Understanding TR

[Catrina]

My kitty has been getting some green numbers and I don’t want to reduce because he still has some yellow numbers often. I am thinking about switching to TR but I am very lost with that protocol. I have read it many times but don’t understand it. When do I increase the dose, or reduce or maintain it? SLGS is very clear on when to do that and what numbers to see but I don’t understand Tr. can someone help better explain it?

 

[Sienne and Gabby (GA)]

With TR, if your cat is within the first year since diagnosis, you reduce the dose if numbers drop below 50 (if you're using a human meter). If numbers drop below 50, it doesn't matter if most of Molson's spreadsheet reflects numbers that are over 200. You still take a reduction.

If numbers are outside of the normal range but below 200 for 3 days (6 cycles), you increase the dose by 0.25u. If numbers are over 300, you can increase the dose by 0.5u. There are some exceptions to increasing the dose based on how new to lower numbers your cat may be but these reflect how long you hold the dose not on whether or not to increase.

Also, with TR, you must get at least four tests per day. You need to get your two pre-shot tests and at the minimum, one test during both the AM and PM cycles. Lantus dosing is based on how low the insulin takes your cat's numbers and the low point is typically not at shot time. If you are trying out TR, you need to be evaluating the dose every 3 days/6 cycles. It looks like you've been holding doses for a bit longer than indicated.

Does this help?

 

[Catrina]

With TR, if your cat is within the first year since diagnosis, you reduce the dose if numbers drop below 50 (if you're using a human meter). If numbers drop below 50, it doesn't matter if most of Molson's spreadsheet reflects numbers that are over 200. You still take a reduction.

If numbers are outside of the normal range but below 200 for 3 days (6 cycles), you increase the dose by 0.25u. If numbers are over 300, you can increase the dose by 0.5u. There are some exceptions to increasing the dose based on how new to lower numbers your cat may be but these reflect how long you hold the dose not on whether or not to increase.

Also, with TR, you must get at least four tests per day. You need to get your two pre-shot tests and at the minimum, one test during both the AM and PM cycles. Lantus dosing is based on how low the insulin takes your cat's numbers and the low point is typically not at shot time. If you are trying out TR, you need to be evaluating the dose every 3 days/6 cycles. It looks like you've been holding doses for a bit longer than indicated.

Does this help?

When you say “numbers” do you mean nadir or just all the numbers?
Does the below make sense?

hold a dose for 3 days, after three days evaluate and make a dose adjustment.
if at any point he drops below 50 (2.8) immediate dose reduction of 0.25u.
If nadir is between 99 - 200 (5.5 - 11.1) increase by 0.25u
If nadir is above 300 (16.6) increase by 0.5u


I was holding the dose longer because I was on SLGS but have decided today to switch to TR

 

[Ale & Bobo & Minnie (GA)]

When you say “numbers” do you mean nadir or just all the numbers?
Does the below make sense?

hold a dose for 3 days, after three days evaluate and make a dose adjustment.
if at any point he drops below 50 (2.8) immediate dose reduction of 0.25u.
If nadir is between 99 - 200 (5.5 - 11.1) increase by 0.25u
If nadir is above 300 (16.6) increase by 0.5u


I was holding the dose longer because I was on SLGS but have decided today to switch to TR

Yes that is correct. You’re looking at the nadir not the preshot numbers.

if you’re unsure about a dose adjustment, you post on the Lantus forum and ask for help