2.13 Rufus AMPS 490, +3 459, + 7 426

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Sandy and Black Kitty said:
Good morning :coffee:

I’m wondering if his p-titis is causing him pain and if he would benefit from some bupe.
Also, has he ever had a dental?
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Good morning :) I have some gabapentin, but he's not lip smacking today, so not sure if panc or teeth is acting up. He ate his whole bowl of food, so I always take that as sign of no pain. I could be wrong though.

Oh don't get me started on dental. Ugh. Been wanting to have his teeth cleaned and xray since before he was diagnosed diabetic. Now we can't do anything until his numbers are better. Regular vet sent me to dental specialist who said she needs to see a fructosamine test come back at least "fair". Good news is I'm seeing the internist/specialist tomorrow who will loop in the dental part of it. Pretty excited to hopefully get a plan going, slightly nervous that I'm expecting too much and they will be a let down on helping him.
 
Sean & Rufus said:
Regular vet sent me to dental specialist who said she needs to see a fructosamine test come back at least "fair".
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Did she quantify what she considers ‘fair’?

That makes me crazy. After recovery from conjunctivitis, upper respiratory infection, 2 episodes of DKA my BK had a small lump removed which thankfully was benign. While he was under the vet took the opportunity to get a good look inside his mouth. She saw a fragment of a broken tooth that she easily removed however his teeth and gums were really bad- well beyond what she was comfortable handling. She recommended a veterinary dental specialist. Two dentals (and 1 year) later it was party time- the last cat anyone imagined would go OTJ did just that.

Take a look at his insulin needs relative to these dates:
10/23/2008 - lump on back of neck removed and sent for for biopsy. tooth fragment removed.
12/08/2008 -first dental surgery
5/29/2009 - second dental surgery
10/23/2009 - party time.

F78E0160-10FB-415E-A998-0F01278FBC25.jpeg

Expecting BG to be regulated before addressing an infection that is fueling high BG is backwards thinking.
 
Sandy and Black Kitty said:

Expecting BG to be regulated before addressing an infection that is fueling high BG is backwards thinking.
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This is my issue. Rufus has other issues going on. Underlying. Regular vet wanted to get him regulated and then work on other issues. When I went to the denatl specialsit, and later to an emegency vet, they both said we need to work on the underlying issues now to get him regulated. Regular vet said specialist was a waste of money. Now she finally referred me to the specialst because she's frustrated with me and doesn't want to see Rufus anymore (for the regulation part). After I see the specialist, I'll be going back to the vet I used to use.

As far as teeth goes, nobody "sees" anything wrong with them visually. But he has lost 3 teeth in the last 3 months. We've talked about tooth resobtion. And he eats dry food funny, drops it, chews side of mouth. Wouldn't even attempt to eat dry for over a month. Everybody said it was his pancreatitus causing him pain to chew. I dunno. So much going on.

As far as fruct test, I think she wanted it like 30 points lower. But regular vet wouldn't retest because his number weren't getting lower. Ugh.
 
I brought this conversation over from yesterday’s thread.

Sean & Rufus said:
That's why I'm confused. Aren't you supposed to dose according to the lowest number? He had a couple blues. But then bounces up. And how do I know its not the symogi effect? I so wish I could start this whole process over and test at home and do curve at home from the beginning.
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You start from where you are. Follow the protocol and adjust the dose accordingly. Monitoring strategically is key to seeing the whole picture and catching the signals that call for dose adjustments.

I mentioned this yesterday but it bears repeating- to reduce insulin when a kitty is teetering towards ketone development is opening the door to DKA. You don’t want to go there-trust me.



 
Sean & Rufus said:
Regular vet wanted to get him regulated and then work on other issues.
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This is backwards when issues are those know to fuel high BGs.
Sean & Rufus said:
As far as teeth goes, nobody "sees" anything wrong with them visually.
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That doesn’t mean there is nothing wrong- so much of what can cause chronic infection is going on under the gums.

Sean & Rufus said:
But he has lost 3 teeth in the last 3 months.
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did they just fall out or were they removed? Even with professional extraction fragments can remain and cause infection.
Sean & Rufus said:
And he eats dry food funny, drops it, chews side of mouth. Wouldn't even attempt to eat dry for over a month.
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Sean & Rufus said:
As far as fruct test, I think she wanted it like 30 points lower.
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Ditch the dry, both food and treats. It’s really best. Try it and see - it just might be the key to bringing his BG into the dentists comfort zone.
 
FWIW, pancreatitis doesn't cause your mouth to hurt. It makes your gut area hurt like crazy.

Teeth falling out, at least to my way of thinking, is a pretty good sign that there are dental problems. Teeth just don't fall out for no reason.
 
Sandy and Black Kitty said:
This is backwards when issues are those know to fuel high BGs.
That doesn’t mean there is nothing wrong- so much of what can cause chronic infection is going on under the gums.

did they just fall out or were they removed? Even with professional extraction fragments can remain and cause infection.

Ditch the dry, both food and treats. It’s really best. Try it and see - it just might be the key to bringing his BG into the dentists comfort zone.
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The teeth fell out on their own. I know dry isn't ideal, but with me being gone and the other cat refusing wet, and with Rufus' dietary needs it just has to include dry.
 
Sienne and Gabby (GA) said:
FWIW, pancreatitis doesn't cause your mouth to hurt. It makes your gut area hurt like crazy.

Teeth falling out, at least to my way of thinking, is a pretty good sign that there are dental problems. Teeth just don't fall out for no reason.
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You and me would both think that. But EVERYONE else is telling me his teeth look ok. I'm like yeah, then why are they falling out? Why does he chew that way? Why did he avoid dry? But, nobody will do xray until he's better. Hoping they do a fruct test tomorrow. Honestly, if they are worried about the anestitia I am too. Just want him to get the numbers down and I'm not sure they will if their is teeth issues. Thing is though, I had him on gabapentin for 4 days and didn't seem to change his eating habits. He won't even eat regular wet food now. It's all liquified with water into a puree.
 
Sandy and Black Kitty said:
I brought this conversation over from yesterday’s thread.

You start from where you are. Follow the protocol and adjust the dose accordingly. Monitoring strategically is key to seeing the whole picture and catching the signals that call for dose adjustments.

I mentioned this yesterday but it bears repeating- to reduce insulin when a kitty is teetering towards ketone development is opening the door to DKA. You don’t want to go there-trust me.


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No, absolutely don't want DKA. I guess I've been told they they dose based on nadir. If we were still dosing based on his once a week check in at the vet, and that happened to be the 144 I caught, we would stop at the current dose. That's why I'm confused. I know that he's having high numbers right now, but also his lowest. I guess we'll see whta they say tomorrow.
 
If you look on the days that he has his best numbers, he also has his worse numbers. How is that we don't know that he's getting to much insulin and his body is dumping glucose because it is freaking out from the lower numbers? Look at the other days. Reds and pinks, and then blacks, blues, and yellow. I can not wrap my head around these things.
 
Sienne and Gabby (GA) said:
Unless your cat is a horror at the vet's office, I'm not sure a cat needs to be anesthetized for x-rays. My kitty just had x-rays and an ultrasound without anesthesia.
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I think the reason why the does the anesthia (sorry sp) is because they do it all at once. Both the reg vet and the dental specialst do everything in one swoop. Cleaning, xrays, extractions. I guess I could look for a different dentist if they could do xrays without putting them under. I'm not too excited about going to specialst because the low end cost is $1950 :(
 
Would be good to find a place that does an X-ray to see if there is a problem. You can wait for surgery at a later time and you shouldn't need to have anesthesia for just an X-ray. Maybe that would be a good medium to rule in or out dental problems, then address what you can with FD before surgery...if he needs it.
 
My vet does it all in one fell swoop, too...I know they can do other x-rays without anesthesia, but I'm not sure they can do dental x-rays without anesthesia. Still, it's worth asking.

Rufus is inching down!!!
 
Amy&TrixieCat said:
My vet does it all in one fell swoop, too...I know they can do other x-rays without anesthesia, but I'm not sure they can do dental x-rays without anesthesia. Still, it's worth asking.

Rufus is inching down!!!
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Yeah, just called my old old vet (the one I'll be returning to soon), and they do it all in 1 swoop too. To difficult to do xrays on cat awake. I do feel that Rufus' numbers have hopefully improved enough to get in the "fair" range.
 
Side question - Was anybody (or how many) lucky enough to have pet insurance before their pet was diagnosed with diabetes? Ugh.
 
Sean & Rufus said:
If you look on the days that he has his best numbers, he also has his worse numbers. How is that we don't know that he's getting to much insulin and his body is dumping glucose because it is freaking out from the lower numbers? Look at the other days. Reds and pinks, and then blacks, blues, and yellow. I can not wrap my head around these things.
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The reason you see his worst numbers the same day as his best numbers is because his counter-regulatory systems are currently quick to freak out over those good numbers. The counter regulatory hormones can take up to 72 hours to clear so 2 bounces, back to back can eat up 6 days easy. You are just closing in on 1 week (7 days) of data for both the AM and PM cycles; your first real look into the complete picture. The SLGS guidelines recommend the following:
  • After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
I recommend you do a curve soon. It looks like the most recent bounce is clearing and that would be a perfect time to do the curve and really get a look at where this dose may be taking him. If you wait until after the next low then all you will see is where his counter-regulatory takes him (and we already know where that is).


 
Sandy and Black Kitty said:
The reason you see his worst numbers the same day as his best numbers is because his counter-regulatory systems are currently quick to freak out over those good numbers. The counter regulatory hormones can take up to 72 hours to clear so 2 bounces, back to back can eat up 6 days easy. You are just closing in on 1 week (7 days) of data for both the AM and PM cycles; your first real look into the complete picture. The SLGS guidelines recommend the following:
  • After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
I recommend you do a curve soon. It looks like the most recent bounce is clearing and that would be a perfect time to do the curve and really get a look at where this dose may be taking him. If you wait until after the next low then all you will see is where his counter-regulatory takes him (and we already know where that is).
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I'm sorry I'm so dense. I really don't understand if he's getting a good number, say that 144 the other day, wouldn't that be his nadir and therefore we are on the correct dose? It's obvious he's still bouncing, right? He continues to bounce. If I did a curve tomorrow and the numbers came up the same as they did on 2.7.18 what would the dosage recommendation be then?
 
And why does it seem the numbers are getting worse by the day? I'm going to see what the specialist says about possible cold he has. I can't imagine you'd want to do a curve on a day he's sick.
 
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