? What is considered a failed reduction ?

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Arman Matin

Arman Matin

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According to protocol "If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction."

Do you have to allow the reduction to settle after a bounce to know whether it was a successful reduction ? Does that require 2-3 cycles ? Or do you count the bounce as a failed reduction and go back up to the last known good dosage ?
 
You do want to give the new dose some time to see what it can do once the bouncing has stopped. Usually I'd hold the dose 6-8 cycles. However, when a kitty is well regulated and you have a lot of data some will bring the dose back up a bit sooner. It is OK to increase the dose during a bounce but you want to avoid the increase on a bounce breaking cycle. There's more information about this here Myths Debunked which is found in the Where Can I Find sticky.

I see you decided to try 6.25 as the new dose for Raja which is fine. Raja will tell you soon enough if that's a good dose and you test enough which is great. Typically when over 5u of insulin increases and decreases are done in .5u increments. However, sometimes going with .25u increases/decreases work too. Our favorite saying is ECID. Also remember it takes 4-6 cycles for the depot to fill/stabilize with an increase and the same thing for a decrease in dose. With higher dose kitties like Raja and like my Doodles was with IAA, I lean toward the 6-8 cycles for the depot.

Does this help?
 
It can be tricky to tell whether a reduction has failed or whether a kitty is just bouncing of the low. Looking at Raja's ss, recent bounces have taken 3 cycles to clear, so I would have perhaps waited at least till pm 4/14 or am cycle of 4/15 before calling a failed reduction and taking him back up.

He went below 50 last night on the 6.25u, as a newly diagnosed kitty that has earned him a reduction, not too sure what the thinking was behind holding the dose this morning.

Here's the link to Raja's previous condo
http://www.felinediabetes.com/FDMB/...-50s-nadir-in-50s-stalled-and-reduced.176296/
 
Gill & George said:
He went below 50 last night on the 6.25u, as a newly diagnosed kitty that has earned him a reduction, not too sure what the thinking was behind holding the dose this morning.
Click to expand...
Good catch Gill, I didn't scroll over enough in the SS to see that :oops:. I agree with Gill, that he earned that reduction and the dose should be reduced to 6u tonight.
 
Gill & George said:
It can be tricky to tell whether a reduction has failed or whether a kitty is just bouncing of the low. Looking at Raja's ss, recent bounces have taken 3 cycles to clear, so I would have perhaps waited at least till pm 4/14 or am cycle of 4/15 before calling a failed reduction and taking him back up.

He went below 50 last night on the 6.25u, as a newly diagnosed kitty that has earned him a reduction, not too sure what the thinking was behind holding the dose this morning.

Here's the link to Raja's previous condo
http://www.felinediabetes.com/FDMB/...-50s-nadir-in-50s-stalled-and-reduced.176296/
Click to expand...
I was looking at this from Tillas site "if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. "
at least three times on separate days is what I thought was needed for a reduction ? or something along those lines ?
 
Since your kitty is newly diagnosed (less than 1 year) the usual protocol for TR is taking a reduction when the number drops under 50 on a human meter. TR is an aggressive approach to begin with and for the sake of keeping our kitties safe it is is advisable to follow the basic TR protocol...especially when in the early part of the treatment,


"
REDUCING THE DOSE:
The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus & Levemir ISG safe by suggesting and taking appropriate reductions.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further."
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/
 
When a cat is newly diagnosed (less than 1 year), and especially in Raja's case where it's just a couple of months, you want to take the reductions as they are earned, every time his blood sugar drops under 50.

The reason is that some cats start on insulin, do really well, and begin to go down the dosing scale quickly.

If a cat has established that they fail reductions, ie, you reduce the dose and the cat's blood sugar trends upward, then we move to the guidelines you're referring to on the Tilly site. Just makes it a little harder for the cat to earn a dose reduction, and hopefully that means that when you do reduce the dose it will "stick."

The part you referred to about failed reductions specifically says that you DON'T want to wait a specific number of cycles before deciding it's a failed reduction. Ideally when you reduce the dose, the cat's blood sugar still stays in the green range. If it trends upward, immediately go back to the last good dose. In practice, my understanding is that you wait for any bounce to clear, and at that point if the nadirs have trended upward from what they were pre-dose reduction, then go immediately back to that last dose.

The reason for this is that you get momentum going when a cat is in good blood sugar control. You don't want to lose that momentum by holding onto a dose too long if it isn't getting a cat's blood sugar into normal range.

Here's another explanation of failed reductions in the 1st and 2nd posts in this thread.

Hope some of that is helpful.
 
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