I just want to be sure everyone understands this correctly as I see it repeated often. I think Christie does understand it but the wording might lead others to get confused.
When you reduce, there is no set number of cycles that you must wait to increase if it’s apparent it is a failed reduction. It is not like an increase where you give the dose time to settle and the depot to fill (six cycles, typically).
What you want to consider after a reduction before you decide whether it’s a failed reduction is:
- if kitty bounced and the bounce has cleared, where is the BG? If it’s not in green, it’s a failed reduction and you should return to the last good dose. Keep in mind that bounces “might” take six cycles to clear (thus some of the confusion).
- If the depot was very full, it can affect up to six subsequent cycles so if kitty gets into green the first few cycles after the reduction, hold it for at least six cycles to see if the depot is causing those numbers or if it’s the new, reduced dose talking.
As Wendy said, today’s cycle is the sixth cycle since reduction. That red number could be the “high before the break”. I would see what she’s doing during this cycle. If the 0.25u is not enough for her, she can bounce from blues even though we’d like to think when they’ve been in green, why bounce? Well....the dose is lower.
I know it’s frustrating when we don’t set out scenarios but I really think we should see if this is the high before the break and what she does today. As soon as we start making “plans” for a dose tonight, she’ll do something totally different. I will keep checking in to see how she does. However, I’m fine if you want to send me a PM when she’s at +11 and that way I’ll know to pop on the condo and we can talk about tonight’s dose.....just in case your day goes faster than mine
Back to yesterday’s condo.....I fell asleep last night and didn’t get back to answer some questions for you:
The insulin left out is not likely the issue. That happens sometimes to everyone and the insulin is fine.
Also what happens is you have to do what you have to do in terms of food to keep them safe when you have to work and when you have to take care of yourself. Whenever I make comments as to what I see, there’s no judgment involved. I’m just telling the CG what I see. Sometimes they can do something about it and sometimes they can’t but at least they know what “might” be the issue.
I actually was referring more to having to leave out 13% when she’s stopped dropping (or you hope she has). That could affect duration....but that’s ok when you have to go to work. It’s just a reason why the insulin might not get it’s full duration. When she is dropping so fast and quick, you need to get her stopped, especially if you are leaving, and the MC is appropriate. Don’t worry about that.
And here’s the other thing.....some days, duration just is different than other days. And there are a ton of reasons why. So I wouldn’t get too worried about a time here or there. I’d look at trends or patterns of her losing duration. I just wanted you to see a difference between loss of duration (for whatever reason that cycle) and a bounce. And sometimes, the duration fizzles and then they also bounce.
Thank you for providing the specifics.
The first bullet under Jill’s post is self explanatory. You don’t continue to hold a dose if another reduction is earned as long as you know it’s not depot causing a back-to-back reduction.
I see the second bullet to be the same as all the info above it. Once you know the dose has failed (e.g. the bounce has cleared and numbers are not in green, the depot is no longer affecting the new dose, etc), take the dose right back up. In other words, if you see numbers trending higher, don’t hold onto the reduced dose thinking with more time, it will settle. It won’t. You are just risking glucose toxicity.
And for the third of Jill’s bullets, if the kitty is getting into green and lower blue nadirs, there is no need to call it a failed reduction.
Does that help any?
