? TR Protocol questions

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Panic, Feb 13, 2020.

  1. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Before my question(s), I HAVE already read the TR protocol guidelines/additional pages, I just need some clarification concerning them.

    When am I increasing the dose exactly? Every 5-6 cycles if nadirs are over 100?

    TR Protocol says: "when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing."

    Why exactly am I increasing the dose if nadirs are already under 100? Are we aiming for staying in non-diabetic numbers (50-120) at all times? Following that, what kind of cycle would I need to be seeing to maintain the dose rather than increase/decreasing?

    And finally, do pre-shots, unless exceptionally low, really not matter when giving full dose? Like I would give full dose if pre-shot was 150, 100, or 80 (assuming I have enough data)?

    TR seems so much more aggressive I really want to fully understand how to do it to keep my girl safe. Thanks. :)
     
  2. Susan & Claudio

    Susan & Claudio Member

    Joined:
    Sep 20, 2019
    Good questions. I would like the answers also. Not that Claudio is anywhere near the 100 nadirs. But it would help to know for future reference.
     
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  3. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Are you going for possible remission or just regulation?
    • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
      • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
      • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
    • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
    • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
    the 50-120 range is referred to as “the healing numbers “. If you are interested in possible remission you want your kitty to spend as much time as possible in that range. It gives the pancreas a rest. Once you have 7 consecutive days of cycles in that range, with no signals to increase or decrease, you then decrease by 0.25u.

    they do indeed matter for a number of reasons. They help you figure out onset and duration and also whether the numbers are heading up or down. In terms of going OTJ, once the nadirs are sorted out the next step is for the PS numbers to go green. Generally the PMPSs go green before the AMPSs.

    once you are data ready anything over 50 is generally shootable
     
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  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    In addition to Sandy's comments about the pre-shot numbers, a Lantus "curve" is flat once a cat is generally in green numbers. Shooting low numbers is counterintuitive to most people. If your kitty can drop from the 300s to the 50s, most people will assume if they shoot a 90, their cat's BG will bottom out. While anything is possible, that's generally not the case. Take a look at some of the spreadsheets of cats that have gone OTJ or where someone is shooting low numbers or if the cat is well-regulated (Chris' China is one of the latter). You'll see a kitty that surfs green numbers.

    Unless your cat is new to nadir numbers <200, you increase the dose after 3 days/6 cycle. If the cat is new to lower nadirs, you hold the dose for 5 days/10 cycle. As Sandy quoted above, there's a little wiggle room (i.e., 8 - 10 cycle) if the kitty is new to lower nadirs. Once nadirs are largely <200, hold doses for 10 cycles.

    You need to think in terms of how low a dose is taking your cat's BG. You have the option to increase if numbers are in the 80s, for example. However, I would not suggest increasing if numbers are sticking around the 50 - 60 range. And, again as Sandy noted, if numbers are staying in normal range, you can decrease the dose after a week.
     
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  5. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Remission is always the end goal, though I know it won't always happen.

    Yes, I've read that already but I need clarification... hold the dose when nadirs are less than 200 before increasing but higher than what? 80? 100? What nadir range constitutes an increase?

    Okay so once nadirs get sorted (in the greens) then the curve will flatten out so it won't matter if a pre-shot is say 90 because they should stay in the 90 range all day with full dose? While we're getting to that stage where kitty can still dip a lot (250 pre-shot to 90 nadir for ex) do we practice more caution with a lower than average pre-shot?

    Thank you for the help both of you!
     
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  6. Bandit's Mom

    Bandit's Mom Member

    Joined:
    Oct 18, 2019
    The requirement to hold the dose for 10 cycles when the cat "starts seeing" nadirs below 100 is applicable only for the first dose in which the cat saw a nadir below 100? Or every dose? And that dose has to be held for 10 cycles in all? Some people talk of "counting cycles" from the cycle in which the cat hit the sub-100 nadir.

    And one increases the dose every 6 cycles till what point? Till the cat earns a reduction by falling below 50?
     
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  7. SnowKat

    SnowKat Member

    Joined:
    Jan 11, 2020
    Following.
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Talking in terms of hypothetical situations can lead to problems and/or over generalizations. How about when you have a question about what to do, we can discuss an actual situation? Also, keep in mind, you are asking for my interpretation of TR. Someone else may put a different spin on TR.
     
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  9. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Of course. I'm thinking in terms of that a lot of times situations are time-sensitive and no one who can help is available, so I prefer to have at least a general direction to go by if I'm on my own.
     
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  10. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Hi. No you don’t increase the dose until your cat falls under 50. Please reread the TR protocol copied above. I can’t copy the relevant part from my iPad. Hold the dose for at least” 10 cycles when you start to see nadirs under 100. You will not need to make a split second decision on dosing at that point so you will have time to post and give folks time to respond. You will reduce if you see a nadir under 50 though. The next dose after that will be .25 lower. Does this help?
     
  11. Krystina & Nelli

    Krystina & Nelli Well-Known Member

    Joined:
    Jul 4, 2018
    Valid question ❤️
    I’ve been there!
     
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  12. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Why did you reduce the dose on the 2/13 PM cycle?

    .
    First things first. - Know thy cat on Lantus - build a solid foundation of data.
    Find a dose that you can shoot consistently, AM and PM. When a shot is skipped the cycle count starts over.
    Along with testing before each and every shot, you must get at least 1 additional test somewhere during the 12 hours between shots- both AM and PM cycles. When you have the opportunity to grab additional random spot checks do so. Strive for an ss that doesn’t have wide open white areas of no data. I’m seeing only 3 spot checks between PM+5 and AMPS and only 3 between AM+7 and PMPS since 01/01. That’s nearly half of the whole picture missing. A whole lot can happen during the bottom half of the PM cycles.

    regarding help with time sensitive decisions getting some +10s and +11s. gives you (and anyone trying to help) a sense of whether Panic is going up or down when compared to the upcoming PS value. Keeping the ss updated to the minute saves time when you are looking for help.

    If you do find yourself in a pinch and no one is available to help err on the side of caution.

    Better a day too high than an hour too low.
     
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  13. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    I had asked if I should keep or reduce the dose after the 78 AMPS + switching to TR but never got an answer, so I erred on the side of caution.

    I am usually working during those gaps. Starting today I've been laid off and will be starting a new job soon so I'll be available to do it more.

    Oh that makes sense, I hadn't thought about that, thank you!
     

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