NEW to Board and Diabetic Kitties :(

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beclt

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Hi Everyone!

My name is Becky and I am new to this board. My husband and I have newly diagnosed cat, Cali, who is about 5 years old. I had an idea that she may be diabetic as she started to crave water from odd places like our drinking cups and vases of water. I had an older cat growing up that had diabetes (untreated) and acted the same way. Luckily, our vet said we caught it early because we could recognize the signs.

Our vet put us on Humuin. We started at 2 units, once a day. Our cat HATES the vet so going there to do a curve and other tests are not an option. She would be so stressed it would skew the results. Therefore, we have to figure it out for ourselves at home. She was still acting out, even trying to get into the shower with us to get to the water. He suggested we go to 2 units twice a day. From what I have heard (I spoke to Lori today) this is way too high. We received a newbie kit and her tests are coming in over 500, which makes us very nervous.

We are very clueless as what to really do. We've heard so many things (different insulin, where to inject, what is normal, etc) that we don't know where to turn. We are trying to do everything possible to make our cat comfortable but are terrified we are only hurting her in the end as we continue to aimlessly poke and prod her. We've hired a pet sitter for when we travel ($$$$!!) and are trying the best we can, but obviously need help.

We'd appreciate any help and knowledge that you all have in hopes of getting our Cali back to normal.

Thank you!
Becky
 
First of all, BREATHE. You've come to the right place, and you're not hurting your cat, you're helping.

The first thing you should worry about is home testing. All you need is a diabetic meter, test strips, lancets, and some way to warm the ear. A human meter works fine, and you can get one at any pharmacy. Or, you can contact Lori for a FREE (you pay shipping only) newbie kit. If you don't want to wait, many of us use the Relion Confirm or Micro from Wal-Mart. It seems to have the cheapest test strips. You warm kitty's ear up with a rice sock (thin sock filled with dry rice, warmed in microwave) or an old pill bottle filled with warm water. The you poke the edge of the ear to get a drop of blood. There are videos on You-Tube, or I'm sure someone will be along with links.

Once you're testing, you will have the information you need to decide if the insulin dose is too high or too low (I suspect it's too high).

Good luckj!
 
Hi Becky,
Please print out the Janet and Binky's food chart and take it with you to the store. Buy only the 8 carb and under flavors.
Next, reduce your dose to 1 unit.
Next, let's see if we can get Sue and Oliver to call you to help you pur up your spread sheet.
You will be fine in no time.
I am glad you are here.
Call me tonight to let me know the strips I sent you so I will know if they are the right one's for that meter. Another idea...test yourself to see if it looks accurate.
Hugs,
Lori
Things will get easier, promise.
 
For all of you in the public....this cat registered 200 something at dx...was put on 2u bid....and now is showing 500+
I'm sure you all are thinking the same thing. WHAT?????
That 200 something at the vet's office was vet stress....and that dose is over the top.
Lori
 
Hi Becky and of course you too extra sweet Cali.

First off Breathe! Now Breathe again...there better now?

You are in absolutely the best place you never wanted to be, but will soon feel so blessed to have found.

Very few cats do well on Humulin N, but if it is what you have to work with right now lets see what we can do to at least start getting Cali feeling better.

Some quick questions so we can help you sort this all out...what are you feeding Cali right now?

There are 3 big key aspects to treating a diabetic cat.

Diet, Insulin and home testing.

Diet: Cats are obligated carnivores so they need a diet that is high in protein and low in carbs and perferrably grain free. With a diabetic kitty you want to stay under 10% carbs. All dry cat food for the most part doesn't fall into this catergory. We have an excellent list here that breaks it all down for you. http://binkyspage.tripod.com/canfood.html I, personally have 13 cats two of which are diabetics. Maxwell has been in remission and off insulin now for over a year on just changing is diet to good old fashioned Friskies Pate Style canned food, Musette is still a work in progress but her insulin needs have been steadily decreasing, and my other 11 non-diabetics are doing fabulous on the change in their diet to what my diabetics eat. You can't tell my 13 year old from my 18 month olds by anything other than of course my older cats just look more grown up. They all run, jump, climb, purr and chase toys. They are all sleek, shiny and oh so soft to the touch. In fact I would lay odds that just looking at my cats no one that didn't know who were my diabetics could tell me which ones they are.

Insulin: Starting dose should be between .5u - 1u. The perferred insulins are Lantus, Levermir, and PZI as these are long lasting gentle insulins, whereas, Humulin N hits too hard and wears off before the 12 hours are up, so Cali is on a rollercoaster ride all day, She goes up really fast, stays high, then gets her next shot and drops really low quickly only to rinse and repeat between one shot to the next. If at all possible do you think you might be able to get your vet to switch her to one of the other insulins? We have very few folks here that use Humulin N, but we will try our best to help you figure this all out if you can't get your vet to make the change. If you can get him to change Cali's insulin to either Lantus or Levermir ask that he write the script for the solostar/flex pens rather than the vial. While the pens will be more $$ up front with the pens you get 5 to a package which you open one at a time, and you will be able to use up almost all the insulin in those pens before it goes bad, and with 5 pens you will have enough insulin for almost a year if it is handled properly.

Home Testing: Here you will find a ton of hints, tips and video's on how to test a kitty at home http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287. If you have any problems post back here with what part you are having trouble with, and we will do our best to help you out as we all have little tricks that we have picked up along the way to make it not only easy but pleasant for you both! Musette actually looks forward to her test times and will tell me if I'm running late.
Also if you want to give us a general location (City, State) we might just be able to round up someone local to you that can pop over and give you some hands on help in learning to test.

Mel, Maxwell, Musette & The Fur Gang
 
Hi!

Thank so you much for the quick responses. Here is some more info.

I did receive the kit from Lori, who has been a fantastic source of help already :)

We have been feeding her varieties of Fancy Feast. She loves anything with the gravy. She used to love the meat varieties but now leaves a lot of pieces on her plate. We did give her some seafood ones and she licked the darn plate clean. I did print out the lists from that site and I am already going to the store tonight to pick out low carb varieties. We will also try to give her some more food.

Testing is new to us (literally lat night) but we will drop her dose and test before we inject her, so if there was a log or spreadsheet that we should use, that would be super helpful. I can't tell you enough how NEW we are to this! Although, testing her when she isn't all cuddley on the couch will be interesting...shes not one to be held.

We are going to ask our vet to switch her insulin prescription to one of the two suggested in pens. I am nervous in regards to his reaction (questioning his "expertise") but we will do what we need to do!

Thanks again!
Becky
 
Most of what you will be looking for as regards to food will be the pate style stuff...anything that is in gravy is normally too high in carbs. Now that said I do have one comfirmed gravy lover here, luckily he isn't one of the diabetics, but the way I have tricked him into thinking he is still getting gravy is to simply add hot water to the can, swish it around to melt that jelly like substance, and then mush this into the pate food...he never knows the difference...lol

A couple ways of testing a cat that doesn't like to be held. One is to plop them on a big towel and wrap them up until just their heads are showing. Or two, simple don't hold them...Maxwell is one of those cats that while he loves to sit beside you and be brushed and petted, just isn't a lap kitty, he is also a lean 17lbs, and an overall big kitty! With him, I just sit down next to him, get the brush out, brush and pet for awhile, reach over grab the ear, poke, and test. If I try to restrain him in anyway the battle is on, but just poking his ear is no big deal, especially with treat already in hand. lol

Mel, Maxwell, Musette & The Fur Gang
 
I did print out the lists from that site and I am already going to the store tonight to pick out low carb varieties.

Awesome! Another "crazy cat lady with a list" that will be spending "hours in the cat food aisle"! Lots of us do that. If you ever see another person poring over the canned food choices with list in hand, you'll have found another mom or dad of a sugarkitty, so be sure to introduce yourself!
When looking at the FF varieties, look for the "classics" and try to stay away from that gravy style. The gravy seems to be the source of the carbs in most canned food.
It would be good to have a couple of cans of the gravy style stashed away in the cupboard however. Sometimes if the kitty's BG goes "low", and the numbers make you panicky, that type of food is ideal in order to force the BG to come up a little. A part of your "hypo kit" that you should always have close by, and it works better than honey or karo syrup when it isn't a dire emergency.

Welcome to the board, Becky!

Carl in SC
 
Becky,

If you need help with the spreadsheet, send me a pm. (Button in lower left hand corner of my post.)

The gravy foods are higher carb. But you may be able to fool Cali by chopping up the pates a little and adding some warm water to make "gravy".
 
We've tried that type before (pate) and she doesn't really like it. She won't eat it. any advice there?
 
Some kitties like it soupy. Some like parmesan cheese on top. Some like it heated until nice and stinky.

My civie (non diabetic) didn't like the pate ones at first - wanted the higher carb gravy ones. We compromised by mixing for awhile, gradually reducing the gravy ones and making the pate ones "gravy like". It is worth trying to get her to eat them. In some cases, the gravy ones are in the 17% carb range.
 
Welcome!

Sprinkle dust of freeze dried a) chicken b) liver c) shrimp over the pate. I think KT will eat ANYTHING if I sprinkle half a teaspoon over it. PetSmart has it in cat treats AND dog treats - the dog treats are a much cheaper way to buy. The only difference is the dog ones are a little larger chunks but I just break them up smaller.

One thing I wanted to be sure you know - even tho' we buy the pens, we do not use the 'pen' part for the injections, we still use a syringe to draw. The pens don't allow breaking it down more than 1 unit, we shoot halves, quarters, big drops, little drops. You'll POSSIBLY still use the same U100 syringes you use with the Humulin. If you're not using them, there are 8mm (5/16th) needles.

Hugs! We've ALL been in your shoes when WE first arrived so do REALLY understand....
 
Here is one of the reasons people here are suggesting your dose is too high. There is this thing called "Rebound". This is a term to describe the process in which the body reacts to low blood sugar or a rapid drop in blood sugar. When the body perceives a fast or low drop in glucose, it protects itself by releasing natural glucagons which raise the blood sugar. When this occurs, we call it somogyi or somogyi rebound, and this rebound or high blood glucose can last up to 72 hours. Treatment is to decrease the insulin dosage by 25-50%. (This is from FDMB Glossary: viewtopic.php?f=28&t=15885). Some people think rebound really doesn't happen, but I do. I saw it happen with my Maggie. So we usually recommend that new people start low (1U), stick with it for few days, then increase gradually if needed.

Here is a food idea: Avoderm makes a Chunk Chicken in Gravy (http://www.avodermnatural.com/Cat_Foods ... chunks.htm) that is low carb, the gravy is really more of a broth. But it's kind of expensive.

As to testing, if you're having problems, post your general location. There may be a member close by who could help you learn.
 
beclt said:
I did print out the lists from that site and I am already going to the store tonight to pick out low carb varieties.
carlinsc said:
Awesome! Another "crazy cat lady with a list" that will be spending "hours in the cat food aisle"! Lots of us do that.

Thank Heaven! Since 2008 when Tinkerbell (11 months OTJ after 28 months of being on Lantus and this Board!) was first dx'd and now of course with Tawny I have always thought I was the only person on the planet who does this!

Welcome to FDMB Becky. You are now officially a member of the greatest group of people on the planet. No, in the universe.

Desi, Tinkerbell, Tawny, et al
 
Thank you--you've all be fantastic! I've left a message for our vet re: a different insulin, so hopefully that will work out. We'll get some new food tonight, test her blood, lower her dose and hopefully be on our way to a happier kitty.

Any tips and tricks along the way are greatly appreciated! I'll let you know how we net out with the insulin.
 
Hi there and welcome

I just want to make a quick caution here..

While 2 units is a bit high to start with, its not insane. Second, we do not know that the 200+ at the vet clinic was inflated due to stress. It may be but do not assume as some cats do not exhibit vet stress inflated BGs. Third, how do we know that the cat is now showing 500s? Fourth, was a fructosamine test done? Fifth, is there any infection? Sixth, any test for ketones done?

Dropping the dose without testing for ketones is a recipe for potential disaster, as insufficient food/insufficient insulin and/or infection can lead to the development of ketones.

Humulin N is not a once a day insulin, so this puts the cat at further risk for developing complications including hepatic lipidosis and ketones, so twice a day dosing is a must.

While sorting out all the details, there is no reason to not stay with N, but please do give twice a day, and if you've reduced the carb component of your cat's diet please do consider 1 unit instead of two.

Finally, you can inject into the scruff, it is easiest when first learning. Later you can learn about other options :)

Jen
 
Just got off the phone with the vet and her is what he said re: insulin.

1.) he sticks with humulin as it is less likely to come on/off the market as the others
2.) he has had success with cats being regulated on it in the past
3.) he think the dosage we are on (2 units twice a day) are still really low
4.) made mention of a once a day insulin called "prozinc" (Sp?)

Any thoughtso n the above. I've gotten terriblly conflicting stories today and am feeling more confused! He is happy to write the prescription and is also going to reach out to an endocrinologist for his opinion as well. I'll hear back tomorrow.
 
I know it is very hard when people on the internet have different advice than your vet. All we can say is that we deal with hundreds of diabetic cats a week and our protocol has helped thousands into regulation and remission.

1. Lantus and Levemir are human insulins and very unlikely to "come off the market" Prozinc is a milder longer lasting insulin than Humulin. The only insulin that has gone off the market in the last year that I know of is Vetsulin. ProZinc is not dosed once a day in cats. It is dosed twice daily. Cats metabolize insulin rapidly and by 8-12 hours, ProZinc and Humulin will be gone. This leaves the kitty with high blood glucose levels for the next 12+ hours. We have lots of members here using ProZinc and they all are dosing twice daily.

2. Two units is not a really low dose unless there are some unusual circumstances . We like to start low and go slow. So we start with a low dose and increase if and when we get numbers that suggest that is wise. It is much easier to increase the dose than deal with a hypo. Once the insulin is in the cat, there is no way to get it out. If you are dosing once daily, I would suggest cutting the 2 units in half and give one unit twice daily. The caveat that would change this is, as Jen said, an infection or other complication. Anything you can tell us about a fructosamine test done at the vet or ketones being present would be helpful.

3. If you are planning to change to wet lo carb food, it is especially important to reduce the dose. When we changed from dry to wet, our Oliver went down 100 points overnight.
 
Lantus and Levermir are both human insulins and are about as likely to come and go off the market as Humulin N however they are 'off list' for use in cats as of yet, but there have been several medical studies done on the use of Lantus (Levermir is still fairly new). Unless someone beats me to it...I'll find you the link to the Rand study that you can print off and take to your vet.

No insulin is a once a day insulin in cats, as cats metabolize insulin twice as fast as either dogs or humans. Yeah I know hard to believe that any creature that sleeps 3/4th of their lives could metabolize anything that quickly, but they do. :-D

that 2units is a low dose as compared to some, but it is certainly not as low as what many cats end up needing. I can only speak from personal experience, and am not a vet by any means. My original diabetic Muse was started on 2units of Humulin N, she passed away 3 days after she got home from the hospital to hypoglucemia <sp?> on June 1st of last year. Through this board I adopted Maxwell on October 15th of last year, on November 1st of last year after being on Lantus for about a week and a half of no higher than 1 unit twice a day, he went into remission and there he has stayed ever since. July 25th of this year I adopted Musette through this board at the time she was on 1.25 units of Lantus, she is now on .5units and looking and acting great, and well on her way to needing her dose decreased yet again.

When my cats and I started this journey neither I nor my vets knew a whole lot about treating a feline diabetic, but I shared with my vet what I learned from these fine folks with my vet. He now calls me to ask questions about newly diagnoised cats, I have gone in with Maxwell to the clinic to teach them how to teach other sugarcat moms and dads how to home test, and my vet now hands out Binky's List not only to newly dxed sugarcats, but to all new cat owners.

Mel, Maxwell, Musette & The Fur Gang
 
Well your vet has proven beyond a reasonable doubt that he knows not of which he speaks.
PZI is NEVER used as a once a day insulin.
Sigh.
Lori
 
the pamphlet for PZI says it is once a day and the old guidance for PZI is once a day. But it is NOT once a day.

He may well have cats who were 'regulated' on N, but that likely depends on what you call regulated. Was it based on clinical signs? Random tests at the clinic? Hometesting?

Regardless of his definition, N is NOT a once a day insulin. Nor is it anywhere near the best for cats due to its quick onset, short duration and short finish.

I know this is confusing. Trust me, most of us had conflicting info at the beginning. But he sounds nice, and willing to work with you and address your concerns (somewhat). So listen to your gut, find a compromise that works for now, and we'll help you and your vet will help you

Jen
 
lori and tom (GA) said:
Hi Becky...have you gotten an evening number yet?

(This is Jon, Becky's husband) Becky tested her this evening and the meter once again read "HI" meaning it's >500. Becky gave her 1 unit while she ate her Friskies Tuna & Egg. She seemed to like it and has been quiet and pleasant since she ate, laying beside me.
 
My own vet who treated my cat for 10 years knew nothing about feline diabetes and still does not, She made a lot of mistakes and I made a lot of mistakes. Please listen to people here. They have many years experience with these insulins and dosing with them.
My own vet talked about once a day dosing, had my cat on too much insulin and I had my cat on to little insulin because I got no help from the vet whatsoever.
Then she told me NOT to test the cat at home. I would get the cat off of the humulin to start. I was not here long but that much I do know. Get that beautiful kitty on one of the better insulins that the others are recommending and if your vet won`t do it change vets.

Terri
 
Those are high numbers. Please try to get another test tonight to see if she does come down mid cycle - 4-6 hours after the shot (Lori is right - please try the strips on yourself to be sure you are getting an accurate number.)

Hopefully the food will help bring her numbers down also.

Do you have ketone strips so you can test her urine for ketones?
 
Well the number is accurate. Becky tested on herself and she was 70 something.
The thing is Cali had such a low dx number. That is why it seems to me to be insulin induced high numbers.
It's odd.
One wonders why Cali was doing better with no insulin on board than with.
I hope we see a spread sheet up soon.
 
Hi Everyone!

Thank you for all the advice! I'll be speaking to the vet again today and will let you know where we net out.

A point of clarity--my husband took Cali to the vet when she was diagnosed and I could have sworn they said she was over 200. However, they didn't say how much, so please don't read into that too much.

Here is how the night went: We set up the spreadsheet and tested before her dinner/shot. It still said HI which is over 500. We gave her new lower carb food based on the list (we've been giving her wet, but not the best kid). She ate most of it but let some. By this morning it was gone. After 6 hours her new reading said 407, which was encouraging. We tested again this AM and it said 454. We lowered her to one dose, both last night and this AM, especially with the adjustment to her food.

Interesting to see what tonight's readings will be and what the vet has to say.

Do you have any recommendations for a good treat? Our cat loves the ones that came in the newbie kit, but do you like anything that is bought more locally in-stores?

Thanks!
Becky
 
Those numbers are pretty high. It would be good to get a number around 4 -5 hours after the shot to see if she has gone lower. I would say if she continues in the 400-500 range, you might consider raising the dose to 1.5 We don't want her to sit in those high numbers overall It may be that she is in those numbers preshot and then goes down - that is pretty common with Humulin - but if not, raising the dose might be a good idea. The food may bring the numbers down significantly today also - any tests you can get in will help you figure this out.

While you are doing this reduced dose trial, be sure to test for ketones: ketones
 
NOOOOO, sorry Sue. This is not a raise the dose thing. The kitties numbers are coming down with a lower dose.
Please DO NOT raise dose yet.
Test lower 1 unit for a few days.
I had this experience with Tom
He rode continual 600's for weeks as I was unwittingly overdosing him to bring his numbers down.
Switched then from pzi to levemir and started over at 1u and he gradually came down.
To nice 100-200 numbers.
Lori
 
Lori,

What am I missing? I don't see her numbers coming down. She is HI and in the 450-500s at preshot and at +6.

I just hate to see her hang out in these high numbers very long.
 
Sue on that meter HI means over and above 500...could be 600.
All of her readings before were HI so the 400's are a slight improvement.
Just maybe give it another day.
I think the lev. or lantus is on the way.
 
Sue there were a couple of HI readings before that I believe are not on the SS
 
I would like to see how the food change and lower dose effets her readings over the next day or so. Although still high, I was encouraged to not see "HI" on the screen. We will test again later tonight and see how she is doing.

We will need to work on getting the keretones tested. That is another item on the to-do list...
 
WIth the food change there may be room to wait a few days but if things don't trend lower by thursday I'd consider bumping the dose up. Humulin N is not PZI...

Jen
 
In answer to your question about the treats; I go to PetSmart (but you can probably get them at most pet food places) & they have freeze-dried chicken and freeze-dried salmon in the cat treats section, but they're small bags/containers. If you go over to the dog treats section, they have freeze-dried chicken, freeze-dried beef & liver, and they come in bigger bags-but it makes them cheaper. The chunks are also bigger, but I just break them into smaller pieces. So far, I've only bought the chicken, since my cat throws up anything w/beef in it. I think I may splurge on some of the salmon in the kitty section & give those to him when he has to get a shot of insulin, since we're down to needing a shot only about once a week! Just make sure that when you get the freeze-dried treats, the only ingredient is the meat (no fillers, preservatives, etc.)
 
Just heard back from the vet--he spoke to a veterinary endocrinologist and she thinks that the ProZinc is the best way to go. Newbie question--is that the same as PZI I see written on the forum?

He is going to have it tomorrow so we can start working on that. Any thoughts on this?

Thanks for all the help!
 
ProZinc is not a bad insulin (better than Humulin), but recent studies show that with the combination of a low carb, canned diet and dose adjustments via home testing, Lantus (glargine) or Levemir (detemir) have the best remission rates (80+% vs. >50% for PZI). I've attached a couple articles for you to print and bring to your vet.
 

Attachments

While Julie is right, Prozinc is not a bad way to go and there are many people who like it.

Personally? if it were me, I'd go with lantus or levemir.

You have to find something you and your vet can agree on, and if he's consulted and suggests Prozinc, it won't hurt to go that way.
 
If you get the ProZinc (which is much better than Humulin) you will need to get new syringes. I believe ProZinc is a U-40 insulin, which means there are 40 units of insulin per milliliter of fluid. Humulin is U-100, which means 100 units of insulin per milliliter of fluid. Insulin syringes come as U-100 or U-40 syringes to match the concentration of the insulin. So make sure you get the correct ones for the new insulin. (It is possible to use the old ones, but a conversion is needed and to avoid a mistake at this point, I would only use the correct size syringe.)
 
Hey, I have 100 u40's packed and ready to ship out....shipping fee's only. Want them.
 
Maggies Mom Debby said:
If you get the ProZinc (which is much better than Humulin) you will need to get new syringes. I believe ProZinc is a U-40 insulin, which means there are 40 units of insulin per milliliter of fluid. Humulin is U-100, which means 100 units of insulin per milliliter of fluid. Insulin syringes come as U-100 or U-40 syringes to match the concentration of the insulin. So make sure you get the correct ones for the new insulin. (It is possible to use the old ones, but a conversion is needed and to avoid a mistake at this point, I would only use the correct size syringe.)

Correct, Prozinc is only available in U40, while PZI is avaiable in both U40 and U100 concentrations (according to the websites for both).

In answer to the question about "is Prozinc the same as PZI", no they are not the same. Prozinc is a recombinent human insulin: (as are Lantus and Levemir, if I am not mistaken)
http://www.prozinc.us/faq.aspx#prozinc
PROZINC is a sterile aqueous protamine zinc suspension of recombinant human insulin indicated for the reduction of hyperglycemia and hyperglycemia associated clinical symptoms or signs in cats with diabetes mellitus.1 It is the first FDA-approved protamine zinc insulin for cats.

PZI is
100% bovine protamine zinc insulin (PZI). With only one amino acid difference occurring at site A18, bovine PZI is the closest match to feline insulin available.
http://petdiabetes.wikia.com/wiki/BCP_PZI

Carl
 
Thanks Everyone!

Lori--I will PM you re the syruinges.

Last night, we test Cali and she was at 353. This morning she was 388. Down over 100 since we started a few days ago. We are sticking with what we are doing tonight and going to probably start ProZinc on Monday as we have to travel out of town this weekend.

So far so good....I think...
 
Here is a question--she's been making good progress over the past few days--are we in danger of it going TOO low? The reason I ask is that we will be away this weekend and the pet sitter, while a professional, won't be testing her. It'll only be one night shot and one morning shot that she would be without a test--are we okay?
 
You can reduce the dose while your out of town and away from kitty....that should keep you safe.
Do a lot of mid cycle testing before hand and see if the trend is getting better.
Ok?
 
Becky,
I 2nd what Lori said. You can reduce over that 24 hours to be safe.
Is there any way you can maybe get some tests in between shots the next few days? Filling in some of the blanks on that SS will give you and us a better idea of what the 1u dose is doing while it's working. If you can maybe get a test or two in tonight, that would be great!

Carl
 
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