? Surgery & insulin time don’t work out

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Sebastian’s mom (Lauren)

Sebastian’s mom (Lauren)

Member Since 2023
Sebastian’s insulin times do not fit with his surgery tomorrow morning. His insulin is for 12, but his surgery is at 9:45. They told me to feed him a small meal prior, bring his insulin and if at 12 he needs it, they’ll administer.

Is this adequate?

I have read you’re supposed to give half insulin and half meal the morning of surgery, but unfortunately the timing doesn’t match.

Sebastian usually gets 3 units of Lantus. His typical meal looks like 1/2-3/4 can of Fancy Feast Turkey pate with a 1:1 added water ratio. He’s already high risk for surgery and I want to make sure this doesn’t further increase that.
 
Vets seem to differ regarding how long they want a cat fasting before s surgical procedure and whether to give insulin or how much. The latter is a matter of both the anesthesia and the pre-anesthesia lowering blood glucose levels. Withholding his insulin makes sense.

I would be hesitant to feed him even 1/4 of a can. My vet has always indicated to not feed my cats past midnight but they could have water.
 
Sienne and Gabby (GA) said:
Vets seem to differ regarding how long they want a cat fasting before s surgical procedure and whether to give insulin or how much. The latter is a matter of both the anesthesia and the pre-anesthesia lowering blood glucose levels. Withholding his insulin makes sense.

I would be hesitant to feed him even 1/4 of a can. My vet has always indicated to not feed my cats past midnight but they could have water.
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Not even feeding diabetic cats past midnight? Well Sebastian gets fed at. 11:30pm so then I guess it’s just a matter of how to handle the morning. I’m hesitant of food, but I’m also weary of them giving him his full dose on an empty belly post anesthesia. Seems like they don’t consider food & numbers to the extent we do.
 
I would ask the vet about whether they will feed him if they are giving insulin. To be honest, I'd be surprised if they do either. Not only does the anesthesia lower blood glucose levels, it slows down the gut. On the other hand, the pre-anesthesia can act like an appetite stimulant. In most cases, when you bring Sebastian home, he'll be hungry. You don't want to give him his usual amount of food all at once. Many cats will "scarf and barf" because their GI system is moving slowly and they just inhaled their food. We generally suggest feeding several small means post-surgery. Also, make sure that Sebastian will eat since his mouth will hurt. You don't want to give insulin and have him refuse food. Getting numbers to rise in a cat that won't eat is not fun. Make sure that you get pain meds. We typically suggest buprenorphine.
 
Sienne and Gabby (GA) said:
I would ask the vet about whether they will feed him if they are giving insulin. To be honest, I'd be surprised if they do either. Not only does the anesthesia lower blood glucose levels, it slows down the gut. On the other hand, the pre-anesthesia can act like an appetite stimulant. In most cases, when you bring Sebastian home, he'll be hungry. You don't want to give him his usual amount of food all at once. Many cats will "scarf and barf" because their GI system is moving slowly and they just inhaled their food. We generally suggest feeding several small means post-surgery. Also, make sure that Sebastian will eat since his mouth will hurt. You don't want to give insulin and have him refuse food. Getting numbers to rise in a cat that won't eat is not fun. Make sure that you get pain meds. We typically suggest buprenorphine.
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I was thinking about feeding him a small amount at around 4am, surgery would be at around 9:45, but probably a lil later since they’re doing an exam first.
I’d also give him .5ml of gabapentin at 4:45am to prepare for the 2 hour and 45 minute car ride we will start at 6:15am. The vet did clear both of these things, but I’ve found I’ve had better luck and advice from this group. If you’re telling me withholding food after his PM shot tonight is the safest way, then that’s the approach I’d like to take.

Additionally since they did ask me to bring his insulin, if I bring it in a cooler with an icepack do you think it will be okay for the about 3 hour car ride?

I’ll certainly make sure I ask if they feed him before insulin, if they even give him any at all. And I’ll also ease him back into his normal meals, make sure he eats before any insulin! :)
This is his second dental and if I remember correctly after the first one he went right back to eating his hard kibble (was prescribed Royal Canin urinary SO at the time which is what I think ultimately led to the diabetes.) So I hope he’s just as willing this time around.

sorry if this is all over the place, I’m a bit scatterbrained lol.
 
Neko's dental specialist suggested 1/3 of her meal before 6AM but her surgery was typically late morning. The newer anaethesia protocols for diabetics seem to allow a bit of food the morning of and several hours ahead of time. The small snack at 4 AM is might work. You can always call the vet office today and verify that's OK. Some of the newer induction drugs do not lower the BG, Neko's never went down with anaesthesia, but they can still slow gut motility. I would always bring some of Neko's breakfast with me, so they had that ready to feed when she was awake and able to eat.

I'd be tempted to just skip insulin in the morning. Unless ketones are a concern. But if you do want to take the insulin, the 3 hour car ride should be OK. I'd wrap the pen/vial in some bubble wrap and put it in a plastic container like a tupperware to keep it stable. Then inside a small cooler with a gel/ice pack. I took Neko on days long car rides, 9 hours, in the heat of summer and the insulin was fine like that.
 
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My cat was very nausea after anesthesia. You may ask for some ondansetron to have in case this occurs with your cat as well. It is miserable to have a nausea cat for you both.
 
Basic's Mom said:
And ondansetron specifically, not cerenia.
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May I ask why that specific medication and not the other?
So far what I’ve gathered is
-ask for buprenorphine for pain
-ondansetron for nausea if needed
-ask for BG monitoring during procedure (preferably every 30 minutes)
-ask that they don’t give him insulin unless they test him and his numbers are above 200 AND he ate
- let them know of current medical issues like unknown allergens, weird sleep behavior, etc.

Anything I’m missing??
 
I find ondansetron works way better for nausea. Cerenia is good if there is vomiting.

I doubt you'll get as frequent BG monitoring as every 30 minutes, unless they see him trending low.

Another topic is antibiotics if he has extractions. I'm not a fan of Convenia.
 
I'm so sorry that you've had snow which caused uncertainty this morning.

I'm big on signs and I'd take that as a sign for sure.

He may have been so low because he didnt have full meals last night, unless you changed your mind about that.

I know you are very stressed. I also know he needs a dental. Maybe this can buy you some time to find another vet you are more comfortable with doing the procedure or that will allow you to do all the necessary things that will make you and Sebastian comfortable with this all.

When my cat was sick and everything that could go wrong was going wrong, I told the universe, I was the wrong one to be testing my will when it comes to my cats. It seemed to help. I will do whatever it takes to help my cats.

Hugs to you both. BREATHE.
 
Clindamycin is a good antibiotic for mouth issues. But it is quite strong, meaning could lead to tummy issues. I'd recommend getting a probiotic for him to take a couple hours before or after the antibiotic.

176@+5 is not what I'd call low. My girl once pulled a 72 on a pet meter at the dental vet. :rolleyes: Fortunately, the type of anaesthesia induction drug she got does not lower BG and the vet expected her numbers to go up instead. Which they did.

Taking Neko in for a dental was one of the most stressful things for me. Any anaesthesia procedure is hard on us caregivers. :bighug:
 
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