Starting dose when switching from Caninsulin to PZI?

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Dr Schrodinger

Active Member
Morning all,

My cat Milo was diagnosed 8 weeks ago & is now on 3U Caninsulin twice a day. It disappears after ~6 hours post injection so the vet has just prescribed Hypurin Bovine PZI to try & keep his numbers down for longer.

I'm picking up the insulin & syringes this afternoon & will hopefully switch him this weekend & do his first curve at home. The Vet is very supportive of my home-testing & suggests I start with 1.5U x2 based on Milo's numbers (spreadsheet in my sig) but this makes me nervous. I would like to start at 1U & see how we go.

What would be the most appropriate starting dose, do you think? Am I being over cautious?

Thanks

Juliet
 
Hi Juliet, and welcome to PZI,

I think either dose would work, but the key is what you are comfortable with it. From your post, I'd say that is 1u? Do you know if Hypurin is a U40 or a U100 strength?

Note to everyone - from what I have read on Health, Hypurin PZI is a bit different than what we use. Juliet is in Great Britain is I remember correctly, and that's what is available there. If you read her Health posts, as well as Elizabeth & Bertie's, it would appear that Hy-PZI can have a longer duration for some Kitties.

Juliet, what about food? That's a bit different as well? What's Milo eating?

Carl
 
Hi Carl,

Thanks.
Yes, I am in the UK. Hypurin Bovine PZI is a U100 insulin, so more concentrated than Caninsulin. I have done Milo's past couple of injections with a syringe rather than the pen needles to get used to it, and I'm (hopefully) picking up the U100 syringes this afternoon. I will practice with water first!

Milo's been switched to a wet diet for a couple of weeks now, but it has taken a while for his belly to settle into it. This week has been the first 'regular' week for a while with no sickness or squelchy poops. He's eating premium grade canned food: Ziwipeak...(the favourite probably because it's the most expensive!), Grau, Granatapet & the occasional Applaws as a night time snack. He is used to free-feeding & switching to mealtimes is too much for him at the moment. He is underweight & we need him to pile on the pounds.

If you have a look at my spreadsheet, today his BG seems to have dropped somewhat, which makes me think it might be a better idea to start low on the PZI. I'd love to know what other people think, though?

J
 
I agree on this morning's numbers. Looks like the best day he's had for some time:-)
What is his current feeding schedule?
Carl
 
Yes, fingers crossed it will be the first of many good days!

His appetite is now back with a vengeance, so he will try & eat ALL the time!

I fill up their bowls at 6.30am & 6.30pm, or thereabouts. After his ear-stabbing & insulin. They don't eat the whole lot at once, but keep coming back throughout the day & night. If they do finish their evening's portions by bedtime, then I add a little more to keep them going throughout the night. It also stops us being woken up by howling, yowling & having our bedroom door beaten in!

They like to graze & nap, graze & nap, graze & nap. They're both ~12 yrs 6 months (we think). The 'civvie', Lola, is overweight (now losing some of her baggage due to new diet) & Milo's the opposite. I'm just letting them obey their appetites at the moment & seeing how they equilibrate.

J
 
Lots of cats do well with the grazing rather than regular meals. I would stay with what is making them happy. If he becomes better regulated and starts gaining more weight than you want, you can cut back a little, with amount and/or frequency.

I'm always for starting lower. You can always increase if he is running higher than you would like after a few cycles. And I am big on going with your gut. Yours seem to be telling you to start with the one unit?
 
Thanks Sue & Carl.

I shall play it safe & start with 1U, then report back.

(BTW: Niko looks likes a pesky clown! He or she is lovely!)
 
Hi and welcome to our group.

I like the 1 unit to start with. They are very different insulins and that way you can monitor and see how that works for him and adjust accordingly. It is so much easier to systematically increase and monitor the results, that way you will know you havn't missed the right dose by starting too high.
 
Carl & Bob said:
Hi Juliet, and welcome to PZI,

... Hypurin PZI is a bit different than what we use. Juliet is in Great Britain is I remember correctly, and that's what is available there. If you read her Health posts, as well as Elizabeth & Bertie's, it would appear that Hy-PZI can have a longer duration for some Kitties.

Carl

Yep, Carl is right. Hyp PZI is the longest lasting of any insulin. Can have considerable overlap. But it may take a couple of days for that to kick in... In my own cat - after I switched from Insuvet PZI to Hyp PZI - I didn't see much change for the first couple of days and then...I seemed to suddenly be in a different ballpark... But, ECID (every cat is different).

I'm glad you've found the PZI forum, Juliet. You're in good hands there. :smile:
 
Thanks People!

Well, today started rough for Milo with AMPS: 30.1 (542). On this basis I chose to start him on 1.5U rather than the 1U I had decided on yesterday. No, I'm never very decisive.....or am I?

Anyhoo, the story thus far:

AMPS 30.1 (542)
+2: 24.3 (437)
+4: 18.2 (328)
+5: 15.2 (274)
+6: 17.5 (315)
+8: 23.8 (428)

I've attached a graph for those who like pics to understand things (like me). I'll update it later.

I'm thinking if he's in mid 20s (430-460) at +12, I'll give him 2U tonight. The curve is a nice shape, it's just not reaching the right numbers. Looks far more gentle that Caninsulin curve, which is encouraging.

EDIT: Removed attachment & added Photobucket link.

http://i235.photobucket.com/albums/ee20 ... 6f5ec9.jpg
 
Much gentler curve, shaped like a smile. Couple of thoughts...

It's the first dose on a new insulin, so don't read too much into it. You might see the same thing that Elizabeth saw - a couple of days of nadir and duration that appear normal, and then a change to longer duration and later nadir.

Although I'm more aggressive with dose than most folks, I don't advise an increase based on just one cycle, especially at the beginning. A reduction, certainly can be based on one cycle if you see hypo numbers. But I like to use Dr. Lisa's thoughts when she says "look for repeatability before making an important decision like adjusting a dose." I'd be inclined to stay at 1.5u for two or three days and see how it plays out before increasing. Once you have a better idea of how the pzi is going to work, it may make sense to "adjust as needed", but you need more data, IMO.

Carl
 
I agree I'd stick with the 1.5 unit for now. You got a nice 50% drop on that dose, if you raise the dose you could push him down faster and harder to a much lower nadir and set him up for rebound. Once that starts it's hard to stop.

You want to see a drop of 50% to about 65% but not much more than that.

If it took Elizabeth's Bertie several days to adjust to the new insulin it may be the same for you.
 
Thank you.
I'm really appreciating your advice here. I do feel like I'm stabbing away in the dark at the moment. Quite literally, actually!

The bad news is that I've managed to give Milo a fur shot 2 nights running. ohmygod_smile
Now he's a little stronger he's more mobile & wriggley, and I am yet to hone my rapid-injection-by-stealth technique with the new tiny syringes. I much prefer them to the Caninsulin pen, but he's a long haired cat & they can get quite lost in the forest of fuzz. I do feel a bit useless.

The good news is that this allows me to have an extended BGC over 16 hours. Although I don't have such frequent data points, I think I like this insulin! His PMPS yesterday was 12.2 (220)! :mrgreen:

EDIT: Attachment removed. Link to photobucket added.

http://i235.photobucket.com/albums/ee20 ... 142176.jpg
 
Hi Juliet,

Don't beat yourself up over the fur shots. We've probably all done fur shots at some time or other. I certainly used to do plenty of those. And you're getting used to using new syringes too. Be kind to yourself.

And actually, I was almost relieved to find this morning that you'd done a fur shot last night! When I saw on your SS that the Hypurin duration was getting established, and that you'd still shot 1.5 units in the evening (at PMPS of 12.2 (220)) when there was no clear indication that the BG was rising, I was really concerned that the 1.5 units might to be too much insulin at that stage. (Especially given that quite a few cats have lower BG at night anyway...)

Hypurin is very different to Caninsulin. And one of the challenges of working with Hypurin is finding a dose that works with the - sometimes considerable - dose overlap.

Regarding the shots themselves. Hmmm... I know Milo has a lot of fur so that's bound to be challenging....

Are you using the 'tenting method'? (pulling skin into a 'tent' and then shooting in sideways into the middle of the tent?). Many people do. But I must confess it never really worked for me.... :oops:

I use a different method for Bert and perhaps this is something that might work for you too...

I find that giving shots directly downwards is much easier. So, while Bertie is engrossed in eating I lean over him, feel around on his scruff for some loose skin, grab a handful, and pull it upwards firmly between my fingers and thumb. Then I shoot directly downwards into the skin that I'm holding, mid way between my fingers and thumb. I find it much easier to see what I'm doing that way, and also, if he moves at all then I can just move with him a bit, still holding firmly onto that handful of skin, so I don't lose control of the shot. The Hypurin manufacturer also recommends keeping the syringe in place for 5 seconds before removing it. So, while I'm mentally counting to five, I use that time to check that I really have pushed the syringe home and have pressed the plunger completely.

It's great news to see that Hypurin looks like having a good effect on MIlo. Very promising indeed! :smile:
 
I hear you, Eliz. Thank you.

You have a point about shooting 1.5U at such a low BG (for Milo). As soon as I did it I panicked & got the honey & high carbs out. This is why I did so many tests afterwards. I must use my brain a bit more here. Poor Milo.

I like your direct pinching technique. I will try that for his next shot. That might work over the tenting method.

Yes, I'm used to the 5 second rule! VetPen is just the same but more awkward trying to follow an escaping cat around with it inserted in their shoulders! I'm realising more & more that the whole system really is designed for dogs. I shall donate the equipment to the next noob.

Juliet
 
Hi Juliet,

Just looked at Milo's SS. Nice to see those blue numbers but it looks like they gave the boy a bit of a fright! A little bit out of his comfort zone at the moment, perhaps.... That was quite a jump up between +8 and +10....
 
Hi Juliet -

I'm Lu-Ann and my boy Grayson started here on ProZinc. I was not familiar with your Hipurin - very interesting! I just wanted to let you know what I did to avoid fur shots. Grayson doesn't have long hair, but it's dark gray, so it was difficult for me to see if the needle went all the way in. (I'm sure it had nothing to do with my 50 yr old eyes!).

I did a couple of things. First of all, good lighting at your testing spot. I also wear my reading glasses when I shoot. If he's being wiggly, like Grayson was initially, I wrapped him in a towel and held the towel against the table with my stomach. Kinda like a kitty burrito! ;-) Lastly, I took a little hair trimmer, and shaved a patch in two locations on him. I had trimmed a mat out of his fur near his behind, so that was where I initially tried it. I later did a second patch on his shoulder. It didn't look great, but he didn't seem to mind, and I could see the needle going in, which gave me a sense of calm.

My dad used to say "The difference between a good haircut and a bad haircut - is about 2 weeks!" It's since grown in and I've gotten better at avoiding fur shots. You will too. Be sure to take your time doing it. Don't rush, don't allow yourself to be interrupted.

Good luck with the PZI - I'll try to peek in on you from time to time.

Lu-Ann
 
Hi Lu-Ann,

Thanks for the tip. He needs a little trim in places anyway as he has a couple of tiny dreadlocks. I shall get the clippers out!! He quite likes the buzz for some reason. :lol:

Eliz - I tried your method last night whilst we were cuddling post-ear-stick. It worked brilliantly! :-D He didn't move an inch, apart from the vibrations from his manic purring! I think you may have cracked it for me, there.

This morning his AMPS was 9.8 (176), so no injection!! Weeeeeeeeeeee!!

(Unfortunately this means he'll probably be 'HI' when I get back home from work this evening. It's a move in the right direction, though, isn't it? nailbite_smile
 
Yes, it is indeed "moving in the right direction", Juliet! :smile:

If this 'too low to shoot' situation happens again very soon then it may be worth considering a dose reduction, so that you can find a dose that you can give 12-hourly to even out those numbers a bit. (Although with Hypurin - because of the long duration - there may still be some times when Milo is too low to shoot.... It happened with Bert today too.... :roll:)

Back to the kitchen for me now. Got salad stuff to prep..... Such fun.... :-|
 
Another way you can deal with a lower preshot, Juliet, is to wait 20 minutes (without feeding) and test again. Not only do you want to make sure he is going up, not down, but to possibly get a preshot number over 200. It will also let you know how the insulin might be working for him. Does it work for longer than that 12 hour cycle like it does for Bertie or does he shoot up after that 12 hour mark and how soon? (I assume, Elizabeth, that even though it is longer lasting than the US version of PZI, it might work differently in different cats?)

Skipping is the last best choice since, yes, after 24 hours, he is very likely to be high. Reducing the dose a smidge as Elizabeth suggests is a good option. Seeing what he does in the 13th hour might also be useful.
 
Sue and Oliver (GA) said:
(I assume, Elizabeth, that even though it is longer lasting than the US version of PZI, it might work differently in different cats?)

Yes, indeed, Sue. 'ECID'...

The data on how cats respond to Hypurin PZI is actually very limited. It's only really been used for cats in the last couple of years since the discontinuation of Insuvet PZI (which had similar duration to Prozinc, I think).

In humans Hypurin PZI can have a duration of around 30 hours or more. And in cats it seems to have duration of up to 15 - 17 hours. But, Hypurin seems to behave quite differently in different cats; and onset, peak, and duration seem to have greater variability than is seen in other insulins. So, working out how a particular cat responds to Hypurin is very important...

The only 'constancy' (in terms of 'negatives') I've heard reported about Hypurin - with respect to it's use in cats - is that the long duration has been the biggest challenge (for those shooting 12/12 schedules and those trying to shoot more frequently using certain TR protocols). And, although it is a PZI insulin, I wonder if - because of the long duration - it shares some characteristics with depot insulins like Lantus...?
 
Yes, I was hoping its long duration might be a blessing, but it might also prove to be a somewhat poisoned chalice!

I wanted to stay at home this morning & record how the PZI 'wore off' but there's this annoying thing called 'work' that gets in the way of real life. :sad:

I have to be at work early tomorrow too, so no staying behind & testing. I'll give him his shot this evening & see what happens. If he's real low tomorrow morning then I can reduce the dose tomorrow pm.
 
Work does so get in the way of life. A curve (tests every 2 hours) on your next free day should give you some good information - especially if the preshot is too low to shoot. It would be nice to know how long it tends (although you can't count on the same cycle every time)to last in Milo. And when he has a nadir and how low it tends to be.

I suppose you might think of it as being more like Lantus, Elizabeth. It would be hard to know if it is just a longer lasting insulin or whether it truly has a shed like Lantus does. And I don't know how it would react to shooting doses into low numbers as the protocol suggests with Lantus. Tight regulation Lantus users do not reduce the dose until they get a 40 nadir, regardlesss of the preshot numbers. I don't know how that would work with this kind of PZI.
 
Dr Schrodinger said:
...Yes, I was hoping its long duration might be a blessing, but it might also prove to be a somewhat poisoned chalice!

Nooo, Juliet! The long duration of Hypurin really CAN be a blessing! When it works well it works really, really, really well!
It can level out erratic numbers and give lovely 'flat-bottomed' curves. But - assuming that it does have a longer than 12 hour duration in Milo (and we don't know that for sure yet....) it will just mean finding a dose that can be shot 12 hourly; or, if that's not possible, then it may mean learning to make small dose adjustments if the preshot numbers remain variable (a version of a sliding scale, maybe).

Remember, with Caninsulin, Milo only had insulin in his system for about 8 hours out of every 12. With Hypurin - even if the overlap is pretty small, it can be possible to have insulin working in your cat all (or most) of the time. That will be an enormous benefit!

Have a little faith, Juliet! ;-)
 
Nooooooooooo! I didn't mean to be so negative! I meant logistically speaking, whilst trying to get him regulated, it is a bit of a palavah/palaver/pavlova! From Milo's point of view, it is sooo much better!

I had a bit of a flap last night. I thought I had given him a fur shot again. I hadn't in the end, but I had to be 'talked down' and given a bit of perspective. ohmygod_smile

Last night's PMPS was lower than has been recently, and this morning's AMPS he was 11.8 (212). Rather than the full 1.5U shot, I gave him 0.5U to see him through the day. He has plenty food in his bowls & should be OK. He was very inquisitive & chirrupy this morning! :-D
 
Yes, yes, YES!

He had a gooood day yesterday! ;-)

Shame he was so high this morning. He made a bid for freedom when I was injecting him last night, so I'm not sure how much of the dose was actually delivered. :YMSIGH:

He was a bit on the high side in comparison this morning. I'm going to start trying a 1.5U shot in the morning (numbers permitting) and a 1U shot in the evening & see how that goes. I'm hoping it'll keep him mellow, but allow me to shoot him before I go to work.

Eliz - with Bert, do you vary his dose depending on his PS numbers?

J
 
Dr Schrodinger said:
Yes, yes, YES!

Eliz - with Bert, do you vary his dose depending on his PS numbers?

J

Yep, we use a 'sliding scale'. That has worked well for Bert because his preshot numbers can be quite variable (though they've levelled out a lot over time). Fixed dosage didn't work for us because the same dose could very often be way too much or nowhere near enough. But for some cats fixed dosage works well. And there is a school of thought that a fixed dose should be tried for a certain length of time and the cat will sort of settle into it (and the fixed dose can then be raised or lowered as needed). That is certainly my own vet's view. He still doesn't know I use a sliding scale... And I hope he never reads this; it feels like a guilty secret! :oops:

Quite a few PZI users use some form of sliding scale. How it is worked out depends entirely on how the individual cat responds to insulin. And that response may change over time too. Bert's scale used to be between 1 unit and 4.5 units. When we switched to Hypurin his numbers started to level out a lot, and his scale is now typically between .75 of a unit and 1.25 units.

With longer lasting insulins like Hypurin the duration itself can also play a part because the doses can overlap. A low dose given after a higher dose may have extra 'wellie' because of the boost from the previous dose (some of which is still in the system). A higher dose following a low dose may have less effect than expected because the lower dose has run out of steam (loss of overlap). Your 'yellow day' yesterday might be an example of the latter. The PM dose held the numbers for a while, but couldn't really drop them.

This sounds like we ought to be able to factor in the effects of previous doses, and adjust the dose accordingly, but...in my experience with my own cat that isn't as easy as it sounds... There can are so many other variables involved in determining how much a cat's BG drops, or doesn't... But it is always worth knowing that the previous dose can have an effect. It helps enormously when trying to make sense of patterns in BG numbers.

Edited to add;
I thought the dose adjustments you tried yesterday were very sound choices. :smile:
 
Hi Juliet,

Just looked at Milo's chart and see that the pesky little wotsit (bless 'im!) is still trying to get away from you during shots. That must be SO frustrating for you... :YMSIGH:

What exactly is it that Milo dislikes so much about the shots? Can you talk us through your routine? Maybe someone can offer some suggestions.

Edited to add:
My own most common mistake when giving shots was not to pull the skin up far enough away from the flesh/bone underneath. And quite a few times in the early days I think I hit a muscle with the syringe and Bertie was not a happy bunny about that at all. Clearly, that hurt him, and he was extremely wary when it was time for his next shot. You need to pull the skin waaaay up. Then the shot shouldn't hurt at all...hopefully...

Are you giving Milo the shot while he's eating? (I rely on a spoonful of Bert's favourite food to keep him engrossed while he gets the shot.)

Sometimes cold insulin can sting. You can warm the insulin ever so slightly by rolling the filled part of the syringe in your fingers for a few seconds just to take the chill off.

Are you stressed about giving the shot? Cats pick up on our own emotions. And if we're relaxed (or even pretending to be relaxed ;-) ) then they are inclined to relax more too.
 
Thanks Eliz.
Yes, he is picking up on my angst & we haven't managed a regular routine.
There's a lot happening at the moment (work, family & other stuff), and trying to give a wary cat a jab in a hurry when your brain is elsewhere is a mistake.
As soon as the needle touches him, he squeaks & jerks. I always make sure that I have pulled the skin away from his body to the extent that my finger & thumb almost meet behind the skin fold. His skin is paper thin at the moment, which probably doesn't help either.
Stressed Mum = stressed kitty.
As soon as I start scruffing him he knows what's coming, whether he has his face in a bowl of meat or not. It is very frustrating. I relaxed a bit this evening & popped him on the back of the sofa under his favourite nice warm light. He still squeaked & struggled, but immediately started purring again. I think for both of us the idea of injection time is actually worse than the reality, but at the moment, it is just becoming more & more of a traumatic experience for both of us.
 
(((Juliet))),

My heart goes out to you. I know this feline diabetes stuff can be hard, especially when we take into account all the other stuff that life throws at us, and all the demands that life makes upon us...

I know that you are doing everything in your power to help Milo.

But maybe 'a squeak and a struggle' is the price that Milo has to pay in order for you to give him 'life-saving' and 'life-enhancing' insulin...

Maybe I need to send Bertie over your way and sort that Milo out! ;-)

Sending positive vibes your way. I SO want this to be easier for you...
xxx
 
Elizabeth and Bertie said:
(((Juliet))),

But maybe 'a squeak and a struggle' is the price that Milo has to pay in order for you to give him 'life-saving' and 'life-enhancing' insulin...

Maybe I need to send Bertie over your way and sort that Milo out! ;-)

Thank you. It's much appreciated. I don't want to have to physically restrain him twice a day. After all, it is quality of life that we are after, but if I have to pin him down to needle him (see what I did there?! :roll: ), I will.

Bertie would scare him out of his wits! Maybe that's the next approach to try....!!

J
xxx
 
Just looked at Milo's chart, Juliet, and also your comments. I think you're probably right about the high preshot number this morning being a little bounce from last night. I'm guessing he dropped into blue numbers and he doesn't seem comfortable with those yet. His body will learn to like them though!
 
Juliet, - just had another look at Milo's chart...

OK, it's been a challenging day. They happen. I really do know how frustrating this is. Bertie was an incredibly difficult case initally. And I often felt cross with myself for not dealing with things better, and cross with Bert for presenting me with a problem that - try as I might - I just could not seem to resolve...

Today was just one day though; very little in the scheme of things. Tomorrow is another event entirely and things may be entirely different.

Get some good sleep, Juliet. And be kind to yourself...
 
Thanks Eliz!
He's such a forgiving cat. I am so lucky!
I walked out of the room after last night's attempt & was upset. The little chap followed me downstairs to the sofa, jumped up all purry & started head-butting my hand for strokes & tickle.
I tested him 2 hours later & his BG had dropped 30%, so some insulin obviously got in somehow. I dunno how, but it did!

This morning was much calmer. He was lying down on the spare bed having had brekkie. I showed him the syringe & gave him a full body massage (why don't we get these everyday?). Then scruffed him like his mother with my left hand, pulled the scruff towards me & quickly inserted the needle whilst holding the syringe like a dart & pushed the plunger with my index finger. Over in a flash. He stopped purring but at least there were no squeaks or struggles & then had another full body massage to bring back the purrs. Hopefully it all went in through the fuzz! I'm off-sick today so will do some more tests.

I spent an hour or so last night looking at different injection techniques. I never knew there were so many! I think my technique has just been far too hesitant for fear of hurting him.... and that has simply achieved what I have desperately been trying to avoid :oops: . I've also tried to be sneaky & surreptitious about it - he senses my anxiety & braces himself to make a bolt for it. The key is to be relaxed & open, and be swift with the actual needle - something that has obviously been evading me cos I've been so scared of hurting him.

As you say, it's only one day in the grand scheme of things & this day has started off more positively than yesterday.

I really appreciate your support, and I'm sure Milo does too!
 
Actually, Juliet, that was a nice looking smile curve today! He seems to be getting more used to the blues. Of course, we'd like the preshots a little lower, but that will come. When you get discouraged, be sure to look back at all those blacks with the Canninsulin. His numbers are getting to look so much better. You both are doing great!
 
Preshot numbers in pink I don't mind too much, it's the reds & the blacks that aren't good, and they are fewer & further between on his new Moo Juice.

I weighed him last night. And I weighed Lola. On the 5th January, 26 days ago, he weighed 3.67kg. :cry: Last night, according to my crappy fishing scales, he weighed 4.1kg!! flip_cat

I didn't believe them. So I recalibrated them with bags of flour & weighed Lola. In November, she was 6.4 kg. She's now 5.4kg!!! Weeeeeeee! I recalibrated them again, just to make sure & weighed Milo. Yup, another 4.1kg score........

:mrgreen: :mrgreen: :lol: :razz: :mrgreen:

The Vet Nurse phoned yesterday to check up on him too. I'm going to take him in for a check up on Valentine's Day. How romantic. They want to do a fructosamine, but I think I'll just give them a print out of my spreadsheet instead.

Yay for Moo Juice!!
 
Wow, great news all round, Juliet!
Weight loss for Lola, weight gain for Milo, and improving numbers for him too! dancing_cat

Re the fructosamine; no, you don't need it. It'll give an average of glucose levels over the preceeding couple of weeks, and why would you need that when you know what Milo's BG is doing on a day to day basis. :smile:

Excellent stuff!
 
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