Mowgli is here! Advice needed!

Hi Everyone,

For a little history on this case: vet started Mowgli on 5u 2x/day; eating kibble DM... Had to move him out west with me to avoid euthanasia... after chatting with the forum concluded that upon his arrival we would change the dose to 1u 2x/day and that we would wait to change his diet until he settles into his new home. Now the questions begin:

After a long day of waiting, Mowgli has finally arrived. When he had arrived I was very surprised at how thin he was , how elderly he was looking, and I’m concerned he may be having nerve issues with his front paws... he’s walking with the second joint flat in the front... which sounds like neuropathy to me... Does anyone have any advice on how to deal with this? I’m pretty concerned about it...

Additionally, he didn’t have a shot this morning or much to eat since he had a full day of flying. I tested his blood sugar at 9:30pm or so and got 19.5mmol/L, he still wouldn’t eat much but I gave him 1u of caninsulin anyway around 10:00pm.

I was planning to set him up on a 6am - 6pm insulin schedule because I have to work. Since he had his last shot at 10pm... do you think it would be best to skip tomorrow mornings dose althogether and get back on track at 6pm? I still plan to do an am BG reading.

Also... what amount of food should he consume before you consider it enough to administer insulin?

First night as a sugarcat caregiver and so many questions / concerns

 

I am sure it seems overwhelming at the moment. But Mowgli is safely with you so that is the main thing.
Yes that does sound like neuropathy in his front legs. It will improve in time when the BSLs improve but you can buy some Zobaline which is especially for cats and it does help. Here is the link
https://www.amazon.com/d/Multivitamins-Prenatal-Vitamins/ZobalineTM-Diabetic-Cats-60-tabs/B008G3LI2M

With caninsulin you need to make sure kitty has eaten a good amount as it is a fairly quick acting insulin so you need to have food aboard to counteract the insulin. So I would make sure he has eaten at least 3/4 of his allocated amount.....maybe others can be more specific as I don't use caninsulin.

With when to give the insulin. .......If you want to skip, you need to make sure he doesn't have any ketones as skipping will make them worse. To test for ketones you need to buy some Ketostix from Walmart or a pharmacy and test the urine.
Do you have to work in the next few days? The other option is to go backwards 15 minutes each shot until you get to the right time.

He will be thin because unregulated diabetic cats cannnot utilise the nutrients properly in the food. I would feed him as much as he wants at this point because he is thin and needs to put on weight. My Sheba got very thin at diagnosis as well but she eventually put the weight back on.

I would test a few hours after the insulin tonight to see how low the insulin takes him.
Ask all the questions you like.
Bron

 

Here are your other two threads for continuity
http://www.felinediabetes.com/FDMB/threads/where-to-start.212134/
http://www.felinediabetes.com/FDMB/threads/looking-to-air-concerns-and-receive-advice.212095/

 

While backing up in 15 minute increments is used with the longer lasting depot insulins, Vetsulin is an in and out insulin and often doesn't last a full 12 hours so as long as your pre-shot reading is high enough to give insulin (over 11 mmol or 200 US), you can shoot up to an hour early. In this particular situation, skipping the AM shot is probably the quickest way to get back to your preferred time but if you get home from work before 6pm, you could shoot earlier Thursday when you get home and then Friday morning get onto your preferred schedule.

With Caninsulin, you should feed Mowgli and wait 20 to 30 minutes to allow the food to start getting into his system before shooting insulin. As Bron mentioned, Caninsulin starts working quickly so it's important to be sure kitty has food on board and doesn't do a scarf and barf before administering the shot.

In case you were told by the vet to feed Mowgli only twice daily at shot time........forget that advice. Our kitties do much better with multiple meals and they will help Mowgli gain back some weight. As Bron said, don't be afraid to feed more than you think he would normally need. He needs the extra calories right now. Probably wasn't eating well yesterday as a result of all the turmoil of the travel and a totally new environment. Hopefully his appetite will pick up today. Just keep an eye on it.

When you do pre-shot testing, it should be done at least 2 hours after food so you are getting a "fasting" BG without any food influence. You may want to consider a timed feeder that you can program to roll to an empty dish 2 hours before pre-shot test time particularly at night when you don't want to be getting up early just to remove a food dish. Many folks here use the PetSafe5 feeder.

It would be helpful if you could put "skip" in the AM dose box for the 20th/21st, a notation about travel/delayed PM shot across the 20th row just so anyone helping won't be questioning the dosing.

 

Hey.

So I use canininsulin, I'm new to this so can give no advice on dosing. However looking at what tests you have in, I would strongly advise a Nadir (lowest blood glucose point) measurement..
Canininsulin tends to work fast, fairly hard, and many cats don't get a full twelve hours on it. From the later test times it looks like they were measuring his Nadir quite late. I'd try for a couple of days to get at least a +4. Preferably a +2 a +4 and a +6 to figure out when the lowest point is.

If you check my two ss in signature you can see the difference between vets dosing not checking Nadir and my dosing based on what I learnt here. My Kraken is still being regulated but she spending a lot more time under the renal threshold. All of my dosing decisions are based on her BG numbers, vets seemed to be more of a guess.

If you have a day where you can be home for 12 hours between shots í would advise doing a curve as soon as you can. It tells you so much about how they are processing the insulin

I ended up cutting Krakens insulin dose by 70% or so..

 

@MrWorfMen's Mom thank you for clarifying about Vetsulin and being able to shoot earlier than the 12 hours. I have only used the longer lasting insulins. I hope I haven’t confused Amanda.

 

Last night Mowgli ate 1/2cup of food and a few kibbles when I fed him this morning. I waited 0.5hrs and then ended up giving him 1u since his BG was 19.8mmol/L

I’m kind of struggling with the strategy behind free feeding him, I’m worried that if he eats well during the day that he won’t eat for me before his dose. Or that if I leave food out for him I wont know when or how much he ate. If I leave a half cup out for him today and it’s gone when I get home will I be able to assume he has enough “food on board” for a shot in the evening? It’s tough because I can’t monitor him during the day.

I’ll look into a timed feeder but I’m still kind of worried that he won’t be hungry when he needs his shot. Does this forum recommend force feeding at all? My vet had mentioned sometimes they force feed with wet food if the cat won’t eat before a shot.

Instead of feeding 1/2cup all at once should I do 1/4 *4 / day? I’m really just used to leaving a pile of cat food out and topping up when needed so I don’t really have experience with portioning.

Hopefully I didn’t do any damage administering insulin within a 7hr window instead of 12.

@Kitty Anderson On curves: I will be off Friday to Sunday this week so I will try to do some curves and get mowgli on more of a mix of a free feeding / timed feeding strategy as well as try and get a grip on how he is processing the insulin during the day.

@Bron and Sheba tonight I will take a couple additional readings after his evening shot. Also that Zobaline doesn’t ship to Canada, unfortunately. Do you think any methyl B12 supplement could work? @MrWorfMen's Mom any advice on where to get Methyl B12? I will say even after eating he seemed to be a little less flat footed this morning but I can tell the poor boy is having mobility issues. Sin.

I’m a little more overwhelmed than I thought. Who knew that feeding schedules might be one of my larger stresses? I hope Mowglis Neuropathy clears quickly, I’m so shocked at how much more hurtin’ he seems than the last time I saw him.

 

Just a short answer as I don't have too much time atm and haven't read the full thread so apologies if I have misunderstood, but... ref your query about giving insulin within a seven-hour window instead of 12 - be careful with this. Caninsulin is meant to be given bid (twice a day) at evenly-spaced intervals, ie every 12 hours. Giving another dose after seven hours is not normally a good idea because there is quite possibly some insulin from the first dose in the kitty's system at +7 and we don't want him going too low. Caninsulin is a fast-acfing insulin and doesn't usually last the full 12 hours in cats, but +7 would normally be considered pretty early. On a highish bg and a lowish dose, you may be fine, but be aware!

There are some experienced owners who give insulin more frequently than every 12 hours - usually every eight hours - if the dose isn't lasting long enough. But that can be difficult to do and isn't really part of the plan atm.

 

If you get a timed feeder, the problem goes away. You can leave food out until the time you want to remove it prior to shot. As for eating, most kitties who are not regulated will willingly eat anything you put in front of them anytime so I doubt that getting him to eat will be a problem. Picking up the food ahead of shot time and knowing when he last ate without a timed feeder or being home to monitor is a problem you have no control over right now and you'll just have to work it best you can. Sorting out feeding can be a bit of a pain in the early days. This too will get easier.

I think I'd suggest leaving out 1/4 cup dry during the day and 1/4 cup during the night for now. I take it Mowgli is getting the wet food at proper meal times (before shots) only.

On the shot front, I hope nothing we said about shot times caused any confusion. At most as mentioned by Diana, there are a limited number of folks who sometimes shoot every 8 hours but that requires a lot of monitoring and obviously is a lot more intrusive on your life. There is no reason to think Mowgli needs shots any more than every 12 hours right now. You can shoot at +11 but I wouldn't recommend shooting any earlier at least until you get more data to see how he reacts to the lower dose.

I'm a bit confused by your statement

You indicated you gave him a shot at 10pm last night. If you shot at 6 am, your indicated preferred shot time, that would still be 8 hours post the shot last night. Did you shoot earlier than 6am?

Zobaline (B12 supplement for neuropathy) is available online but shipping seemed to be expensive through their website. There is some info here from another CDN member and how she got it. http://www.felinediabetes.com/FDMB/threads/where-to-buy-zobaline-in-canada.142504/

 

@MrWorfMen's Mom No wonder you're confused, that is my bad math... I gave him food at 6 and shot 1u at 6:30 am... he had eaten 1/2 cup of kibble PVD DM over those 8.5 hours (b/w 10p & 6a) and a few bites of the 1/2 cup I had left out for him for today (@6am). So the 1u dosage I gave him this morning would have been at at +8.5hrs (6:30am).

To be clear, I do not currently have wet food for him. I was intending to wait until he's all settled into his new environment until introducing any new food. Also, thanks for the link for canadian Methyl B12.

@Diana&Tom This was definitely a one time thing (additional shot was actually at +8.5hrs not +7, as I had previously miscalculated) Now that I have Mowgli on a schedule I will maintain the 12hr window. I don't plan to play the expert at all I just want to get him on a schedule ASAP, if you get a chance to take a look at his SS the vet had him on a super chaotic dosage schedule so I want to put an end to that immediately.

@Bron and Sheba I think I will get some Ketostix... although there was nothing in Mowgli's lab work that suggested the presence of Ketones.. I am a little more nervous now that I have him in person and he's showing signs of neuropathy that the vet hadn't reported to me (he boarded there for 2 weeks before coming here) so I'm struggling with trust of their reports right now.

Additional question: the vet had Mowgli on 5u caninsulin bid, but as per the advice from the forum I am trying him on 1u bid. Should I change my signature to such even though it wasnt a vet presciption?

Also... I hit a VEIN in Mowgli when testing this morning... SO MUCH BLOOD. what a sin, poor boy.

 

Ok so shooting at +8.5 isn't quite as early as +7 and I appreciate that it's easy to miscalculate! - just be extra careful when quoting numbers of any kind here, as even a small variation might make a difference to the advice given. In a nutshell, FD is all about numbers!

 

Poor Mowgli and poor you. We've all hit the vein even with experience under our belts so give yourself a pat on the back for getting testing down this quickly and don't worry....Mowgli will forgive you. I did that one day while testing just before leaving the house and my girl decided to toss her head. I had a totally white outfit on which ended up with blood spatters from top to bottom. Needless to say I was a little late arriving at my destination!

Re: the food......my misunderstanding. I guess I assumed the vet might gave been feeding both dry and wet. My bad. And yes definitely let Mowgli get settled before making any food changes. Lots of changes for him right now so best not to rock his world too much all at once.

The vet may not have mentioned the neuropathy because it isn't something they will give you medication for. I'd suggest you ask the vet to send you copies of their records so you'll know what they ran in the way of labwork and have them for future reference. You will no doubt be taking Mowgli to your own vet at some point and they would find any history helpful too. Those records belong with Mowgli so there should be no problem getting them sent to you.

You really don't need the dose of insulin in your signature at all. It will likely change before you find the best dose for Mowgli. That information is on your spreadsheet and anyone helping with dosing will be checking for information there anyway. I'd just remove it from your signature now that we have dealt with the high dose issue.

 

@Diana&Tom For sure, It was a late night and an early morning for me! I will be more careful next time, and I would say that I will get a better mind for the math as I gain experience using the sheets / administering the meds. I appreciate the feedback though

 

OMG I almost spit out my coffee I laughed at that so hard... I think I will be finding blood spatters around the bathroom for a while to come

I have to say... Mowgli doesn't seem to mind getting his shots or blood tests... the tough part is keeping him still. He's such a good and handsome man.

I was wondering guys... I'm having trouble with the motion of the small drawback of the plunger before the shot of insulin...I'm so awkward with everything

 

Oh don't worry about drawing back. Just insert needle, push plunger and withdraw needle. It's nearly impossible to draw back with our less than statuesque fur kids unless someone is holding them. I know some vets still tell you to do so (it's old school) but you are not injecting into an area where you are going to hit any major blood vessel. Worse case scenario, you knick a capillary which doesn't matter.

 

Try sliding the plunger up and down a couple of times before you draw up the insulin. There is a bit of lubricant in the syringe, this will help spread it around, making it easier to calibrate the correct dose.

 

I think you are doing really well. The first few weeks are overwhelming as you learn about FD and you have had the shock of seeing Mowgli arrive thin and with neuropathy. A lot of cats get like that but as it happens gradually it is not such a shock. With your care he will put on weight and the neuropathy will eventually go. Sheba had neuropathy and she couldn’t jump up at all, her back legs would slip sideways if she stood still and she would have to sit down every so often before walking again. Walking up stairs was very slow and hard to watch. I remember how excited I was when she jumped up on the bed again one day. She eventually regained all her normal abilities and regained her weight and muscle mass. You need to take a before and after photo of him and you will be able to see how far you have come with him.
When you get midcycle tests can you update the SS so we can see the results please We look at the SS a lot as they give us so much information. There is a remarks column on the right side of the SS. Add information there as its good information for us and good reference for you to look back on. Put in such things as food type and intake, appetite, any issues such as bowels, nausea, if you were early/late with insulin and why, ketones test results and weight.
I never drew back to inject the insulin either.
Mowgli is a lucky boy having you to care for him.

 

Thanks @Bron and Sheba it means a lot that you’re sharing Sheba’s story with me. It puts my heart at ease to hear mowgli could improve. I had good news for Mowgli today. I wasn’t going to be able to get him into the vet here in town until April 8th but there was a cancellation so I’m going to get him into the vet tomorrow... I’m relieved.

Tonight when I gave mowgli his shot, I was not sure if I made it in or if I deposited on the skin. There was a little moisture on his fur. I took BG again at +2 and it was 23.4mmol/L. In this case do still act as if I gave him a shot and not give him another? Or since his BG increased should I give him another one ? If I don’t hear back I will just wait until the morning.

Any advice on questions to ask the new vet? I have all of Mowglis paperwork from the previous vet and have typed some of the results into the spreadsheet.

@MrWorfMen's Mom & @Erin & Scott thanks for the shooting advice. I’m hoping to get some more tips from the vet tomorrow.

 

Good question. Don’t EVER give the shot again if you think you have given a fur shot. It is impossible to tell if you got some insulin in, none in or all in so we recommend never giving it twice. Too risky. A fur shot happens to us all at one time or another so don’t worry about it.
Re the vet...
I would ask about swapping over to Lantus insulin. It is a long acting insulin and very suitable for cats. It has a slower onset which means you don’t need to make sure kitty eats everything before the shot and the duration is longer which means kitty is in higher numbers less often than with caninsulin.
I would tell the vet you are home testing. It will be interesting to hear his comments on that. Some vets are happy for you to test. Others are against it.
You need to make sure the vet is willing to work WITH you in partnership to get Mowgli back to good health. We have found a lot of vets do not know a lot about feline diabetes and have not kept up with current treatments. They have a lot of different animals and diseases to get their head around so it is understandable.
If they suggest giving Mowgli a prescription diet, I would decline the offer. It is expensive and no better than food brought from the pet store.... and often higher in carbs.
It sounds like you are getting a really good idea of how it all works. It takes time.
Good luck with the new vet. Let us know how you get on
Bron

 

So. I met with the new vet today. He agreed that due to my work schedule lantus will be the better insulin option for mowgli since he isn’t always hungry early in the morning and I can’t be home to monitor him. He wrote me a prescription and we will start it tomorrow morning. He also said that due to Mowglis high BG we should really be giving 2u of caninsulin at the least BID. Mowglis BG was 15mmol/L before the appointment so the vet asked me to test when I got home and if it was over 10mmol/L to give him an additional unit.

I gave Mowgli an additional unit but I’m more sure that I made a fur shot than last time. The vet told me that I should test BG again at 6 and admin 1u more for the night before we switch to lantus tomorrow. My suspicions of fur shot were verified with a reading around 19mmol @+6

Because I am beginning the Lantus prescription tomorrow I will be abandoning my attempt at a blood curve today ( sorry for all the poking mowgli!)

Mowgli will be on 1u BID of Lantus. He was prescribed the pens with long needles. Any advice on the best way to use them? The vet wasn’t very clear and he said you just jab them in!

I’m relieved the Vet is pro blood testing... he asked me how long I had been diabetic based on the questions I asked, I just said I had been doing a lot of online research referencing felinediabetes.com which he had heard of!

The vet did recommend to stay on DM food but he mentioned it would be helpful to add in a wet food component.

The vet reviewed all of the paperwork from the previous vet and he said that Mowgli was looking in really great shape so that was a relief. On Neuropathy he echoed what @Bron and Sheba said earlier that once the diabetes was on control he would get back to his old self.

One situation that I’m in now though is that I have a LOT of extra insulin. The Nova Scotia vet prescribed another vial for mowgli in case we ran out and I wasn’t able to get to a vet out here. SO: does anyone know what I can do with an untouched caninsulin vial? Can it be returned for a refund if the seals aren’t touched? Are there donation programs I can look into? Ditto for the U40 needles.

I would say tomorrow I will do a curve... thoughts?

The vet had mentioned that I should do a fructosamine curve in 3 weeks... is that sound advice?

Again. Thanks for all the advice. I’m so glad I will be using an insulin that I don’t have to worry as much about how much mowgli eats in the early morning and is less prone to Hypo.

 

Great news! I think Mowgli will do much better on the Lantus. He seems to be having a very early nadir on the Caninsulin and a lot of bouncing. Lantus should give him a smoother curve.

The vet may be right that Mowgli will need that much insulin but given how much he was on, it will take a few days on a lower dose to see how effective it really is. A common issue with vets. They react to the numbers and don't take other potential causes for the high numbers into consideration i.e too much insulin can look exactly the same as too little. We see a lot of overdosing from this.

So if understand correctly, you gave Mowgli 1u this morning, another unit at 6 (I take that to mean 6 hours after initial shot?) and he wants you to give another unit tonight, which I take it would be before 12 hours past the second shot? If that is correct, how long after second shot would you be shooting the third dose?

Now that is even more interesting. If he was so sure Mowgli needed 2u of Caninsulin BID, why did he drop the Lantus to 1u BID? (rhetorical question.....HMMMM!) 1u is a good starting point for the Lantus.
We don't recommend use of the pen as it only allow for dose adjustments in full units. We adjust doses in increments of 0.25u, another thing most vets don't even know is possible. We use U100 syringes 3/10 ml, 31 gauge, 5/16th inch, with half unit markings. The pen cap can be removed and the cartridge inside is used similar to a vial but without the need to inject air into it. Simply insert needle and draw up dose. You can use the pen needles for the 1u dose now though. I have no experience with the pen but there may be videos available on You tube or the Lantus site to get more information.

You obviously impressed the daylights out of him which is great! You've got his respect now and that will work wonders toward a partnership rather than a dictatorship.

The DM is no better (perhaps not as good) as a lot of retail brands. It is however a lot more expensive and available only through the vet. Vets get their nutritional training from the big brand pet food makers and get brain washed into thinking their so called "prescription diets" are good stuff. The DM pate is Ok but many cats get sick of it very quickly. The DM Savory Select wet food is too high in carbs as is the dry.

You have a few options. You can post the Caninsulin in the Supply closet on this board HERE and see if anyone is interested in purchasing it or taking a donation of it or you could contact DCIN (Diabetic Cats in Need) and offer it to them. They supply folks who for financial reasons need help for equipment and insulin to keep their kitties healthy. There may be a rescue group in your area that would gladly take the unopened vial.

I don't think a curve is going to tell you anything you don't already know right now. As for the fructosamine test (its a blood test) you may find it helpful since you can't monitor mid cycle through the week which limits your testing but if you can do more testing on the weekends, the fructosamine may or may not be worth while. I had one done that told me my cat was under good control when my daily testing clearly showed she was no where near Good control levels so I admit to being a major skeptic of the test. It also gives an average over a 2 or 3 week period so any high/prolonged bounces or a number of low readings through the period covered can skew the results. The test doesn't tell you how low a dose is taking BG and therefore isn't a good tool for determining dose adjustments.

 

I agree with all @MrWorfMen's Mom has said.
It sounds like your new Vet is pretty good on the whole. I'm glad he is onside with home testing. And really good he swapped Mowgli over to Lantus.
I don't think it is necessary to get a fructosamine test done if you are home testing. You are getting much more detailed testing with the home tests and the SS is a wonderful way to see how Mowgli is progressing with Lantus.

 

@MrWorfMen's Mom, @Bron and Sheba I did decide on the pens for now, if it turns out I need to increase dosage I will look into getting the U 100 syringes or use the conversion provided in the forum to use my U40 syringes since I have so many now.

My sister is going to try to return the Caninsulin to the vet when she gets back to Nova Scotia. If they can’t give a refund, I asked her to request that they donate it to a pet family in need.

On the dosing of caninsulin. The vet mentioned that it’s administered by weight, maybe lantus has a different weight formula than caninsulin. I can say though, that I pointed out that the caninsulin website throws a caveat out there that 2u should not be exceeded in the first 2-3 weeks which is exactly what everyone here has been telling me.

Today I’m doing a bit of a BG curve just so that I can understand what Mowgli reacts like to the Lantus. Because I’ve had visitors I couldn’t get a reading at +2 but at +3 he was higher than this morning by 0.8mmol/L which could maybe just be the accuracy of the BG monitor.

I have to say, I don’t think it’s in my head, but Mowgli already seems to be looking healthier; his fur is nicer and he even ran a few steps today, which was hilarious since he has neuropathy paws! I also notice that he’s less ambivalent when I’m trying to get a blood sample... showing he’s gotten a little of his attitude back- his BG is still really high though.

Since he seems to be settling in, I think I’ll start cutting his dry food with some wet food.

Thanks a lot to everyone who has been responding to this thread you’ve really helped me along in these first couple days. I feel a lot better about Mowgli and his health and your support played a big part in it.

 

So glad we could help and that you are already seeing an improvement in Mowgli. Those observations are just as important and meaningful as any BG readings you get.

The slight increase in BG at +3 could just be a food bump that still hasn't completely dissipated.

The first little while can be a bit trying for everyone and you've had more to contend with than most of us but you are dealing with it like a pro! Take the food switch slowly and whenever possible, check Mowgli's BG mid cycle because a switch to low carb wet food from dry can have a significant effect on BG for some cats. Yes his numbers are high right now but they may come down just from the food switch so a little extra caution if considering dose increases is in order until the switch is complete.

We do NOT recommend that practice at all. I'd be very careful doing that as the risk of overdosing Mowgli is much higher when using U40 syringes with U100 insulin. It's up to you but it does add an extra safety issue to the process.

 

Noted! Thanks for the intervention

 

My vet just called me to follow up and see how Mowgli was getting along.. I think you're right that "on the whole" he's pretty good... definitely gave me a little more confidence in him.

 

My vet just called to follow up... based on Mowgli's data he suggested that I increase my dosage to 1.5u BID... I was like... how can I with pen? he was like... oh yeah! and encouraged me to stay at 1u for now until we have a better data set.

To clarify: are you saying I can use a U100 syringe and treat my pen as a vial? based on Mowgli's up coming days I may be interested in this method (if that was what you were saying)

PS: as I mentioned to @Bron and Sheba I am encouraged that my vet took the initiative to call and follow up... that is not my typical experience with vets... I like it

 

Yes, you absolutely can do this. This is the cartridge that sits inside the pen. Remove the pen cap and pen needle and you'll see this grey rubber seal. That's where you insert the syringe needle.

 

Thanks! It's good to know that option exists!

 

BTW - did you know that you can buy Lantus over the counter in Canada?

 

Whuuuuuuuuuut!?

I did NOT know! Wow. That’s so great!!

 

Yes indeed! A 5 pack of the cartridges will cost around $110 to $120 depending on the pharmacy you buy from. That's enough insulin to last almost a year for most kitties. The unopened cartridges are good until the package expiry date (usually about two years ahead) if kept properly refrigerated.