Info REDUCTIONS and Why We Should Take Them

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Marje and Gracie

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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:
  • 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.
Another option for kitties that fail reductions is to shave the dose if the kitty drops below 50 once. But please do not mix and match reduction strategies as you could be compromising your kitty's safety. As an example, it is not recommended to allow kitty to drop between 40-50 on three separate days and then shave the dose.

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:

Reductions.jpg


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.
 
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Re: 10/16 TODAY'S LESSON--REDUCTIONS

Marje, this was very informative. It helped clear a bit of the fog but I'm sure I'll still be posting for advice.
 
Re: 10/16 TODAY'S LESSON--REDUCTIONS

Thank you Marje - it is so great to have this reviewed again and to see it all in one clear and concise post to bookmark!
 
Re: 10/16 TODAY'S LESSON--REDUCTIONS

Thanks for the reminder, Marje. I know I can still use them once in a while. They're helpful for advanced as well as new caregivers.

Melanie & Racci
 
Re: 10/16 TODAY'S LESSON--REDUCTIONS

Thanks Marje for the reminder! I am a life example of this these 2 days! nailbite_smile
 
Re: 10/16 TODAY'S LESSON--REDUCTIONS

bippity boppity bump
 
Re: 10/16 TODAY'S LESSON--REDUCTIONS

HI Marje, thanks so much for this, I was wondering just today what I needed to do with Scrabble's reduction and this clarified everything! Thanks!!!!
 
Thanks, Marje. I was actually wondering when I'd need to start worry about reductions, but you've cleared that all up.

Thank you.
 
Talk about bumping this up at the perfect time! Julia earned her reduction today (will update spreadsheet after dinner) and I was wondering if I should shoot through the bounce. I have my answer. :-D

*Bump*
 
Thank you! I had that "this is all about me" feeling while reading since I missed Elian's reduction yesterday morning and gave it to him last night instead. But then I was reminded that the world revolves around my daughter, not me. :-) Really appreciate the information. Thank you.
 
Thank you Marje! I bookmark and then also copied & pasted to word and printed off,complete with the pic of Gracie ;-)
 
Thanks, Marje - this is really great info. Julie reminded me of it, & I read something I hadn't noticed before:

Marje said: And while it is not add... fallen below the thresholds mentioned above.our sugarbaby would've

Somehow I missed that, & I think its a critical point. We all have days where we work too hard to keep our kitties above that 'reduction threshold', when we know that without all that effort, our sugarbabies would've dropped below 50 (BIG finger-point ohmygod_smile).
 
Thank you for this helpful reminder as I was one that was pondering what to do in the middle of :lol: the night LOL.
 
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