New member Zorro - Caninsulin to Levemir

Discussion in 'Lantus / Levemir / Biosimilars' started by Zorro's mom, Apr 18, 2019.

  1. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi fellow cat parents :)

    (I am copying my introduction post on this forum too since it is Levemir related.)

    My tuxedo boy Zorro is a 12.5 year old neutered male. He currently weighs 5.2kg's and had been moderately overweight for a large part of his adult life. At the moment he does not appear overweight and I would estimate his ideal weight to be about 5.5kg's. He was diagnosed with diabetes around August 2017. At that time I knew nothing about FD and trusted our vet completely. Long story short, Zorro's doses were quickly increased from 2u Caninsulin twice a day after diagnosis to 9u Caninsulin twice a day (I know...) No glucose curves were done at the vet's practice, I was discouraged from home testing even though I enquired about it and so the doses were increased purely on the strength of urine strip test results and my telling the vet about Zorro's poor clinical signs - all of which I now know were the results of the most extreme, most severe rebound. My heart aches thinking back about it now. By some mercy I happened to be home from work one afternoon shortly after the 9u doses were started and I saw a hypoglycemic attack approaching. I rushed him to the vet where he had a seizure in the reception area. He received intravenous glucose and miraculously survived. Thereafter he seemed to do quite well on 2u Caninsulin twice a day for about a year. Early this year I saw signs that his dose may need adjusting (I still didn't know how to home test or even if it could be done - the vet was very vague whenever I enquired about it.) Anyway so we upped his dose again until we had reached 5u Caninsulin twice a day and Zorro's clinical signs were still poor. At that point I decided to educate myself about FD. I switched his Royal Canine Feline Diabetic dry food to lower carb canned food (Purina Fancy Feast) and I started to use a human glucometer to check his BG. I also first found another online forum that introduced me to Tight Regulation. All the people there were very helpful but I found it impossible to reconcile my work schedule (and my nerves) with Tight Regulation using Caninsulin. Caninsulin seems to be metabolized by Zorro very quickly so I was on a +6 dosing regime that had my nerves on edge day and night for nearly 2 months. Much, much sleep and working hours were missed so I had to give up that protocol. However I continued to keep track of Zorro's BG and have since acquired Levemir insulin and U100 syringes with half unit markings and I intend to change over to the Levemir tomorrow morning at 09h00 (South African time). Zorro experiences a lot of bouncing with the Caninsulin and if I had to dose him only every 12 hours then he would be in the HI's for hours before a next dose. I am hoping that the Levemir will give him and myself a break and will enable me to regulate him much better. (Oh, and I often check for ketones and Zorro does not seem to be prone to ketone formation, fortunately.)

    When I came across this forum I felt relieved to see that there is a "Go Slow, Stay Low" protocol that can also be followed and I felt that it might be more "my speed". However, I noticed that the recommended starting dose for that protocol is very low whereas Zorro is currently often HI pre-shot so I think he'll need adjusted dosing.

    At this stage I would therefore appreciate advice / suggestions regarding the following:

    1. Do I need to give 12 hours since the last Caninsulin shot before I switch over to the Levemir or would 10 hours be okay? I would feel better about giving 12 hours between the 2 types of insulin but I know that then Zorro will be in the HI's for a few hours before I give the first Levemir shot. I currently dose his Caninsulin at approximately +8 because by that time it seems to have no more effect in his system. I gave his last Caninsulin shot at 20h45 this evening.

    2. What starting dose would you suggest? I have found a few veterinary sites that suggest 0.5u per kg body weight if bg is over 20mmol/L and 0.25u per kg body weight if bg is under 20mmol/L. Our vet suggested the same but his "cut-off" bg was 36mmol/L.
    Zorro is currently on an average dose of 3u when his bg is 28mmol/L and over - which is normally the case pre-shot. That kind of dose gives him a nadir of only 11.0 or 12.0mmol/L after +5.5 to +7.75 so his constant bouncing is not a case of having gone too low - it's probably just much lower than he had been used to for a long time. I have been avoiding the proper low numbers since I stopped Tight Regulation to see if that will flatten out his curves but so far it hasn't.

    With it being Easter weekend it is the ideal time for me to make the change to Levemir insulin as I can watch him for 4 whole days. I'll really appreciate your suggestions.

    I intend to start a spread sheet with Zorro's numbers over the weekend.

    Thank you!
     
  2. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    Hi Maritsa! I'm so glad you're here :bighug::bighug::bighug::bighug::bighug: I think what you're doing is the right thing for Zorro. I can't comment on much anything because I'm not an expert but they'll be here shortly.

    Just to clarify, are you giving Canninsulin less than every 12 hours when you mean you give Zorro a shot at +8?

    Looking forward to seeing Zorro's SS and his journey with Levemir.
     
  3. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi Crista, thank you for the lovely welcome :bighug:
    Yes, For the past two weeks or so I've been dosing the Caninsulin at approximately +7.5 to +9.5, averaging +8. While I was doing Tight Regulation with another support group I shot every +6 but it was so nerve-wrecking and not at all compatible with my work schedule - but I tried for as long as I could.
    Here's to hoping that the Levemir will provide us with an ideal 12+ dosing schedule!
     
  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hello and welcome. My Neko started on Caninsulin, we did a couple years in Lantus before moving to Levemir. I think you will like the change. OK, onto the questions. First, regardless of which dosing method you choose, we take the dose of the existing insulin into consideration. Which may or may not mean starting at 3 units. You definitely don't use the formulas for kitties new to insulin at this point. Any chance you could set up a spreadsheet with the last couple of weeks of data in it? Without a spreadsheet, no one here should be giving dosing suggestions. Here is the link to making a spreadsheet. More details about what the entries mean is in the New to the Group Sticky Notes. I suggest you spend some time reading through all the Sticky Notes too.

    Again, it would help to see some data on the Caninsulin duration before suggesting you shoot earlier the first time you do Levemir. Having said that, it's "probably" OK, as Levemir typically doesn't onset for 4 hours after the shot.

    By the way the "tight regulation" you were doing is probably different than our, ours is from a Roomp/Rand paper on Tight Regulation and only Lantus/Levemir have been studies and published with their version of TR.
     
  5. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi Wendy,
    Thank you for the reply to my post.
    All of the above was posted very late yesterday / early this morning so I didn't have time to prepare spread sheet data yet before the switch to Levemir this morning.
    I waited the near full 12 hours (only dosed 10 mins early) and not surprisingly, he was HI pre-shot. To stay safe I dosed only 2.5u Levemir. I will prepare a spread sheet during the course of today.
    I stayed up with him until 02h45 this morning. On his last Caninsulin shot of 3.5u given at 20h45 yesterday evening he reached nadir of 10.4mmol/L at +5 and at +6 (02h45) it had started to rise to 11.3 mmol/L. He normally bounces quickly and high so he has probably been in the HI's for a good few hours by now - which I do feel terrible about. I'm hoping that my conservative first dose of Levemir this morning will at least bring him into numbers that register on my Accu-Chek meter so that I can start to keep track of them.

    Regarding TR: Yes, I think the other forum had a different take on TR. Like I've said, it was very hard (for me) to do with Caninsulin but I will be happy to give it another try if the Levemir turns out to give us more gentle, predictable curves. I will read through all of the applicable stickies as soon as I can.
     
  6. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi to those who follow Zorro :)
    I managed to get his Levimer Spreadsheet up and running last night. So far his responses to 2 - 2.5u seem good so I think I'm in the right range for now and if it's okay I won't be adding in his old Caninsulin numbers and sliding scale doses - it will take me too long to decipher all my handwritten "logs" of the previous couple of weeks.
    I saw Bron's reply to my message on the Introduction forum this morning (I must check again how to tag someone - hope you'll see this, Bron) and I feel a bit silly and a little worried about having Zorro's AMPS number influence my decision to dose him 2.5u again, like I did yesterday morning when he was HI pre-shot.
    Last night I dosed him only 2u (again my decision was influenced by the PS number) and in my opinion he had a very good response to that dose so I'm actually relieved that I didn't repeat the morning's 2.5u dose.
    I have read the notes about the depot and how it works but I am still not clear on exactly how changes in doses like I've mentioned above will influence Zorro's numbers. I guess it will be come clearer as I get used to the new insulin. Unless something unexpected happens with his numbers I don't intend to deviate from 2 - 2.5u for now. Is my thinking flawed (as far as Levemir goes) to think that I could have an "am dose" of say 2.5u and a "pm dose" of say 2u? All of our pets sleep inside through the night and I don't have an automatic feeder so it feels to me that a slightly reduced pm shot might be in order. Again, I admit that I don't quite understand the depot effect yet so if I'm advised to stick with 2u for all of his doses then I'll do that.
    Lastly, just looking at his results from yesterday, is anyone of the opinion that I should be concerned about having dosed him 2.5u instead of 2u this morning? I will watch him carefully anyway but just so that I'm mentally prepared.
    Thank you!
     
  7. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    PS: Thank you so much Marje for preparing that fantastic spreadsheet for this forum! It is a pleasure to use. Your instructions to set it up were also so clear that even someone as IT challenged as me managed to do it :bighug:
     
    Last edited: Apr 20, 2019
    Reason for edit: Spelling
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  8. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    To tag someone just add a @ before typing in their username and a box should come up with their name on it. Click on that and it will tag the person you want.
    No it is not a good idea to give one dose in the morning and another dose in the evening. Because it is a depot insulin you need to stick to the same dose night and morning unless Zorro drops too low, in which case you would reduce it by 0.25 units. If you chop and change the dose you will mess up the depot and won’t get consistency with the numbers. I hope that makes sense. Pick one dose and stick to it and let the depot fill and stabilise.
    I don’t know what his numbers were like on caninsulin but it looks like he has bounced up high after the blues last night. If he has been consistently bouncing with the caninsulin it may take a while for him to stop bouncing. Or it mightn’t. ECID (every cat is different ).
    keep asking lots of questions. We are happy to help.
     
  9. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Thank you for the tagging instructions.
    Okay I understand better about the need for consistency. In that case I think I'll stick to 2u for now so I might have to make a final change this evening. I'll read up more about the depot too.
    Zorro did bounce to extremes on the Caninsulin so yesterday's first curve on the Levemir was actually good in terms of his standards. What happened yesterday and this morning over 24 hours often happened twice over 24 hours with the Caninsulin - and often without a good number like 6.7 in the mix.
    Waking up to a reading of 6.7 this morning was wonderful. We will just have to see the bouncing through and hopefully it will eventually subside.
     
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  10. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Hello there! Looks like you're already getting really great answers to your questions - so I'm just going to say what a handsome fellow Zorro is! I'm sure when you see my Luci's pic you'll see why I think so - those tuxedo cats - ooooh... just love 'em!

    Hope things come together for you soon and give Zorro a scritch for us :) Welcome to the group :)
     
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  11. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi Sue, thank you so much for the welcoming and encouraging words :bighug:
    Your Luci is so gorgeous too! Those eyes! I adore black cats (we have two other black ones and one tabby) but tuxedo'ed bodies just seem extra squeezable :)
     
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  12. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I see some nice numbers so far on Levemir. Hopefully that will get even better as the depot fills. One thing you will have to wrap your head around is that with the depot insulins we decide how to change the dose based on the nadirs, or how low the dose takes the cat, and not the preshots.
     
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  13. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    @Wendy&Neko I just watched your tribute video of Neko...oh wow...
    She was a stunning girl. Your written piece about her and then the video had me in tears. Don't know if it's exhaustion or the past couple of months' stress about Zorro but I've never cried so much about someone else's pet before.
    Thank you for continuing to help people like me on here :bighug:
     
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  14. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    I've temporarily removed the link to Zorro's SS while I thrash around for a good Levemir starting dose that will see him through the daytime and not take him too low at night when there's no food out.
    Having looked at today's daytime numbers I regretted my decision to settle on 2u for AM and PM because it didn't do much for him during the day and I shot his PM shot early again (+11.25).
    I don't want to confuse anyone on here who may be looking at his SS so will get ourselves sorted and set the link up again in due course :)
     
  15. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to the group!

    If I may make a suggestion -- Please leave the link to your Zorro's spreadsheet (SS) active. There are those of us who automatically look to open your SS any time we stop by your thread (aka "condo"). This is especially the case for someone who is new to the forum. You've given a great explanation and you can always note in later posts that you're working on the SS if you think people will be confused.

    I'd also encourage you to stick with the dose you started on. There is a huge difference between Caninsulin, and other shorter acting insulin and Lantus and Lev. First, with non-depot insulin, your dosing is based on the pre-shot number. Hence, the use of a sliding scale for dosing. With Lev, dosing is based on the nadir (lowest number in the cycle). If you intend to follow SLGS, you reduce the dose if numbers drop below 90 and increase after a week if numbers aren't in the range you want.

    Second, you need to give the depot time to stabilize. With all cats that are new to a depot-type of insulin, it takes 5 - 7 days for the depot to form. Any time you change a dose, the depot needs to stabilize. If you make back-to-back changes, since you're just starting Lev, you prolong the time for the depot to stabilize. Once Zorro's depot forms, if you make rapid dose adjustments you can get wonky numbers.

    I suspect I know the forum you joined previously. For what it's worth, there is no tight regulation protocol for Caninsulin. The only insulins where there has been published research to support a tight regulation approach are Lantus and Lev. The folks in the other forum can be a bit, ummmm....., rigid.
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I second Sienne’s comment on restoring the spreadsheet. The members here with lots of experience on dosing the depot insulins will look first to the spreadsheet. We can help you towards a better starting dose.

    And one other comment, do you have an automated feeder? That really helps ensure there is food available when he might need it at night.
     
  17. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Have no fears about giving someone the wrong idea, etc. We're all learning from one another - and often it's so very helpful for the experts to see what you're doing, right or wrong, in order to make better suggestions about the next steps that you might take for a better result. Don't worry...we were all new and beginners at one time...a lot of very understanding people here - and there's no better record of the impact of the dosing than the SS - even when you 'think' it might not be looking the way you think it should...they might see a trend that you aren't really aware of ...just saying...if you look back at my early days...what a mess...and I was helped to at least get some information on the SS that made sense - and help point me in the right direction.

    Hang in there...it'll get better with time :)
     
  18. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I'm hoping you'll start tomorrow by posting a new thread/condo like this 4/22/ Zorro AMPS ### - whatever his number is...so we can start seeing a new post...I didn't realize when I responded that this is your original/first post... :)
     
  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Maritsa. How is Zorro going?
    I agree with Sienne and Wendy about restoring the SS. No one will judge you but they will be able to help you, if you need it, by making suggestions and then it is up to you whether you act on them.
    Zorro was responding to the Levemir. And all cycles aren’t the same on levemir, especially when kitty isn’t regulated. Some you get a good response to and others very little response.
    I joined FDMB about a year after Sheba fell out of remission which she’d been in for 2 1/2 years. By the time I joined I was at my wits end as I had tried everything that my vet and specialists had suggested. Within a couple of weeks of joining here, Wendy, Sienne and Chris were showing me ways to stop or slow down the continual bouncing and of course how to go up and down in 1/4 unit increments not whole units. And they talked about trends and other observations in the SS that I couldn’t see, and I remember the pure joy I had when Sheba had a 10 day run of green and blue numbers. Sheba continued to be a bouncing and diving champion but I learn strategies to help control them. And to look at a SS and see trends etc.
    Of course it is all totally up to you. We always say that you hold the syringe and the decisions are up to you. This is a very supportive community and how much you want to interact with others and ask for suggestions is up to you.
    We are here if you need us. :bighug: Hope we see you soon :)
     
  20. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    @Sienne and Gabby (GA) @Wendy&Neko @Sue and Luci @Bron and Sheba thank you for the kind words of support and encouragement. I will write more about my situation tomorrow / as soon as possible; Right now it's midnight here and I am half asleep. I'd better get a few hours in before I have to check bg again :cat: In the meantime I'll quickly try to activate the link to the SS again.
    :bighug:
    Oh, and Zorro is doing well :)
     
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  21. Amina&M'row

    Amina&M'row Member

    Joined:
    Jan 2, 2019
    Hi there, Zorro and Mom! What a handsome fellow you are, Zorro. M'row was on free-feeding with kibble when he was diagnosed 3.5 months ago; there were all sorts of recommendations on how often to feed him, so I just decided to carry on with (now canned, low-carb) food being always available. I just put out more food at bedtime so he doesn't run out. I see some folk here put out some of the food frozen when they want to put out food for a longer period; seems a good idea.
     
  22. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi @Amina&M'row Thank you for the suggestions :) Zorro also used to be on free-feed kibble before diagnosis in August 2017. Thereafter the vet put him on Royal Canine Feline Diabetic dry food which I portioned out twice a day only. Now he is on low-carb canned as well, fed bits during the day that add up to 2.5 - 3 small cans per day. However he is such a piggy that I can't try free-feeding yet. Hopefully if I find an even lower carb canned food (current Purina FF that I can find here is 10%) and when he is better regulated, I can try free-feeding. It will make life so much easier!
     
  23. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I just checked online and found this food has This formula contains 25.2% carbohydrates.
    Chicken Meal, Corn Gluten Meal, Soy Protein Isolate, Ground Corn, Barley, Chicken Fat, Natural Flavors, Brown Rice, Powdered Cellulose, Dried Beet Pulp (Sugar Removed), Psyllium Seed Husk, Potassium Chloride, Anchovy Oil (Source of EPA/DHA), Soya Oil, Fructo-Oligosaccharides, Calcium Carbonate, Potassium Citrate, Choline Chloride, Taurine, Vitamins [Dl-Alpha Tocopherol Acetate (Source of Vitamin E), L-Ascorbyl-2-Polyphosphate (Source of Vitamin C), Niacin Supplement, Biotin, Riboflavin Supplement (Vitamin B2), D-Calcium Pantothenate, Pyridoxine Hydrochloride (Vitamin B6), Vitamin A Acetate, Thiamine Mononitrate (Vitamin B1), Folic Acid, Vitamin B12 Supplement, Vitamin D3 Supplement], Tea (Green Tea Extract), Trace Minerals [Zinc Proteinate, Zinc Oxide, Ferrous Sulfate, Manganese Proteinate, Copper Proteinate, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite], Marigold Extract (Tagetes Erecta L.), L-Carnitine, Rosemary Extract, Preserved with Natural Mixed Tocopherols.

    Personally I wouldn't feed this to my diabetic cat - there's so little meat in it and too many grains; corn, barley, rice - those are all fillers and not good for diabetic kitty. Please re-consider this choice and find foods that start out with at least meats.

    For instance as a suggestion - this is Dr. Elsey's Clean Protein ingredient list: Chicken, Dried Egg Product, Pork Protein Isolate, Gelatin, Chicken Fat (Preserved With Mixed Tocopherols), Flaxseed, Natural Flavor, Salmon Oil, Potassium Citrate, Calcium Carbonate, Fructooligosaccharide, Calcium Carbonate, Choline Chloride, Vitamins (V....

    protein isolate, which is named so due to labeling regulations, is derived exclusively from pork meat.

    Although many here would say to drop the dry foods altogether - and stick with wet only - you may need to transition slowly from dry to get him to eat...every cat is different...but this is my suggestion.

    Thanks
     
  24. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi @Sue and Luci :) Thank you for the info on clean protein ingredients.
    Regarding the Royal Canine dry diabetic food: It sounds as if you misunderstood what I wrote. Although the vet initially put Zorro on that food, Zorro has not been on it for months. He currently eats the Purina Fancy Feast Chicken Feast Chunky with 10% carbs as that was the lowest that I could find locally. He has not had dry food since I found out about the dangers of it a few nonths ago.
    Thank you again for your concern!:bighug:
     
  25. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I apologize! I should have read more carefully before replying :) Glad to hear that you're free of the dry food for Zorro! I do think he is a handsome fellow! Luci is looking over my shoulder at him now with 'googly eyes'. :)
     
  26. Zorro's mom

    Zorro's mom Member

    Joined:
    Apr 16, 2019
    Hi @Sue and Luci :) No worries, I know there's so much information on the forum that sometimes one is only able to scan things briefly. You meant well with your information so I appreciate it :bighug:
    I know that Zorro would go gaga for little Luci too! ;) I'm just in the process of trying to get him off his little bouncy trampoline so that hopefully he'll soon be able to appreciate the better things in life again - like fellow tuxedo ladies!
     
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  27. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Maritsa - just a housekeeping note. We encourage members to open a new thread (aka "condo") every day -- or every day that you post. You can link the previous day to the current day so it's easy to backtrack to find information. If you keep the thread going, it can get impossibly long and people will not read through as carefully as you'd like. If you are going to post tomorrow, could you start a new condo?

    It looks like Zorro is seeing some good numbers on Lev!! It would also be a good thing if you were able to get at the very least, a before bed test every night. Many cats experience lower numbers during the PM cycle. You want to be sure that Zorro is in safe numbers before you go to sleep.
     
  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Maritsa
    How are things going?
    Looking at your SS there are no numbers or doses in the PM cycle for the last several days. Then i looked further and it looks as if you are dosing the Levemir every 10.5 hours and documenting it all on the AMPS side??? Is that correct.
    I know you were trying to get Zorro regulated on Vetsulin and were dosing every 8 hours. However Levemir is a 12 hour insulin and unlike Vetsulin which has a much shorter duration. Also I see you are changing the dose each cycle.
    I know you are wanting to get Zorro regulated and I completely understand that, but honestly that is not the way to do it. I tried more frequent dosing with Sheba before I joined FDMB and it didn’t work. Levemir works best when it has consistent dosing. Chopping and changing the dose each time is messing with the depot and will give you numbers all over the place.
    I would encourage you to go back to 12 hour dosing and stick to one dose.
    Insulin is a hormone and doesn’t work like an antibiotic or pill that fixes things in the body straight away. It takes time for the body to adjust to insulin... some cats take longer than others.
    Zorro is your kitty and I know you are doing what you think is best for him and I certainly ‘get’ that you want him regulated but please consider what I have said. :)
    Hope to hear from you soon. :bighug:
     

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