell me who’s getting the food.
I’ll follow ur advice on lowering the reduction number.
Thanks so much.

 

[Waheeda]

FWIW, I worked full time and did TR. Take a look at this post on working and using TR. Some of the suggestions may be helpful.

I can’t hold the food the whole day cos my 3 cats like to eat small meals. One civvie is already so thin due to multiple illnesses. And my diabetic always goes lower during the day when I’m at work. I’ve been running home at +4 or/and +6 when I feel worried.