Re: 2/20 Buster PMPS 198 - 3 under 50 before reducing?
in the interest of clarification...
The original
Tight Regulation protocol has this to say about reductions:
Phase 4: Reducing the dose
When the cat regularly has its lowest BGs in the normal range of a healthy cat and stays under 100 mg/dl overall for at least one week, attempt to reduce the dose. Alternatively, if the nadir glucose concentration is 40 - <50 mg/dl at least three times on separate days, try lowering the dose. If the cat drops below 40 mg/dl once, reduce the dose immediately! The reduction is done very slowly in a step-by-step manner (0.25 or 0.5 IU increments). At each newly reduced dose, try to make sure the cat is still stable in the normal range before reducing the dose further.
Notice that going under 50 three times is an option, but also notice that she specifies that reductions should be in 0.25u or 0.50u increments.
In the
Modified protocol used by most in Lantus Land, we say the following:
Reducing the dose:
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. 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.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Notice that the modified protocol calls for a reduction for going under 50 ONE time (not three), but also notice that we allow for shaving the dose if a cat does not hold reductions well.
Basically, you can use the Modified protocol and reduce for going under 50 once and reduce by 0.25u, or using this protocol you can shave if your cat is one that doesn't hold reductions well. OR you can use the original protocol and wait for three times under 50, but then you'll need to take a full 0.25 unit reduction instead of just shaving.
In one way the original protocol is more aggressive by allowing you to wait until your cat goes under 50 three times to reduce, and in a different way the modified protocol is more aggressive by allowing for shaves instead of full reductions. Combining the two protocols should not be done because that would be more aggressive than either protocol allows.
