New Member Snowball has been testing low all weekend

jwbsings Snowball said:
The vet is worried about how the anesthesia will affect his kidneys, but I will see him tomorrow and ask about the Antirobe. I used to brush his teeth when he was younger, but he stopped letting me near his teeth after a couple of years. Snowball and his catmate Sissy travel well. I don't sedate them and bring them in the cabin with me. He is agitated going through the security screening, but then settles down and sleeps most of the time.

I will discuss all of this with the vet tomorrow and let you know what he says. Snowball is still fluctuating - today he stayed in the blue range. I will test him again before I go to bed and will not feed him before his vet visit so that he gets an accurate reading. I'll bring the syringe I have

Happy New Year to you, too, Suzanne! Thank you so much for your support of me and Snowball. It means the world to us!
I just tested Snowball again at +4 hours from his PMBG. His BG was 143. I'll let you know what the Vet says tomorrow.
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I’d say he’s kind of borderline with these numbers. I would not call it remission yet, but very good for no insulin. I’ve seen vets tell people their cats were in remission when they’re in the 200s and then later they need to restart insulin. Anyway, I will wait for your report from the vet and not bug you further. :)
 
Suzanne & Darcy said:
I’d say he’s kind of borderline with these numbers. I would not call it remission yet, but very good for no insulin. I’ve seen vets tell people their cats were in remission when they’re in the 200s and then later they need to restart insulin. Anyway, I will wait for your report from the vet and not bug you further. :)
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You never bug me! I look forward to your messages and your advice is much appreciated. I felt so alone and over my head with this diagnosis until I found this forum! So, bug me all you want!
I just got back from my vet and you were right - he told me Snowball is in remission and I don't have to give him insulin. He did another blood work-up (I'll know the results of that tomorrow) to be sure. I also took a copy of Snowball's spreadsheet with all the doses of insulin I gave, the date I stopped giving insulin, as well as the BG test results. Today, his AMBG was 220 and at the vet +2 hours and after his feeding, it was 164. I asked about his teeth and he gave me an antibiotic gel that I'm to rub on his gums once a day. Snowball now weighs 5 kg - up from 4,375 kg in November.
Once I have his blood work results, I'll send them to you. I'd like to know what you recommend and more about the micro doses of insulin. The information about the syringe sizes is confusing to me. I sure don't want to get him off insulin sooner than necessary and would like for his remission to be solid and as long-lasting as possible. Let me know what you think.
Suzanne & Darcy said:
Oh, and I would love to know more about how you got Snowball. You said his birthday is January 10, you know when he was born, and maybe who his mother was? I bet there’s a story behind you and Snowball coming together :cat:
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I met Snowball's mother and father. The mother was a blue British shorthair and the father, also a British shorthair, but completely white like Snowball, with a huge head - very regal looking. My husband found him - when we arrived to pick him up, he walked right over to my husband, very self-confident and rubbed up against him. So he and my husband actually picked each other, basically. I fell in love right away and we have created a special bond over the years. When my husband died unexpectedly, Snowball was my rock. He never left me alone. He slept with me, cuddled with me, followed me around the house - just seemed to understand. It's funny, sometimes I call him by my husband's name, Fred! My other cat came about a month after Snowball. She is very sweet and shy. My husband found her, too! I suspect she was possibly abused as when I would go towards her, she'd retreat. If I tried to pet her, she always ducked her head as if she were afraid. My husband really helped her to build up trust. He was so loving with her and talked to her and showed her affection. I became a little distant, as she didn't warm up to me, hard as I tried. When Fred died, she suffered like I did. I finally began doing what he did with her: coaxing her with lots of love and attention and playing with her - even when she didn't seem interested at first. Now, we're like old friends and these two cats are my family.
 
Hi. I saw your thread over on the other forum and saw you got some helpful comments from Bron and Sienne. I think you have probably seen the information with photos on the smaller doses?

You already know that I do not believe Snowball is in remission just yet. I would like to start Snowball on .25 units of insulin, because of his propensity to drop low. If you have syringes with half unit markings, you draw the plunger back to between the “zero” mark and the .5 unit mark. If not, we can do some small doses with U-100 syringes. I don’t know how difficult it is to get syringes in Germany — here I don’t need an Rx. You may already have what we need.
 
[QUOTE="

I met Snowball's mother and father. The mother was a blue British shorthair and the father, also a British shorthair, but completely white like Snowball, with a huge head - very regal looking. My husband found him - when we arrived to pick him up, he walked right over to my husband, very self-confident and rubbed up against him. So he and my husband actually picked each other, basically. I fell in love right away and we have created a special bond over the years. When my husband died unexpectedly, Snowball was my rock. He never left me alone. He slept with me, cuddled with me, followed me around the house - just seemed to understand. It's funny, sometimes I call him by my husband's name, Fred! My other cat came about a month after Snowball. She is very sweet and shy. My husband found her, too! I suspect she was possibly abused as when I would go towards her, she'd retreat. If I tried to pet her, she always ducked her head as if she were afraid. My husband really helped her to build up trust. He was so loving with her and talked to her and showed her affection. I became a little distant, as she didn't warm up to me, hard as I tried. When Fred died, she suffered like I did. I finally began doing what he did with her: coaxing her with lots of love and attention and playing with her - even when she didn't seem interested at first. Now, we're like old friends and these two cats are my family.[/QUOTE]
This is a beautiful story. Fred must have been a very special, kind and loving man. Thank you for sharing this — it really warmed my heart.
 
Oh, did you get the bloodwork back from the vet? I think the Fructosamine test will be very skewed since it’s pretty much an average of BG over a period of a few weeks. As with all averages they are affected by highs and lows. And Snowball has had a lot of lows at times since he started insulin.
 
Suzanne & Darcy said:
Oh, did you get the bloodwork back from the vet? I think the Fructosamine test will be very skewed since it’s pretty much an average of BG over a period of a few weeks. As with all averages they are affected by highs and lows. And Snowball has had a lot of lows at times since he started insulin.
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I spoke with my vet this morning. He told me that the Fructosamine, which was 1300 on November 16th, was now at 462. Unfortunately, Snowball's kidney levels have risen. His Creatinin was 171 and is now 244. He believes this is related to his diabetes diagnosis and said that diabetic cats with kidney deficiency would often have higher BG levels and his opinion is that the number or limit as to when a cat with CKD no longer needs insulin is 250 and below. I know that you and others disagree strongly with that. I asked him about micro-dosing insulin for Snowball and he also told me I'd need the right insulin syringe for that and that he didn't think Snowball needed insulin support at the moment. I know you and others disagree with that assessment. He then spoke about an oral anti-diabetic liquid that is administered once a day and prohibits the sudden dangerous drop in BG. Unfortunately, it has been said to have a negative affect on the kidneys, which is why he didn't recommend it initially. My concern is that he didn't stress the importance of testing from the beginning - and even now, only recommends testing once a week. I see how that can be very dangerous and that makes me question some of his advice concerning diabetes. I am to call him on Monday with the test results over the weekend. His secretary is supposed to email me the actual lab report from the blood tests on Monday.
As you can imagine, I'm a bit unsure what to do. I am leaning towards the micro dose approach to be on the safe side. The reason for my hesitancy is that I don't want to give Snowball insulin if he doesn't need it. Looking at Corky's spreadsheet, it seems he's been in a safe zone for months, but still gets the insulin. Is that a personal choice? Could he actually be in remission and not need insulin support for his pancreas?
 
Suzanne & Darcy said:
Hi. I saw your thread over on the other forum and saw you got some helpful comments from Bron and Sienne. I think you have probably seen the information with photos on the smaller doses?

You already know that I do not believe Snowball is in remission just yet. I would like to start Snowball on .25 units of insulin, because of his propensity to drop low. If you have syringes with half unit markings, you draw the plunger back to between the “zero” mark and the .5 unit mark. If not, we can do some small doses with U-100 syringes. I don’t know how difficult it is to get syringes in Germany — here I don’t need an Rx. You may already have what we need.
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I can get the syringes I need. Right now I have U-100 syringes.
 
jwbsings Snowball said:
I spoke with my vet this morning. He told me that the Fructosamine, which was 1300 on November 16th, was now at 462. Unfortunately, Snowball's kidney levels have risen. His Creatinin was 171 and is now 244. He believes this is related to his diabetes diagnosis and said that diabetic cats with kidney deficiency would often have higher BG levels and his opinion is that the number or limit as to when a cat with CKD no longer needs insulin is 250 and below. I know that you and others disagree strongly with that. I asked him about micro-dosing insulin for Snowball and he also told me I'd need the right insulin syringe for that and that he didn't think Snowball needed insulin support at the moment. I know you and others disagree with that assessment. He then spoke about an oral anti-diabetic liquid that is administered once a day and prohibits the sudden dangerous drop in BG. Unfortunately, it has been said to have a negative affect on the kidneys, which is why he didn't recommend it initially. My concern is that he didn't stress the importance of testing from the beginning - and even now, only recommends testing once a week. I see how that can be very dangerous and that makes me question some of his advice concerning diabetes. I am to call him on Monday with the test results over the weekend. His secretary is supposed to email me the actual lab report from the blood tests on Monday.
As you can imagine, I'm a bit unsure what to do. I am leaning towards the micro dose approach to be on the safe side. The reason for my hesitancy is that I don't want to give Snowball insulin if he doesn't need it. Looking at Corky's spreadsheet, it seems he's been in a safe zone for months, but still gets the insulin. Is that a personal choice? Could he actually be in remission and not need insulin support for his pancreas?
Click to expand...
Wow. That is a lot for you to take in. Yes, I do disagree that he does not need insulin. I disagree about the kidney disease because it is better/easier on Snowball’s kidneys for his glucose levels to be in normal numbers. It is not true that a cat with kidney disease cannot get better BG numbers. Just a look at my own sweet Mr. Darcy’s numbers in his last year of life (2021) shows that a cat can be in very good BG numbers with kidney disease. My poor baby’s kidneys were trashed by his Acromegaly. His kidney values were literally off the charts at the end of his life, but he was getting pretty decent BG numbers — and that was for an acromegaly cat. Acromegaly causes extreme insulin resistance. Anyway, I feel really sad for you about being told that his kidney values have gotten worse. I hate that. I know you have read a lot on tanya’s site and that you are doing the SUC therapy.

With regard to Corky, he does actually need the insulin. If Maria stopped the insulin, Corky would go back up into high numbers. I have worked with Maria and Corky since the very beginning. She does hope for remission, but Corky is not there at this point. If Corky were in remission and still receiving a dose of 1.5 units, he would be going hypo all the time. If Corky were headed for remission, what we would expect to see would be that he repeatedly would drop below his reduction point (50) and each time he would then earn a reduction. His dose would go down and down, and he would keep on earning reductions until he was at the drop dose and finally we would do an OTJ Trial (off the juice, as in, no insulin.). When a cat is able to stay in all normal BG with zero insulin (normal BG being 50-100-ish or little higher than 100 for a pet meter) for 14 days, we consider that cat to be in remission or a diet-controlled diabetic.

I’m going to tag @Marje and Gracie on this thread because I believe she will have some valuable insights.
 
Suzanne & Darcy said:
Wow. That is a lot for you to take in. Yes, I do disagree that he does not need insulin. I disagree about the kidney disease because it is better/easier on Snowball’s kidneys for his glucose levels to be in normal numbers. It is not true that a cat with kidney disease cannot get better BG numbers. Just a look at my own sweet Mr. Darcy’s numbers in his last year of life (2021) shows that a cat can be in very good BG numbers with kidney disease. My poor baby’s kidneys were trashed by his Acromegaly. His kidney values were literally off the charts at the end of his life, but he was getting pretty decent BG numbers — and that was for an acromegaly cat. Acromegaly causes extreme insulin resistance. Anyway, I feel really sad for you about being told that his kidney values have gotten worse. I hate that. I know you have read a lot on tanya’s site and that you are doing the SUC therapy.

With regard to Corky, he does actually need the insulin. If Maria stopped the insulin, Corky would go back up into high numbers. I have worked with Maria and Corky since the very beginning. She does hope for remission, but Corky is not there at this point. If Corky were in remission and still receiving a dose of 1.5 units, he would be going hypo all the time. If Corky were headed for remission, what we would expect to see would be that he repeatedly would drop below his reduction point (50) and each time he would then earn a reduction. His dose would go down and down, and he would keep on earning reductions until he was at the drop dose and finally we would do an OTJ Trial (off the juice, as in, no insulin.). When a cat is able to stay in all normal BG with zero insulin (normal BG being 50-100-ish or little higher than 100 for a pet meter) for 14 days, we consider that cat to be in remission or a diet-controlled diabetic.

I’m going to tag @Marje and Gracie on this thread because I believe she will have some valuable insights.
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Thanks for your detailed explanation. It makes more sense to me now - all of this is a lot of information and a big learning curve for me, so I appreciate you and the others answering my questions, no matter how uninformed they may be.
 
I understand. You have a lot to sort out in your mind about all this. I can tell you are a very well-informed cat owner, but this whole diabetes thing is new and, first and foremost, you don’t want to do anything to harm Snowball. I think it can be a bit paralyzing when getting influenced in one direction by the vets (who always appear to be so confident) and influenced in another direction by others (like us.)
 
Suzanne & Darcy said:
I understand. You have a lot to sort out in your mind about all this. I can tell you are a very well-informed cat owner, but this whole diabetes thing is new and, first and foremost, you don’t want to do anything to harm Snowball. I think it can be a bit paralyzing when getting influenced in one direction by the vets (who always appear to be so confident) and influenced in another direction by others (like us.)
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Yes - I've trusted my vet for many years. But, he wasn't the one who told me about SUC therapy and though he wasn't informed about it, he did read up on it and check out the data that was available. In the end he supported my decision to try it, and it has been working well, until this last blood test. So, he is open. The micro dosing insulin therapy may perhaps be a stretch for him, but I will discuss this again with him tomorrow. The data is clear on Corky's spreadsheet.
 
Hi Janet. Take a look at the spreadsheet of my good friend Julie whose cat, Liberty, went into remission in 2024. Be sure to look at the 2024 tab of the spreadsheet. See how Liberty keeps earning reductions in dose (he didn’t start at a really high dose). When we finally tried him on the drop dose and he maintained all green numbers for two weeks, we did an OTJ trial for two weeks with no insulin. After two weeks we declared him in remission. Liberty is fortunately still what we call a diet-controlled diabetic (remission.). Let me know if you have any questions about this spreadsheet.

https://docs.google.com/spreadsheet...01afbl5PzQcvszKRvLG0JrxR6JincG5314pd/pubhtml#
 
Suzanne & Darcy said:
Hi Janet. Take a look at the spreadsheet of my good friend Julie whose cat, Liberty, went into remission in 2024. Be sure to look at the 2024 tab of the spreadsheet. See how Liberty keeps earning reductions in dose (he didn’t start at a really high dose). When we finally tried him on the drop dose and he maintained all green numbers for two weeks, we did an OTJ trial for two weeks with no insulin. After two weeks we declared him in remission. Liberty is fortunately still what we call a diet-controlled diabetic (remission.). Let me know if you have any questions about this spreadsheet.

https://docs.google.com/spreadsheet...01afbl5PzQcvszKRvLG0JrxR6JincG5314pd/pubhtml#
Click to expand...
This is really amazing. Thanks for sharing this!
 
jwbsings Snowball said:
I spoke with my vet this morning. He told me that the Fructosamine, which was 1300 on November 16th, was now at 462. Unfortunately, Snowball's kidney levels have risen. His Creatinin was 171 and is now 244. He believes this is related to his diabetes diagnosis and said that diabetic cats with kidney deficiency would often have higher BG levels and his opinion is that the number or limit as to when a cat with CKD no longer needs insulin is 250 and below. I know that you and others disagree strongly with that. I asked him about micro-dosing insulin for Snowball and he also told me I'd need the right insulin syringe for that and that he didn't think Snowball needed insulin support at the moment. I know you and others disagree with that assessment. He then spoke about an oral anti-diabetic liquid that is administered once a day and prohibits the sudden dangerous drop in BG. Unfortunately, it has been said to have a negative affect on the kidneys, which is why he didn't recommend it initially. My concern is that he didn't stress the importance of testing from the beginning - and even now, only recommends testing once a week. I see how that can be very dangerous and that makes me question some of his advice concerning diabetes. I am to call him on Monday with the test results over the weekend. His secretary is supposed to email me the actual lab report from the blood tests on Monday.
As you can imagine, I'm a bit unsure what to do. I am leaning towards the micro dose approach to be on the safe side. The reason for my hesitancy is that I don't want to give Snowball insulin if he doesn't need it. Looking at Corky's spreadsheet, it seems he's been in a safe zone for months, but still gets the insulin. Is that a personal choice? Could he actually be in remission and not need insulin support for his pancreas?
Click to expand...
Hi Janet

Suzanne asked me to drop by as I’ve been in FDMB for almost 15 years now and was mentored by our most experienced (and amazingly knowledgeable about FD) member.

I’ve also dealt with German vets as I lived in Germany 6 years. I know their approach can be quite different from US vets but I have also seen US vets (including one I saw with my Gracie) state a cat was in remission when they clearly were not.

It is extremely rare to see a cat go into remission from 2u bid of insulin even though I note he had one shot at 1.5u and one at 1u. Snowball is not in remission and leaving him at these higher BGs can actually cause his CKD to progress. Just as in human diabetics, feline diabetics are prone to developing CKD and heart disease if the BG is not properly controlled. And while he is doing well when he’s in the 100s, his BG is not in the normal range for a diabetic cat.

If you were to take your nondiabetic cat to the vet and the BG was 150 mg/dL on a pet meter, that could be seen as vet stress and perhaps that is what your vet is used to seeing. But for a diabetic cat where you have real-time data at home, that number is way too high consistently for him to not be receiving insulin.

Starting him back at 0.25u is a modest approach and I would strongly encourage you to consider it. On a pet meter, we would not be considering a cat for a remission trial until the BG was consistently in the 68-100 range most of the time. Those cats about to go into remission with those BGs are usually on doses between one drop and 0.1u of insulin.

I understand lower BGs are a bit scary but you’ve now had experience dealing with them. One key is to test early after the shot….no later than +2 so you can catch any drops and prop them up a bit with food to keep them from dropping so low. Members here can help you do that.

Please let me know if you have questions.
 
Last edited:
@Marje and Gracie here’s the post about the SUC therapy for CKD.


  1. Dec 28, 2024EditDeleteReport
    Reply


  2. jwbsings Snowball
    ↑
    Tell me about this SUC therapy.
    A friend told me about it, as it helped her cat with kidney disease. It's a homeopathic combination of Solidago compositum ad us. vet., Ubichinon compositum and Coenzyme compositum. It helped my Snowball tremendously. He had been treated for kidney insufficiency since 2017, but last year things got worse.He was all but given an immediate death sentence over a year ago when in the USA. He'd lost a lot of weight even though he ate full meals, and he was drinking a lot of water. I took him to the vet who did a blood panel and the diagnosis came back Stage 4 Renal Disease. When I got back to Germany, my friend told me how SUC therapy had saved her cat's life. I spoke with my vet and got the okay to try it and Snowball made a complete turnaround. In fact, when he began to show the same symptoms again, I was afraid the SUC had stopped working, but the blood test results showed that his kidneys weren't the cause - they were not worse than before, in fact, the values had improved. Instead, it was the diabetes - which brings me here! Snowball continues to take SUC by mouth two to three times a week. Here's more info about a study done in 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7384345/
    https://www.google.com/search?q=Hee...d=0CCMQ9_gLahcKEwjI--WW0MuKAxUAAAAAHQAAAAAQEw

    https://docs.google.com/spreadsheet...QUQqz5cc7zeM_jYceF7NITqkYFBKo92z8afQz/pubhtml
    Dec 28, 2024Report
    LikeReply
 
Marje and Gracie said:
Hi Janet

Suzanne asked me to drop by as I’ve been in FDMB for almost 15 years now and was mentored by our most experienced (and amazingly knowledgeable about FD) member.

I’ve also dealt with German vets as I lived in Germany 6 years. I know their approach can be quite different from US vets but I have also seen US vets (including one I saw with my Gracie) state a cat was in remission when they clearly were not.

It is extremely rare to see a cat go into remission from 2u bid of insulin even though I note he had one shot at 1.5u and one at 1u. Snowball is not in remission and leaving him at these higher BGs can actually cause his CKD to progress. Just as in human diabetics, feline diabetics are prone to developing CKD and heart disease if the BG is not properly controlled. And while he is doing well when he’s in the 100s, his BG is not in the normal range for a diabetic cat.

If you were to take your nondiabetic cat to the vet and the BG was 150 mg/dL on a pet meter, that could be seen as vet stress and perhaps that is what your vet is used to seeing. But for a diabetic cat where you have real-time data at home, that number is way too high consistently for him to not be receiving insulin.

Starting him back at 0.25u is a modest approach and I would strongly encourage you to consider it. On a pet meter, we would not be considering a cat for a remission trial until the BG was consistently in the 68-100 range most of the time. Those cats about to go into remission with those BGs are usually on doses between one drop and 0.1u of insulin.

I understand lower BGs are a bit scary but you’ve now had experience dealing with them. One key is to test early after the shot….no later than +2 so you can catch any drops and prop them up a bit with food to keep them from dropping so low. Members here can help you do that.

Please let me know if you have questions.
Click to expand...
Thanks so much Marje. I will be in touch about the whole process of micro dosing for Snowball.
 
How about, when you are ready, to start a new thread for Snowball here. This one is getting too long. You can link this thread to your first post in the other thread.
Can you increase Snowball’s SUC therapy/frequency? I was just wondering about that.
 
Suzanne & Darcy said:
@Marje and Gracie here’s the post about the SUC therapy for CKD.


  1. Dec 28, 2024EditDeleteReport
    Reply


  2. jwbsings Snowball
    ↑
    Tell me about this SUC therapy.
    A friend told me about it, as it helped her cat with kidney disease. It's a homeopathic combination of Solidago compositum ad us. vet., Ubichinon compositum and Coenzyme compositum. It helped my Snowball tremendously. He had been treated for kidney insufficiency since 2017, but last year things got worse.He was all but given an immediate death sentence over a year ago when in the USA. He'd lost a lot of weight even though he ate full meals, and he was drinking a lot of water. I took him to the vet who did a blood panel and the diagnosis came back Stage 4 Renal Disease. When I got back to Germany, my friend told me how SUC therapy had saved her cat's life. I spoke with my vet and got the okay to try it and Snowball made a complete turnaround. In fact, when he began to show the same symptoms again, I was afraid the SUC had stopped working, but the blood test results showed that his kidneys weren't the cause - they were not worse than before, in fact, the values had improved. Instead, it was the diabetes - which brings me here! Snowball continues to take SUC by mouth two to three times a week. Here's more info about a study done in 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7384345/
    https://www.google.com/search?q=Hee...d=0CCMQ9_gLahcKEwjI--WW0MuKAxUAAAAAHQAAAAAQEw

    https://docs.google.com/spreadsheet...QUQqz5cc7zeM_jYceF7NITqkYFBKo92z8afQz/pubhtml
    Dec 28, 2024Report
    LikeReply
Click to expand...
Thank you. I did find a couple of resources online.
 
jwbsings Snowball said:
Thanks so much Marje. I will be in touch about the whole process of micro dosing for Snowball.
Click to expand...
You’re welcome. And, actually, it’s not really microdosing until you get to 0.1u or a drop. The 0.25u is a fairly standard dose to all of us but not to vets who usually dose in 1u increments ;)

The more important thing is Snowball still needs insulin. Without it, I doubt he will stay in the BGs he’s experiencing right now and his BG will most likely start to creep back up.

I also would suggest you not try the oral medicine I believe you said your vet mentioned. Most of the new oral diabetes meds for felines require the cat has never been on insulin.
 
Suzanne & Darcy said:
How about, when you are ready, to start a new thread for Snowball here. This one is getting too long. You can link this thread to your first post in the other thread.
Can you increase Snowball’s SUC therapy/frequency? I was just wondering about that.
Click to expand...
Yes, I'll do that. I have increased Snowball's SUC frequency for the next couple of weeks. I meet with his Vet on Thursday. I have decided to start the micro dosing - his BG is slowly rising every day...I'll start a new thread now and ask for instructions from you about how to start. Thanks so much, Suzanne. By the way, Mr. Darcy was absolutely adorable. I'm so sorry you had to say goodbye to him, yet I know he had the best loving care ever! I want to give Snowball that as well!
 
Thanks. I also had recommended that we start with the .25 dose so I feel very comfortable with that as a starting point …. great minds ;) you can monitor his carefully and you’ve already had some experience with managing low numbers. I recommend that the first test be at +2 so we can see if there’s been any significant drop in BG at onset time (+2 is a typical onset time with ProZinc.) I also recommend a snack at that time as I am sure I already mentioned. If .25 is too much, we will know based on his numbers and can go to the drop dose.
 
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