Discussion in 'Lantus / Levemir / Biosimilars' started by Libby and Lucy, Dec 2, 2014.

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  1. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Dec 28, 2009
    :cat: :cat: Yes! :cat: :cat:

    You can make this work. It just takes some planning.

    Here is an example of my schedule when Lucy was on Lantus.

    Shot time was normally between 6:15-6:45. Lucy had a fairly typical Lantus curve, onset between +2 and +3, nadir around +6. This was my general schedule – of course there were times when I needed to test more, like if she was dropping sharply or when she was careening down the dosing ladder toward OTJ. Note that this is just 4 tests a day on a typical work day.

    6:15 am – wake up, test/feed/shoot
    7:30 am – leave for work. This allowed me an hour in case I needed to get a +1.
    6:00 pm – come home. Test/feed/shoot whenever I got home, preferably before 6:30 but later was ok if necessary.
    8:30 pmevery night - +2 to see how the night is going to go. If already heading down, test more as needed.
    10:30 or 11:00 pmevery night - before bed test. Sometimes the numbers would demand that I stay up later, but if this test was comfortable, then off to bed.

    • In addition, I would squeeze in extra tests whenever I could – if I got home at 5:00 one day I would grab a +11, etc. Lucy’s nadir was around +6, so by shooting at 6:15, even if I had to monitor a low cycle I was usually done shortly after midnight.
    • Saturday was curve day, and Sunday too if I was home. If I was gone for a few hours on curve day, it was not a huge deal because I already had a good bit of data collected throughout the week. With the curve, I was basically looking to confirm what I already knew from those weeknight tests.
    • Sometimes I came home at lunch if I had reason to believe she would be going too low that day, for example shooting very low or if a bounce was due to clear and I wanted to catch the low number. 20 minute drive home, 15 minutes at home, 20 minute drive back.

    The hard part of managing tight regulation while working is the point at which the cat starts RUNNING down the dosing scale. This is not an easy time for anyone – be conservative if you need to. I was very lucky that Lucy made her big run during the holidays, when I could take extra time off work. If you are not able to do that, be prepared to skip shots or take reductions when you may not want to. It’s ok, if your cat is intent on getting those dose reductions he or she will do so anyway! The payoff during this time can be huge, so some short-term sacrifice can be worthwhile. Post on the board for suggestions.

    Tips for working within a tight schedule:

    • No dose increases without enough data to know where this dose is taking your cat. If I was able to get the right tests during the week, I could often increase the dose after 3-4 days. If I wasn’t confident, I would wait until after curve day. It is VERY important that you are able to trust your dose if you will be gone every day. Fortunately that is not hard to do if you manage your dose changes methodically.
    • Know your cat – plan your dose increases around your cat’s typical response. For example, if your cat usually responds on cycle 3 of a dose increase, plan so cycle 3 will be a cycle when you’re home. I often did increases on Thursday nights – that would leave me home and able to monitor on cycles 3-7. Depending on the results of those cycles, I could do another increase if needed on Sunday night.
    • To avoid getting into situations with too much overlap and having to leave for work, especially because Lucy was prone to dramatic responses, I tried to avoid shooting any earlier than +11 during the week. If there was a day I arrived home after 7:30 pm, I would either skip that evening’s shot or skip the next morning’s. Use your head about which one to skip – if at 7:30 she was high, I would go ahead and shoot and skip the AM. If the evening number wasn’t too bad, I might skip the evening shot and plan to shoot in the morning (which would be +24). This might cause higher numbers for a few days, but is sometimes necessary.
    • High carb food can be your friend. Of course you don’t want your cat to be over dose, but if you do run into a low number at a time when you have to leave, carb her up! We call that aborting the cycle. High carb gravy, syrup, whatever works for your cat. If you have been following the Tight Regulation protocol and being careful with your dose increases, your cat should not ever be so far over dose that you can’t fix it with food. Safety first.

    This all sounds great, but is it safe?

    Diabetes is never 100% predictable, but by getting a few spot checks every evening, you will have a good idea of how low each dose is taking your cat and whether an increase or decrease is appropriate. By contrast, basing your dosing on the results of a single curve can leave you guessing – kitty was high all day on the curve, but is he really high all the time, or did you just happen to choose a day when he was bouncing to do your curve? To me, getting some midcycle tests in 8 or 9 cycles out of every 14 seems safer than relying on curves in only 1 or 2 cycles.

    Others who have managed Tight Regulation while working, please add your suggestions to this thread!
    Last edited by a moderator: Jan 10, 2016
    Reason for edit: update
  2. Marycatmom

    Marycatmom Well-Known Member

    Oct 24, 2014
    I'm a newbie, but I'm doing it. I've found that a timed feeder is very helpful when you can't be home.
  3. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

    Feb 14, 2011
    I shifted my sleep schedule to accommodate TR with Trix, and it ultimately worked well for her AND the civvies! I started the test feed process around 5:15am and shot by 5:45. Since I left for work at 9:45ish, this allowed me to test her up until +4 before I left the house. And, since I was up so long before I had to leave the house, I was able to either fit in a workout or go back to sleep for a while after shooting.

    Likewise, I tried to grab tests when I could, especially before I really learned Trix's patterns (which we all know can change at the drop of a hat :roll: !).

    Because of work, I did plan her increases when I knew I'd be home the following day for close monitoring.

    It is doable, especially when you have an amazing support group that is loaded with ideas like the folks here in LL!
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Dec 28, 2009
    Like Libby, I work a full time job. I was in a previous position where I had a great deal more flexibility with my schedule when Gabby was first diagnosed. In my current position, I have much less flexibility, a great deal more responsibility, and I have to be at my office by 8:00 AM. It would be exceedingly rare that I would be able to run home to check on Gabby even though I don't live very far. I am still able to and do use TR with Gabby and have been doing so for 5 years. My shot times (5:00) are based on having a kitty that loves to keep me on my toes with early, fast dives. My schedule accommodates getting those early tests in so I know that Gabby is safe when I leave the house. I also don't hesitate to add carbs to her food if I have any concerns about her numbers dropping too fast or too low. (You can see the notes on my SS.)

    The points that Libby made are right on target. Take the time to understand when your cat's onset and nadir occur and how much duration you get from a shot. Know YOUR cat. Gabby's onset can be as early as +1 and her nadir is at around +3 or +4 (except when it's not) -- she doesn't follow the rules with regard to a mid-cycle nadir. Whether you use a timed feeder or not (I do, but I'm convinced that Gabby sleeps all day and Gizmo eats what's in the feeder) or leave bowls of food in strategic places around the house, carbs are very much your friend. I will give an extra meal with HC before I leave if I think it's necessary.

    The other thing I do try to do is to set limits. The folks at work know I need to be home by 5:00. I can come back to the office if I need to but I am home for shot time. Some of the people I work with may think I'm a crazy cat lady, but there are quite a few animal lovers where I work and they actually do appreciate that my kitties are my family. In fact, I was providing coverage for a colleague who's cat needed a cardiology appointment a few weeks ago.
    Last edited: May 3, 2015
  5. Josie & Ripley (GA)

    Josie & Ripley (GA) Well-Known Member

    Nov 10, 2012
    With Ripley, I was able to work full time and follow TR.
    I work early (7:00am), so I would wake at 5:00am and T/F/S between 5 and 5:30. I would get a +1 at 6:30, before I left the house. Being a teacher, there is no flexibility (can't just leave my class to run home and check on my girl), so I would test immediately when I got home (about +8/+9), T/F/S at 5:30pm, and get a before-bed test at +3. Then I would get a 'midnight/nadir' test each night (slept with her testing kit on my nightstand, set the alarm, and got a sleepy test while she was sleeping next to me, holding a tiny flashlight in my mouth ~ we both were often more asleep than awake during these late night tests). Luckily, Ripples was pretty stable and predicable with her numbers. But there were days when I would give her some extra carbs in the morning, mostly to ease my mind while I was at work. And I'd also make sure her dose changes were on weekends.
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  6. Suzanne & Cobb(GA)

    Suzanne & Cobb(GA) Well-Known Member

    Nov 24, 2013
    I'll chime in. Absolutely, it is possible to do TR while having a full-time job. I know. I do it.

    Here is my general schedule:
    5:45am: Wake up (thanks to an 18-month-old!)
    6:00am: Test/feed/shoot Cobb
    Stalling is never an option in the morning. I can't test, stall, shower, get everyone dressed and fed, and then go back to test/feed/shoot. No stalling here. It's shoot or skip.
    7:00am: Pulling out of my driveway
    6:00pm: Test/feed/shoot Cobb
    Now, if he is too low here, I will stall until -- at the latest 7pm. Cobb can nadir late on Lev, so there have been a few instances where stalling was the decision to make. And I always go back to 6am the following morning (see the no stalling option above). I don't always follow the "rules" when getting back on track if I stalled the night before. I do not endorse doing that for anyone else. It is a risk I take, knowing that shooting early can act as a dose increase. If I feel the next shoot needs to, I will shoot a reduced dose. I try to give myself options there.
    8:00pm I will get a test at +2, if Cobb has been low, or if I need to get to bed soon.
    9:00pm: This is my before bed test. Again, Cobb nadirs late on Lev, so if this test is low...I ask DH to test the next morning.
    3:30am: This is my "Cobb was low last night" test. DH will get a test on his way out the door to work if I ask him to, and Cobb is being cooperative.

    When we joined FDMB I was a stay at home mom with a new baby so while I was caring for my child, I was able to run upstairs any time I needed to to check on Cobb.

    I went back to work full-time in July -- at a job 40 minutes away from my house. Absolutely no way to get those midday checks. I shoot at 6a and 6p. Theoretically I could get a +1 in the morning, but have learned those rarely tell me anything. I leave work at 5pm and am usually home by 5:45. First thing I do, hug my son and head upstairs to test/shoot/feed Cobb. Now...I am lucky enough to have a husband who comes home around +7, but he doesn't really like testing Cobb so I have to remind him to do it -- IF I am not too busy at work to realize the time. :roll: We are also lucky that I had about a year's worth of data under our belts to know how Cobb was reacting to the insulin. All that data? Worthless really when we switched to Levemir.

    The tricky time, as Libby pointed out, was when Cobb started flying -- literally flying -- down the dosing scale. Back in September we were at 31u. We're now at 8.5u. I couldn't always count that DH would be at home if, and when, Cobb started his downward slide. There were some reduced shots, some skipped shots...and a lot of nail biting on my part. I was terrified (given Cobb's history and IAA) that a skipped shot would throw us completely off track and we'd be climbing the dosing ladder instead of coming down. That hasn't really happened. Those days when I was faced with a lower than usual preshot, I had a choice: shoot and leave or skip and leave. My fear of getting thrown off track pushed me to shoot and leave. I would leave some HC food in the timed feeder. I'd rather him get a little HC treat at insulin onset and buy me some time, rather than him hypo. Yes, there were times before we switched to Levemir, that I shot an entire 31u on a lower than normal preshot. Call me's okay.

    This week, if you look at Cobb's SS, is just an illustration of how we haven't had the time to monitor him as much as TR "requires." I've only been able to get a AMPS and PMPS during the day cycle, and an occasional +3 at night. External factors -- being sick, transitioning a toddler into his own bed, work demands, DH being out of the house all day -- have made it impossible to get those mid-cycle tests. Literally impossible. Does that mean I'm not longer practicing Tight Regulation? You can make that determination yourself. If so, oh happens. You'll see this week I've held this dose for almost 8 cycles, even when I probably should have increased after 6 since I haven't seen any green. I haven't seen any green. Does that mean there hasn't been? Nope. But because I don't have the data -- I can't say for sure Cobb has gone under 100. BUT...I know my cat. I know his curves pretty well. I can say with much certainty that he hasn't...until today. Yesterday when Cobb was above 200. I had an itchy finger and thought about increasing, but I know he earned the reduction to this dose a little bit ago, and knowing our schedules this week, I figured it was best to wait until tonight. Low and behold, Cobb is below 100 today.

    Do I always shoot every 12 hours? Nope. Life sometimes get in the way. Sometimes I get stuck in traffic on the way home. Sometimes I sleep through my alarm, or forget to set it on the weekend. Sometimes I lose track of time on Saturday evening and find myself sitting at a restaurant at 6pm, instead of at home holding a needle. Life happens. I, personally, refuse to be tied to my house to worry and watch Cobb all the time. That's no quality of life for me and my family. Cobb didn't sign up for FD. We didn't sign up to have a cat with FD. I refuse to let it bring my life to a standstill. I take Cobb on trips out of town -- it sucks, but we do it. If I can't take him, we don't go right now. Cobb is part of my baggage at the moment. If he can't tag along, it's not somewhere I want to go.

    I think, if you work full time and want to follow TR, you need to invest in:
    1. A timed feeder...that way if you are faced with a low preshot and decide to shoot, you can leave some HC for later on in the day
    2. Good curves on days when you can dedicate the time to testing so you can learn the cycles
    3. Plan A. As well as a Plan B and a Plan C. You have to have a plan. What is your cutoff, no shoot number? Will you shoot a full dose at 70? What about at 51? If you won't shoot a full much will you shoot and at what number? Is stalling an option? If not, what's your plan?
    4. A vet who is willing to entertain insulin options. Is Levemir a better choice of insulins for your cat because most cats nadir later so you have a little more of a grace period while you're out of the house?
    5. Commitment to KNOW YOUR CAT. When is onset? Does the cat have BIPO (big insulin poop out) at the end of the cycle? Does it take a few cycles of NDW before he responds to an increase? You have to know your cat. But I think that is a wise thing to do even if you aren't working full time and/or not following TR. Knowing your cat keeps your cat safe, and your wallet safe from unexpected trips to the emergency vet.

    That is way more than I had planned on writing, but it's my experience with doing TR with a full-time job. This topic touches a nerve with me -- I have no idea why -- but it does. So...there you have it. :smile:
  7. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Feb 17, 2011
    I didn't work when punkin was first diagnosed, so had the luxury of learning about FD without trying to manage it with a work schedule. I went back to work about about 9 months after his diagnosis. Initially I worked from his +1 to as late as his +8 or so. From experience, I knew his nadir was typically around +5.5, and I also knew that he basically never dove suddenly. I didn't need to routinely get a +1 with him because I already knew with his patterns, that wasn't typically needed, so I opted to schedule his shot so I could get home sooner.

    He'd already had the SRT (radiation) done for his acromegaly tumor by the time I went back to work. That changed what I did with his dose, because there was the expectation that he might suddenly go down the dosing scale. I made judgements on his dose based upon his amps, which isn't usually recommended, but with the SRT i needed to be flexible. So there were times that I reduced his dose based upon his preshot if I was leaving for work. I didn't ever shoot low and leave without making plans for coming back home and checking him, as well as always leaving food in the feeder.

    We used the Petsafe 5 compartment timed feeder. It has 4 covered compartments that you can prefill. We always fed punkin at +3 from the feeder, both am and pm. That let us be confident that he would listen for it and go eat from it. Because he had acromegaly, he also had a very reliable appetite. :lol: (that's an understatement!) I never needed to worry that he wouldn't eat, which is something a person with a "delicate eater" might need to be concerned about. I knew with complete certainty that if the feeder opened, I could count on him eating whatever was there.

    If his preshot was in a lower range, we might have put food in all 4 compartments of the feeder and set them to open every half hour for 2 hours. Sometimes we put high carb food in the feeder. My husband and I each work 3.5 miles from home, and he has more flexibility in his schedule than me, so sometimes he drove home as early as +3 to check punkin's BGs. If needed, DH would reset and refill the feeder to continue opening until I got home. Sometimes I drove home at +4 to recheck him again if we were concerned and to reload the feeder if needed.

    Now that was probably a little crazier than it needed to be, and we certainly didn't do it every day. I did drive home at lunch every day to check him, but honestly, i think that was more for me than because he NEEDED it. If we'd worked farther away from home we'd have made other plans.

    Someone recently mentioned that they'd bought 2 feeders, which I thought was brilliant and well-worth the expense to have the ability to have the feeder open for an extended series of feedings if you wanted.

    We always tested in the evenings at +3 and if it looked like we needed to, also at +4.5, which was before bed.

    It's easy to look at the people who test often and think that is required to follow tight regulation, but it's not. There will be days when you have to test more often, but I routinely checked about 5-6 times per day - both preshots, always pm +3, often pm +4 and when i got home from work.

    We didn't keep punkin tightly regulated because of his acromegaly and my fear post-SRT that at any point the tumor might wane or suddenly shut off. It can happen like that with acromegaly, especially post-SRT, and then the cat might suddenly need no or far less insulin. We felt he needed a cushion to keep him safe. I agree with Suzanne that the very most important thing is to know your own cat - pay attention and learn his or her patterns from the data you do gather. Use what you know in planning how to cope with being gone.

    We still had some vacations. Our son took care of punkin for a week while we travelled to California. Being a control freak, i had him call me to consult if Punkin had anything lower than expected and i told him when to test next. We went out of town to see our kids in the evening several times and had a vet tech at our veterinary clinic come test and shoot punkin for us. We took him with us when we went to rental homes at the coast several times. He was very portable. :D

    I'll also add that punkin didn't die from the acromegaly or the diabetes, just in case anyone is wondering. Most likely it was cancer.
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  8. Christianna

    Christianna Member

    Jul 19, 2014
    This is SUCH a helpful post! So many good ideas to work around life's unpredictable events and schedules. Thank you, Libby and Lucy! I'm bookmarking this page for sure. There are so many good suggestions from everyone who weighed in.

  9. KPassa

    KPassa Well-Known Member

    Oct 23, 2012
    Yes, it is physically possible to do the testing required for TR with a full-time job, but TR is more than testing. I tried to do TR for the first year of Mikey's diagnosis, but the biggest problem for me was that I couldn't increase his dose as rapidly as TR required. Mikey never followed the TR rules and would drop super low the first day or two of an increase so I had to be around to monitor him and would have to wait for weekends to time the increases. There are several other quirks Mikey has that made it so TR just wasn't possible for us (for example, sometimes when he's getting too much insulin, his numbers will go high and flat with no lows to cause it and people would tell me to increase again, leading us nowhere).

    What I think it comes down to is that a protocol is a good starting point for you when you know next to nothing about feline diabetes and/or your cat's specific reaction to insulin. Since ECID (Every Cat and Caretaker Is Different), the protocol eventually ends up getting modified to fit the uniqueness of your personal situation. So, don't get discouraged if you still don't think you can do TR, regardless of whether or not you have a full-time job. You do the best that you can do; not what others can do.
  10. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    May 30, 2010
    While OT, I just want to point out, for new members, that there aren't any "TR rules" and I see several cats that drop lower the first few cycles of an increase. Gracie often does this so I don't think it is an anomaly just as NDW is not.

    Not discounting the fact that some cats do dance to their own diabetes tune, there are also some patterns in terms of reaction to the insulin that while, not common, may be seen in several cats in the forum. That is the beauty to studying SSs, visiting condos, and discussions such as this one where members share how they handle those situations and maintain normality...and jobs.
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  11. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Dec 28, 2009
    it's so interesting how perspectives can change in a relatively short period of time.

    When Lucy and I started our diabetes journey (you know, back in the old days when I had to walk 10 miles uphill both ways in the snow, just 7 years ago), Tight Regulation meant Dr. H's protocol for PZI. You tested at preshot and gave insulin on a sliding scale, then starting at +6 you were supposed to start testing again. As soon as you saw a rise after +6, you gave insulin again. So every single cycle you were glued to your cat's ear from +6 until you shot again. And since cycles could be as short as 6-7 hours, that's at least 3 cycles per day in most cases.

    I could see the benefits of tight regulation, and I recognized that it was the most likely path to a healthy cat and possibly OTJ, but there was no way on earth I could have made that happen.

    I was thrilled to find out that there was such a thing as longer-acting insulins and a way to try tight regulation on a 12 hour schedule. I'm home every 12 hours, I can do this! This is WAY easier than I thought tight regulation would be. Sure, it took me a little while to get into the swing of things and figure out a routine, and there were some compromises along the way, but it was worth every minute (and even more worth it when Lucy went OTJ and I didn't have to worry about testing and shooting schedules at all).
  12. tibbs5

    tibbs5 Well-Known Member

    Jul 15, 2014

    LOL I love that .:D:D:D
  13. blove7

    blove7 Member

    Aug 28, 2013
    I'm thinking about getting a timed feeder. Just curious, did all of you use wet food in your feeders or do you have to use dry?

    Thank you!
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  14. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

    May 9, 2015
    Brigitte, I use wet food in mine. Add a little water to it to keep it from drying out.
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  15. Melanie and Smokey

    Melanie and Smokey Well-Known Member

    Feb 24, 2010
    I've only used wet in the timed feeders. The feeders keep it a bit fresher than sitting out on a plate too.
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  16. blove7

    blove7 Member

    Aug 28, 2013
    Thank you Shiloh and Rhonda and Melanie and Smokey. I am going to buy at least one of the feeders, if not two.
  17. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Oct 11, 2015
    I am just learning lanuts and tp--this is a great and informative look at "life with feline diabetes and living-thank you for sharing--we are just on shot number 2 in about 20 minutes-
    just the beginning of our lantus journey but we were on vetsulin (not good for us--sad depressed kitty) Pro zinc did great for personality but numbers stay too high. Hoping for my Christmas miracle !! Happy Thanksgiving ;)
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  18. Suzanne & Cobb(GA)

    Suzanne & Cobb(GA) Well-Known Member

    Nov 24, 2013
    Good luck!! I hope Lantus works for you and your kitty! TP seems really overwhelming. I know I actually found FDMB about 5 months before I joined, but everything looked so complicated and really intimidated me. But once I got my feet wet and really listened and absorbed what I could, treating the diabetes was like second nature. We just fit it into our lives.
    MollynSkooter and jayla-n-Drevon like this.
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