Just a little refresher course on reductions, primarily for new members, but if it helps experienced members, that's great!
I've noticed in looking at many SSs, that sometimes reductions are missed.
FD is time consuming and we all get exhausted and sometimes, we just miss taking the reduction. Other times, we see our kitty finally doing great...getting all those greens and blues and when he/she just slightly drops below 50, we possibly think "oh...meter variance..could have been above 50; I'll hold off on the reduction". I've done it myself.
Under the modified protocol, reductions are earned when:
If the kitty drops below 40 once, regardless of whether it is newly diagnosed or a long-term diabetic, a reduction of 0.25u should be taken.
And while it is not addressed in the protocol, if the CG is having a cycle where they are working hard to keep numbers up, it is wise to reduce the dose regardless if numbers have not fallen below the thresholds mentioned above.
Be aware that the depot from a higher dose can affect up to six subsequent cycles. If you reduce the dose per the protocol and the very next cycle or two, kitty gets into the 40s again, you might consider holding the dose as these subsequent low numbers are likely the influence from the depot of the higher dose you reduced from. If you are a new member and not sure whether you should take a back-to-back reduction, it is always good to have an experienced member (or more) help you decide whether to take a back-to-back reduction or hold the dose until the depot drains a bit. In some cats, back-to back reductions will not hold and the dose will need to be increased back to the last good dose.
It is acceptable on an earned reduction, to shoot through the bounce once and then take the reduction. For kitties who clear bounces quickly (in a cycle), shooting through the bounce may not be the best option and, instead, it might be safer to take the reduction at the next shot time after it is earned. If your kitty clears bounces in one cycle and you decide to shoot through the bounce, it is important to monitor numbers the cycle that the CG shoots through the bounce. If the CG accidentally overlooks the need to reduce, the reduction should be taken as soon as possible; reductions are not "lost".
The reason it is important to take the reductions when they are earned is due to the cumulative nature of lantus/levemir where one shot builds upon the preceding shot. At some point, when the depot is full and numbers drop to levels warranting a reduction, if the reduction is not taken, the CG could be working feverishly to stay ahead of that depot.
The best example I can give is when I failed to take a reduction with Gracie and the depot got ahead of me. She had already been into the 40s three times on the c1u dose when she dropped into the 30s on the morning of 5/8. I should have reduced her the PM cycle of 5/7 because her third time into the 40s was the a.m cycle of 5/7. Note the PM cycle of 5/8 below:
Even for an experienced CG, this was a scary cycle because we could not keep her out of the 20s even with carbs and karo. I had let the depot get way ahead of me.
I hope this refresher and example will stress the importance of taking those reductions. Remember...you can always go back up if the reduction fails. It is safer to take a reduction that may fail then to let the depot get the upper hand.
I've noticed in looking at many SSs, that sometimes reductions are missed.
FD is time consuming and we all get exhausted and sometimes, we just miss taking the reduction. Other times, we see our kitty finally doing great...getting all those greens and blues and when he/she just slightly drops below 50, we possibly think "oh...meter variance..could have been above 50; I'll hold off on the reduction". I've done it myself.
Under the modified protocol, reductions are earned when:
- A newly diabetic cat (dx under one year) drops below 50 once;
- A long term diabetic cat (dx over one year) drops below 40 once;
- A kitty has had normal numbers for a week;
- For kitties that tend to fail reductions, a dose can be held and the reduction not taken
until the kitty's BG has dropped between 40 and 50 three times on different days on that specific dose. The reduction taken should be .25u because this is an aggressive method of earning reductions.
If the kitty drops below 40 once, regardless of whether it is newly diagnosed or a long-term diabetic, a reduction of 0.25u should be taken.
And while it is not addressed in the protocol, if the CG is having a cycle where they are working hard to keep numbers up, it is wise to reduce the dose regardless if numbers have not fallen below the thresholds mentioned above.
Be aware that the depot from a higher dose can affect up to six subsequent cycles. If you reduce the dose per the protocol and the very next cycle or two, kitty gets into the 40s again, you might consider holding the dose as these subsequent low numbers are likely the influence from the depot of the higher dose you reduced from. If you are a new member and not sure whether you should take a back-to-back reduction, it is always good to have an experienced member (or more) help you decide whether to take a back-to-back reduction or hold the dose until the depot drains a bit. In some cats, back-to back reductions will not hold and the dose will need to be increased back to the last good dose.
It is acceptable on an earned reduction, to shoot through the bounce once and then take the reduction. For kitties who clear bounces quickly (in a cycle), shooting through the bounce may not be the best option and, instead, it might be safer to take the reduction at the next shot time after it is earned. If your kitty clears bounces in one cycle and you decide to shoot through the bounce, it is important to monitor numbers the cycle that the CG shoots through the bounce. If the CG accidentally overlooks the need to reduce, the reduction should be taken as soon as possible; reductions are not "lost".
The reason it is important to take the reductions when they are earned is due to the cumulative nature of lantus/levemir where one shot builds upon the preceding shot. At some point, when the depot is full and numbers drop to levels warranting a reduction, if the reduction is not taken, the CG could be working feverishly to stay ahead of that depot.
The best example I can give is when I failed to take a reduction with Gracie and the depot got ahead of me. She had already been into the 40s three times on the c1u dose when she dropped into the 30s on the morning of 5/8. I should have reduced her the PM cycle of 5/7 because her third time into the 40s was the a.m cycle of 5/7. Note the PM cycle of 5/8 below:
Even for an experienced CG, this was a scary cycle because we could not keep her out of the 20s even with carbs and karo. I had let the depot get way ahead of me.
I hope this refresher and example will stress the importance of taking those reductions. Remember...you can always go back up if the reduction fails. It is safer to take a reduction that may fail then to let the depot get the upper hand.
Last edited:
Really appreciate the information. Thank you.
