Hi Everyone, Bijan and I (Maryam) are new to the forum and were recommended to post here after having some trouble getting our dosing correct. Here is our original thread if you are interested... TLDR: I am pretty sure Bijan's vet does not know how to actually treat diabetes in Cats so she had me start him off on 2 units and then told me to increase to 3 after not seeing good numbers... she didn't really give me a good understanding of the curve, what to look for in dips, or that I shouldn't necessarily shoot if a PS number is I decided not to go all the way up to 3 because I was scared and at the same time found this forum and started doing some reading and realized he should have been decreasing instead due to some very low numbers in the SLGS method (I figured this would be a good place to start since it was less aggressive). Fast forward to today, and we are down to 1.25 units as we are still getting nadirs in the 50s/60s and have been unable to really keep him at a consistent hold. He is a big boy- @Bron and Sheba (GA) were asking why I don't do the TR method- I am a bit worried since I have not been able to find a good cadence with his dosing yet to move to a more aggressive method. Looking for any insight or advice you may have on how we can get my big boy into a more regulated pattern. Should we move over to the TR method? Thank you so much
Hi Maryam and Bijan! Welcome to the LBL forum. (I had to google TLDR. LOL) Vets not knowing how to treat diabetes is not surprising and I'm glad you found this forum. Looks like Bijan is heading for better numbers. He's bouncing less already and seeing blues and greens more often. Considering how much you test, it would be good if you can follow TR. TR is more aggressive but it is also more agile. Dose changes are faster and you can hold doses in which Bijan can spend more time in healing green. SLGS has a lot of safety measures built in for caregivers who cannot test beyond preshots. Every drop below 90 is a reduction and back-to-back reductions often fail. This is because Lantus is a depot insulin and the depot takes at least 4 cycle to catch up. In Bijan's case, the 66 you saw today was possibly the 1.75U depot still at play and reducing twice in 2 days might lead to a failed reduction. Of course, ECID and some cats who are zooming down the dosing ladder do hold (and even need) back-to-back reductions. Dealing with lower numbers is indeed scary when you are new to them, but with time and experience, they actually become addictive. And cats love being back in lower numbers. The symptoms of diabetes reduce (and then disappear), they become more playful and energetic and recapture their "old selves".
@Bandit's Mom Hi Booma thank you so much for the warm welcome Bijan has definitely been more playful and chatty lately! He has a monitor on him right now so its fairly easy for me to test frequently. I am a bit confused about where to start with his dosing on TR. We have changed so much recently I worry I am not helping but making things worse! Is the goal with TR to see more low numbers more consistently? Should I just keep the 1.5 for now and see how it goes? Am I understanding correctly to hold this dose since his nadirs are in the 60s? for at least 10 cycles unless he needs a reduction (nadir below 40/50)? I am confused as to why I would then increase this dose if he is under 100 Would you mind sharing some guidance?
Yes, the goal of TR is tight regulation which means you want him to spend as much time in normal numbers as possible. The normal range with a human meter is 50-100 mg/dl and this is also the range in which the pancreas get a chance to heal. I don't know what dose you gave this morning, so you could hold the 1.25U for a few cycles (6-8) and see how he fares on it. If he doesn't hold the reduction, you can go back up to 1.5U after 8 cycles. That would be enough time for him to clear any bounce and show you what he can do on the dose.
