9/12 Copernicus PMPS=421 +3=499 +4=464 +9=562

[Krista & Copernicus]

PP

His BG continues to rise to dangerous levels as I increase his dose. I am starting to question if there is causation. You can see when he went on 9, he started to go up incrementally. I didn't increase his dose over the weekend because I was not with him, but he has not had a positive response to the latest increases. Yesterday, I captured a 246 on the AlphaTrak, but he continues to rise to a dangerous 562. I'm assuming that's a "bounce" as you refer to it, but what to do about it? His ketones have been in the .8/.9 range and he is eating. Yesterday evening at 8pm was his first dose of cabergoline. He's gotten anywhere from 40-100 mLs of fluids (sometimes they hear a murmur) almost daily for the last week to try and dilute his high numbers. If he ends up back in the ER, I fear that is it because each stay is an average of $4000-$11,000 and he's already had 3 of them. I posted Libre data from May 22 at 7 units (the last time I saw yellows). I could never get his ear sticks to be close to what the Libre said, so I have been recording his AlphaTrak numbers and not the Libre numbers. If his numbers show low on Libre, I would go test his ear and he would be high (I know they will not match). I will also be emailing a vet but I have yet to find an IM that works on a Friday.

 

[JL and Chip]

Black numbers are anxiety inducing but it’s one number. Take a deep breath.

Yesterday Copernicus got down to 246. 246!! That’s progress! I’m not at all surprised he threw you a high number in the next cycle. As you suggested, it looks like a bounce. Bounces happen — they’re extremely frustrating but you just have to ride them out. His body is used to higher numbers and likely overreacted to going lower than he’s used to.

What else can you do? I would continue everything you’ve been doing — keep him eating, give anti-nausea meds if warranted, soup up his food with extra water, give subQ fluids as often as is safe, keep monitoring ketones, and follow the TR protocol to fast-track him up the dosing scale as quickly as possible.

I know it’s hard to believe that last item when it looks like he had better, or at least flatter, numbers at a lower dose. Don’t let that mislead you. Celebrate the 246, ignore the black, and remind yourself that you’re on a journey and are making progress one day and one shot at a time.

 

[Krista & Copernicus]

I just know him and he crashes out when his numbers remain this high. The 246 was very short lived, he's been slowly increasing over the 400 to 500 and now 600 mark. This is when he lays on his side and doesn't move sadly. And this is when he gets acute kidney injury. So I cannot celebrate yet.

 

[Marje and Gracie]

Black numbers are anxiety inducing but it’s one number. Take a deep breath.

Yesterday Copernicus got down to 246. 246!! That’s progress! I’m not at all surprised he threw you a high number in the next cycle. As you suggested, it looks like a bounce. Bounces happen — they’re extremely frustrating but you just have to ride them out. His body is used to higher numbers and likely overreacted to going lower than he’s used to.

What else can you do? I would continue everything you’ve been doing — keep him eating, give anti-nausea meds if warranted, soup up his food with extra water, give subQ fluids as often as is safe, keep monitoring ketones, and follow the TR protocol to fast-track him up the dosing scale as quickly as possible.

I know it’s hard to believe that last item when it looks like he had better, or at least flatter, numbers at a lower dose. Don’t let that mislead you. Celebrate the 246, ignore the black, and remind yourself that you’re on a journey and are making progress one day and one shot at a time.

Excellent advice. Thank you, JL.

I just know him and he crashes out when his numbers remain this high. The 246 was very short lived, he's been slowly increasing over the 400 to 500 and now 600 mark. This is when he lays on his side and doesn't move sadly. And this is when he gets acute kidney injury. So I cannot celebrate yet.

I’m really sorry he bounced so high and now he feels horrible. Our emotions are definitely tied in to how our kitty’s BG is so it’s often hard to celebrate the small victories but that is where it starts….smaller ones turn into longer stretches of good numbers. I know you might get tired of looking at other SSs but it is helpful. Look how bad Simon was doing for so long. We suspect he might be acro, too, but he hasn’t had the tests yet. As you know, 400 is the highest a Libre will read so I’m certain he was seeing much higher BGs than that. So there is hope

Unfortunately, when you’ve very systematically raised his dose, we can’t look back and think because he looked better at 7u, perhaps that is a better dose. Things change and so many things can affect the BG especially with an acro kitty. We just have to keep giving them the insulin they need as you are doing.

I took the “911” down. It is for immediate life-threatening emergencies like a symptomatic hypo or a very, very ill cat with high ketones. You can just use the “?” Prefix and we will respond.

 

[Wendy&Neko]

I personally think those black numbers were given the right colour on the spreadsheet, cause our emotions go black when they see those numbers. I saw plenty of black with Neko. I did ask her IM vet how concerned I should be by those over 600 numbers, and he said that as long as she was getting some relief between (lower numbers), then a day or two in black numbers was not concerning. It's the long continuous high numbers, meaning too low a dose, that are when you need to be concerned. You are doing right by testing for ketones.

It helped me to think of those high numbers from bounces as a sign that the insulin was finally doing it's job and getting my cat into lower numbers. As JL said, celebrate the 246. I hope it's a sign of more and even lower numbers to come. As he sees more good numbers, he will at first bounce, but then get used to them and not bounce as high. It took Neko a full year before she stopped bouncing to reds. I can relate to how you feel.

 

[Krista & Copernicus]

Excellent advice. Thank you, JL.


I’m really sorry he bounced so high and now he feels horrible. Our emotions are definitely tied in to how our kitty’s BG is so it’s often hard to celebrate the small victories but that is where it starts….smaller ones turn into longer stretches of good numbers. I know you might get tired of looking at other SSs but it is helpful. Look how bad Simon was doing for so long. We suspect he might be acro, too, but he hasn’t had the tests yet. As you know, 400 is the highest a Libre will read so I’m certain he was seeing much higher BGs than that. So there is hope

Unfortunately, when you’ve very systematically raised his dose, we can’t look back and think because he looked better at 7u, perhaps that is a better dose. Things change and so many things can affect the BG especially with an acro kitty. We just have to keep giving them the insulin they need as you are doing.

I took the “911” down. It is for immediate life-threatening emergencies like a symptomatic hypo or a very, very ill cat with high ketones. You can just use the “?” Prefix and we will respond.

Excellent advice. Thank you, JL.


I’m really sorry he bounced so high and now he feels horrible. Our emotions are definitely tied in to how our kitty’s BG is so it’s often hard to celebrate the small victories but that is where it starts….smaller ones turn into longer stretches of good numbers. I know you might get tired of looking at other SSs but it is helpful. Look how bad Simon was doing for so long. We suspect he might be acro, too, but he hasn’t had the tests yet. As you know, 400 is the highest a Libre will read so I’m certain he was seeing much higher BGs than that. So there is hope

Unfortunately, when you’ve very systematically raised his dose, we can’t look back and think because he looked better at 7u, perhaps that is a better dose. Things change and so many things can affect the BG especially with an acro kitty. We just have to keep giving them the insulin they need as you are doing.

I took the “911” down. It is for immediate life-threatening emergencies like a symptomatic hypo or a very, very ill cat with high ketones. You can just use the “?” Prefix and we will respond.

This is challenging to communicate over a chat, but it's not the specific number that is giving me anxiety. It's the fact that each time his number has been this high, he ends up with an acute kidney injury costing 10,000 dollars. I should lead with I'm worried about another acute kidney injury event from high BG. I think that's why I put it as a 911.

 

[Krista & Copernicus]

I personally think those black numbers were given the right colour on the spreadsheet, cause our emotions go black when they see those numbers. I saw plenty of black with Neko. I did ask her IM vet how concerned I should be by those over 600 numbers, and he said that as long as she was getting some relief between (lower numbers), then a day or two in black numbers was not concerning. It's the long continuous high numbers, meaning too low a dose, that are when you need to be concerned. You are doing right by testing for ketones.

It helped me to think of those high numbers from bounces as a sign that the insulin was finally doing it's job and getting my cat into lower numbers. As JL said, celebrate the 246. I hope it's a sign of more and even lower numbers to come. As he sees more good numbers, he will at first bounce, but then get used to them and not bounce as high. It took Neko a full year before she stopped bouncing to reds. I can relate to how you feel.

I think I articulated my concerns in a better way in my reply to to Marje. His kidneys and my wallet always take the hit when he goes this high. So it's not the actual number but more of what follows on the inside for him. And we don't have any more of the expensive ER visits in me and I certainly don't want his kidneys to take a hit. I hi k I could be more chill if it was just a BG number.

 

[Marje and Gracie]

This is challenging to communicate over a chat, but it's not the specific number that is giving me anxiety. It's the fact that each time his number has been this high, he ends up with an acute kidney injury costing 10,000 dollars. I should lead with I'm worried about another acute kidney injury event from high BG. I think that's why I put it as a 911.

I guess I don’t understand what you mean (sorry…don’t mean to be obtuse). I have a lot of experience with AKD and CKD as well as PKD (polycystic kidney disease). I am not trying to downplay your concerns.

From the labs you posted when he was in the hospital (it would be great to have his labs entered on his lab tab on the SS), I did not see renal numbers that were, honestly, that worrying. I’ve seen much, much worse. With those numbers, I don’t know what they were charging you $10000 for if it was just renal issues, I did not see any renal numbers that would have warranted a hospital stay.

My PKD cat (and PKD is the worst) was not hospitalized until his creatine approached 15 and his phosphorus was over 20.

There was so much more going on with Copernicus that needed hospitalization. Again I’m just going from what you’ve posted in the past when he was in the hospital.

While every cat is different, we’ve had cats in the 600s longer than Copernicus without renal “injury”. Any time a cat is over about 200-250, they are over renal threshold and the kidneys dump glucose into the urine. An occasional quick bounce into 500-600 is not going to cause renal “injury” and I’m not even sure what you mean by that. Obviously anytime they dump sugar, it’s not good for their kidneys but we’ve had some cats here who were diabetic for over ten years and constantly bounced way up into black and red numbers and it wasn’t the diabetes or kidney issues they passed away from.

 

[Mary & Jude]

Krista, I'm FEELING your concern over the expense you will incur if Copernicus gets worse. Just the thought of that makes me feel anxious. I have nothing to offer other than my empathy and prayers that he will soon come down. One question that I'm sure you've dealt with on here before, but it's worth mentioning: you are not shooting insulin at the same site as the fluids, right? Well, and here's another question: how old is your vial?

 

[Krista & Copernicus]

The pen is only a week old and stored in fridge. I try to do them 2 hours apart and in different areas. Sometimes he growls and runs off before I can inject all the Lantus in one spot. This just started happening at the higher doses so I have to go back and put the rest in somewhere else. Also, he has zero fat under the subq layer so he has floppy skin tents if that makes sense.

 

[Krista & Copernicus]

I guess I don’t understand what you mean (sorry…don’t mean to be obtuse). I have a lot of experience with AKD and CKD as well as PKD (polycystic kidney disease). I am not trying to downplay your concerns.

From the labs you posted when he was in the hospital (it would be great to have his labs entered on his lab tab on the SS), I did not see renal numbers that were, honestly, that worrying. I’ve seen much, much worse. With those numbers, I don’t know what they were charging you $10000 for if it was just renal issues, I did not see any renal numbers that would have warranted a hospital stay.

My PKD cat (and PKD is the worst) was not hospitalized until his creatine approached 15 and his phosphorus was over 20.

There was so much more going on with Copernicus that needed hospitalization. Again I’m just going from what you’ve posted in the past when he was in the hospital.

While every cat is different, we’ve had cats in the 600s longer than Copernicus without renal “injury”. Any time a cat is over about 200-250, they are over renal threshold and the kidneys dump glucose into the urine. An occasional quick bounce into 500-600 is not going to cause renal “injury” and I’m not even sure what you mean by that. Obviously anytime they dump sugar, it’s not good for their kidneys but we’ve had some cats here who were diabetic for over ten years and constantly bounced way up into black and red numbers and it wasn’t the diabetes or kidney issues they passed away from.

I'm reading what the vets posted in his hospital notes and they called it an acute kidney injury. He didn't just bounce high, he was high for several hours and days depending on which incident we are talking about. And you are correct, the 10,000 wasn't just for renal issues. It will not be my approach to wait until things get much much worse, I will always try to catch things early because what wasn't harmful for another cat may be harmful for Copernicus. And those kidneys do not regenerate after being damaged as you know best. I'll try and work on getting his labs in the spreadsheet.

 

[JL and Chip]

Just checking in. How is Copernicus doing? I see he’s still running reds and pinks, darn it. Sometimes it feels like we’ll never find a good dose. Tubby went up to 15u, other acros go even higher. But getting there can be frustrating.

Once we get to 10u, and with the numbers Copernicus has been hanging out in, I think the increases can be 1u at a time. I don’t like to give dosing guidance, but I think at this point he’s due. @Wendy&Neko ??

I'm reading what the vets posted in his hospital notes and they called it an acute kidney injury. He didn't just bounce high, he was high for several hours and days depending on which incident we are talking about.

I’m wondering if this is a “which came first…the chicken or the egg” scenario. Did the IM vet say Copernicus’ high BG actually caused the AKI? In Tubby’s case, we found that perhaps the opposite was true — the other things he had going on caused AKI and that manifested as crazy high BG. Anyway, just curious and always trying to learn.

How is the Cabergoline going? Any side effects?

 

[Krista & Copernicus]

Just checking in. How is Copernicus doing? I see he’s still running reds and pinks, darn it. Sometimes it feels like we’ll never find a good dose. Tubby went up to 15u, other acros go even higher. But getting there can be frustrating.

Once we get to 10u, and with the numbers Copernicus has been hanging out in, I think the increases can be 1u at a time. I don’t like to give dosing guidance, but I think at this point he’s due. @Wendy&Neko ??


I’m wondering if this is a “which came first…the chicken or the egg” scenario. Did the IM vet say Copernicus’ high BG actually caused the AKI? In Tubby’s case, we found that perhaps the opposite was true — the other things he had going on caused AKI and that manifested as crazy high BG. Anyway, just curious and always trying to learn.

How is the Cabergoline going? Any side effects?

I know I sound like a broken record but his Libre did go low around 7.5 units. I thought maybe it wasn't working but maybe he did go that low. I used to get some response from dose increases. Now I can't ignore the trend that he goes up as I go up. Acro is a slow disease and I could not find any evidence that the tumor grew in the last 2 weeks. Thank you for checking in. I have been quiet lately with a migraine lasting days. Hope you are great.

 

[Wendy&Neko]

JL is right, increases are now by 1.0 units at a time. And since he isn't seeing numbers below 200, you should be increasing every six cycles.

I don't see anything on the spreadsheet showing lows on 7.5 units. The lowest I see is a 240.

Acro is a slow disease and I could not find any evidence that the tumor grew in the last 2 weeks.

I see evidence on the spreadsheet. One of my mentors on acro, Julie & punkin, once described dosing an acro like chasing after a speeding train. You have to keep increasing when you can safely do so, in order to keep up with the changing demands in insulin. At some point you will reach a dose that moves him, but you aren't there yet. Happy to see those ketones are still relatively low.

Sorry about the migraines.