New to FDMB: 24 hours post hypo, now what?

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Gracielinda Prescott

Hello, my kitty Pum'kin has been diabetic for 5 years and mostly well regulated on Lantus (Solostar pen). He just turned 12 this month and has been in good health other than diabetes. His current dose is 3 units every 12 hours. For the past month he has been eating only Soulistic canned and homemade food (no dry or treats). Prior to a month ago I kept a small bowl of grain-free kibble out throughout the day because I was paranoid of him getting too low especially if I was not home to watch him, but I have 9 other cats and some who should not have dry food whatsoever. Two years ago he got hypo 2x on the very same days I removed the dry food, so we modified the insulin and then he'd be ok. He went over 18 months without an episode until 2 weeks ago when I found him twitching 6 hours after insulin. I was not home testing at the time because I was religious about taking him to vet for tests twice a month. Emergency vet said he was 40, they administered dextrose and he went up to 300 while at the hospital for 18 hours. We brought him home the next day, without any suggested modifications to his insulin. He had really bad diarrhea and a poor appetite for a day, which I think is due to vets just giving dextrose and not offering food. I started home testing and found him to be in high 200's before insulin and 130-140 at nadir. I kept his food and insulin the same and saw no signs of hypo. Fast forward to yesterday when I found him just 3 hours after receiving 3 units at BG 19 (on my Contour meter that I hear reads low?). I applied karo to his gums, offered the gravy from his canned food (which he ate) and rushed him to emergency vet. We did see him eat before getting insulin that morning so no idea why the big crash so soon after Lantus. When he got to vet 10 mins later he was 33. They did the usual dextrose IV and he got up to 100 in 7 hours (no food given). I decided to bring him home at that time and monitored all night. When we got home he tested on my Contour at 71, then after eating a lot of Temptations, wet food gravy and Fancy Feast dry food, he was up to 100 in 2 hours. Then two hours later he tested at 261 (this was 14 hours since insulin). He ate and drank throughout the night, and was very purry and cuddly. This morning (now 24 hours since last insulin dose) he was 452. I need to know what the next step should be to get him stabilized. My vet is not available to speak to me today and her tech isn't calling back. I've lost all confidence in both the emergency and my regular vets because they just want to band-aid the hypo and not offer any help in modifying his treatment. I am thinking 1 or 2 units now, test every few hours, cut off the carbs/junk food and resume normal foods? I'm going to continue reading the threads for similar circumstances. Thank you in advance!
 
The most important thing you can do right now is to home test. Pum'kin's glucose levels cannot be checked only twice a month at the vets. His numbers can go very high or very low in the same day depending on the insulin dose and where in the cycle he is at. My Tuxie has had anywhere from 446 to 52 within a 12 hour period. You need to get a glucometer and test before each shot and if possible several times in between shots ( at + 3 and +6 for example) to see how he is reacting to the insulin. A test every 2 weeks gives no informatin on how Pum'kin is processing the insulin. Doing a curve...testing before shot and every 2 hours for a 12 hour period, once every week or 10 days, when you are able to, gives a good picture on what is happening.

Hypos are VERY dangerous. Here is a link to more information on recognizing and treating a hypo...but the best way to catch it is to home test:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
 
Thanks Tuxedo Mom.. Yes, I have been home testing the past two weeks. He was doing so well, so it was shocking to find him so low yesterday. I was prepared yesterday with karo and food gravy when I tested him and found him at 19. I'm just not sure how to get back onto insulin from here. Obviously don't want to do 3 units, but he is super high right now. My instinct says to start low at 1 unit, test every few hours and start seeing the pattern.
 
Gracielinda Prescott said:
Thanks Tuxedo Mom.. Yes, I have been home testing the past two weeks. He was doing so well, so it was shocking to find him so low yesterday. I was prepared yesterday with karo and food gravy when I tested him and found him at 19. I'm just not sure how to get back onto insulin from here. Obviously don't want to do 3 units, but he is super high right now. My instinct says to start low at 1 unit, test every few hours and start seeing the pattern.
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Thank goodness you are home testing. If you have more information you can start a spreadsheet and record the numbers, or in the meantime just list them out. I am not comfortable giving dosing advise but some of the more experienced members can help, if they have more information and numbers. Also you can change your title and add a "911" icon to get quicker help. There is a spot on the top right, near your first post with "Thread Tools" If you click on that it will give you the option to edit your title. The click on the "no prefix" in your title and add "911" which means need help right away. Also you could post your current numbers and how soon he is due for his next shot.

Good Luck!!
 
How often are you testing? Can you give us the numbers for the last two weeks. If you go to the section on tech support you will find directions on how to set up a spreadsheet. It then does all the work for you. All you have to do us plug in the numbers. Human meters read about 30% lower but that is what most of us use and are familiar with as the strips for the pet ones are costly. How much does Pumkin weigh? Clearly 3 units is too much. Most of us feed the lowest carb foods we can and don't use dry. The fancy feast classics are 3-4% as are most of the pates. Friskies pates are low too. I use fancy feast turkey and giblets, chicken and liver and chicken.

I'm in Los Angeles too, by the way.
 
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Hi Gracielinda.

I'm glad you joined up and posted on the board. As Mary Ann mentioned, if you put the 911 icon on your subject line, you'll get a LOT of eyes on your condo really fast. Have you read any of the "stickies" at the top of the page? Here's the one with most of the info you need right now: New to the Group? There are links there to instructions for setting up the spreadsheet that Elise mentioned. We find it very useful to be able to look at kitty's numbers before giving advice.

Here is some info from that sticky about hypos:
After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.
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I know you weren't too thrilled with the vet's office during Punkin's stay there. Did they give you any instructions for what to do after you got him back up? Generally we recommend starting kitties on 1.0 units twice a day, but there is a formula for calculating the best dose based in the kitty's weight, and I can't put my hands on it right now. I'm sure someone will be along that knows where to find it. I would say you do NOT want to go back to the previous dose.
 
Tricia & Cinco said:
Generally we recommend starting kitties on 1.0 units twice a day, but there is a formula for calculating the best dose based in the kitty's weight, and I can't put my hands on it right now.
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For Tight Regulation it's 0.25u per kg weight of the cat (ideal weight if kitty is overweight, actual weight if kitty is normal- or under-weight).

For Start Low Go Slow it's 0.5u if the cat has been switched completely to low carb wet food and 1.0u if he hasn't.

All twice daily doses unless a pre-shot number is too low to shoot.

(Can't you tell I've spent way too many years working with numbers and spreadsheets - once I've heard a formula I have problems forgetting it)!! ;)
 
His cat was on insulin already. So I'm thinking you think he should start all over like he never was?
 
I'm not sure on that Elise - I wasn't trying to give dosing advice at all. I just noticed Tricia's post about the formula and happened to know what it was. I'm leaving the whether or not to start over with dosing to others to comment on I think - I can see he needs a reduction but whether or not that means starting over, I'm really not sure.
 
manxcat419 said:
I'm not sure on that Elise - I wasn't trying to give dosing advice at all. I just noticed Tricia's post about the formula and happened to know what it was. I'm leaving the whether or not to start over with dosing to others to comment on I think - I can see he needs a reduction but whether or not that means starting over, I'm really not sure.
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That's what I think too and don't know where to start either. Smart minds think alike.
 
Thanks, All! I will set up the spreadsheet asap. Answers to some of the questions: Pum'kin is 15.5 pounds (not overweight, actually on the thin side as he's a DLH that is very tall with a huge head and pawsies). He eats Soulistic Good Karma
Chicken Dinner and Nautical Nirvana Tuna & Skipjack Dinner varieties, as well as a modified version of Dr. Lisa Pierson's homemade diet. (I feed Dr. Lisa Pierson's raw rabbit/semi-cooked poultry diet to my 9 other cats exclusively, but Pum'kin will not touch raw food so he eats a cooked version of her recipe.) Is there a lower carb tuna/chicken variety with gravy (without carrageenan) that anyone recommends? He loves Dr. Pierson's homemade recipe, but tires easily from one food, so I alternate between the Soulistic varieties and homemade throughout the day. The homemade food is 3/4 of the way cooked shredded organic chicken thighs mixed with Omega 3, taurine, Vit. E, B complex, and bone meal powder. I put down fresh food for all of my cats 4x per day, sometimes more. Pum'kin has never been food motivated and likes to graze. He always eats before insulin and whenever I see him I offer him more food since his version of eating is just a a few minutes here and there. My husband and I are very conscious about making sure he eats. We are thinking he may need to be kept in our bedroom with his food for awhile until we figure out how much he's actually eating and what his insulin needs are.

We gave him 1 unit today at 10:15 am PT. This was right after he tested 452. I tried to test him a few minutes ago, but my nerves kicked in. His ears are a mess, some pooled blood under the skin on both. I applied Neosporin with pain relief and am giving them a break. I feel terrible because he's so good, doesn't struggle or protest at all despite my poking and bothering him. I tested him after the last episode 2 weeks ago just fine and yesterday when I saw him twitching I was a champ and got him on the first prick, but now I'm shaken and not able to. I wasted 10 test strips this morning due to not getting a big enough blood drop. :( I have an AlphaTrak 2 arriving tomorrow, until then I will keep trying. The lancets I have are 28 gauge tri-beveled, they seem to bend without breaking the skin...or maybe I'm just too shaken up?

The emergency vet gave us no take-home instructions. In fact, I have not even heard from them today to "check in". I spoke to the tech at my regular vet's office (she has her own diabetic cat at home) and she said 1 unit 2x a day for a week to start. Then she wants me to leave him with her for 12 hour curve. She told me just to test him 6 hours after insulin, but I don't agree. Had I waited to test him 6 hours yesterday he would have died since I found him twitching just 3 hours after getting insulin and his BG was 19! I'm going to try to test in a little while...at least by 4:15 pm PT when he should peak.

A couple of questions: If nadir is supposed to be at 6 hours after injection, how is that possible when Lantus can take 16 or more hours to wear off? Wouldn't it make more sense for nadir to be 8 hours? It's confusing to me that we treat our cats in a 12-hour cycle but the drug we use can stay in effect for 16+ hours. As far as feeding, does everyone here feed 2 (or 3 or 4) meals per day on time everyday? Could my giving him food whenever be the problem? I do it because he won't eat a "full meal" in one sitting, and now realizing the changing times and amount of food could be triggering these episodes.

Thank you! I'm working on the spreadsheet now.
 
Just like almost everything about FD, nadir varies not just from cat to cat but from cycle to cycle with the same cat. Max has a nadir around+4-7. Because it is a depot drug it builds up over time. Some cats nadir at pre-shot time. Then sometimes the cycle is flat and you don't catch the nadir. To complicate things even more, some run lower at night than day like my guy. I feed Max starting at pre-shot and stop at +5-6 unless he drops low and I need to feed later or he won't eat past +4. It's been suggested he get a snack at +9 to see if we can bring down his pre-shot numbers but he isn't interested in food at that point.
 
You've had a rough time!

The nadir is simply the low point of a cycle. A cycle is the length of time in between 2 shots.

Your feeding schedule isn't causing the problem. He needs a reduction in his dose. Since you removed the dry food, the amount of carbs he is getting is less, and therefore the amount of insulin he needs is less.

After a cat has had a symptomatic hypo - what Pum'kin has experienced - they can be more sensitive to insulin. I think I would work on testing him and be very conservative with the insulin at the moment. Your reduction to 1u this morning was probably a good idea. After hitting low numbers, his body would've responded to that by releasing stored sugar and counter-regulatory hormones to bring up his blood sugar and save him from the hypo. We call that a bounce. The second post here explains it a little bit more. THat's why you saw that 400+ number this morning.
 
Gracielinda Prescott said:
If nadir is supposed to be at 6 hours after injection, how is that possible when Lantus can take 16 or more hours to wear off? Wouldn't it make more sense for nadir to be 8 hours?
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Hi Gracielinda! Happy to see you made it over here from the Facebook group!

The easiest way to explain this is that you have to remember that the reason Lantus works as well as it does is that there is an "overlap" of action from one shot to the next, so even though the nadir may be earlier in the cycle, there's some still "working" when you give the next shot

Insulins like ProZinc and Vetsulin are "in and out" insulins...once the cycle is over, that's it...with the "L" insulins like Lantus and Levemir, there's a "continuing action" from one shot to the next

I think the 1U was a good choice today too. With the sympomatic hypo, we want to be more conservative starting back on insulin. We've seen some cats who had symptomatic hypos that never needed insulin again
 
by the way, if you can get the spreadsheet up it's really, really helpful for us to get the bigger picture of what's going on. If you need help, either ask at the Tech Forum or here and someone can give you a hand. We depend on seeing the tests in the context of the spreadsheet. It's a great tool once you get the hang of using it.
 
Hi, I looked into the Soulistic canned foods I was feeding Pum'kin and they weren't really that low carb. I figured now is a good time to get the "right foods" since we're basically starting over with insulin and I'd like to keep his dose as low as possible and find acceptable foods that he will eat and thrive on.

This is what I purchased today:
  • Weruva Cats in the Kitchen Goldie Lox cans: 4% carbs / 0.68% as fed
  • Weruva Cats in the Kitchen La Isla Bonita cans: 3.4% / 0.94% as fed
  • Tiki Cat Puka Puka Luau cans: 0% carbs
The plan will be to offer one of the 2 Weruva varieties (chicken + fish) 2x per day. The other 2 meals will be Tiki Cat or my homemade Dr. Pierson modified recipe. This way two of his four meals will have minimal carbs (Weruva) and the other 2 meals will be zero (Tiki and homemade). Hopefully this plan will keep him from fluctuating day to day. It would be ideal if I could keep him on one food, but he's too picky.

As for testing, I'd like to post photos of what I did to his ears. Not sure I have anymore places to prick him. There's blood collected in between the skin on both ears, lots of marks and redness. I'm afraid to keep pricking him because its all been for nothing today. I was so good at this, now my nerves have taken over. I hope I don't cause trauma to his ear or a hematoma. One of my cats has a cauliflower ear, though its quite cute on him.
 
You are doing a SUPER job with all of this, Gracielinda. :) :) Give yourself a ton of credit for doing the new stuff that you are, it's hard, but it will get easier. What gauge lancet are you using? A smaller number is a bigger poke, and will be easier to get blood at first.
Liz
 
If you need help with the SS, please send me a private message and I can help you or do it for you in three shakes of a bunny's tail. To send me a private message, just put your cursor over our names to the left under Gracie's picture and select "start a conversation". That will take you to your inbox where you can also send and receive replies. You can also just click on "inbox" in upper right corner and then "start conversation" .

His dose absolutely needs to come down but you have to be careful that you don't take it so low that you leave him in high numbers to build up glucose toxicity. That's where the SS helps us help you determine a dose.
 
I can't do anything with the spreadsheet because I don't have any ongoing data right now. All I have is what happened the past 36 hours and that's not even really accurate because a good chunk of that time he was hospitalized on dextrose and then eating junk food at home to raise his BG. I'll have to start logging it going forward since we're "starting over", but as of now I can't even test him so the SS is going to be difficult.
 
A lot of vets want to do curves because their clients don't home test. If you can get comfortable enough with testing regularly, you will be able to do a curve yourself, and it will be more accurate than one done at the vet's because Pum'kin won't be as stressed. Are you warming the ear first? Here is a link to the page that has testing tips, with links to videos and more advice than you ever knew existed. Marje's video is great. Don't worry - most, if not all of us, had a hard time getting the technique down at first, and we were all scared we were hurting our cats. You'll get it!!! Are you freehand with just the lancet, or using a lancing device?
 
I was finally able to test Pum'kin tonight (his spreadsheet is updated)! It's been exactly 12 hours since his 452 BG. His BG is 366 tonight. This morning he got 1 unit right after the 452 BG. He had some "junk food" this morning before the 452 BG (as well as all the junk food overnight to get him over 100 after the hypo). He is now eating the low & no carb foods I mention in a post above. We just gave 1 unit and will retest in the morning after another 12 hours of just low & no carb food. He's been super patient and sweet through it all.
 
Hi Tricia... I'm not sure why I've been so afraid of testing, as I used to do it fine and have tested a dozen or so fosters over the years. I test freehand, too much anticipation and noise with the device. My guess is nerves from almost losing him again in under two weeks.
 
It's great that you're home testing now and Pum'kin will be a lot healthier (and safer) because of it!!

Don't beat yourself up over what you didn't know....You're here now and that's the important part! Knowledge is power against this disease so you're in the right place to learn everything your vet didn't teach you!

It can take several days for the high carb dry food and treats to work it's way out of his system, so don't panic for the next few days if he runs a little high.....he has to re-establish a depot and that can take 5-7 days before we'll really know how well the 1U is doing ...but you still want to test! At least before every shot and mid-cycle on the AM cycle (like around +5 to +7) and a "before bed" test at night just to make sure he's not going to go too low overnight. Most cats go lower at night, so it's an important test to get.
 
the most I ever tested punkin was 22 times in one day, I believe. You won't hurt his ears by testing - on the contrary, you're keeping him safe by doing so. You can minimize trauma to his ears by always applying pressure for a few seconds afterwards to staunch the bleeding and prevent bruising. At the end of the day I always put a generous amount of Neosporin with Pain Relief ointment on punkin's ear - they would literally heal overnight. Then in the morning I would wipe off pretty much all of it so it wouldn't goo up the test strip.

Some people apply some about 20 minutes before testing, wiping it off right before the poking. I tried the Neosporin on my own foot where the cats had run across me and scratched it and the stuff is pretty much miraculous. It completely took the pain out.

Here is a post where people gave their best Testing & Shooting Tips.

Good job getting the spreadsheet going! The concern that Marje mentioned is a real one - you don't want the dose reduced so far that his blood sugar goes too high. He's high at the moment because he bounced from the low numbers yesterday, combined with the skipped shot last night and the reduced dose this morning.

Your tests over the next couple of days will help us see if this dose is going to work for him or if it's too low.
 
Welcome to L&LL, Gracielinda and Pum'kin! Great job getting going with testing and getting your spreadsheet up and running - those two tools are among the most important in getting Pum'kin's BGs under control and safe! We are here to help, so ask as many questions as you need!!
 
Gracielinda Prescott said:
I'm not sure why I've been so afraid of testing, as I used to do it fine and have tested a dozen or so fosters over the years. I test freehand, too much anticipation and noise with the device. My guess is nerves from almost losing him again in under two weeks.
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Pretty sure I cried the first few times I home tested Skooter :rolleyes: After the crying, I got better at it and have learned that my silly boy likes to nadir around oh +2 or +3 in most cycles....

I would highly suggest adding in all the info you have, even from when he was in the hospital and eating "junk food"......I would just denote those types of things...ALL data is helpful....it is good to know what he does when he has HC (high carb) food, LC (low carb) food, etc.....as much data that we can collect on our babies is going to be helpful in the future....even when I think for sure I did a fur shot, I still do a few tests throughout the cycle if I can, so I can see how he does with that.....one thing I have learned, I am TRULY lucky as Skooter doesn't really skip a beat if he has a missed shot or a fur shot.....so on days when I am questioning if I should give a dose or not because I will not be home to test, I know that he will get right back on track.....on the other hand, some cats can take a few days to recover from missed or fur shots.....

I thought I was hurting Skooter when I was testing him.....one thing I found to help calm my nerves is to talk to him while I am doing it....telling him what I am doing and why and tell him what a good boy he is.....more to distract me from thinking about what I am doing than to distract him.....you are doing great!
 
Thanks, Molly... I find talking to him helps calm me, too.

Pum'kin had a good night in our bedroom. He had two no/low carb canned foods to snack from throughout the night, and then had a small pre-breakfast when we woke up. His BG was 327 this morning. We've been able to test him right on time since coming home from the hospital. I'll try to get a mid-day test in today so there's more information in his SS. We will hopefully have the AT 2 by this afternoon.
 
Gracielinda Prescott said:
Thanks, Molly... I find talking to him helps calm me, too.

Pum'kin had a good night in our bedroom. He had two no/low carb canned foods to snack from throughout the night, and then had a small pre-breakfast when we woke up. His BG was 327 this morning. We've been able to test him right on time since coming home from the hospital. I'll try to get a mid-day test in today so there's more information in his SS. We will hopefully have the AT 2 by this afternoon.
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Great report!

This reminds me...when you have a chance, please be sure to update your signature to include which meter you are using. This will also be a huge help with our ability to assist you, since there is a noteworthy difference in readings between the AT meters and human meters.
 
You are doing great! Putting pressure on the poke for a good 20 seconds really helps prevent the bruising you are seeing on Dino's ears. Our Tess is a very bouncy cat and we test 10 to 12 times a day. You would never be able to tell from looking at her ears. His ears will " learn" to bleed and things will get easier.

How long before his preshot test did you give the snack? Food can start to show up in the bloodstream after about 20 minutes. We usually try to give no food for 2 hours before the preshot tests to get a "clean" (non food influenced) number.
 
Hi Ann, he had food out all night (because he's a grazer) and last I heard him eat was around 6:30 AM when my husband gave him a refill. We got up at 9:30 AM and I don't think he ate anything from 6:30 AM on. What he did eat once we were up was done within 10-15 mins of his test. We gave him 1 unit after his test and continued to offer food.

I just filled out the remarks on his spreadsheet.
 
Amy&TrixieCat said:
Great report!

This reminds me...when you have a chance, please be sure to update your signature to include which meter you are using. This will also be a huge help with our ability to assist you, since there is a noteworthy difference in readings between the AT meters and human meters.
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Amy, I updated my signature & will do my best to get some tests today. Thank you!!
 
You're doing great. I know we seem to be nagging you about the mid-cycle tests, but they really are important. Hang in there. I just know you and Pum'kin are going to be fine. :bighug:
 
Gracielinda, that is awesome! :)

If possible, we do ask that you start a new thread each day. You can include a link to your previous day's thread so everyone can follow what's been going on. It just gets too unwieldy to keep posting on the same thread for several days. Do you think you can start a new one tomorrow morning, please? Thanks!
 
Tricia & Cinco said:
Gracielinda, that is awesome! :)

If possible, we do ask that you start a new thread each day. You can include a link to your previous day's thread so everyone can follow what's been going on. It just gets too unwieldy to keep posting on the same thread for several days. Do you think you can start a new one tomorrow morning, please? Thanks!
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Yes, NP!
 
Hello, I am going to start a new thread Thursday AM, however want to post tonight's PMPS. I received the AT2 from my vet this evening and had a chance to talk with her at length. We tested tonight on the AT2 and he was 414 (this is after 24+ hours on no/very low carb food). Would have been nice to test same blood on the Contour to see the variation, but I ran out of strips. Given the 414 tonight, my vet said 2 units is a better place to start than 1. Pum'kin is a very big cat (tall, not fat) and it would be unlikely for 1 unit to regulate him. He received 2 units tonight and I will try to test him again in a few hours before bed. Thanks for all of your help and advice thus far!
 
I wish you'd hung off on the increase, especially a whole unit increase. When we do suggest increases, they're always in .25U increments so you don't blow past a "best dose"...Insulin is a very powerful hormone and even a tiny bit difference can make a BIG difference on the numbers. We've had lots of cats here that did really well on say 1.25U, but when they went up to 1.5U, they went too low and risked a hypo.

With Pum'kin just having survived a systematic hypo, he could be one of those cats that will be extra-sensitive to insulin, so that's another good reason not to try to rush it.

Also, since she'd been in the hospital and off Lantus, it's important to give her the 5 days to rebuild the "depot" so you can really see how that dose is going to do. Once the depot is full, then we make changes every 3 days until we start to see nadir's where we want them (50-120)

The dosing with Lantus is based on the NADIR (how low it takes them), not how high the Pre-shot number is...we've had cats that would go from 400 to 40 and back to 400 in the same cycle...if you were dosing based on the Pre-shot, you'd think he needed more, but understanding that the dose is based on the nadir tells you it's already taking him too low and he may need a reduction, not an increase

If he were my cat, I'd go back to the 1 unit dose and hold it until he's been on Lantus for a full 5 days....then we can start making adjustments to his dose to try to get him spending as much time in healing numbers as possible.

Do you have any questions, Gracielinda?
 
After kitties see a low number, it's very common for kitties to bounce (see the second post here). It's a temporary condition that produces high numbers. A bounce can take up to 6 cycles to clear and is likely what is causing the high numbers you saw yesterday and today with Pum'kin. We usually wait until a bounce has cleared to decide whether a dose is working.
 
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