5/30 Copernicus AMPS 399 advice on constipation?

[Krista & Copernicus]

PP

1. Copernicus hasn't pooped in up to 3 days now. This has never happened. He has always been regular. Appetite is normal. I was so focused on protein and carbs and giving him boiled chicken, that I forgot about fiber. What do?
2. As I am blowing through insulin with no end in sight, what is the most cost effective way to get more Lantus pens?
3. His BGs and 3 Ps were better at 7.5 units than when I increased to 8. He is more lethergic now too. Any advice here?

I know in a previous post, phosphorous binders were recommended, but the CKD group warned me that I better know his calcium levels before choosing a binder and that is not something I know, but he has some follow up appointments this week. He hasn't officially been diagnosed CKD because they aren't sure if due to dehydration.

I look forward to your responses.

 

[Staci & Ivy]

PP

1. Copernicus hasn't pooped in up to 3 days now. This has never happened. He has always been regular. Appetite is normal. I was so focused on protein and carbs and giving him boiled chicken, that I forgot about fiber. What do?
2. As I am blowing through insulin with no end in sight, what is the most cost effective way to get more Lantus pens?
3. His BGs and 3 Ps were better at 7.5 units than when I increased to 8. He is more lethergic now too. Any advice here?

I know in a previous post, phosphorous binders were recommended, but the CKD group warned me that I better know his calcium levels before choosing a binder and that is not something I know, but he has some follow up appointments this week. He hasn't officially been diagnosed CKD because they aren't sure if due to dehydration.

I look forward to your responses.

Glad to see your update. Been thinking about you and Copernicus

For insulin, see below $35 per refill coupon with GoodRx
Sometimes it takes a “thinking” pharmacist to get it to work.
Sometimes the clerk just says no “it’s for a pet “.
It’s ok and works for pets, they just don’t know it does.

Ask for the pharmacist in that case, or go to another local pharmacy if a problem.
Remind them you’re not using any insurance.

I’ve had success at a CVS and my local grocery store pharmacy.

I use a pinch of psyllium husk as maintenance with Ivy 2x daily.
https://www.amazon.com/dp/B007729DSE?tag=felinediabetesfdmb-20
(Whole Foods may carry this)
You can also try S Boulardii in small amounts and work up if needed.
https://www.amazon.com/dp/B0013OVW0E?tag=felinediabetesfdmb-20
(You may be able to buy locally, my Whole Foods carries it)

Is he dehydrated, do you think? Has he had fluids?

I hope he feels better on this dose. Are you planning on another increase soon?

Really hoping the vet visit will bring more clarity this week
Sending you both lots off love and hugs

 

[Krista & Copernicus]

Glad to see your update. Been thinking about you and Copernicus

For insulin, see below $35 per refill coupon with GoodRx
Sometimes it takes a “thinking” pharmacist to get it to work.
Sometimes the clerk just says no “it’s for a pet “.
It’s ok and works for pets, they just don’t know it does.

Ask for the pharmacist in that case, or go to another local pharmacy if a problem.
Remind them you’re not using any insurance.

I’ve had success at a CVS and my local grocery store pharmacy.
View attachment 78443View attachment 78443View attachment 78444

I use a pinch of psyllium husk as maintenance with Ivy 2x daily.
https://www.amazon.com/dp/B007729DSE?tag=felinediabetesfdmb-20
(Whole Foods may carry this)
You can also try S Boulardii in small amounts and work up if needed.
https://www.amazon.com/dp/B0013OVW0E?tag=felinediabetesfdmb-20
(You may be able to buy locally, my Whole Foods carries it)

Is he dehydrated, do you think? Has he had fluids?

I hope he feels better on this dose. Are you planning on another increase soon?

Really hoping the vet visit will bring more clarity this week
Sending you both lots off love and hugs

Thanks! He doesn't appear dehydrated on skin elasticity test. I did fluids anyway just to try and move things along. Do you do husk instead of pumpkin bc pumpkin can raise BG?

 

[squeem3]

The $35 coupon may or may not work. And you may get a pharmacist who won't sell you an entire box See yesterday's condo: 5-29 Leroy AMPS 371 PMPS 251

Miralax or generic equivalent helps with constipation. There's a Feline Constipation web site but it doesn't seem to working at the moment. You can try viewing a WayBack Machine archive of the site: Home Page

Pumpkin has natural sugar in it so that would raise bgs (maybe) more thatn psyillium husk or other fiber.

Is the CKD group the Tanya CRF one?

 

[Krista & Copernicus]

The $35 coupon may or may not work. And you may get a pharmacist who won't sell you an entire box See yesterday's condo: 5-29 Leroy AMPS 371 PMPS 251

Miralax or generic equivalent helps with constipation. There's a Feline Constipation web site but it doesn't seem to working at the moment. You can try viewing a WayBack Machine archive of the site: Home Page

Pumpkin has natural sugar in it so that would raise bgs (maybe) more thatn psyillium husk or other fiber.

Is the CKD group the Tanya CRF one?

I just looked at our Rx, and Walgreens only gave me 1 pen when the Rx says 3 pens and 5 refills. And I don't think I can prove it if I go back. But I paid for 3 and only got 1. This is exhausting. Anyway, I don't know what Tanya CRF means lol, but I would love a link! It's the FB CKD group if that helps. Interesting about the pumpkin, several of his canned foods has it as an ingredient and I've always said the food spikes his BG even though says it's under the 10% carb.

 

[squeem3]

This is the go-to place for all things CKD: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease – Everything You Need to Know to Help Your Cat There's a board but it's not set up like FDMB is. It's more like a typical email inbox so confusing to use and it's one thread per cat. Tanya’s Support Group – Tanya's Comprehensive Guide to Feline Chronic Kidney Disease I'm on the board but haven't found it too helpful, just people questioning my vet and disagreeing with bloodwork results.

FDMB has a sister board for kidney issues if you want to join and like a typical message board format: Feline Kidney Message Board - FKMB Not too many members there yet.

Leroy's prescription says quantity 3 but I'm not sure if that means 3 ml (one pen) or 3 pens. I went to Walgreens this time too because CVS couldn't get the coupon to work last time. But at least CVS gave me a whole box.

 

[Staci & Ivy]

I just looked at our Rx, and Walgreens only gave me 1 pen when the Rx says 3 pens and 5 refills. And I don't think I can prove it if I go back. But I paid for 3 and only got 1. This is exhausting. Anyway, I don't know what Tanya CRF means lol, but I would love a link! It's the FB CKD group if that helps. Interesting about the pumpkin, several of his canned foods has it as an ingredient and I've always said the food spikes his BG even though says it's under the 10% carb.

I am able to get a box of 5 pens no problem.
Hopefully the prescription may spell that out clearly in case pharmacy is not too bright.
I try to ensure my scripts are explicit to avoid these issues.
You can always point to the GoodRx coupon, which indicates the $35 price is for either a vial or a box of 5 pens (Not just one one)

It can make your head spin to get what you should without complications, for sure

 

[squeem3]

The single pen cost $20 so the coupon didn't apply.

 

[Staci & Ivy]

The single pen cost $20 so the coupon didn't apply.

I buy a box at a time. More cost effective and I won’t run out and have to scramble for one pen.

 

[Wendy&Neko]

I would worry as much about phosphorus if he hasn't been diagnosed with CKD yet. Leave that problem for another day. Scrolling back, it looks like on 5/15 his P values were better. BTW, you might find it really handy to fill in the Labs tab of the spreadsheet. You have to manually enter values, but it's a great way to see trends. My non diabetic cats now have Labs spreadsheets.

I never found pumpkin raised Neko's BG is the amount you give. You can also try baby food squash if he doesn't like pumpkin. Psyllium husk fiber is easy to give, but you need to make sure there is plenty of water in the food. Miralax can also help. Unfortunately, constipation can be a common side effect of acromegaly, so you need to find a solution that will help. It's not something I had to deal with much. Constipation can also raise the blood sugars.

@squeem3 The owner of the felineconstipation site sadly passed away.

 

[Krista & Copernicus]

If this cat looks at carbs it raises his blood sugar. I just took a look at your lab tracking. I did fluids and pumpkin this a.m. (bc I had a can of it) and he just pooped!

 

[Wendy&Neko]

If this cat looks at carbs it raises his blood sugar

That's hard to tell in higher numbers, much easier as he becomes more regulated.

 

[Staci & Ivy]

If this cat looks at carbs it raises his blood sugar. I just took a look at your lab tracking. I did fluids and pumpkin this a.m. (bc I had a can of it) and he just pooped!

We like to say around here “poop poop hooray”

 

[squeem3]

@Staci & Ivy Yes I know a box of pens is better to have on hand but the pharmacist wouldn't sell me a box. See yesterday's condo.

 

[Staci & Ivy]

@Staci & Ivy Yes I know a box of pens is better to have on hand but the pharmacist wouldn't sell me a box. See yesterday's condo.

What a

 

[JL and Chip]

3. His BGs and 3 Ps were better at 7.5 units than when I increased to 8. He is more lethergic now too. Any advice here?

I’ll let others guide you on dosing, but I will say that diabetes isn’t a static biological process, especially with acro in the mix. Sticking at a dose too long or trying to move down in dose because the BG numbers looked “better” (even if still too high) at a lower dose in the past can foil the process. Glucose toxicity (sounds worse than it is) can set in quickly so we generally want to be nimble and move up in dose as the data dictates. That’s true of any diabetic, but particularly so with acros. Have you decided whether to try TR? The spreadsheet still says SLGS but I think it is important to try to get Copernicus out of those higher numbers as quickly as possible. I believe TR woold let you go to 8.5u now. @Wendy&Neko @Marje and Gracie ??

1. Copernicus hasn't pooped in up to 3 days now. This has never happened. He has always been regular. Appetite is normal. I was so focused on protein and carbs and giving him boiled chicken, that I forgot about fiber. What do?

Has Copernicus passed stool yet? If so, what is the consistency? Constipation can definitely be a problem in acros. Sometimes it’s rock hard stools, but other times it’s lack of motility. Tubby had a big problem with getting “backed up” annd that always led to higher BG. Given Copernicus hasn’t had this problem before, hopefully it’s just an aberration. You’ve been given a lot of good options — canned pumpkin, psyllium husk, Miralax, hydration — or even a combo. I wouldn’t worry too much about the carbs in pumpkin at this point, he just needs to be able to “download” (my fun term for the process, lol). Sometimes it’s trial and error to find what works.

know in a previous post, phosphorous binders were recommended, but the CKD group warned me that I better know his calcium levels before choosing a binder and that is not something I know, but he has some follow up appointments this week. He hasn't officially been diagnosed CKD because they aren't sure if due to dehydration.

Yes, important points. I thought I saw calcium and phosphorus on some of his lab work but I might be wrong. What caught my attention was twofold — you mentioned he has very higher phosphorus at diagnosis that they were able to get down, then it happened again before he ended up at the ER and hospitalized recently. High phosphorus can definitely make them feel punky. Also, you don’t want the calcium x phosphorus value to be much over 65 mg/dl or the kidneys and soft tissues can begin to mineralize. Not something I want you to stress about, but that’s why I mentioned the binders. But that’s a discussion you can have with your vet and research in Tanya’s website linked in a previous post. Did they do an SDMA test by chance?

How is Copernicus acting and feeling today?

 

[Wendy&Neko]

Good catch @JL and Chip on Copernicus needing an increase. SLGS does allow for some exceptions, especially for ketones. @Krista & Copernicus have you gotten a recent ketones test in? If so, please put it in the spreadsheet. JL is also correct that especially in the case of an acro in higher numbers, they will do much better following TR, at least until he gets much closer to a good dose.

 

[Krista & Copernicus]

I’ll let others guide you on dosing, but I will say that diabetes isn’t a static biological process, especially with acro in the mix. Sticking at a dose too long or trying to move down in dose because the BG numbers looked “better” (even if still too high) at a lower dose in the past can foil the process. Glucose toxicity (sounds worse than it is) can set in quickly so we generally want to be nimble and move up in dose as the data dictates. That’s true of any diabetic, but particularly so with acros. Have you decided whether to try TR? The spreadsheet still says SLGS but I think it is important to try to get Copernicus out of those higher numbers as quickly as possible. I believe TR woold let you go to 8.5u now. @Wendy&Neko @Marje and Gracie ??


Has Copernicus passed stool yet? If so, what is the consistency? Constipation can definitely be a problem in acros. Sometimes it’s rock hard stools, but other times it’s lack of motility. Tubby had a big problem with getting “backed up” annd that always led to higher BG. Given Copernicus hasn’t had this problem before, hopefully it’s just an aberration. You’ve been given a lot of good options — canned pumpkin, psyllium husk, Miralax, hydration — or even a combo. I wouldn’t worry too much about the carbs in pumpkin at this point, he just needs to be able to “download” (my fun term for the process, lol). Sometimes it’s trial and error to find what works.


Yes, important points. I thought I saw calcium and phosphorus on some of his lab work but I might be wrong. What caught my attention was twofold — you mentioned he has very higher phosphorus at diagnosis that they were able to get down, then it happened again before he ended up at the ER and hospitalized recently. High phosphorus can definitely make them feel punky. Also, you don’t want the calcium x phosphorus value to be much over 65 mg/dl or the kidneys and soft tissues can begin to mineralize. Not something I want you to stress about, but that’s why I mentioned the binders. But that’s a discussion you can have with your vet and research in Tanya’s website linked in a previous post. Did they do an SDMA test by chance?

How is Copernicus acting and feeling today?

I think I just forgot to update the verbiage to TR. I can go up to 8.5. He did poop. And yes you are correct in that I have that bloodwork from the hospital before they said they got him better on fluid therapy. But I don't have any recheck calcium/phos bloodwork. I should have that this week. I don't think it's something to overlook that he had high phos. twice. Sometimes the vets just look at the moment and not the big picture.

 

[Krista & Copernicus]

Good catch @JL and Chip on Copernicus needing an increase. SLGS does allow for some exceptions, especially for ketones. @Krista & Copernicus have you gotten a recent ketones test in? If so, please put it in the spreadsheet. JL is also correct that especially in the case of an acro in higher numbers, they will do much better following TR, at least until he gets much closer to a good dose.

I haven't checked ketones since Thursday when they were .4. I can check them again in the a.m.

 

[Wendy&Neko]

Getting him out of higher numbers, where he is peeing away the precious liquids more, will also help the constipation.

 

[Staci & Ivy]

When you meet with the vet this week (new one, correct? And a mobile vet?)
I would have a list of things you need and make requests for what you will need (so you won’t have to hassle with all the uncooperative vets you’ve seen prior)
Perhaps scripts for:
Mirtazapine, ondansetron, Cerenia, fluids, lines and needles, Lantus vial or box of pens (all with refills!)

If anyone has any other suggestions, please add to this list

Good luck with the increase. Sending many hugs to sweet Copernicus

 

[Krista & Copernicus]

Good advice to have a list, but just because I ask doesn't mean I will receive. The vet school vet will probably just follow previous treatment plan laid out. But yes definitely add to Staci's list...!!!

 

[Staci & Ivy]

Good advice to have a list, but just because I ask doesn't mean I will receive. The vet school vet will probably just follow previous treatment plan laid out. But yes definitely add to Staci's list...!!!

I understand, just want you to have the “request list” ready to discuss while you’re with the vet.
Easier than after the fact.
Also,.. pain meds (buprenorphine)

 

[Krista & Copernicus]

Good catch @JL and Chip on Copernicus needing an increase. SLGS does allow for some exceptions, especially for ketones. @Krista & Copernicus have you gotten a recent ketones test in? If so, please put it in the spreadsheet. JL is also correct that especially in the case of an acro in higher numbers, they will do much better following TR, at least until he gets much closer to a good dose.

Ketones .5 today