6/4 Tessa AMPS 321 +2 285 +4 246 +6 204 +9 198 PMPS 275 +2 281 - dental appt advice?

tessa's mom

tessa's mom

Active Member
Previous: https://felinediabetes.com/FDMB/thr...-175-5-147-6-145-8-240-pmps-305-2-272.290735/

No muscle twitch today when getting her shot so that's good. She did flick her tail a little but otherwise seemed perfectly normal. I warmed the syringe between my fingers for just a few seconds so I'm not entirely sure if it's cold related (can a few seconds really do much?) but it doesn't hurt for me to continue doing that just in case.

I'm wondering if stopping food at +4 is not the solution to getting lower preshots? It's possible that she's bouncing so we'll see what this cycle looks like before changing anything but so far, I'm not convinced that this is helping. This morning was her highest preshot since she started insulin again.

I kinda wonder if Tessa is one of the rare cats who actually needs some food after the nadir to stay in lower numbers. I was feeding at +4 and +8 up until 5/25 and her preshot numbers were almost all lower before than they have been since I started limiting food to the earlier parts of her cycle. Maybe a small snack later in the cycle would help?

I'm really not sure though, looking back through her spreadsheet it looks like I tried all sorts of food schedules the first time around so I must have had this issue back then too but I can't remember for sure. It does look like she often had food around +5 or +6 during the day at least. I apparently only gave one meal at night back then but the thought of doing that now is crazy to me.

We're on day 3 of this dose and normally I would increase tomorrow but she has her follow up dental and will be getting anesthesia so we have to skip the AM dose and might have to skip the PM dose too from what I've read on here. So I'm thinking about giving her 1-2 more days on 1.75u after the dental. Skipping a day and then increasing doesn't sound like a good idea to me and I'd feel a lot more comfortable sticking with the same dose for another day or two. She's also been getting some nice low to mid blue stretches with this dose so it wouldn't hurt to keep her on the dose for a few more days anyway.
 
I also posted this in the main forum but no response yet so adding it here too:

Tessa is going in for another follow up tomorrow from her extractions since she's still experiencing some pain at times. The vet is planning to do a new set of x-rays since the post-extraction x-rays were lost when they lost a server.
They are not sure whether she will actually need anesthesia (if nothing is found on x-ray, no procedure needed so no anesthesia) but as a precautionary measure we are to withhold food from 1am (vet drop off is 7-7:30 am). They asked us to send her with her normal food and insulin so they can give it to her in case they do not need to do anesthesia but I am concerned about this because she normally gets insulin at 7am so it would be at least an hour late, possibly more.

The original plan was to just skip insulin that morning (and originally they wanted her to fast from 10pm) but when we brought up that she had had ketones in her urine when she was fasted that long last time, they changed the plan and asked us to bring in the food and insulin. I am very concerned about this because of the timing and how it will affect the next cycle.

Should I tell them our regular dosage or tell them that it's less than it actually is? They know that we do the TR protocol but aren't super familiar with how it works. The last time they asked about her dosage (a little over a week ago) she was on 1u so they may be surprised at 1.75u and also unfamiliar with how to give quarter units. I was thinking about telling them it's actually 1.5u or maybe just stick with 1u.

Should I give them a time limit on how late they can give the insulin? I don't want to be a Karen and tell them what to do but I am definitely concerned about this.

The other question I have is IF they do need to do anesthesia and she skips her dose, how do I handle her PM cycle? I know that anesthesia can lower blood glucose so I am prepared for the possibility of needing to skip her PM dose but how do I know whether I should skip? Is it based on a certain preshot number or something? I've tried searching the forum for answers but I have come up empty.

I can give more background on what's going on if anyone needs that info. I just didn't want to leave a giant wall of text lol.
 
Decided to go ahead and send the insulin with her in the morning. We settled on saying 1.5u is the dose since I don't think they can easily do quarter units and I included a note asking them to just skip the dose if they haven't decided by 8am (1 hour past normal shot time) and explained why (because it might make the PM dose act like a dose increase which might make her go too low overnight). I also included instructions on how to use the pen as a vial since I doubt they've used it that way before and I don't want them injecting air into it. Hopefully everything goes well tomorrow, I'm stressed and probably won't sleep well tonight. :(
 
Since 5/25, she gone on to higher doses, and seen lower nadirs. Which is causing more bouncing. It's not the food that's the problem. Also, food experiments take time. If nothing else, move the +8 snack to +6 for a while, and see if that makes a difference.

Information on dentals plus a second post showing modern anaesthesia feeding guidelines, including for diabetics: Info on Dental Procedures (including pictures) Typically cats getting anaesthesia can get a half dose.

If they shoot an hour late in the AM, you could shoot 11.5 hours late tomorrow night, then back at the normal time the following morning. You can move the schedule 1/2 hour once per day, or 15 minutes per cycle. There's also a bit more wiggle room if she's really high, which might happen due to vet stress or partial dose. Post tomorrow and we can guide you.

As far as tomorrow night goes, test first when you get home, then test again at PMPS. If she's dropping, then the vet may have used the older style induction drug that drops BG numbers. The one commonly used in Canada does not drop the BG.

Paws crossed for a good vetty visit tomorrow.
 
Wendy&Neko said:
Since 5/25, she gone on to higher doses, and seen lower nadirs. Which is causing more bouncing. It's not the food that's the problem. Also, food experiments take time. If nothing else, move the +8 snack to +6 for a while, and see if that makes a difference.

Information on dentals plus a second post showing modern anaesthesia feeding guidelines, including for diabetics: Info on Dental Procedures (including pictures) Typically cats getting anaesthesia can get a half dose.

If they shoot an hour late in the AM, you could shoot 11.5 hours late tomorrow night, then back at the normal time the following morning. You can move the schedule 1/2 hour once per day, or 15 minutes per cycle. There's also a bit more wiggle room if she's really high, which might happen due to vet stress or partial dose. Post tomorrow and we can guide you.

As far as tomorrow night goes, test first when you get home, then test again at PMPS. If she's dropping, then the vet may have used the older style induction drug that drops BG numbers. The one commonly used in Canada does not drop the BG.

Paws crossed for a good vetty visit tomorrow.
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Thanks, this is very helpful! Do you think that keeping her on 1.75u for another day or two is okay? We would have been increasing to 2u today but the dental stuff is messing everything up and I'm a little nervous about increasing before I know how the dental is going to affect her.
 
Sounds like from your update on Feline Health, you don't have to worry about dental after effects. And that they skipped insulin. :banghead: Meaning you can shoot anytime. You can stick with 1.75 for a couple more cycles if you want. She did see mid blues and we hold doses with nadirs under 200 for 6-10 cycles. Towards the longer end of that range for low blues.
 
Wendy&Neko said:
Sounds like from your update on Feline Health, you don't have to worry about dental after effects. And that they skipped insulin. :banghead: Meaning you can shoot anytime. You can stick with 1.75 for a couple more cycles if you want. She did see mid blues and we hold doses with nadirs under 200 for 6-10 cycles. Towards the longer end of that range for low blues.
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Thanks! I'm actually a bit glad that they skipped insulin because I was very concerned that they would give it at like 9 or 10am and then I'd have to slowly work back to her normal dose time while also having to get up in the middle of the night to get any PM cycle tests. It sucks that she missed a dose but it's not the end of the world.
 
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