Smokey update, continuation from the Hello thread

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This statement really concerns me. I know of no place which states below 69 on an Alpha Trak is a hypo alert zone. It's certainly a "pay attention" number. But I'm not sure who the "we" is because most of us with experience don't consider that a "hypo alert" zone.

Really, that low is alert zone? I would think higher like 100. Surprised he is so alert and active though. Sunday he was 32 but lethargic and didn't come when popping the can open. It was also 11pm. I had a feeling something was wrong then but didn't know about all this. I had just found this site and had been reading most of the day. When ok let's test.
 
@Marje and Gracie - I really don't have time to argue this point with you right now. Just trying to keep her kitty safe.
Yes, please; feed again.
Actually..I'm not arguing. I'm just giving the facts. It's a number that needs attention and certainly for a new member it needs an action. But for an experienced member, depending on where it is in the cycle, it could be a surfing number that just needs to be watched closely.

Paula...it would tell me the dose needs to be reduced.
 
Paula, I suppose that some would rather we call this a "pay attention #" than a "hypo zone alert #." Matters little what you call it, it is BEST that you keep your cat from approaching a number that could be indicative of hypoglycemia - and this can, in fact, differ from cat to cat. This is why I wanted you to err on the side of caution tonight and start steering with food & retesting at 80, rather than a lower number.
 
Actually..I'm not arguing. I'm just giving the facts. It's a number that needs attention and certainly for a new member it needs an action. But for an experienced member, depending on where it is in the cycle, it could be a surfing number that just needs to be watched closely.
I don't disagree with you, Marje - but Paula is not yet an experienced member; she is a new member with a kitty on Vetsulin, using an AT2 meter.
 
I would have started testing. Now I know 2U at BS of 147 is to much. I hope I can get more strips at the vets tomorrow. All most out of them.
 
47 more syrup and dry food given. still better than sunday though
Hey Paula - just fyi - no need to give any dry food. It doesn't increase the BG as quick as the wet, high carb food or syrup does. So eliminate the dry food and just stay with the wet food or syrup. You do not want to fill him up with food that is not helping you now (the dry food).
 
Losing cable connection. Got to switch to phone. So don't know if you'll get the sheet but I will post here by phone. Having a much needed storm. If I lose power, thanks everyone. We'll get through it again if not hospital is 45 minutes and hubby is home to drive since I'll be a basket case if it comes to that.
 
Paula, as you're new to this, we recommend that you do not shoot at an AMPS/PMPS that is under 200. As you can see from what's happening tonight, even when you lowered his dose by a full unit, he has dropped low too quickly, requiring that you steer with food & retest over & over again. As Sue had said earlier, we want to keep your kitty below the renal threshold (roughly 250+) as much as we can; however, dropping too far down in the cycle (more than 50% of the preshot blood glucose test #) can result in "bouncing" - which means that the cat's body reacts to the super-low BG # by producing even more glucose. And then you see a much higher # at the next pre-shot test. So we try to avoid having that happen. (Sometimes the bounce anyway, despite our best efforts!)

Just saw your note re: bad connection - hope you can keep us posted. If not, you know what to do now. :bighug:
 
I don't disagree with you, Marje - but Paula is not yet an experienced member; she is a new member with a kitty on Vetsulin, using an AT2 meter.
I'm totally aware of this. I made up her SS and put the large red bar across it. As I said, a new member certainly needs to pay attention and take action.

I just don't like blanket statements which could be read, and misinterpreted, by anyone. The normal range on an AT is 65 to about 160.

If Smokey is eating HC wet food and syrup just fine, I would continue that. But dry food can also be used, if necessary. It's listed in JoJo's hypo toolkit.
 
I'm totally aware of this. I made up her SS and put the large red bar across it. As I said, a new member certainly needs to pay attention and take action.

Thank you so much for the ss Marj. It seems to be working just fine. So glad you were able to do it. And I can print it out and take with me to the vet on the 1st. It's easier for me to see the large picture than it being written all over papers.
 
You're welcome, Paula. I can fix the stacking numbers for you.

One other thing I want to add is that it actually does take almost 30 minutes to see a food spike even from HC. You would probably see some increase in 20 mins from syrup or honey. But typically, it's 30 minutes to start to see an increase from food and an hour to see the full result.
 
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I think we'll be okay now. Thank you all. I don't want to "meet" for this reason again, but I think we will.
Okay, Paula - you're doing great!:) Will be interesting to see what Smokey's # is at AMPS. It's all a process, remember ... I will be around until about 11 pm Pacific time, just in case. :bighug:
 
I'm totally aware of this. I made up her SS and put the large red bar across it. As I said, a new member certainly needs to pay attention and take action. I just don't like blanket statements which could be read, and misinterpreted, by anyone. The normal range on an AT is 65 to about 160.
@Marje and Gracie - Sorry if you perceived what I'd said earlier in this thread as a blanket statement that could be misinterpreted by anyone; really was not my intent. ("Hypo alert zone" means - to me, anyway - to "be alert for possibility of hypo symptoms occurring somewhere below this number.") My "watch it" # (<69) as appears on the far right tab of my SS is all of 4 small points above the <65 you mentioned. From my current vial of AT2 strips (exp. 10/2016), the insert from manufacturer Abbott reads:

Unexpected Results
Low or high blood glucose readings can indicate a potentially serious medical condition. If the blood glucose is unusually low or high, or if the animal does not show symptoms consistent with the results, repeat the test with a new test strip. If the reading is not consistent with any symptoms, or if the blood glucose result is less than 65 mg/dL (3.6 mmol?l) or higher than 250 mg/dL (13.9mmol/L) for dogs and cats, contact a veterinarian/ veterinary surgeon.


I'm simply not understanding why you chose to interject any concern about a "blanket statement" in the middle of this particular situation, as anyone could see how quickly and sharply Smokey was dropping after +2. This would have made more sense to me if I were, for example, telling Paula it was just fine to let her kitty drop to 50 (which was the human glucometer "watch it" number that was sitting atop her AlphaTrak2 SS). And yes, I know that an 80 - or even a lower number - can be considered a "surfing" number at some point in a cat's treatment journey ... but not in this particular situation; not at that moment in time.

Btw, was really great of you to help Paula get her SS up & running ... and adding that red band to it later on was a smart touch, too. Everybody using an AT meter should probably have a red band like that across the SS. (I want one! How do I copy that?) Makes it clear to anyone who is helping someone out that they're using the "less-oft-chosen" type of meter, which has a reference range that differs from that of the human meters more commonly in use among FDMB's membership.

My veterinarian has viewed my cat's AT2 SS countless times over the past 6+ months and considers the AT reference range prudent, as shown on the tabs at top.

I, for one, would rather err on the side of caution when giving advice here, whether I'm dealing with a newbie or not. As some cats can go hypoglycemic at higher numbers than other cats and/or be asymptomatic when going hypo, why take the chance? (Especially when a cat is dropping as quickly as Smokey did tonight.)

Finally, as someone who came close to killing my own cat by shooting her at too low a number on Lantus back in 2013, I will always encourage a new member to be on alert/steer with food at a somewhat higher "low" number than some others might. What is it that has so often been said around FDMB: Better too high for a day than two low for a moment? (Or something to that effect...)

Anyway, no offense taken, Marje - and none intended. Have a good night!
 
His AMPS is. 407. I'm staying with 3U. Let's hope I can get strip from vet. I only have 5 left. My order hasn't come yet. This bottle was new but I rarely tested. Didn't know to. When I first got him I did because he was so off.

Smokey seems to be an asymptomatic cat. At the 32 he was just laying behind chair which he doesn't normally do. At the 47 he was wrestling with the kitten. And then washing kitten's head. Does it sound as if he's not feeling well?

I will be at my own doctor today late morning and be gone about 2 hours. Not worried about his amps.
 
Wow Paula another sleepless night! Lots more info to help figure out your dosing though. I think I read somewhere that you can use other strips in the Alpha trak meter -Freestyle lite maybe? Maybe someone can give you that info. If I'm remembering correctly they are cheaper and can be bought at any pharmacy.
 
Good morning, Paula. I know this whole thing is hard to get your head around. Your problem last night was that you shot at a pre shot that was too low. And may have been still dropping. (That is a good sign that 3 units is too much insulin) This early in the sugar dance you don't want to shoot under about 230 or so with your AlphaTrak (200 with a human meter). It wasn't necessarily that your overall dose was too high - it was too high for that number. So he dropped too low and you had to give high carb syrup. Predictably this morning he bounced.

You want to lower the dose from the dose that gave you the low pmps. It looks like a higher amps This morning, but it isn't a "normal" high number. It's a bounce. When you get that low a nadir, you can expect a high the next time, but you want to lower the dose. Or you risk that today's cycle will be a repeat with an unshootable pmps.

Course, it is a sugar dance and he may be high and flat today. But generally after a hypo episode, I would lower the dose even on a high pre shot test the next cycle. I think 2.5 is a good dose for now, unless you get a low pre shot test. Then you do the stall thing. Wait 20 minutes and retest without feeding. If he has come up and is high enough, then shoot (but a little bit less than the dose that gave you the low pre shot number)

I know this is a steep learning curve and it seems like we keep throwing info at you. You are doing great. You have literally saved Smokey's life twice. I am just trying to let you get some sleep at night. :confused:
 
Wow Paula another sleepless night! Lots more info to help figure out your dosing though. I think I read somewhere that you can use other strips in the Alpha trak meter -Freestyle lite maybe? Maybe someone can give you that info. If I'm remembering correctly they are cheaper and can be bought at any pharmacy.

Don't you need a script for them? I never see any on the shelves. My co-worker says they needed scripts for her husband.
 
Don't you need a script for them? I never see any on the shelves. My co-worker says they needed scripts for her husband.

You should't need a script for the test strips.

Wow Paula another sleepless night! Lots more info to help figure out your dosing though. I think I read somewhere that you can use other strips in the Alpha trak meter -Freestyle lite maybe? Maybe someone can give you that info. If I'm remembering correctly they are cheaper and can be bought at any pharmacy.

Yes, thanks to @Mogmom and Goofus, I use Freestyle Lite strips with my Alphatrak. They are made by the same company, and the BG readings compared to the Alphatrak strips' seem to be very close. The Freestyle Lite strips are a good bit cheaper!
 
Good morning, Paula. I know this whole thing is hard to get your head around. Your problem last night was that you shot at a pre shot that was too low. And may have been still dropping. (That is a good sign that 3 units is too much insulin) This early in the sugar dance you don't want to shoot under about 230 or so with your AlphaTrak (200 with a human meter). It wasn't necessarily that your overall dose was too high - it was too high for that number. So he dropped too low and you had to give high carb syrup. Predictably this morning he bounced.

You want to lower the dose from the dose that gave you the low pmps. It looks like a higher amps This morning, but it isn't a "normal" high number. It's a bounce. When you get that low a nadir, you can expect a high the next time, but you want to lower the dose. Or you risk that today's cycle will be a repeat with an unshootable pmps.

Course, it is a sugar dance and he may be high and flat today. But generally after a hypo episode, I would lower the dose even on a high pre shot test the next cycle. I think 2.5 is a good dose for now, unless you get a low pre shot test. Then you do the stall thing. Wait 20 minutes and retest without feeding. If he has come up and is high enough, then shoot (but a little bit less than the dose that gave you the low pre shot number)

I know this is a steep learning curve and it seems like we keep throwing info at you. You are doing great. You have literally saved Smokey's life twice. I am just trying to let you get some sleep at night. :confused:

It was 2U that gave the drop, but pmps was low. Let's say tonight if pmps is 200-250 give 1.5u or 1u would be safe? This is where I wrestle with my self. When do I give less or none at all????? And try to avoid the amps high. I want even keep is that to much to ask for!!!!!

How did you learn all this info? I read and read but it jumbles together. The correlation between reading on meter and if it the same as drawing and running sample at a lab, different meter have different levels.

What is normal for a cat and then what would those numbers on the alpha Trac 2 be. Then if he borderline low say 160-200 do I shoot or not and if so how much???? I question myself.

Thought giving insulin 1/2 hrs after dinner would be good so when he starts to drop the food would be kicking in. It works in the morning why not at night.

Just venting don't mind me. Stay tuned for tonight's episode. Pmps will be @ 7pm eastern time. You won't want to miss it. Set your DVR. I will need to know how much if he's low.
 
It was 2U that gave the drop, but pmps was low. Let's say tonight if pmps is 200-250 give 1.5u or 1u would be safe? This is where I wrestle with my self. When do I give less or none at all????? And try to avoid the amps high. I want even keep is that to much to ask for!!!!!

How did you learn all this info? I read and read but it jumbles together. The correlation between reading on meter and if it the same as drawing and running sample at a lab, different meter have different levels.

What is normal for a cat and then what would those numbers on the alpha Trac 2 be. Then if he borderline low say 160-200 do I shoot or not and if so how much???? I question myself.

Thought giving insulin 1/2 hrs after dinner would be good so when he starts to drop the food would be kicking in. It works in the morning why not at night.

Just venting don't mind me. Stay tuned for tonight's episode. Pmps will be @ 7pm eastern time. You won't want to miss it. Set your DVR. I will need to know how much if he's low.
Where is PA are you? We are right outside of Doylestown.
 
Wow Paula another sleepless night! Lots more info to help figure out your dosing though. I think I read somewhere that you can use other strips in the Alpha trak meter -Freestyle lite maybe? Maybe someone can give you that info. If I'm remembering correctly they are cheaper and can be bought at any pharmacy.

I know some of you have run tests using your AT with Freestyle Lite strips and have gotten results that make you feel comfortable using Freestyle Lite strips in the AT. I have an AT2 and I also use it to do spot checks on the Micro, especially at lower numbers because I know my Micro runs low. But I would never use a human strip in a pet meter regardless of how close the results might be on testing. I'm sure if you called Abbott, they would tell you the same thing. I know the AT2 strips are expensive and if they are too expensive for you, then buy a human meter and use the appropriate strips for it and spot check your human meter with the AT using the AT strips.

I just wouldn't put Gracie in any danger by using strips that are not appropriate for the meter I'm using.....I don't care what anyone else's tests or any vet would say. IMHO.

@Robin&BB ...thank you. Normally I would never intrude on a condo when someone is working low numbers but putting a statement like that in bold in a new member's condo is unwarranted. And the info was incorrect. Yes....I could have waited until later when the low numbers were coming up and I probably should have but I wasn't sure I'd have the chance to get back around to it and people (e.g. lurker) tend to not read comments after numbers come up. The remainder of your comments, I'll address in a PM instead of doing a condo hijack.

I can also help anyone who would like a red line inserted into their SS indicating use of an AT. What I strongly recommend against is using the AT SS that has been developed or changing the ranges on the current SS for the AT. The majority of the ranges on the AT SS developed are not based on any science and could result in members making incorrect dosing decisions.
 
Please please please no fighting here. I need all of you. I read inserts of meds even my own. Can't say I agree with everything printed. Never thought once on insulin you can ever go back to not needing it. This I have learned here. Not sure I have wrapped my head around that possibility yet. It would be great but scares me not to give any at all. That's where my conflict is. So I need my hand held through this.
 
It was 2U that gave the drop, but pmps was low. Let's say tonight if pmps is 200-250 give 1.5u or 1u would be safe? This is where I wrestle with my self. When do I give less or none at all????? And try to avoid the amps high. I want even keep is that to much to ask for!!!!!

How did you learn all this info? I read and read but it jumbles together. The correlation between reading on meter and if it the same as drawing and running sample at a lab, different meter have different levels.

What is normal for a cat and then what would those numbers on the alpha Trac 2 be. Then if he borderline low say 160-200 do I shoot or not and if so how much???? I question myself.

Thought giving insulin 1/2 hrs after dinner would be good so when he starts to drop the food would be kicking in. It works in the morning why not at night.

Just venting don't mind me. Stay tuned for tonight's episode. Pmps will be @ 7pm eastern time. You won't want to miss it. Set your DVR. I will need to know how much if he's low.

I have just picked things up from others and stored the info away. At first, I ran off the pages and put them in a 3 ring binder! I had a diabetic cat over 8 years ago, started posting then and never stopped. So it's a lot of time learning. And seeing what doses do for other cats. Luckily, ProZinc - the insulin I am most familar with - behaves a lot like Vetsulin so I can help. There are lots of people here more experienced than I. My knowledge is old but refined with daily experiences. They may have a diabetic cat and have years of experience treating him. We have few experienced Vetsulin users.

Your meter does make things complicated. We have set ranges for human meters and feel they are pretty reliable. There hasn't been a consensus on AlphaTrak so in a pinch we just think it's maybe around+ 25-30 points higher than human. So a 40 on a human meter might compare to something around 65+ on an AT. That is far from perfect, but in a hypo situation it may be the best we can do. It is the range we are generally looking at - not so much a specific number - but sometimes, like with a hypo, you want to be more precise. I have to say whether the number you pick is 69 or 65 or 67 is unimportant; what is important is that when you see your cat in that range, you pay attention fast. Your AT should match your vet's AT on the same sample of blood at his office at the same moment. Other than that, it's all a grain of salt thing. Humans complain that meters are imprecise and meter manufacturers even say their meters have a +/- variance of 20%.

You decide a range you are comfortable with. I wouldn't want to shoot below the 200 range for a preshot until you know how he will react. What we know so far is that he reacts to a lower range by going into very low territory. That could change, but for now it seems a good baseline

Giving the insulin 1.5 hours isn't awful. We set an arbitrary 2 hour no food before preshot rule because we need some guidelines. We do say, test, feed (with Vetsulin in case he has a harsh drop) and dose, within a few minutes. If his tummy is empty at shot time, then it's possible the insulin will hit harder. It is fine to give him a snack about +2/3. In fact, good with Vetsulin as it can avoid a fast drop.

Glad you are keeping your sense of humor. It is vital to the process. :D
 
Please please please no fighting here. I need all of you. I read inserts of meds even my own. Can't say I agree with everything printed. Never thought once on insulin you can ever go back to not needing it. This I have learned here. Not sure I have wrapped my head around that possibility yet. It would be great but scares me not to give any at all. That's where my conflict is. So I need my hand held through this.

Please know we aren't fighting. It's discussion :) and it's important because you should know that on a peer reviewed forum, everyone is not going to agree on dosing, on meters, on many things. That's the beauty....you read it, you decide what works best for you and Smokey. We aren't here to make your decisions for you. We are here to offer a breadth of experience and information to consider and perhaps discuss with your vet ....and then you make the decisions. We understand all new members need some hand holding ....we've all been there.:)
 
Well vet had strips so I'm ok with that. Asked them to allow extra time on his visit so we can talk. The office staff mentioned the have seen a rise in hypo episodes lately. Said they just had another yesterday a pug puppy. Wonder if it's them advising blanket doses or what ever insulin being used is a bad batch.

Me personally would use a pet specific meter as long as they have one out there. I never mix brands for appliances or parts. To me things work better if coordinating parts are used.
At my doctors today. I asked about test strips for humans. A script is needed if going through insurance. At the drug store I asked them. They said the same.

Back to Smokey. Does anyone have an opinion about possibly switching to another kind of insulin. Just looking for opinions here. I would think a new curve would have to done to figure out a dose. I would definitely let a vet do it. Maybe even a new vet. I will see how his visit goes and if they are open to ideas and willing to work with me.

When I lived in NJ I had a vet I'd been with for over 30 yrs.. He came in on his day off to see my 20 yr old over the bridge. We bottle fed her from 3 days old. And he took care of her from 3 days old. He knew me and my cats. That's what I'm looking for. When we moved here I tried all the area vets until I found one I liked. The one I really like stopped working on the days I could go.
 
I can always tell now when Squallie's BG takes a sharp drop, he comes begging for food, usually around +2. I test him, give him a snack, and all is fine in his world, lol! :)

That might explain Smokey at +3. Never really put that together. He would beg a very short time but I ignored him and he go way. Because he had just eaten I didn't think he really needed it. I tried to keep his feedings even intervals at 12 & 6 hrs. I give him 1 oz boiled chicken. Just learned something new again. Thank you.
 
Back to Smokey. Does anyone have an opinion about possibly switching to another kind of insulin. Just looking for opinions here. I would think a new curve would have to done to figure out a dose. I would definitely let a vet do it. Maybe even a new vet. I will see how his visit goes and if they are open to ideas and willing to work with me.

When I lived in NJ I had a vet I'd been with for over 30 yrs.. He came in on his day off to see my 20 yr old over the bridge. We bottle fed her from 3 days old. And he took care of her from 3 days old. He knew me and my cats. That's what I'm looking for. When we moved here I tried all the area vets until I found one I liked. The one I really like stopped working on the days I could go.
Hi, Paula - The only trouble with having a curve done in the vet's office is that a cat's stress from being there can elevate the BG levels; then you end up with the vet advising you to put the cat on a dose of insulin that is too high for him when he's at home and more relaxed. I wonder if this isn't what happened with Smokey when he was first diagnosed? As you had the first bout of Smokey dropping to low on your very first night.

We generally recommend going slow with the insulin dose, then increasing as indicated by the #s you're getting with careful home monitoring (just like you've been doing lately). My concern it that the dose you started out with may have been estimated at the vet's office based on stress-induced higher BG #s; do you think that may have happened with Smokey? I don't know which hour your at in today's cycle, but maybe would be good for you to go ahead and do a spot-test now? (Unless you've already done one & just hadn't gotten around to posting any new #s on his SS.)

I don't think you have a bad batch of Vetsulin; I just think his dose has been too high, IMHO.
ETA: This is why some of the others who posted here last night were recommending that you reduce the dose this morning, even though we knew you'd be seeing a higher number due to bouncing from the extreme low #s last night.
 
Wanted to add: My vet actually told me he prefers that I do BG curves myself at home, specifically because the stress of a vet visit can really raise BG levels pretty sharply! (Yep, I love my vet!)
 
I don't remember seeing the posts about lower dose for this morning. Since it was higher than yesterday I just kept to same dose.

@Robin&BB. Smokey was dx in 2012. Put on 2u. I believe they kept him 4-5 days doing the curve. Then he was increased to 3u but don't know when. But has not seen a vet since 2012. When I got him he stayed on 3u for quite awhile. Over the past year he started vomiting more often, going outside of box and constantly begging and crying. Would take him to the vet. They knock 20-30 points of his reading (some meter some vein) for stress. But always raised his dose usually 1/2u but one time raised by 1u twice a day. Started feeding smaller feedings every 2 hrs + medicine for vomiting. When they did his crying stopped, vomiting stopped, going purposely on floor stopped. About 2 months ago he had vomiting and diarrhea don't know why, BS was 596 if I remember. Started 5u twice a day. They said they can't go higher. They said he could be insulin resistant, maybe change insulin (which they didn't want). I suggested cut out all dry food and giving boiled chicken in place of dry and continue with canned. They said try it. Started that about 1 1/2 months ago when the vomiting and diarrhea stopped. I set up regular quarterly appointments and of course anytime in between if needed. Made him medically exempt for rabies (whole story in itself). Because of his age his routine vaccinations aren't needed. And we didn't want to start them from beginning again. He had not received them for about 3 yrs prior to me taking over. And now here we are. So combination of different food, scheduled feedings, monitoring more often, strict timing for insulin in the last 1 yr is now making a difference. A lot has changed for him this past year and even more change last 6 weeks.
 
Wow, Paula - that's been quite the ordeal, for both Smokey and you! (Amazing that it had to be you to suggest cutting out all the dry food - rather than the vet, I mean. Great call, Paula!)

So ... does Smokey have any other health issues besides the diabetes? And what's his weight? Is he overweight/underweight at this time?
 
Hi Paula--just saw this, don't know the entire story of your recent scare, but it sounds pretty rough. So glad you had help here and that Smokey is doing OK. I have to repeat what someone else said about your incredible devotion to this wonderful old guy. Hope he stays stable and happy and that you get some rest!
 
Ok here is his latest BS 449. Haven't give shot yet. Thinking of keeping it at 3U But on 9/7/15 he was 431 and got 3.5 and did well. of course that was the following morning after his episode.
 
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It is so hard to figure today out without the mid cycle numbers. Yesterday, you gave 3 units on a lower pr shot and got the low pmps. If I have to guess, I'd guess there is a low mid cycle today and both amps and pmps are bounces. If he were mine, I'd give 2.5. Get some sleep and see how he looks tomorrow. What do you think?
 
Wow, Paula - that's been quite the ordeal, for both Smokey and you! (Amazing that it had to be you to suggest cutting out all the dry food - rather than the vet, I mean. Great call, Paula!)

So ... does Smokey have any other health issues besides the diabetes? And what's his weight? Is he overweight/underweight at this time?

No other issues. Vet is surprised how well his labs were except his BS in April 2015. I'll get them on the spread evenutly.

His top weight was 22-25 lbs. He has always been large. When i acquired him he was down to 12.13 pounds. Since January he is holding at 18.06-18.63.
 
Have you dosed Smokey yet tonight? Were you planning on a slight reduction for the overnight cycle or will you be holding the dose at 3U? (Keep in mind that he is probably bouncing a bit.)
 
It is so hard to figure today out without the mid cycle numbers. Yesterday, you gave 3 units on a lower pr shot and got the low pmps. If I have to guess, I'd guess there is a low mid cycle today and both amps and pmps are bounces. If he were mine, I'd give 2.5. Get some sleep and see how he looks tomorrow. What do you think?
 
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