?Regulating BG after 911 hyperglycemic incident?

[AEHawkeye]

I am new to this forum and new to feline diabetes. I have a 14 year old cat who had previously had undiagnosed diabetes and stopped moving Saturday (still conscious). I took him to the emergency vet and his blood glucose didn’t even register a number at first as it was too high. He was also severely dehydrated. Also does have ulcers in his mouth due to previously diagnosed gingivitis stomatitis which we were previously treating with a steroid (knowing diabetes was a risk and would have to discontinue steroids if it happened). They don’t want us to take him home until they get insulin to regulate his BG and he eats on his own. nHe was also severely dehydrated. He’s gotten the hydration back, most of his bloodwork looks clear, no visible obstruction or masses on an X-ray. He is doing better, visibly shows a will to live, but his BG is still unstable and he is eating only a little on his own (ulcers in his mouth) so they are supplementing with syringe feeding. I am seeing a lot of information that 4 days isn’t long enough to try and stabilize his BG for a new diagnoses this severe. My question - financially we have to decide tomorrow if we will keep him treated in the hospital, try to convince them to let us work on it at home with frequent visits, or put him to sleep. We foremost want him to have quality of life which is not guaranteed at this point because of his stomatitis. And we don’t want to give up, but any more than a couple of days more at the hospital isn’t financially feasible. We have to stabilize his BG before addressing the stomatitis. So I’m wondering if it is reasonable to try and continue regulating the BG at home rather than hospital since it seems like it isn’t abnormal to take weeks.

 

[Jerry dutchboy]

I am new to this forum and new to feline diabetes. I have a 14 year old cat who had previously had undiagnosed diabetes and stopped moving Saturday (still conscious). I took him to the emergency vet and his blood glucose didn’t even register a number at first as it was too high. He was also severely dehydrated. Also does have ulcers in his mouth due to previously diagnosed gingivitis stomatitis which we were previously treating with a steroid (knowing diabetes was a risk and would have to discontinue steroids if it happened). They don’t want us to take him home until they get insulin to regulate his BC and he eats on his own. nHe was also severely dehydrated. He’s gotten the hydration back, most of his bloodwork looks clear, no visible obstruction or masses on an X-ray. He is doing better, visibly shows a will to live, but his BC is still unstable and he is eating only a little on his own (ulcers in his mouth) so they are supplementing with syringe feeding. I am seeing a lot of information that 4 days isn’t long enough to try and stabilize his BC for a new diagnoses this severe. My question - financially we have to decide tomorrow if we will keep him treated in the hospital, try to convince them to let us work on it at home with frequent visits, or put him to sleep. We foremost want him to have quality of life which is not guaranteed at this point because of his stomatitis. And we don’t want to give up, but any more than a couple of days more at the hospital isn’t financially feasible. I guess I am looking for recommendations as to if this is possible and humane to try and manage at home right now.

Sorry to hear this, sounds like the little guy has had a rough time. I have no experience with stomatitis but there are a lot of members who do. You may want to add a ? to your thread title to get more eyes on it. I'll see if I can find someone who has some experience with this and tag them for you.

 

[AEHawkeye]

Sorry to hear this, sounds like the little guy has had a rough time. I have no experience with stomatitis but there are a lot of members who do. You may want to add a ? to your thread title to get more eyes on it. I'll see if I can find someone who has some experience with this and tag them for you.

Thank you. I made the suggested edit to title and also clarified my question. We have to stabilize his BC before addressing the stomatitis. I’m wondering if it is reasonable to try and continue regulating the BC at home rather than hospital since it seems like it isn’t abnormal to take weeks.

 

[Jerry dutchboy]

Thank you. I made the suggested edit to title and also clarified my question. We have to stabilize his BC before addressing the stomatitis. I’m wondering if it is reasonable to try and continue regulating the BC at home rather than hospital since it seems like it isn’t abnormal to take weeks.

We all struggle to get our cats regulated and it can take a long time to get it under control. Perhaps the vet wants to stabilize him and make sure he's eating on his own before discharging him.

@JoyBee&Ravan, I think you have experience with stomatitis so perhaps you could help with this or tag some other members who could lend some advice?

 

[Veronica & Babu-chiri]

Is hard to give an opinion on what to do, you need to assess a lot of aspects, I do not have much experience with stomatitis, but probably you will need to address both issues at the same time and not one after the other.

Regarding the diabetes it is certainly treatable and diabetic cats can have an almost normal long life once they get regulated but it takes time, it is very common for the glucose levels to be terrybly high at diagnose time, and usually the most the vet can do in 3 or 4 days is lower his levels a bit (and maybe only for a few hours ) but it is not realistic to think it is going to be regulated, and given the fact that diabetes is influenced by stress and being at the vet means stress it is usually easier to regulate at home, you will need to learn how to test his glucose levels at home using a glucose meter that can be a human one and how to give insulin since it will have to be given twice a day but we can help you with that ( it sounds worse than it actually is ) and you could also assist feed him (syringe feed) at home yourself all of this depending on his overall condition and if there's not some other issue that would actually need the constant monitoring from the vet

 

[AEHawkeye]

We all struggle to get our cats regulated and it can take a long time to get it under control. Perhaps the vet wants to stabilize him and make sure he's eating on his own before discharging him.

@JoyBee&Ravan, I think you have experience with stomatitis so perhaps you could help with this or tag some other members who could lend some advice?

Yes that’s what they said. But he is unlikely to eat on his own all of the time because of stomatitis. I can syringe feed him until we deal with that. I can’t keep him staying in the hospital at $300 a night for much longer, and I am seeing/learning it could take weeks to regulate it. So I am wondering if it is reasonable to take him home (with care training and instructions) and bring him back frequently to check-in until it is stable?

 

[Veronica & Babu-chiri]

Yes that’s what they said. But he is unlikely to eat on his own all of the time because of stomatitis. I can syringe feed him until we deal with that. I can’t keep him staying in the hospital at $300 a night for much longer, and I am seeing/learning it could take weeks to regulate it. So I am wondering if it is reasonable to take him home (with care training and instructions) and bring him back frequently to check-in until it is stable?

For the diabetes part, you can do all the test and monitoring at home without the need of taking him to the vet you will then only have to take him for his other issues

 

[Tanya and Ducia]

We have to stabilize his BC before addressing the stomatitis.

You can deal with the stomatitis symptomatically whilst working at home on his BG levels - I mean giving painkillers, and anti-inflammatory meds. The problem is that systemic stress / inflammation can keep the BG levels artificially elevated and will (highly likely) require you to do frequent dose reassessments and adjustments. That can be done with close monitoring at home by taking the BG tests on the regular basis. Inexpensive human meter would work fine for the task.

 

[AEHawkeye]

Is hard to give an opinion on what to do, you need to assess a lot of aspects, I do not have much experience with stomatitis, but probably you will need to address both issues at the same time and not one after the other.

Regarding the diabetes it is certainly treatable and diabetic cats can have an almost normal long life once they get regulated but it takes time, it is very common for the glucose levels to be terrybly high at diagnose time, and usually the most the vet can do in 3 or 4 days is lower his levels a bit (and maybe only for a few hours ) but it is not realistic to think it is going to be regulated, and given the fact that diabetes is influenced by stress and being at the vet means stress it is usually easier to regulate at home, you will need to learn how to test his glucose levels at home using a glucose meter that can be a human one and how to give insulin since it will have to be given twice a day but we can help you with that ( it sounds worse than it actually is ) and you could also assist feed him (syringe feed) at home yourself all of this depending on his overall condition and if there's not some other issue that would actually need the constant monitoring from the vet

The vet has told us we have to get him stabilized with the BG before considering further stomatitis treatment (pulling all of his teeth to remove the autoimmune trigger for the ulcers). I can definitely learn and manage the treatment at home if it is do able so I will suggest this at my next phone check-in. Thank you.

 

[Tanya and Ducia]

@AEHawkeye
HERE is the link to the old thread on stomatitis, perhaps you can find some of it useful.

 

[Idjit's mom]

I am also so sorry to hear that your kitty has been so sick. I would like to ask if you have been told what type of insulin is going to be prescribed. There are different insulins with different protocols and effects. The glargine insulins like Lantus and Levemir work more slowly on a shot by shot basis, but are gentler and longer lasting. They build up in the system and provide a much better controlling effect. If you are in US, you can get a Rx and get them from Marks Marine Pharmacy in Canada for much less cost, and get the pens so you can use them as mini vials, to use to the last drop. https://rxcanada4less.com/

You might have to syringe feed and/or administer subcutaneous fluids at home. You also would want to test kitty's blood sugar consistently at home, so you would know first hand and currently how the insulin is affecting him. Diet has a significant impact on blood sugar, so that would also need to be taken into consideration. Since his BG is so high, you would also need to test his urine for ketones with urine testing strips called Ketosix which are relatively inexpensive at pharmacies. Alternately, there are meters that test for ketones from a blood sample, but the strips for that are more expensive than regular glucose meter strips. Still, it's an option.

Are you in a position to be at home to nurse him back to better health, as it will take time to work on this process.

Your initial costs are going to be insulin, syringes, blood sugar testing supplies (which we can help with suggestions for lower cost options), feeding assistance supplies, possible SubQ supplies, and a proper diet for his condition and diabetes.

Your decision is of course going to be based on what you are prepared and are able to do. I do know that there have been instances where a kitty has been deathly ill, and with coordinated efforts with the caregiver, the vet, plus the information, support and advice from members here have been able to turn that around.

Whatever your decision. you will have our support.

 

[Jerry dutchboy]

Yes that’s what they said. But he is unlikely to eat on his own all of the time because of stomatitis. I can syringe feed him until we deal with that. I can’t keep him staying in the hospital at $300 a night for much longer, and I am seeing/learning it could take weeks to regulate it. So I am wondering if it is reasonable to take him home (with care training and instructions) and bring him back frequently to check-in until it is stable?

With commitment and the help of the good folks here it is possible to manage BG at home, we all do it. It can take a very long time but it's doable. You will need to inject 2× a day and home test BGs. There is a wealth of knowledge here on the forum and you will get the help you need. Diet is also extremely important, it needs to be low carb. Most here in the U.S. (don't know where you are located) feed Fancy feast classic pates or Friskies pates.
Welcome to the group. You have taken the best step in helping your little guy. The folks here are fantastic and extremely knowledgeable.

 

[Tanya and Ducia]

most of his bloodwork looks clear

did they say anything about ketones?
or did they mention DKA in the clinic?
@AEHawkeye

 

[Jerry dutchboy]

One other comment. My cats BG has been extremely high at times just registered HI on the meter and now he is close to being controlled. When diagnosed he was in the 600 range. You can look at his spreadsheet (in the grey area under this post) to see how far he has come since I joined this group.

 

[Red & Rover (GA)]

I have no experience with stomatitis.

Part of the problem from what you've described is that the cat does not want to or cannot eat. I'm wondering if a temporary feeding tube would help more than a syringe in regards to stabilizing the BG numbers. It is certainly easier on a cat's sore mouth than a syringe and guarantees getting enough food into a cat. And a cat can come home with a feeding tube.

Also, if you ask the vet hospital for insulin dosage and BG numbers, then post them here, we can get a better picture of how to help you. You have the right to this information.

 

[Idjit's mom]

I have no experience with stomatitis.

Part of the problem from what you've described is that the cat does not want to or cannot eat. I'm wondering if a temporary feeding tube would help more than a syringe in regards to stabilizing the BG numbers. It is certainly easier on a cat's sore mouth than a syringe and guarantees getting enough food into a cat. And a cat can come home with a feeding tube.

Also, if you ask the vet hospital for insulin dosage and BG numbers, then post them here, we can get a better picture of how to help you. You have the right to this information.

Excellent suggestion of a feeding tube to prevent more irritation and inflammation of that sore mouth. I was just thinking about that and was going to edit my response. Then kitty could be home, in a more comfortable familiar and safer feeling environment.

 

[AEHawkeye]

I can deal with the stomatitis symptomatically whilst working at home on his BG levels - I mean giving painkillers, and anti-inflammatory meds. The problem is that systemic stress / inflammation can keep the BG levels artificially elevated and will (highly likely) require you to do frequent dose reassessments and adjustments. That can be done with close monitoring at home by taking the BG tests on the regular basis. Inexpensive human meter would work fine for the task.

The vet has advised full extraction for the stomatitis, but not until his diabetes is controlled. In the meantime, I am understanding that there are painkillers and/or anti-incantator meds that could help? At two different vet clinics these have not been offered for the stomatitis.

did they say anything about ketones?
or did they mention DKA in the clinic?
@AEHawkeye

I am also so sorry to hear that your kitty has been so sick. I would like to ask if you have been told what type of insulin is going to be prescribed. There are different insulins with different protocols and effects. The glargine insulins like Lantus and Levemir work more slowly on a shot by shot basis, but are gentler and longer lasting. They build up in the system and provide a much better controlling effect. If you are in US, you can get a Rx and get them from Marks Marine Pharmacy in Canada for much less cost, and get the pens so you can use them as mini vials, to use to the last drop. https://rxcanada4less.com/

You might have to syringe feed and/or administer subcutaneous fluids at home. You also would want to test kitty's blood sugar consistently at home, so you would know first hand and currently how the insulin is affecting him. Diet has a significant impact on blood sugar, so that would also need to be taken into consideration. Since his BG is so high, you would also need to test his urine for ketones with urine testing strips called Ketosix which are relatively inexpensive at pharmacies. Alternately, there are meters that test for ketones from a blood sample, but the strips for that are more expensive than regular glucose meter strips. Still, it's an option.

Are you in a position to be at home to nurse him back to better health, as it will take time to work on this process.

Your initial costs are going to be insulin, syringes, blood sugar testing supplies (which we can help with suggestions for lower cost options), feeding assistance supplies, possible SubQ supplies, and a proper diet for his condition and diabetes.

Your decision is of course going to be based on what you are prepared and are able to do. I do know that there have been instances where a kitty has been deathly ill, and with coordinated efforts with the caregiver, the vet, plus the information, support and advice from members here have been able to turn that around.

Whatever your decision. you will have our support.

The ketones are not in play here, no Ketosis. I am in a position where I have enough flexibility to work from home as needed while nursing him back to health and monitoring his progress. They have told me what insulin they are using but I don’t have that info handy. They do regularly update me on his BG readings, times, and insulin dosages, and while I can remember the pattern but not individual readings. Good idea to get them again and write them down. Thank you for the ideas.

 

[AEHawkeye]

Excellent suggestion of a feeding tube to prevent more irritation and inflammation of that sore mouth. I was just thinking about that and was going to edit my response. Then kitty could be home, in a more comfortable familiar and safer feeling environment.

I will mention this option. Thank you both for the advice.

 

[AEHawkeye]

did they say anything about ketones?
or did they mention DKA in the clinic?
@AEHawkeye

No problem with ketones.

 

[Veronica & Babu-chiri]

I will mention this option. Thank you both for the advice.

The feeding tube can be an option haven't thought about it but is good they mentioned it, here's the link with some information written by Dr. Lisa Pierson about it

http://www.catinfo.org/?link=feedingtubes

 

[AEHawkeye]

With commitment and the help of the good folks here it is possible to manage BG at home, we all do it. It can take a very long time but it's doable. You will need to inject 2× a day and home test BGs. There is a wealth of knowledge here on the forum and you will get the help you need. Diet is also extremely important, it needs to be low carb. Most here in the U.S. (don't know where you are located) feed Fancy feast classic pates or Friskies pates.
Welcome to the group. You have taken the best step in helping your little guy. The folks here are fantastic and extremely knowledgeable.

We are located in Iowa. He has been a finicky eater over his life, sometimes abruptly changing his preferences. But mostly we have fed him Hills Science Diet. His diabetes is almost certainly caused by use of a steroid to control an autoimmune disease. His kidney function is fine.

 

[Idjit's mom]

I just wanted to add, Idjit won't eat, pee or poop when he is at the vet and he's healthy. After a day long stay for his first and only BG curve at the vet, he got home, hopped out of the carrier and peed HUGELY in his box, then demanded "his" food.

A few years back we think he ingested something poisonous, possibly antifreeze. He was at the ER vet (as it happened on a Sunday) then transferred to regular clinic on Monday. Yes, he was very sick, and the bill was enormous, but that aside, he didn't want to eat or eliminate there. When we got him home on Tuesday, when lab work was better, he began eating and eliminating better. He still had an IV hookup, just in case he relapsed and needed immediate fluids, but he did so much better and recovered rapidly at home. He did go back to vet for more blood tests and removal of the IV hookup, and suffered no lasting effects that we know of.

So, perhaps your kitty is also objecting very strongly to being at the vet, with strangers, different and odd smells, in addition to feeling pretty punk from hyperglycemia.

I understand that they want him to be in lower numbers and getting food and fluid into him. That's the goal. They saved his life and kudos to them.

I also understand that it is rarely under consideration if you can afford continued hospitalization care. Hopefully with consultation, you can bring him home and help him there.


Just FYI on "regulation".

'REGULATION' - WHAT IT MEANS?
The initial aim of treating diabetes is to get the cat into a better and more stable BG range (‘regulated’). In the FDMB FAQs the degrees of regulation are suggested as follows (based on data from human glucose meters; pet meter numbers would typically be a little higher). But your cat may not fit exactly into one of these ranges. Feline diabetes can be very variable.
Not treated - BG typically above 300 mg/dL [16.7 mmol/L]. Poor clinical signs.
Treated but not regulated - BG often above 300 mg/dL [16.7 mmol/L] and rarely near 100 mg/dL [5.6 mmol/L]. Poor clinical signs.
Regulated - BG generally below 300 mg/dL [16.7 mmol/L] with glucose nadir near 100 mg/dL [5.6 mmol/L]. Good clinical signs. No hypoglycemia.
Well regulated - BG generally below 200-250 mg/dL [11.1-13.9 mmol/L] and often near 100 mg/dL [5.6 mmol/L]. No hypoglycemia.
There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated.

 

[Idjit's mom]

I just read your response about kitty's diet. The Hills "prescription" diet foods are typically too high in carbohydrates for a diabetic cat. Dry is too high, and doesn't contain moisture. We recommend a wet low carb diet. We try to keep the carb level under 10% and many of us feed Fancy Feast Classics and Friskies pates as they fit that criteria, and are easily obtainable and affordable. Other members also feed some of the Weruva brand canned food, and Tiki Cat brands to mention a couple. A little more expensive, but much better carb wise for a sugar cat.

When you find time to breathe, and have other things sorted out, visit www.catinfo.org about feline nutrition and you can go through the food chart that lists many of the processed canned foods available in the US.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

***Diet significantly affects BG levels, and you should always be testing to be aware of lower BG numbers if you begin a lower carb diet or transition from dry to all wet.

 

[AEHawkeye]

He does like some from the Weruva brand. Thanks for the ideas.

 

[Red & Rover (GA)]

It's really important to find out what insulin and how much and what numbers. Some insulins are very harsh and hard and not the best choice for cats. Or it could be that the cat's body is responding to being in safe numbers lower than it is used to and bouncing.

This definition of bouncing is taken from the Lantus insulin forum:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Or it could be that your vet is trying to accomplish in a few days something that takes much longer.

Two questions to ask your vet.
1. What is your definition of regulated?
2. Do you think the cat is bouncing?

 

[AEHawkeye]

Guys I’m bringing him home to try and manage his diabetes this afternoon! I will be making spreadsheets and collecting data points for his care! The doctors are reserved about our ability to manage it with his underlying stomatitis, but agreed it is an ok idea to try as it is really the only feasible option to save him.

 

[Veronica & Babu-chiri]

Good to know keep us posted on how he's doing and don't hesitate to ask here anything you need, don't forget to let us know what insulin he's going to be on

 

[Jerry dutchboy]

Guys I’m bringing him home to try and manage his diabetes this afternoon! I will be making spreadsheets and collecting data points for his care! The doctors are reserved about our ability to manage it with his underlying stomatitis, but agreed it is an ok idea to try as it is really the only feasible option to save him.

There is a spreadsheet on the board that everyone here uses. You'll find it under Tech support.

 

[Idjit's mom]

What wonderful news! It's going to be a challenge, but I think and feel that you are doing the right thing for your kitty.
I know you are going to be very busy, but in order for us to effective help you, please create the signature and set up the spreadsheet, so we can see kitty's information when you post and see what insulin and testing data you will be getting.

1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.
2. Another thing that will help us help you when you get started BG testing at home is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

We are 100% behind you as you work to help this wonderful little being back to health and well being.

Did they decide to install a feeding tube or did they recommend assisted feedings?
We do have videos about assisted feeding as well as administering the SubQ fluids if you need them. Hopefully they will be providing some pain meds for the stomatitis also. This little guy has been through enough. Gentle head kisses, hugs and chin scritches to him.

 

[Tanya and Ducia]

Did they decide to install a feeding tube or did they recommend assisted feedings?

It is good question because for his regulation you are going to rely a lot on his good eating.
It's actually your number One tool in the box "to repair " the BGs.
@AEHawkeye

 

[AEHawkeye]

What wonderful news! It's going to be a challenge, but I think and feel that you are doing the right thing for your kitty.
I know you are going to be very busy, but in order for us to effective help you, please create the signature and set up the spreadsheet, so we can see kitty's information when you post and see what insulin and testing data you will be getting.

1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.
2. Another thing that will help us help you when you get started BG testing at home is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

We are 100% behind you as you work to help this wonderful little being back to health and well being.

Did they decide to install a feeding tube or did they recommend assisted feedings?
We do have videos about assisted feeding as well as administering the SubQ fluids if you need them. Hopefully they will be providing some pain meds for the stomatitis also. This little guy has been through enough. Gentle head kisses, hugs and chin scritches to him.

No feeding tube - he takes syringe feeding just fine when he doesn’t finish his meal. They actually said since it didn’t stress him out to continue that. He is taking 1 unit of Landis every 12 hours. I’m a bit overwhelmed with getting him set up and also getting a workspace set up so I can be home all day for him, but I will review the notes about signature, etc as soon as I have time.

 

[Idjit's mom]

I understand about your feeling overwhelmed. Do what you can first for kitty and be sure to take good care of yourself too. We will be right here, rooting for all of you.

 

[Sandi and Toby]

We have been dealing with stomatitis in our civvie (non-diabetic) Molly for years. It's a frustrating condition. We do a course of meds for about a month, then try to take a month or two off, then back on for a month, etc. It's been pretty successful up to now, and she just turned 5. My vet doesn't even suggest full mouth extractions any more, because even with confirmatory xrays post-extraction, she saw too often that it didn't solve the problem (while also incurring considerable discomfort during recovery for the pet and expense for the owner). We use a combination of Clindamycin (antibiotic), prednisolone (steroid, unfortunately), and tramadol (pain). We start at higher doses and taper off the amounts and frequency for the first two meds. If you are interested in the exact details, just let me know.

Slightly long story but stick with me, it's for a reason. We were actually overdue restarting her meds this time, and it had gotten more inflamed than we knew. We saw that she had lost weight, but we also got an adorable yet annoyingly energetic new kitten, affectionately named "Dammit, Henry!", that was chasing Molly alot and unfortunately divebombing her at her food bowl, so we thought that was it. When we would set her wet food in front of her, she would literally run away. We thought it was an association with Henry, but it wasn't, her mouth was super inflamed again. Not even mostly her gums, which is what most people notice, that red line along the teeth, but over the whole roof of her mouth near her throat, tongue, cheek pockets, were very red and swollen. I felt horrible!! I restarted her on tramadol first Because I was out of the other two until we got to the vet, and she immediately started eating again and we slowly saw her coming around us again instead of hiding most of the time (for which we had again blamed Henry).

And then by her followup appointment two weeks after restarting all her meds, which was early this week, she had gained a full 6 ounces. She's a little girl, so we were thrilled...along with feeling guilty that she was in such pain which we misattributed to Henry...who is still a pain sometimes

Unfortunately, obviously the prednisolone could lead her to diabetes, but we'll cross that bridge if it comes. But I've seen now how much impact the pain has. I really encourage you to try to address he stomatitis now. I realize the pred will impact the insulin, but stomatitis gives a poor quality of life, and pain/inflammation will also raise BG, so in my opinion you should treat the stomatitis and dose the insulin around it.

Do you mind sharing your kitty's name? And yours if you'd like. I'm Sandi, and our current diabetic is called Whispy. We hope things are going ok for you now that you have him home.

Best,
Sandi.

 

[AEHawkeye]

I've seen now how much impact the pain has. I really encourage you to try to address he stomatitis now. I realize the pred will impact the insulin, but stomatitis gives a poor quality of life, and pain/inflammation will also raise BG, so in my opinion you should treat the stomatitis and dose the insulin around it.

Do you mind sharing your kitty's name? And yours if you'd like. I'm Sandi, and our current diabetic is called Whispy. We hope things are going ok for you now that you have him home.

Best,
Sandi.[/QUOTE]

Hi Sandi,
Velcro is my sweet diabetic kitty’s name. Mine is Amy. Velcro is very happy being home and doesn’t want me to be out of his sight. It took us awhile to get our first glucose read, but we finally got it (247) fed him (which he attacked as he hadn’t done in a long time), and got his first unit of insulin in. We’re going to retest glucose later tonight just because we’re nervous being new at this.

The vet does have him on a pain medicine to help with his mouth so he’ll be more likely to eat. He goes back for a checkup in a week (hopefully no scares or emergencies ). The emergency/hospital clinic he was at will pretty much only do the extraction as a way to control the stomatitis after he gets out of this weakened state and is more stable. His normal vet is very anti-extraction but doesn’t have any more ideas to try and won’t do the steroid with insulin. I can of course look for different vets, but right now I kind of agree with the emergency vets in that he isn’t really ready for anything other than healing from the impact of hyperglycemia. I am always open to ideas to discuss with them when I go back!

 

[Sandi and Toby]

It's very nice to formally meet you, Amy and sweet Velcro

I bet he is happy, and glad he is on pain control and eating! And congrats on your first BG test, that's great!

At this point you'll probably be better off starting a new post here in Feline Health for general questions, or in the insulin specific group for questions about dosing. You may also want to note what auto immune disease Velcro has and what he is taking for it now, if anything, since it sounds like he isn't on a steroid any longer.

 

[Red & Rover (GA)]

One of our members has made an excellent video about how to test BG numbers.

 

[Sandi and Toby]

Good job on adding your signature, Amy, and of course the most important addition - a picture of Velcro. Very handsome!

I hope Velcro is doing well today

 

[Diane Tyler's Mom GA]

I hope Velcro is doing ok, one suggestion on your spreadsheet , you should put what type of Insulin he is taking, only because people won't have to go back to one of your posts to find it.

 

[AEHawkeye]

I hope Velcro is doing ok, one suggestion on your spreadsheet , you should put what type of Insulin he is taking, only because people won't have to go back to one of your posts to find it.

It says it in my signature and I named the spreadsheet as the FAQs suggested. Is that enough?

 

[Diane Tyler's Mom GA]

It says it in my signature and I named the spreadsheet as the FAQs suggested. Is that enough?

Hi I just noticed you do have it listed, my bad