New Member - Dosing, Switching insulin, ?Resistance

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lily's mom Ellen, May 22, 2020.

  1. Lily's mom Ellen

    Lily's mom Ellen Member

    Joined:
    Jul 10, 2019
    Hi everyone,

    Please forgive me in advance for a very long first post! It's partly Lily's history and partly my long-overdue venting.

    Lily will be 14 next month. She was diagnosed with FD over 1 year ago while we were living out of state (NY). I originally brought her in because of her worsening hind legs -- wobbly, walking on her heels, etc. Our vet in CA had thought the weakness was arthritis, but as time went on, the problem got worse. The NY vet did bloodwork and determined she was diabetic w/neuropathy. Started her on ProZinc SLGS and she leveled off after several months at about 7 units q12h. I gave her methylcobalamin and while it took a long time, her hind legs eventually improved.


    After returning to California (YAY!) in October, I took her our CA vet and saw a partner who scolded me for "falling for marketing" (?!?!) by feeding her low carb/high protein food liike TikiCat and for not using AlphaTrak glucometer -- UGH. This doc seemed to think she was well-regulated at the time but wanted me to put her on m/d or d/m food, which I reluctantly tried. Since then, her BGs were getting steadily higher. I bought a new bottle of ProZinc thinking the one I had may have been compromised in my tiny fridge. No change, so I increase her from 7 to 8 units. Mild improvement but not to my liking. (I know my testing protocols leave a lot to be desired -- I'm working on that!)


    On May 7th I brought Lily back to my regular vet to see about getting her regulated, if I needed to switch insulin products and to look at a soft lump on her ankle. This was during pandemic protocols so I had to wait in the car outside while the vet did the exam. Afterwards, vet started talking about insulin resistance, acromegaly, dental plaque, thyroid problems, vascular tumors (on her ankle), GI sonograms... I can't afford the testing and tx for Acro so we just went with new insulin -- Lantus, starting at 1 unit q12h, and I succumbed to vet pressure and got the AlphaTrak after a year w/ReliOn Prime. (I got some help from my dtr paying for the exam, labs and insulin, thank goodness.) Six days since starting Lantus and Lily's numbers are higher than they were before. Vet said not to increase for a week and said she had consulted an IM specialist on the starting protocol but I'm upset about the tiny dose.
    I’ll save my food questions for a separate post. We are on LC FF for the most part.
    May 7 labs: (T4 WNL, ketones neg., fructosamine 436.)

    What should we do? Is this really insulin resistance? Lily's NEVER been hypo to my knowledge, but I am prepared with a kit.

    Is "pre shot" meant to be pre- or post-prandial (eating)? She's way too stressed before eating to get BG. I She gets her shot <5-20 min after breakfast/dinner.

    Should there really be a line in the SS for every day, even if I don't test that day?

    I apologize again for this being long. Life has been extremely challenging and complicated for all of us. Thanks for any advice and support. Thank you also to @@Marje and Gracie for help getting started.
     
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  2. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

    Joined:
    Dec 21, 2019
    Welcome Ellen and Lily!

    I’ll let others more experienced with prozync talk about the transition. I use Lantus and I know we recommend starting with 1 unit, but I’m not sure if the same applies when switching insulin.

    Pre shot test does mean testing before the shot and the food because food can and will raise the BG levels so you may get a number that is safe to shoot at only because of the food interference and kitty could go lower than it’s safe then.

    yes there should be a line in the ss for each day so members are not confused thinking you didn’t give her insulin on those days. Also, if you ever need to skip a dose you should put “0” under the dose column.

    I don’t think your tag worked for @Marje and Gracie so here you go :)

    You’ve come to the right place and you’ll get all the help you need here and then some!! :bighug:
     
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  3. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

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    Dec 21, 2019
    I just had a thought and again, I’ll defer to others but do you think you could test her immediately after she eats? That would mean the food wouldn’t have had time to be absorbed and to raise the BG levels. If you can get that done within 5 minutes or so of her eating it should be okay. What do others think?
     
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  4. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Yes, I've tried that a few times and it's definitely doable. If it's acceptable data-wise, I'd need to indicate that somewhere on the SS. We are early birds and she eats between 6-7 every, closer to seven if I can get her to wait. We have food concerns also, but how long after and before eating should the PS BG be? Lily is my alarm clock.
    I guess I can add columns on the SS to say how long after eating the sample was and add any notes. I'm not known for being punctual.
     
  5. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

    Joined:
    Dec 21, 2019
    That might not work. It really needs to happen right away or you risk the number being influenced by the food. Let’s see if anyone else has other tips on this for you. Minnie is my alarm clock too. I literally have everything prepped the night before even the sock in the microwave and I get it done before I open the door to let them out so I’m that case her threat is getting her food and getting to go outside.
     
    Last edited: May 22, 2020
  6. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Welcome! My cat was a high dose cat (acromegaly). Since Lily was on 8u BID I think your Lantus starting dose of 1u is way too low. I’ll tag @Wendy&Neko for help with that. Are you still feeding the m/d? It is higher in carbs, so I would definitely switch back to tiki or another low carb wet food. My cat was extremely difficult to test in the AM because he was so hungry, so I know what you’re going through! I started by testing immediately after his breakfast and gradually I was able to test before.
     
  7. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    I'm curious are you still feeding dry food?
     
  8. Lily's mom Ellen

    Lily's mom Ellen Member

    Joined:
    Jul 10, 2019
    Hi Sharon. Yes, I can definitely test her immediately (1-2 min.) after eating her AM/PM meals. If they're not exactly 12 h apart, it's that a problem? I prefer feeding her at 7:00, but sometimes she's impatient. I don't want her shredding another tax return.
    We stopped the Rx diets and are back on LC FF and others Tiki, Fussie, Weruva BFF and other expensive brands with amusing names. Food will be a separate post for me since I have a # of questions.
     
  9. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    No dry food for almost a year.
     
  10. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
  11. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    perfect!
    Fellow native Californian here ;)
     
  12. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

    Joined:
    Dec 21, 2019
    So having the same hunger issues as you both, I will sometimes test her and feed at 7:30 and wait to give her the shot at 8am so you have some flexibility as to when you give the shot after you test but you really need to test first.
     
  13. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    I can generally keep it at q 12h with occasional flubs. Wonder if I should start her earlier than 7:00 AM? Between working at home and getting the dog out for a few hours that could get complicated.
    I haven't checked out the Lantus group yet, but will.
     
  14. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    She would destroy the furniture if she ate that late. You know how cats escalate the level of annoyance needed before we get up and give them what they want? She's got every step finely tuned. (I still keep a squirt bottle next to the bed. )
    The hour isn't as important as getting a good PS BG, and if I can do that immediately after eating.
     
  15. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

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    Dec 21, 2019
    I was giving you an example in my case. If you give her insulin at 6am then feed/test at 5:30 that’s fine just work backwards from there to get the 12 hour cycles
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    When we switch insulins, we take the dose of the previous insulin in mind. If you saw some nice numbers around 7 units of Prozinc, I would switch to around the same on Lantus. You could back it off a little to 6 units if you want. Some cats react strongly to the change of insulins - partly depending what is the underlying condition causing the need for more insulin.

    Side note, probably too late now, but at higher doses, Levemir is a better choice than Lantus. Lantus has an acid base that can sting at higher doses. The Levemir action is quite similar to Lantus but the onset and nadir can be a couple hours later. Keep this in mind in case you see Lily reacting to the shot. Some cats do fine on higher doses of Lantus, but some don't.

    The reason we suggest people test before shooting, is that we want to make sure it's safe to give insulin before you give it. I gave plenty of freeze dried meat treats at test time. They didn't impact the blood sugar and kept her occupied for a few minute so I could test. Are you spreading out her food into mini meals throughout the cycle? I found that helped keep Neko's starvation at bay. I also got an autofeeder that fed those mini meals. After she figured that out, she stared at the feeder instead of bugging me for food. :)
    Sorry, just had to comment on that. Too funny, guess who is the one who fell for the marketing, not you!
     
  17. Lily's mom Ellen

    Lily's mom Ellen Member

    Joined:
    Jul 10, 2019
    Thank you, Wendy.

    Lily sometimes has a small reaction (like a "hey!") to the tiny injection and I was wondering if it stung. Thank you for mentioning that.

    I was reluctant to spread out her meals during the cycle as I thought it would impact her BG through the day, but now I am trying to give her a some when she asks. She's currently getting 2 cans of FF w/added water for breakfast/dinner pre shot, and up to 1-2 cans spread out during the day. That's a lot of calories. She doesn't get any treats at all.
    Less than 1 hour after eating the morning slurry, she's over at the dog's dish drinking a ton of water and her belly is bulging. :-(

    I emailed our vet about Lily's dose. They said to increase her to 2 units twice daily and do a 12-hour BG curve between 7 and 10 days from now. We were told not to increase the insulin any faster than that, and reminded me that Lantus and PZI (sic) were not equivalent. I don't want to correct and cross our vet (we have a very warm relationship and other animals in their care), but I want the best for Lily and don't want to recreate the wheel with her insulin.
     
    Last edited: May 23, 2020 at 10:16 AM
    Reason for edit: TYPOS!
  18. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    When I switched from Caninsulin to Lantus, the vet told me to start back at 1 unit too Neko was on 5 units of Caninsulin at the time. It took me about three months to get back to 5 units of Lantus. All that time wasted in high numbers. :arghh: Plus is turns out she needed an even higher dose. Numbers above renal threshold are really hard on our kitties kidneys. You might want to ask your vet how much experience they have with cats with acromegaly or other conditions that can cause the need for higher doses. I too had a really good and long term relationship with my vet. After a point, I took over the dosing decisions. She was fine with it once I showed her the dosing methodology and gave her weekly copies of the spreadsheet.

    When you start Lantus, it takes 5-7 days to build the depot, but if you test often enough, you can increase every three days.

    It is really essential if you are going to stick with the vet's dosing, that you test regularly for urinary ketones, which can also show up if the dose is too low.
     
  19. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Wow - three months seems like an unnecessarily long time. Is this typical for SLGS? Renal threshold -- something new to learn about. Lily's BG has been high for a while now. I hope there is no lasting damage. I'm not knowledgeable yet about dosing methadologies. If I can learn and share with our vet and improve Lily's situation, that would be great, but right now I feel like I don't know enough. I have missed out on so much information.
    Yes, I am checking for ketones -- always negative so far.
     
  20. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Its overwhelming. We've all been there. You will "get it" just like we did.
    Its going to be ok. :bighug:
     
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  21. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Actually, I followed Tight Regulation which did faster increases. SLGS allows you to increase by 0.25 units once a week. With SLGS it'll take you 24 weeks to get back to 7 units. However, even with SLGS, your starting Lantus dose would be much closer to your Prozinc dose.
     
  22. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Member

    Joined:
    Dec 21, 2019
    Could what happen to Minnie also be true here? She was on 9 units of Lantus a day and by following the guidelines here she went down to 5 units so you could get to the right dose sooner if that happens
     
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  23. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Wow. I didn't understand the difference between SLGS and TR. We are increasing to 2 u Lantus tonight. It's been one week since we switched from PZ. Is this too slow? Are we doing harm by prolonging Lily's hyperglycemia? I wonder if we could have just stayed on PZ and increased the dose. (Always secvond guessing.)
    Should I take my more specific questions to specific forums? In addition to dosing, I have questions about insulin resistance (when is it officially "resistance"?), Acromegaly (is test worth if I can't afford tx? Vet considered it as a poss. cause), food (protein %, frequency, calories), needle length (I'd been using 1/2" but the last box was 5/16" and it feels very short), can I go back to my old glucometer (lol) all kinds of things.

    Thank you. It's been a very tough year and I haven't been able to give this my full attention. I am grateful for this place.
     
  24. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    As we all are. It will come to you just takes time. You now have a safe place to land and ask questions. :);)
     
  25. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Increasing by 1 unit is a larger increase than what any of our dosing methods say to do. Cats are sensitive to small changes in dose. Given, however, how underdosed she is, it will be OK to do that size of increase. Overall, I think Lantus will be a better insulin choice, you just have to get to the right dose and you aren't near it yet.
    It's hard on her kidneys, and will lead to glucose toxicity. The latter sounds worse than it is, just means her body gets used to higher numbers and you'll need an even higher dose to get over it.
     
  26. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Thanks. I will keep an eye on her anyway. Should I increase the dose tonight or wait until morning? I'd be up for at least 3 hours after her PM shot. I think hypo is unlikely, but want to be careful.
     
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  27. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Her PMPS tonight was 582 - that's the sixth time over 500 in the week since switching to Lantus. This was before dinner -- she was hungry but didn't seem stressed and she let me stick her as she loitered near her dish. (I wonder if the expectation of eating can increase BG?) She had two small cans of FF+water and 1-2 small amounts during the day as well. I gave her 2u of Lantus per the vet's OK and now we wait.
    It's nice to be sharing this information and not have to hold on to it with nowhere to go.
     
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  28. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Not typically. Glad you increased tonight. Get a before bed test, but her dose is so low compared to where it should be, I don't think you need to worry.

    Good to see she's coming down a bit tonight. Out of curiosity, have you considered switching back to the Relion? The strips are cheaper, and our dosing methods were written with human meters in mind. Plus her numbers will look better.
     
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  29. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Thanks, Wendy. I just lost track of time and missed the 3+ mark, but I'll check her anyway.
    You read my mind about the ReliOn! I was just thinking about switching back and if that would be problematic. The strips are so expensive but if it's more accurate, I'd stick with it. otherwise, finish the stripsI game and go back to the Relion? I still don't understand why human/ veterinary meters are so different.
     
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  30. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The company that makes the AlphaTrak has done a very good marketing job to vets. Not that many years ago, we (including vets) all used human meters because that's all there were. So, that's why our dosing methods were developed for human meters. The AT does a better job measuring feline blood, and is closer to the values you will see from the lab. Dunno about you, but I get lab work done at most every 6 months so it doesn't really matter to me. Besides which, my Relion wasn't that far off lab values either. What matters most is having a meter you are comfortable with in day to day use. The blood sugar numbers where we suggest giving high carb food is different between human meters (50) and pet meters (68) and that's really all you need to worry about.

    Some vets really want you to use the AT, but if they're not looking at the spreadsheet every day, then it doesn't matter what they want. You can use the AT to do the odd curve when they are looking for that data. Otherwise, save money on test strips, and you can afford to test more with the Relion.
     
  31. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Thanks, Wendy. That's all good to know, especially if I can still use it for a curve. We've been testing a lot. I guess I will need to revise my SS when I switch back.
    BTW Lily's BG was down to 386 at +3.5, since I missed the +3.
     
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  32. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    How often should I check Lily's BG while we're adjusting her dose?
    Is the AMPS considered fasting?
     
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  33. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    AMPS = morning preshot
     
  34. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    If she's NPO (except maybe water) for 12 hours, is that the time needed to obtain fasting BG, or it that different?
     
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  35. Sharon14

    Sharon14 Well-Known Member

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    Do not feed for 2 hours prior to the Preshot test.
     
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  36. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I'm sorry I'm not following what you are saying. NPO?
    (Its not early here I have no excuse):oops:
     
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  37. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Lol
    "NPO" means "nothing by mouth". Sorry!
    I meant, since Lily doesn't eat after her PM meal (overnight), the AMPS would be akin to fasting BG, no?
     
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  38. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Well I'm not an expert. We never did a fast when Trouble was alive. But I dont think so.:blackeye:
    As always, lets see what others say.
    j
     
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  39. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Just curious -- it's not important. I do wonder how often I should check Lily's BG with the increased dose, though.
     
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  40. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Always check before shot, and it’s good to get a test at +2 or 3 to see where the cycle is headed. If it’s lower, then you would want to get another test, when would depend on how low the number is.
     
  41. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Sharon, do you mean if the +2-3 hr BG is lower than the pre-shot, keep testing that day? Isn't a lower # what I'm looking for? (Not dangerously low, of course.)
    She's still pretty high since switching. I'm sure I'm misunderstanding.
     
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  42. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Yes we want lower numbers, but if she is lower at +3 than at PS, it just means you may have an active cycle. At this point I don’t think you need to worry about any low numbers though, but as you get closer to regulation, the +3 can help you know if you need to keep testing to keep her safe. Have you had a chance to read the Lantus dosing sticky? You test plenty enough to try TR (tight regulation). It seems scary at first, but it’s the quickest way to get Lily out of the reds and blacks. I started with SLGS (start low, go slow) but as I got used to the insulin I switched to TR
     
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  43. Lily's mom Ellen

    Lily's mom Ellen Member

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    Jul 10, 2019
    Thank you, Sharon. Yes, I'm trying to read all the Lantus stickies and relevant posts. A lot of catching up to do.
     
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  44. Sharon14

    Sharon14 Well-Known Member

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    There is a lot to take in and it can seem overwhelming, but before long, you will get it! Just keep asking questions and we’ll do our best to answer them.
     
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  45. Lily's mom Ellen

    Lily's mom Ellen Member

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