Advice Needed: Shorshe's weird long greens + Dental Work

S

Shorshe’s Mum

Member Since 2024
Hi All,

Shorshe is currently on Lantus. I was away in July for 3 weeks and somehow when she became quite disregulated. But even before I left, Shorshe has had one or two AMPS/PMPS greens and/or low blues. This is somehow becoming more and more frequent. And as a result she is frequently getting no insulin or a token amount. Why is this happening? She is also extremely reluctant to eat in her lows. And once her BG is under 100 within 3 hours it's almost impossible even with medium and high carb wet food to keep her in the 70-90 range. In her greens it's nearly impossible to get her BG steady and not dropping without feeding every 15 minutes with a syringe. Any advice regarding such cats whose BG rises very very slowly and drops faster? Here's her sheet: Shorshe 2024-2025


Currently she has just been given her first shot (half dosage) of Solensia and seems to be doing better--her left knee joint is very degenerated and the veterinary orthopedic we saw said she has muscle loss on that leg because she is using it less due to the pain. She is also on pregabalin, Synoquin, antinol, and liver supplements. We have a consultation with a small animal dentist at the university next week, as the CT scan in March revealed degenerative teeth decay in her upper canines. She has been having occasional involuntary facial twitches that vets think might be related to tooth pain and not seizures.

I am quite reluctant to put her through another general anesthetic procedure, but I have been reading about diabetic remissions/significant reduction in numbers after dental work. What should I be discussing with the vet? The same vet had operated on another one of my cats, and the extraction, the cleaning and x-rays were flawless. But the pain management was not great--he was given a fentanyl patch and was seemingly hallucinating till I took it off, and it took him more than 2 weeks to recover from that ordeal, though his mouth was perfectly healed. Shorshe, during her last surgery had very low heart rate and had to be given shots to correct it (in March during the procedure to remove mast cell tumour and obtain biopsy from her ear). She is 13+ now and I worry about frequent general anaesthesia.
 
I would be delighted to see Shorshe in blue or green pre-shot numbers!! Quite honestly, the pre-shots in the 90s are shootable numbers. In contrast, think about Tight Regulation (I know you're following SLGS). With TR, you shoot anything above 50 once your no longer new at managing your cat's diabetes. You have options beside skipping a pre-shot that's in the lower range. You do not feed your cat and you can
  • stall for 20 min or so and see if numbers are rising. You can repeat this several times.
  • shoot a reduced dose
Skipping the shot has the consequence of depleting the depot the most. I suspect what is influencing the numbers is that when you skip or shoot a dramatically reduced amount, you're then seeing higher numbers due to less insulin and that it can take a few cycles for the depot to get caught up.

If Shorshe is experiencing dental pain, it may be contributing to higher numbers. If there are dental issues, buprenorphine may be an option. It's also an opiate, though. I'm not a fan of patches mostly because I have long hair cats and prefer to not to have them shaved for a patch. I've not had any problems with bupe for pain. Another option may be to see if there's a veterinary dentist in your area.
 
Sienne and Gabby (GA) said:
I would be delighted to see Shorshe in blue or green pre-shot numbers!! Quite honestly, the pre-shots in the 90s are shootable numbers. In contrast, think about Tight Regulation (I know you're following SLGS). With TR, you shoot anything above 50 once your no longer new at managing your cat's diabetes. You have options beside skipping a pre-shot that's in the lower range. You do not feed your cat and you can
  • stall for 20 min or so and see if numbers are rising. You can repeat this several times.
  • shoot a reduced dose
Skipping the shot has the consequence of depleting the depot the most. I suspect what is influencing the numbers is that when you skip or shoot a dramatically reduced amount, you're then seeing higher numbers due to less insulin and that it can take a few cycles for the depot to get caught up.

If Shorshe is experiencing dental pain, it may be contributing to higher numbers. If there are dental issues, buprenorphine may be an option. It's also an opiate, though. I'm not a fan of patches mostly because I have long hair cats and prefer to not to have them shaved for a patch. I've not had any problems with bupe for pain. Another option may be to see if there's a veterinary dentist in your area.
Click to expand...
Re waiting for 20 mins to see if the numbers rise and repeating it a few times, what is the latest past her usual shot time that I can shoot the insulin? Because usually, I notice it's about 1.5-2 hours before her numbers come up to blues if she is the greens.

Also, so far I shoot 1 u when she in the blues and nothing when she is the greens. How should I modify it? Start with 1 unit in the greens and go upto 1.5 unit in the blues? Or even more? Is there a "formula" to reduction when giving reduced shots? @Sienne and Gabby (GA)

My main concern is that her BG is so slow to rise once it hits 60 and lower. I can be feeding her HC food like z/d or k/d--syringes, because she absolutely refuses to eat below 90s, even with cyproheptadine, for hours, and it still drops or remains in the 50s, 60s. It's kind of hard for me to monitor this on a nightly basis too, given that would mean me staying up till 1-2 am and then be up for her shot at 6am. As a single caregiver of four elderly cats who all need various levels of care and monitoring, it becomes really hard to function on so little sleep.
 
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I would change my strategy with high carb. Many cats do not particularly care for Z/D or K/D. The ingredients are not great. Many cats prefer a gravy based food (e.g., Fancy Feast Gravy Lovers). My cat couldn't tolerate gluten so I would use her typical low carb food and add a bit of corn syrup or honey. It takes a lot longer for a high carb food to be metabolized than a simple sugar product like corn syrup. It may be why it takes longer for Shorshe's numbers to respond to the Z/D. '

A cat surfing in the 50s or 60s isn't dangerous. Those are normal blood glucose numbers. I'd be concerned if she was sitting in the 30s or 40s. We encourage bumping the numbers up so you have a margin for safety.

There isn't a formula for deciding when to shoot or how much to lower the dose. A lot depends on your cat. I generally suggest that you gradually work your way down to shooting lower numbers. Use that as a way to gather data. I would likely not reduce the dose by more than 0.5u. Keep in mind that you have the depot to deal with.

If you're stalling, you have to figure in your schedule. The longest you would want to stall is 2 hours. However, your next shot time would be 12 hours after you gave your cat the previous shot. You can move the shot time back to your preferred time either by 15 minutes twice a day or 30 minutes once a day. That may or may not be feasible given your schedule.

I was Gabby's sole caregiver so I get it. If you look at her spreadsheet, there were lots of nights I was up late. I also work full time. When someone asked me how I managed, my somewhat smart mouthed response was that sleep is vastly overrated!!
 
Thanks for this. I have shot her first time on a green, not yet updated the spreadsheet. And somehow I cano longer function on less than 5-6 hours of sleep unfortunately. Given another one of my cats is syringe fed and a third needs very close monitoring for his IBD, I am a bit at a loss how to manage.

So far, Solensia doesn't seem to have made a huge difference to Shorshe. But my other cat Kalonji is behaving like a kitten again, aka throwing everything down in his bouts of frequent zoomies. :D
 
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