Help to Understand Skipper's Values

Discussion in 'Prozinc / PZI' started by Kathy4Skipper, Jun 26, 2021.

  1. Kathy4Skipper

    Kathy4Skipper Member

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    This was the fourth day after the fur shot, and I was hoping Skipper's numbers would be settled out by now. I'm trying to be very consistent, but today's numbers were strange.

    I'm feeding twice a day because 1.) That's the way he's always been fed, 2.) That's what my awesome vet wants me to do, for now, 3.) It's my routine for all the cats.

    I can't test at night since the shot time is stuck at 8am/8pm. I'll start doing bedtime tests once I can move the shot time up to an earlier hour.

    I know I'm supposed to wait a full week at the 1.5u dose, but I'm just a little confused.

    Will you please look at Skipper's spreadsheet and share some insight on what's going on? Thanks!
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    If it were my cat i would do 2 units starting tomorrow morning.

    I see hes on Benezapril. Does he have ckd?
     
  3. Kathy4Skipper

    Kathy4Skipper Member

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    Yes, he is a ckd kitty.

    Since we are still so new at this, I'd be comfortable going up to 1.75u tomorrow morning.
    Unless he pulls an AMPS of 285 like he did this morning.

    Why do you think he was flat most of the day?
     
  4. Katsallday

    Katsallday Member

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    Once I switched my sugar cat to 4 smaller meals a day I saw some big improvements in bg. I wonder if you kitty could benefit like mine did? He shoots up in bg if he misses one of his 4 meals
     
  5. JanetNJ

    JanetNJ Well-Known Member

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    I think his dose isn't enough. We want to aim to get the nadir closer to 100. I'm glad you are planning on getting a before bed reading. It may give us more insight as to what is going on. I used to test 6/6pm then at 10-11 pm to get an idea of what the evening cycle was doing.
     
  6. Kathy4Skipper

    Kathy4Skipper Member

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    Looking at your spreadsheet, it looks like you never sleep! :coffee: Am I reading it correctly that you feed/test at 2am, 8am, 2pm, and 8pm?
     
  7. Kathy4Skipper

    Kathy4Skipper Member

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    Skipper's AMPS was 397 so I gave him 1.75u this morning.

    Btw, I tried to look up "cycle" in the dictionary but I didn't see it listed. How long is a cycle? Is it 12 hours?
     
  8. Katsallday

    Katsallday Member

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    Haha my baby is in remission now but I do feed at 2 8 2 8 lol! It's what I've found to best suit his BG! It's wild that his fasting BG is higher than his post meal BG so I just feed him alot
     
  9. Katsallday

    Katsallday Member

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    A cycle is 12 hours :)
     
  10. Kathy4Skipper

    Kathy4Skipper Member

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    What a wonderful kitty Mom you are!
     
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  11. Kathy4Skipper

    Kathy4Skipper Member

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    Thank you!
     
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  12. Hshray

    Hshray Well-Known Member

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    It is possible that he went lower earlier in the day yesterday. If you look at my day from 6/24 it probably would’ve looked similar if I hadn’t tested before +6 (would’ve looked like he stayed relatively flat then spiked at the end of the day). He actually went low at +3 and was high at the end of the day because he bounced from that. Of course it’s hard to say because George has also seen his fair share of pretty flat days.

    One thing that I wish I would’ve done earlier is not have been scared to shoot lower numbers. For a long time his numbers were so high that when I saw a yellow at pre-shot I would want to reduce the dose, but that ended up setting him back, so I would definitely recommend following the dosing protocol when it comes to shoot/no shoot numbers at full doses. Once I stopped reducing, George started seeing much better numbers (and I felt like I lost a lot of time getting him into good numbers before that).
     
  13. Hshray

    Hshray Well-Known Member

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    Every cat is different, but if these were George’s numbers for today it would look like he was heading into a bounce break tonight. Maybe @FrostD can take a look to see if she agrees or has any insight to add.
     
  14. FrostD

    FrostD Well-Known Member

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    I'm not sure if anyone has explained bouncing to you, but when a cat's BG drops faster or goes lower than they're used to, the liver can "panic" and release sugar into the bloodstream. There's nothing to do about it, they eventually get used to lower numbers and bounce less often. A bounce generally clears in 2-4 cycles.

    So I think Skipper has been bouncing a bit - when you see those big drops like on the 23rd, it's a pretty sure guess he'll bounce. Now what makes things tricky is the bounce break - it can often drop a cat lower than usual...and then sometimes trigger another bounce. If you look at the 25th, he was dropping coming into shot time, a pretty sure sign of a bounce break (although they can happen any time in the cycle). That's very likely where the yellow preshot came from on the 26th, he broke the bounce overnight and kept coming down.

    It looks like he's.on track to do the same tonight. Let's see where he is at preshot. Can you monitor during the night? Do you have a hypo kit? How far off schedule can you be(meaning how long can you delay the shot if needed)? That will influence the decision if he's under 200.
     
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  15. Kathy4Skipper

    Kathy4Skipper Member

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    I tested him just now... 15 minutes early so I could reply to you.

    His PMPS is 293. Please take another look at his spreadsheet to see what might happen overnight. I have high-carb dry food and Karo syrup on hand, but I can't really monitor him overnight because of my sleep schedule since tomorrow is Monday (work).

    Do you think it's safe to give the new 1.75u?
     
  16. Kathy4Skipper

    Kathy4Skipper Member

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    What does "bounce break" mean? Is a bounce when they go too high? or go too low? Or just go too far one way or the other?
     
  17. FrostD

    FrostD Well-Known Member

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    Yes I do. Today looks like a late nadir rather than a bounce break, which is good!

    I'll edit with bounce break explanation in a minute just wanted to get you yes/no answer.

    Edit:
    A bounce break is when the bounce, which I described earlier, is over. The liver stops panicking and throwing glucose into the blood...for the time being anyway. So the cats BG comes down naturally, but at the same time you're still giving insulin. So the insulin brings it down further. Anecdotally, in my experience, most bounce breaks return the cat to pre-bounce numbers. But if the timing is right with insulin, it can go up to 20 points lower. Every cat is different of course, some may drop more. With the data you do have, that seems to be the case for Skipper too.


    Cats on ProZinc usually nadir between +6 and +8, it can vary by day, cycle, etc. Hilary's cat George is an interesting exception, he tends to nadir much earlier. Today was the first +8 test you've gotten, so it was hard to tell if he was going to continually drop towards shot time (as with a bounce break), or come back up a little bit (as with a normal cycle).

    Today's late nadir is good because it means his liver didn't panic, and this is a chance to "catch" lower numbers and hold onto them. However, sometimes cats do get delayed bounces, so don't be dismayed is he's pink or higher in the morning
     
    Last edited: Jun 27, 2021
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  18. Kathy4Skipper

    Kathy4Skipper Member

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    Thank you so much for your quick reply! :bighug: I'll go ahead and give him his shot now!
     
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  19. JanetNJ

    JanetNJ Well-Known Member

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    Yes, 12 hours. :)
     
  20. JanetNJ

    JanetNJ Well-Known Member

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    Yes... Good to shoot
     
  21. Hshray

    Hshray Well-Known Member

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    I was out and about but saw Melissa gave a great explanation so didn’t write back right away. Like she mentioned George nadirs early so I pretty much have to get a test at +2 or +3 because when he breaks his bounces his numbers come down really hard and fast. I have a very bouncy kitty, but with any luck Skipper will have later nadirs and hopefully a smoother ride.
     
  22. Kathy4Skipper

    Kathy4Skipper Member

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    I didn't know a cat could nadir so early! Thank you for telling me more about George.
     
  23. Kathy4Skipper

    Kathy4Skipper Member

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    @FrostD I tried to combine everything you told me and I added some extra notes to make sure I understand the bounce and bounce break.

    Will you please read and edit this to make sure I'm correct?

    When a cat’s Blood Glucose (BG) drops faster or goes lower than they’re used to, the liver can “panic” and release sugar into the bloodstream, causing BG values to rise extra high. This response is called a bounce. There’s nothing to do about it; they eventually get used to lower numbers and bounce less often. A bounce generally clears in 2-4 cycles. A cycle is a 12-hour period. 2 cycles = 24 hours, and 4 cycles = 48 hours.

    A bounce break is with the bounce is over, and the BG is going down. The liver stops panicking and throwing glucose into the blood... for the time being anyway. The cat’s BG comes down naturally, but at the same time, you’re still giving insulin, so the insulin brings it down further. Anecdotally, in my experience, most bounce breaks return the cat to pre-bounce numbers. But depending on the timing with insulin, it can go 20 points lower. Every cat is different, of course, and some cats may drop more. Bounce breaks can happen anytime in the cycle. For example, a low pre-shot value can occur when a bounce break happens during the cycle, and the BG continues to drop towards shot time. (In a normal cycle, the BG rises toward shot time.)

    When you see big BG value drops, it’s a pretty sure guess the cat will bounce. Now what makes things tricky is the bounce break - it can often drop a cat lower than usual...and then sometimes trigger another bounce.
    Author: FrostD
     
  24. FrostD

    FrostD Well-Known Member

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    You got it!

    Over time you'll start to see his patterns and it'll get a little easier to predict
     
  25. Kathy4Skipper

    Kathy4Skipper Member

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    Thank you so much! I'll keep a watch on his patterns to see what I can learn.

    I tested Skipper at +4 last night and he was 410. That's as late as I could stay up. :coffee:

    You predicted it right on the pink this morning. AMPS: 369
    So, do you think he bounced last night?
     
  26. FrostD

    FrostD Well-Known Member

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    Hey look at that, sometimes my crystal ball works!

    It's a little bit hard to say. That 410 is more than I'd expect from a food bump that far into the cycle, but factoring in meter variance (up to 20%) it could be a normal cycle. Usually bounces are a little bigger, but not always.

    Either way, pink is progress!
     
  27. Katsallday

    Katsallday Member

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    I don't think you give your crystal ball enough credit :joyful:

    How's skipper feeling today? I noticed with my baby when he was bouncing it was a bit harder to make him eat his whole meal (he's 18 lbs he normally has no problem eating lol!)
     
  28. Kathy4Skipper

    Kathy4Skipper Member

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    He seems to be feeling ok. Ate well this morning.

    Maybe we're bouncing now. His morning +5 is 459. :(
     
  29. Katsallday

    Katsallday Member

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    Yeah that looks like a bounce to me. I'd like to reiterate that I'm still kinda new to FD and to listen to anyone else here over me, but what I'm guessing happened is his pmps was quite low compared to his normal value. I assume he dipped in the night and now he's bouncing. @FrostD do you think I'm close with this logic?
     
  30. FrostD

    FrostD Well-Known Member

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    Are you sure he's only getting 3% Nulo food? Being an outdoor cat, is there a chance he's getting into other things?

    It could just be a flat-ish cycle, they happen sometimes. It's possible he dipped lower again during the night to set off another bounce, but it's not quite reading that way to me (when he bounces, he tends to go high red or black midcycle or at PS). More like there's a higher carb food in the mix somewhere OR he's getting late onset. So he continues to rise to about +4/+5 then he gets the onset and starts to go down.

    I wouldn't go too crazy trying to analyze everything right now, just the general trends are helpful. The important takeaway is that he definitely needs more insulin, but we have to be patient in doing the increases.
     
  31. JanetNJ

    JanetNJ Well-Known Member

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    Good job getting that reading last night. I still think you should try 2. I think there's a bit of insulin resistance going on.
     
  32. Kathy4Skipper

    Kathy4Skipper Member

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    @FrostD Skipper is an indoor cat only, so there isn't any chance that he's getting other food. I've been very routine with the amount of food and the feeding time. His +6 was 352. The protocol is to wait a week before increasing insulin, right?

    @JanetNJ What do you mean to try 2. Do you mean get 2 readings in at night?
     
  33. JanetNJ

    JanetNJ Well-Known Member

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    No I mean 2 units. Your lows are no where near the low 100's so I think a slightly bigger increase would be helpful.
     
  34. FrostD

    FrostD Well-Known Member

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    Oh sorry I had him confused with a different cat.

    On SLGS, as it's written, yes wait a week. Once you can more reliably test at night you could try the Modified Method which allows for quicker increases.
     
  35. Kathy4Skipper

    Kathy4Skipper Member

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    Ok, thanks.

    I just tested again and he coming down fast. +7 = 278
    So I think that might correlate with your late-onset theory?
     
  36. FrostD

    FrostD Well-Known Member

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    That's what it looks like to me, late onset and later nadir.
     
  37. Kathy4Skipper

    Kathy4Skipper Member

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    @FrostD I saw this one coming... PMPS = 167
     
  38. Kathy4Skipper

    Kathy4Skipper Member

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    I'll wait 20 minutes without feeding and test again to see if his glucose is rising.

    He did this on the morning of June 19th. I fed him on that morning and it still took him a full hour to go from 191 to 244. I really don't want to push his shot to 9:15pm because that is just too late.
     
  39. FrostD

    FrostD Well-Known Member

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    Ok let's see where he's at in 20.

    If he's flat or barely rising, you can also do a reduced or token dose. A reduced dose is around half the normal dose, token more like 10-20%. It's generally better to give some insulin vs skip altogether

    If he's still going down (150 or less) I'd just skip altogether.
     
  40. Kathy4Skipper

    Kathy4Skipper Member

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    PMPS+24minutes = 197
     
  41. FrostD

    FrostD Well-Known Member

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    Ok close enough! I'd shoot full dose
     
  42. Kathy4Skipper

    Kathy4Skipper Member

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    er, :confused: Skipper has never had a full dose at this low of a reading.
     
  43. Kathy4Skipper

    Kathy4Skipper Member

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    I think I'll do the token dose. 15% of 1.75 is about 0.25ml for tonight.
    Then I can shoot at 7am tomorrow to get back to a normal schedule.
    What are your thoughts?
     
  44. FrostD

    FrostD Well-Known Member

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    I certainly understand your hesitation. He's never even come close to dangerously low, so I think full dose is safe to give. Remember that insulin isn't "linear", just because he drops 200 points at higher numbers doesn't mean he'll go down that much here.

    It's your call and what you're comfortable with, but these are the opportunities to start catching lower numbers and bring him down overall. By giving a smaller dose, chances are he'll be back in red/black in the morning, and the cycle of high numbers continues. To be fair he'll probably end up pink/red anyway because I'm expecting a bounce.
     
  45. JanetNJ

    JanetNJ Well-Known Member

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    You hold the syringe but I would do a full dose. You can always stall another half hour.
     
  46. Kathy4Skipper

    Kathy4Skipper Member

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    Normally, I've read not to push a shot more than one hour earlier. If I give a low dose tonight, can I shoot a normal dose two hours early tomorrow morning? Will this work?
     
  47. FrostD

    FrostD Well-Known Member

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    Also, you can try 7am with reduced dose, but know you'll probably be shooting a dropping number there too. Less insulin doesn't change how the cat reacts, hell still likely see late onset and nadir. We generally recommend working back an hour at a time.
     
  48. Kathy4Skipper

    Kathy4Skipper Member

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    I just tested at no-shot+1 and he is at 313. Now (in my mind:woot:) it is safe to shoot the full dose, I'm assuming.
    So, the ProZinc won't have a cumulative effect... he will still have his late-onset and nadir at his normal +8? I am correct?
     
  49. FrostD

    FrostD Well-Known Member

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    Yep! And correct. There will be a very slight overlap and he may be a little lower than usual earlier in the cycle, but should still see same overall pattern.
     
  50. Kathy4Skipper

    Kathy4Skipper Member

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    Good! Thanks for understanding that I was asking about the overlap since I read that ProZinc can last 12-14hours depending on the cat.
    This is great information to know! :bighug:
    I gave the full dose of 1.75u about 30 minutes after his 313 value. So, 1.5 hours later than normal. I really must come up with a way to shoot earlier in the day. I think 7am/pm will be best since that's the normal mealtime around here.
     
  51. FrostD

    FrostD Well-Known Member

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    It's hard trying to find a "groove" with shot time. Every time I finally get a solid schedule, something changes or throws it off. Your best bet is to work backwards an hour at a time.

    Is there a reason you waited 30 mins after the 313 instead of giving it right away? I see.yoindid something similar the last time you stalled.
     
  52. Kathy4Skipper

    Kathy4Skipper Member

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    I appreciate that you notice details like this. I waited to try to make sure Skipper was really out of the 12-14 hour overlap timeframe.
    Regarding the schedule getting thrown off and Skipper's bounciness, my vet didn't want me to use ProZinc. He doesn't like it because he's seen too many cats bouncing on it. He instead, wants me to use Novalin-N. I saw a post somewhere that said Novlalin-N only lasts 6-8 hours in a cat but my vet said it works better than ProZinc. Since I'm home testing instead of taking Skipper weekly for bloodwork, the vet wants me to report in regarding any bounciness and if I can't get it under control in a month, to switch.
     
  53. FrostD

    FrostD Well-Known Member

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    Bounciness is generally resolved with time and methodical increases. And cats bounce on all insulins.

    I wouldn't worry about the overlap at these high numbers, or you'll be perpetually off schedule. The overlap is nice because it may help you get his numbers down a little more quickly.

    There aren't a lot of Novolin users here so I can't really speak to that. Both Lantus and Levemir are considered more "gentle" and also suitable cats. Cats do tend to bounce less with those, but still do bounce. The down side to those insulins is that bringing down high numbers aren't their strength, their strength is keeping low numbers low. So it takes a little while to get to better numbers.

    In my experience, most cats on ProZinc almost never go over 3-3.5U before hitting better numbers (unless there's an underlying issue). So I'd just continue the methodical increases and see where it takes you; when your vial starts getting towards the end then see where you are and if you want to switch.

    I switched off ProZinc because my cat just really didn't seem to feel well on it. Numbers were the same as always, he just really seemed off and not himself. But I've not heard that from anyone else here.
     
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  54. Shelley & Jess

    Shelley & Jess Member

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    You want a bit of overlap.

    For most cats Prozinc onset is around +2. By the time the insulin from the last shot is wearing off the next shot is kicking in, that's what keeps the numbers down and why for new members we recommend giving token doses and getting tests in when shooting lower numbers than you're used to for the first few times.

    @FarmKitty wrote a great post about her experience shooting lower and lower preshots - you can read about it in this thread:
    Learning to shoot the lower numbers
     
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  55. JanetNJ

    JanetNJ Well-Known Member

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    I agree the overlap is good. If you can catch it before the overlap wears off you may prevent these numbers up in the 300's.
     
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  56. Kathy4Skipper

    Kathy4Skipper Member

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    Thank you everyone for explaining more! I thought the overlap was a bad thing... like I was doubling up the insulin. With this new knowledge, I'll feel more comfortable giving his shot at lower numbers. Thanks!
     
  57. Katsallday

    Katsallday Member

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    Wow your asking all the questions I never asked! You're doing amazing Kathy!
     
  58. FrostD

    FrostD Well-Known Member

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    You'll want to start a new thread tomorrow with a link to this one (this one is getting long).

    I won't be around tonight, but same advice applies. Looks like he's shaping up for another day like yesterday; if he's low again at PMPS stall without feeding. As soon as he's above 200, shooooot!

    If it takes him more than an hour to be above 200, then do reduced or token dose like I mentioned earlier. That should keep you close to on schedule (plus some cats start to drop without food for that long anyway). I'd only skip if he doesn't come above 150.
     
  59. Kathy4Skipper

    Kathy4Skipper Member

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    Thank you! Being confused helps! :D
     
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  60. Kathy4Skipper

    Kathy4Skipper Member

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    Thanks for the heads up and the great tips. I hope you're doing something fun tonight! I'll start a new thread as you mentioned with a link to this thread.

    I tested Skipper at +8 and I was surprised that he was 351. I thought for sure he'd be in the yellows. I'll follow your tips tonight. Thanks again!
     
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  61. Kathy4Skipper

    Kathy4Skipper Member

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    :D:D:D
     
  62. JanetNJ

    JanetNJ Well-Known Member

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    Probably a bit of a bounce
     
  63. Kathy4Skipper

    Kathy4Skipper Member

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    What a bouncy boy!
     
  64. Hshray

    Hshray Well-Known Member

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    I like that blue pmps though!
     

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