3/2 Kim's Simon amps 167, pmps 103! Dental MONDAY

I hope this is new dose wonkiness! We can't find a good dose for Simon. I raised him back to .3 last night because .2 wasn't quite doing the trick. Do you think that was the right choice? I had started to see some good pre shots at .2, but everything didn't quite come together. I know, I know. . .PATIENCE. I was starting to think we were almost there, but now I just don't know!

Simon did get into some dog contraband yesterday morning, so maybe that's all I'm seeing at amps today. I think he is a bouncy boy (in a small way--not like some sweet kitties I've seen). When he has a green cycle that goes below mid-60s, his next pre-shot will be higher in the blues.

A question: Where are those "healing numbers," exactly? (Or is this another ECID?) Should I be trying to do more food management to keep him in the 70s (as opposed to lower) and up so that his pre-shot might stay lower? I do not ever feed him MC--he always comes up on LC alone.

Happy day to all in LL today!

ETA: Just got off the phone with a veterinary dentist. Simon has an appointment Monday morning. She seems great and I feel confident about the care he'll get after talking with her. Simon doesn't have any known problems, but he also hasn't been examined under anesthesia. This seemed like a good time to get a dental and try to eliminate or rule out any contributing factors to his diabetes.

Questions, oh wise ones of LL:
Vet dentist advised 1/2 dose of insulin an a small meal, 1-2T very early in the morning (our appt is at 8:30). This seems good to me. (Usually pets are NPO for 12 hours, but she thinks that isn't good for a diabetic.)

I have read I should not get Convenia, and no steroids (not that those are expected): Can you list the antibiotics and pain meds that are both good and not recommended for diabetics? I will not know the extent of treatment until after our consult, but she is in favor of doing tx the same day if we want because it is less visits, less stress on Simon. Thanks!

Re: 3/2 Kim's Simon amps 167; dose change last p.m.

Those are good questions. Unfortunately I don't have good answers, so I'll leave that to others. I just want to say Simon is doing great and of course that is due to your efforts. Have a good day Kim.

Re: 3/2 Kim's Simon amps 167; dose change last p.m.

"Healing" numbers are normal BG numbers. I do think you were wise to bump the dose back up. Sometimes, you do need to increase in order to get the numbers back on track. As far as the dog's kibble -- that stuff hangs around for a longer than expected time. (You might want to put a note on Simon's SS about it.) Also, just an FYI, the pre-shots are the last to come down.

With regard to your question about the goal, the objective is what you want for Simon. There are some people here who's goal is tight regulation. For others, the goal is remission.

Re: 3/2 Kim's Simon amps 167; dose change last p.m.

Sienne and Gabby said:

"Healing" numbers are normal BG numbers. I do think you were wise to bump the dose back up. Sometimes, you do need to increase in order to get the numbers back on track. As far as the dog's kibble -- that stuff hangs around for a longer than expected time. (You might want to put a note on Simon's SS about it.) Also, just an FYI, the pre-shots are the last to come down.

With regard to your question about the goal, the objective is what you want for Simon. There are some people here who's goal is tight regulation. For others, the goal is remission.

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We are really really hoping for remission!

Re: 3/2 Kim's Simon amps 167; dose change last p.m.

Hi guys .. this isn't a bad starting point for simon! I know you are really really hoping for remission, I think most of us here do, and I hope you get it .. but if you don't, know that simon is still in healing number ranges and that is so important too! have a great weekend guys!

Re: 3/2 Kim's Simon amps 167, +3 71; Dental is MONDAY! med ?

I just scheduled Simon's dental--see questions in top post.

Re: 3/2 Kim's Simon amps 167, +3 71; Dental is MONDAY! med ?

In addition to no Convenia, absolutely no Metacam (meloxicam). It carries an FDA black box warning for use in cats (effective as of October 2010). It can cause acute renal failure. I have no clue why, but some vets still prescribe it. NSAIDs are problematic for use with cats due to renal complications.

Gabby's vet will give a shot of clindamycin with a dental. The issue of ABs with a dental has been getting a fair amount of attention. The general issue is that like with humans, ABs are over-prescribed in cats causing antibiotic resistant strains of bacteria. From what Dr. Lisa has posted on Health, the only reason to give an AB after a dental is if there is evidence of infection/inflammation. I would think this is pretty much the same logic you would use in your dental practice.

I've used bupe (buprenophine) for post-dental pain management when Gabby's had extractions. Again, this can be an ECID thing. Some cats get agitated with narcotics; Gabby tolerates them well. Bupe can be given either as an oral liquid that is squirted into the cheek pocket or as a sub-q injection. It is also available in a long acting form that lasts 48 - 72 hours. (The latter is what my vet used the last time Gabby had a dental.) If there is need for multiple extractions, my vet once used a Fentanyl patch. (I wouldn't do it again only because the patch was such a PITA to remove.) Some vets will give Tramadol for pain.

Re: 3/2 Kim's Simon amps 167, +3 71; Dental is MONDAY! med ?

Thanks! That's what I need.

Sienne and Gabby said:

Gabby's vet will give a shot of clindamycin with a dental. The issue of ABs with a dental has been getting a fair amount of attention. The general issue is that like with humans, ABs are over-prescribed in cats causing antibiotic resistant strains of bacteria. From what Dr. Lisa has posted on Health, the only reason to give an AB after a dental is if there is evidence of infection/inflammation. I would think this is pretty much the same logic you would use in your dental practice.

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That is exactly right. Overuse of antibiotics is a huge problem. I graduated with my DDS in 2002, and docs around my age and younger were taught to be way more conservative. You will find an older generation who (if they aren't keeping up to date) are more liberal with antibiotics. Our regular vet was going to put him on antibiotics a couple of days before a dental. That didn't really make sense. Unless there is an underlying problem, an antibiotic isn't needed. Cleaning the teeth, along with removing compromised teeth, should actually lower risk of infection and not raise it (in a reasonably healthy patient--even including a regulated diabetic). But that doesn't stop my patients for asking for antibiotics for any little thing! It's an opportunity to educate the patient.

I don't want to be a "difficult owner" who is a know-it-all (I have physicians like that in my practice!) but it's good to have some tips from those of you who have "been there." I met the vet many years ago when Simon was young--she was doing part-time work at a former vet. I always remembered her because she was like the cat whisperer. Even my calico civvie LOVED her, and Molly dislikes most people most of the time :lol:

Re: 3/2 Kim's Simon amps 167, +3 71; Dental is MONDAY! med ?

I should have noted that the reason Gabby gets the AB is because she builds up a lot of tarter so her gums are usually inflamed. In addition, she has problems with FORL. They don't overdo the ABs, thankfully.

Good luck with the dental. Be warned if you get the tramadol liquid for pain that it does make kitties kind of froth out some drool for a while after you've given it. It is rather disconcerting, if you're not expecting it it would be frightening. The vet tells me it's because it is so bitter.