? 04/29 Shmee AMPS 278, dosing during dental?

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Amanda & Shmee

Amanda & Shmee

Member Since 2018
Previous condo: www.felinediabetes.com/FDMB/threads/04-27-shmee-opinions-on-increase.194744/

Good morning everyone,
I am back home from a nice visit with my grandma. Shmee is up to 5 units as of yesterday, and is still seeing pinks and yellows. It's getting frustrating... Per a previous condo my vet is concerned he is on a high amount of insulin and still not going down. Plus he was greens at 4 units but hasn't been back since. But some commenters have mentioned that this is normal, especially since he needs dental work done (appointment on Thursday). His next increase is Tuesday unless I see a green.

Question: What do you recommend as a dose for Wednesday, Thursday, and after the dental? He will be over 5 units by then, and I have heard the dental is supposed to help with BG numbers so I don't want to start him too high after the dental. Reduce to half the dose? I am going to ask my vet too. He is not supposed to eat past 10pm on Wednesday, to get ready for the dental work Thursday. His normal eating schedule is eating at 9pm with his shot, but he is a grazer so he does not eat the entire can at that time. He usually eats about 1/4 - 1/2 can or so by 10pm when I will need to take his food away. Since I cannot give him a shot without him eating, I assume I skip the Thursday AM shot all together. Opinions?
 
Morning and not sure about the dose, but Davidson was lower in BG before his dental, and in fact had lower numbers without insulin before I started him again after being in remission 4 yrs. This is normal, they bounce around from high to lows as the pancreas gets used to working the insulin. It takes a while and we all find it frustrating and since ECID there is no magic dose or timing. Wish there was, especially since this is my second go around and I had hoped Davidson would have lower numbers, but he hasn’t.

The dental will increase his BG until such time the infections are gone, the pain subsides, and his healing begins from the dental which no doubt will cause stress. I saw that with Davidson, and it just takes time. Once the dental clears up, his tests will drop as the insulin starts working.

Keep positive......
 
Amanda & Shmee said:
Question: What do you recommend as a dose for Wednesday, Thursday, and after the dental? He will be over 5 units by then, and I have heard the dental is supposed to help with BG numbers so I don't want to start him too high after the dental. Reduce to half the dose? I am going to ask my vet too. He is not supposed to eat past 10pm on Wednesday, to get ready for the dental work Thursday. His normal eating schedule is eating at 9pm with his shot, but he is a grazer so he does not eat the entire can at that time. He usually eats about 1/4 - 1/2 can or so by 10pm when I will need to take his food away. Since I cannot give him a shot without him eating, I assume I skip the Thursday AM shot all together. Opinions?
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It is usual to keep the insulin the same, though with having to fast him, and the effect that anesthetic can have on the BG (it can lower it in some cats), he may also feel sore and not want to eat or be a bit nauseous, so you may need to consider all these things when you come to shoot just after the dental.

That said, his numbers are not going to drop over night, the dental will usually cause some level of inflammation, discomfort and post op infection is not uncommon. All these factors can affect BG, and are not going to resolve overnight, so it may take a while before you see his BG numbers improving.
Taking the dose down in anticipation of an improvement will only lead to higher numbers, and it will take longer to get on top of the BG.

If this were me I'd monitor closely after the surgery and I would aim to keep the dose and let the numbers guide me.
I'm not sure what to suggest as to the dosing just prior and after surgery I'm going to ask some folk with experience to stop by.

Amanda & Shmee said:
His next increase is Tuesday unless I see a green.
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Just a reminder now that he is up to 5u, if you do not see any green, take him up in 0.5u steps. Once kitties get over 5u we switch to 0.5u changes, think of it as a percentage increase in dose.
If kitty were on 2.5u then a 0.25u increase is a 10% increase in dose
Once kitty gets to 5u a 0.25u increase would only be a 5% increase in dose/ going up in a 0.5u step would be a 10% increase.

Amanda & Shmee said:
Per a previous condo my vet is concerned he is on a high amount of insulin and still not going down.
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Sometimes when vets get concerned they suggesting taking the dose down (rebound check), if he suggests this it's counter productive, I've seen it happen, not with my kitty, but with other members.
Some cats just take a little longer to reach a dose where they start to see movement, and things like infection can make them difficult to regulate, try not to worry, you've been taking the dose up systematically as per TR, he just needs as much as he needs. (We have cats on 10 times more insulin here on the board)
 
Glad you managed to have a good visit away.

Neko had her first dental around 5 units. Red was her favourite colour then. :rolleyes: I did the regular dose the night before, 1/2 dose in the morning of the dental (as per the vet), then skipped the PM. I would first ask the vet what they expect you to do with regards to dosing. Since Neko was a diabetic, they let her eat until midnight. Ask your vet if you can go a little later. For subsequent dentals I went to a dental specialist, who let me feed up until 6:00 AM, but only 1/3 of her breakfast. As for dose on Thursday night, it's best to judge that when you get home with Shmee. Test when you get him home, then test again at PMPS. Some anethesia induction drugs lower the blood glucose, some don't. I've seen some cats with sore mouths due to extractions, not want to eat, and the caregiver regret the full dose. With experience, I found that Neko would always eat and gave full dose. Plus her dental vet gave an induction drug that did not lower BG. You could always post and ask for suggestions when you get Shmee home.

As for what happens after the dental, Shawna is right. If there are extractions, the inflammation can actually make the numbers go up, until they heal. It took Neko about 10 days to react and numbers to turn around. Just follow TR and what the numbers tell you to do. Not all kitties react to better numbers with a dental, but if there are issues, best get them taken care of.

Cats need however much insulin they need. ECID.
 
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I think 10:00 pm the night before the dental is way early, even for an otherwise healthy cat, unless they are going to anesthetize him at 6:00 am! I would remind the vet that he is diabetic and ask if 8 hours before the expected procedure start time would work.

Most vets advise shooting 1/2 dose the morning of a procedure/surgery. As Wendy and Gill said, afterwards depends on the numbers you get and Schmee's willingness to eat. If there have been extractions, hopefully you will have pain meds for him, and possibly antibiotics. These can all combine to upset the tummy on an empty stomach. My vet always said not to feed after a dental, but Harvey was always starving, so I gave him a tablespoon of baby food, and if he kept that down for 30 minutes, I gave another. If he kept that down he got the whole jar (and demolished it). ECID. Let Schmee tell you what he wants at that point, and certainly post for help if you're not sure.

Sending advance good dental vines!
 
Amanda & Shmee said:
Thank you, I'm trying :) Another red tonight though :mad: Looking forward to seeing how the dental work will affect him.
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Silver just had a dental. I kept dose the same until the numbers show me differently. I gave a half dose to the vet to give him after the dental so I could still stick to schedule and give full dose that night.

My vet said no food after midnight when the procedure was at 8am so @Tricia Cinco(GA) & Harvey is right. 8 hrs should be fine.
 
Lots of great advice here, I hope you feel better about it.

I would do increases as planned, assuming nothing changes between now and then. We use insulin to support them in times like this, as long as he is needing a higher dose, you keep on that path until the numbers tell you otherwise. Please don’t worry about the greens you saw way back when and maybe a lower dose was the key. Look at other SSs before the cat arrived at a good dose. Those fluke blues and greens will show up randomly and disappear as fast as they came, it happens a lot and it doesn’t mean that was the right dose and you skipped over it. I like to say it’s the cat giving you some hope and a preview of what’s to come when you are feeling down about the increases doing nothing.

Do call your vet and remind them that Schmee is diabetic (of course they know this, but you’d be surprised) and is the longer fasting the same for diabetic cats as for regular cats. See what vet says about a morning dose before the dental, what I’ve often heard is half dose, but your vet should make that call since they are the ones dealing with the insulin effects and anesthesia during the surgery. Remember, cats (and humans) need some insulin for fasting states as well, not just when they are eating.

Post dental again will be a decision you make when you are at that point, there are many variables that need to play out before you can make that call. I love that you want to be proactive and have a plan in place (me too), but if there’s one thing a diabetic cat will teach you well it’s that planning ahead usually doesn’t work out the way you want it to and you have to make a lot of decisions as things unfold. :p
 
The only other thing I would mention is that the least amount of meds, the better and he needs the insulin, so that’s first. Also needs the abs which the vet will prescribe for 7-10 days to fight infections and any bacteria prior to the dental that was there. Both Harley and Davidson had recent extractions incl. 1 canine tooth, yet after the 1st dose of pain meds, they didn’t need them anymore. A good test is to give some freeze dried treats - if they can chew them, they will not be in pain, or limited that the chewing doesn’t bother them. In that case, I’d stop the pain meds....ECID as are we on how we deal with pain,but to stabilize the insulin I’d take him off the pain meds ASAP. You must finish all the abs to the end.

Good luck, thoughts are with you.
 
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