8/15 Copernicus AMPS=408 +3=425 PMPS=382 +3=445

[Krista & Copernicus]

PP
Checking in again. I've seen Copernicus go up after his insulin?? Even though he's never really been regulated, I've always seen his BGs at least trend down prior. What does this mean? What can I do? Thank you. This a.m. he went from 408 to 425 after insulin. Tonight he went up from 382 to 435 after insulin. On 8/14, he went from 410 to 436 after insulin.

I looked back at his IAA test results at it was 5%. I had primary draw kidney values today and they were still about stage 2 so that was ok news. BUT he still had rods in his urine so the vet gave him a Convenia injection. I didn't realize it could cause side effects for up to 14 days. His appetite doesn't seem as strong as before the shot, but he is eating. He's been under my bed a lot more. I don't see anything about it effecting BGs, but I also don't know if it was the best choice for rods. His previous antibiotic was clavamox.

 

[JL and Chip]

Are they doing a Culture and Sensitivity (C&S) on the urine? Has he been off Clavamox for at least a week?

A lot of vets like to reach for Convenia due to the convenience (hence the name). It’s not always the best for UTIs but maybe the vet saw something that made them think it was the best choice. Has Copernicus had Convenia before?

Was magnesium and phosphorous also checked? Just curious how you’re doing on those fronts.

As for what to do, I think trying to keep him hydrated, treating any infections, and fast tracking up the dosing scale are top of the list. Like Wendy said, you might need to get back up to where you were before — 19u or so — to see much movement.

 

[Wendy&Neko]

408 and 425 this morning are well within meter variance or 20% of each other. They could be the same number. I wouldn't worry about him going up at +3. Like I said yesterday, he is bouncing from the 255 a couple days ago. During bounces, numbers can wobble around. Meaning go up and down. The other factor at play could be New Dose Wonkiness. You just have to wait it out.

 

[Krista & Copernicus]

Are they doing a Culture and Sensitivity (C&S) on the urine? Has he been off Clavamox for at least a week?

A lot of vets like to reach for Convenia due to the convenience (hence the name). It’s not always the best for UTIs but maybe the vet saw something that made them think it was the best choice. Has Copernicus had Convenia before?

Was magnesium and phosphorous also checked? Just curious how you’re doing on those fronts.

As for what to do, I think trying to keep him hydrated, treating any infections, and fast tracking up the dosing scale are top of the list. Like Wendy said, you might need to get back up to where you were before — 19u or so — to see much movement.

Now that I'm reading about it, I wouldn't have allowed Convenia. The culture will take about a week but the shot is already in his system. He's had Convenia before for an URI but this was before his kidney disease. I don't know the exact date but maybe just under a week to week he's been off the clavamox. So good point, not that long. Phos looked good so binders are helping. They don't test magnesium at this hospital. I did 100 mL subq tonight just in case. My husband was there and it seems like the vets are moving to more quality of life conversations at this point because his sugars are so high for so long and so unregulated. The vet said it's only a matter of time now since I can't even get him below 400.

 

[Krista & Copernicus]

408 and 425 this morning are well within meter variance or 20% of each other. They could be the same number. I wouldn't worry about him going up at +3. Like I said yesterday, he is bouncing from the 255 a couple days ago. During bounces, numbers can wobble around. Meaning go up and down. The other factor at play could be New Dose Wonkiness. You just have to wait it out.

Ok but I just notice new patterns. I have seen NDW in the past, but he would always trend down even if just a little bit. I haven't seen this consistent trend upwards before.

 

[Krista & Copernicus]

Are they doing a Culture and Sensitivity (C&S) on the urine? Has he been off Clavamox for at least a week?

A lot of vets like to reach for Convenia due to the convenience (hence the name). It’s not always the best for UTIs but maybe the vet saw something that made them think it was the best choice. Has Copernicus had Convenia before?

Was magnesium and phosphorous also checked? Just curious how you’re doing on those fronts.

As for what to do, I think trying to keep him hydrated, treating any infections, and fast tracking up the dosing scale are top of the list. Like Wendy said, you might need to get back up to where you were before — 19u or so — to see much movement.

The only thing the vet saw was rods. I should have waited a few days for the early culture results.

 

[Krista & Copernicus]

Nope, not with the testing I see. You have some 3 hours gaps during the cycle, but that's not long enough for him to dive down then back up again. You have some longer testing gaps in the last half of the cycle, but insulin effect is typically fading then, so he's be going up, not down. You can see later nadirs if he's breaking a bounce, but then you'd see lower preshots.

Is there any logical explanation why I'm not at least getting the same numbers I was last time he was on 15?

 

[Wendy&Neko]

Is there any logical explanation why I'm not at least getting the same numbers I was last time he was on 15?

Actually several explanations. First is glucose toxicity. As they are used to higher numbers glucose toxicity sets in and you can need even higher amounts of insulin to break through. Two, his depot for 15 units isn't build yet and that means you often don't see the difference until the 5th or 6th cycle at a dose. 15 units wasn't all that great last time, the lowest he saw was very high 200's. And last reason, he's an acro and the pituitary tumour can pulse, meaning amount of growth hormone excreted is not consistant and can go up a down. Copernicus seems to be one of those slow responders to cabergoline, plus I think he's only getting it every other day?

Summary, a cat's insulin needs can change over time. Addition of other conditions that cause insulin resistance (like kidney disease, other infection or inflammation) can change what dose Copernicus needs now. Typically we don't look back more than a couple weeks of the spreadsheet because what he needed past that is not reflective of what he needs now. For example, Neko dose went from 1 units to 8.75 units when she finally got her first reduction, got SRT, went down over a year and a half to 0.75 units, the next year and a half slowly drifted up to 3 units, then her tumour went wild late July 2015 and was up to 7 units 5 months later. We did SRT again, and she went down to 0.25 units a year later.

A lot of acro spreadsheets you look at will see a lot of variability in what is a good dose. Copernicus just isn't there yet and you may be playing catch up with other conditions changing how much insulin he needs. Just keep increasing as fast as you safely can, and you will get there. Every acrocat I've seen here does eventually get there. Some just have to wait a little longer. Hang in there Krista, you are doing a good job with him. All the doubts and questions are also very common amongst caregivers of acros. We've been there too.

 

[Krista & Copernicus]

Actually several explanations. First is glucose toxicity. As they are used to higher numbers glucose toxicity sets in and you can need even higher amounts of insulin to break through. Two, his depot for 15 units isn't build yet and that means you often don't see the difference until the 5th or 6th cycle at a dose. 15 units wasn't all that great last time, the lowest he saw was very high 200's. And last reason, he's an acro and the pituitary tumour can pulse, meaning amount of growth hormone excreted is not consistant and can go up a down. Copernicus seems to be one of those slow responders to cabergoline, plus I think he's only getting it every other day?

Summary, a cat's insulin needs can change over time. Addition of other conditions that cause insulin resistance (like kidney disease, other infection or inflammation) can change what dose Copernicus needs now. Typically we don't look back more than a couple weeks of the spreadsheet because what he needed past that is not reflective of what he needs now. For example, Neko dose went from 1 units to 8.75 units when she finally got her first reduction, got SRT, went down over a year and a half to 0.75 units, the next year and a half slowly drifted up to 3 units, then her tumour went wild late July 2015 and was up to 7 units 5 months later. We did SRT again, and she went down to 0.25 units a year later.

A lot of acro spreadsheets you look at will see a lot of variability in what is a good dose. Copernicus just isn't there yet and you may be playing catch up with other conditions changing how much insulin he needs. Just keep increasing as fast as you safely can, and you will get there. Every acrocat I've seen here does eventually get there. Some just have to wait a little longer. Hang in there Krista, you are doing a good job with him. All the doubts and questions are also very common amongst caregivers of acros. We've been there too.

Thank you for always answering my questions. I just love him so much. I just went to help him before too much damage is done and I feel like I'm racing against the clock.

 

[Wendy&Neko]

If it helps, I've seen cats in higher numbers for a much longer time as their acros needed really high doses. Following TR suggestion, increasing as soon as as much as is safely possible to do will get you to better doses faster. The fact that Copernicus is seeing some yellows is encouraging. I just want a lot more of them and hope to soon.

Are you still using the AT and plan to continue to do so? Might need the spreadsheet updated if so. The AT traditionally shows quite a bit higher numbers in those higher blood sugars. If you were using a human meter, you'd probably be seeing better numbers.

 

[Krista & Copernicus]

Im going to move to a human meter. Ive said it before, but AT is $$. Even if the human meter showed lower, he's peeing and hiding too much for me right now.