? Consistent high BG's caused by stressful vet visit?

Missy continues with mid 200's BGs range, no Ketones but Glucose in urine always present between 1/2 and 1.
Her appetite gotten a bit better but still picky, her weight is stable at around lb. 11.3 but drinking and peeing a lot. Had her start on daily S. Boulardii and that seemed to help stabilize her gut and stools are back normal, she only had an episode of bile puke over a week ago.
Per the IM suggestions, 8 days ago she also started Denamarin to help with the Pancreas and we lower the Budesonide from 0.15 to 0.1 trying to see if her BGs would lower as well but no luck with it...
What really puzzles me is that Missy BGs numbers up 'till right before the visit were around 170 and, since after the appointment, they rised to mid 200's and stayed there; I know she got stressed out at the vet because of the whole procedure (despite giving her Gabapentin) but, IS IT POSSIBLE HER NUMBERS STILL SO HIGH BECAUSE OF A STRESS EVENT EVEN AFTER OVER 3 WEEKS?
My other question is: at the vet visit no glucose was found on urine at 259, but I'm seeing a constant 1/4 to 1 everytime I test her urine even with lower numbers....I use Diastix and exp. date is 2024, could they be bad anyway?
Here's the link from previous post: https://felinediabetes.com/FDMB/threads/glucose-in-urine-question.275013/ @Bron and Sheba (GA) , @Suzanne & Darcy
Tnx in advance

 

I am Sorry I did not get this tag. I just happened to see it. I’ll tag @Suzanne & Darcy again in case she did it get it as well.
No I very much doubt the BG would stay up high from stress three weeks ago.
With no glucose in the urine at 259 at the vet, it is possible that the BG had just gone up to that level from stress and the glucose had not had time to spill over into the urine.
What is happening about insulin?
It looks as if you are still not giving any insulin at all. I am concerned about this because with the yellows in the low to mid 200s, I think she needs insulin. Insulin does more in the body apart from lowering the BG.

 

One of my non diabetic cats tested 220 something at the vet, 53 at home the next day. It was a very stressful visit for him, way more than usual. Numbers won't stay that high for long. We also had another member whose cat hated road trips. He was on an OTJ trial at the time, popped up to reds (400's) after a long drive. Back down to beautiful greens at home the next day. You could always get the vet to run a fructosamine test if you think you've had bad timing with testing.

That 259 at the vet, was that a human meter or pet meter? It might be just under her renal threshold, or she was under renal threshold a couple hours before the urine test. Remember than urine reflects what was in the blood a while ago.

It looks like Missy's BG numbers are steadily climbing. The quicker you can get her regulated on insulin, the greater the chance of remission.

 

IM wanted to try lowering/tapering down the Budesonide and add Denamarin to see if somehow the numbers would go down but I'm not seeing that happening.
I know she needs insulin and I have been in denial about it cause I really don't know where to start with Missy...I thought about try to poke her with a syringe fill with water and the vet said to use saline solution instead (some like that?) to practice but just the thought of it it scares to death, I'm afraid we'll both get hurt. I forsee lots of furshots (she has long hair) and Missy getting traumatized.
The only place I could give her shots would be her scruff, nowhere else....once I try to pretend to gently lift her scruff skin and she almost bit me.
How would you do? What dose insulin would you start with?
Would it be ok if I use Insulin Glargine? I still have a new pen from Micio in the fridge

 

Fructosamine was run at the regular vet along with blood work last December and it was 371 but the Dr. wasn't concerned about it because "numbers were within range"....the highest is 373, I was concerned.
I believe the 259 were taken with pet meter at the IM visit but will ask, going to reach out to the IM by next week.
IM already told me Mkssy is not a good candidate for Bexacat and I agree and I'd have no problem to give insulin again but Missy is a very different cat (I just explained why in my reply to @Bron and Sheba (GA) above)
At this point I know I have to and I agree that the soonetr the better

I did set up a spread sheet and Labs results for Missy, can you guys see it OK? Not sure I was able to change the name correctly (from Micio's Spreadsheet to Missy).

 

Yes I can see the spreadsheet. Can you move it over to the far left so it is the one we see when we open the tab please?
How did you get the BGs that are in the SS? Did you get them or the vet?

I would shave where you think you can give the insulin, so you can see better.
What about trying to give the shot while she is eating? Just lift up the scruff and give the dose quickly. Have your finger on the plunger ready to push it in. If you watch a vet give an injection it is done very quickly in the scruff.
Do you have anyone to help you?
I wouldn’t bother practicing with saline. I would just start with the insulin. If you miss a few times…..so be it. At least you will have started.
Try and be confident. Keep talking to her as you do it or him so she won’t get apprehensive.
I think the glargine would be a good insulin to give.
Missy’s SS says you are using a ReliOn Premier classic. If that is correct would you mind putting it into the signature please so we can see ..thanks.
Regarding the dose….do you think you will be able to test?

 

I started to test Missy's BGs last year and have been increasing testing lately because of her high numbers and the possibility of having to give her insulin...indeed, looks like it became reality.
I have to syringe feed her because that's the way she iis rarely she eats on her own) so I won't be able to give her a shot in that way.
I also have been chopping her fur with scissors, little by little when she's laying down and calm....not a chance I'll be able to shave her scruff with electric razor.
For some reason Missy let me brush her teeth, syringe feed her and test her BG's on her ears but doesn't want me to pick her up, touch her paws, trim her nails, brush her for more then 3 strokes neither lift her scruff (awhile ago I tried to look for a spot on her scruff for possible insulin ijections, I was gently parting the hair and lift the skin a bit and she almost bit me.
And no, nobody else can help me as she doesn't let nobody else touch her, especially my husband which she hiss at all of the times.
I did move the SS link to the left, going to add the meter brand as well.

 

I wonder if you could try desensitising her by lifting the scruff a bit multiple time s a day…would she take a treat.?
Why do you have to syringe feed her all the time?

 

Yes, good idea...this morning after her breakfast, while having her treat I gently pull up her scruff and pretend to give her a shot with a no-needle little syringe...she didn't react and will do that again multiple times throughout the day.

Missy has always been picky about food but I started syringe feeding her years ago when her IBD gotten worse and, through time, I think she ended up liking all of the attention from me and take that as her way to eat most of her meas. Then things gotten more complicated with Micio and I started to spend more time with him because of his multiple deseases, she silently absorbed the drama/stress and most likely gotten worse and, since the day Micio left us, she completely changed her behavior, habits and refused to eat on her own for awhyle...now, rarely she'll eat on her own otherwise she likes to lick it off the syringe or my finger without me holding her or anything.
I feed her raw meat diet and cannot leave the food out there for too long, anyway, she just won't eat on her own. Not fun at all, I just accepted the way she/it is.

I'll start testing her more and more cause I don't want to wait any longer before try to give her insulin and, if she'll let me, I'd like to start with TR: what dose would you reccomend for Missy?

 

How much does Missy weigh? And how much should she weigh? That's how the TR starting dose is determined.

 

At the IM visit on 20 Feb she weighted lb. 11.2 and I remember the Dr. mentioned that, by the chart, Missy is a bit "overweight"? but she said it's an ok weight and we need to make sure she doesn't loose more weight neither (up 'till 1-2 yrs ago she was a bit over lb. 12).
Forgot about TR and starting dose calculation, I'll look it up

 

The initial dose for Lantus = 0.25 x ideal weight in kilograms. However, that's if you're following Tight Regulation. This is the post on Lantus dosing methods. There are two approaches to dosing.

 

Yes thank you, I'm familiar with the TR and will like to start with that and hopefully Missy will let me. Just wrote an email to the IM doctor explaining that I want to start that asap and need to confirm Missy's ideal weight. Meanwhile, if I'm correct and Missy's ideal weight is about lb.11/ 5Kg. then her starting dose should be 1.25u?

 

You're math is correct! It's also fine to start a little lower if you're nervous about the dose.

 

Right, I'm very nervous about the whole thing...should I start at 1u or even .75u or...?

 

You can start where you want. (I hope that doesn't sound snarky!) I think either 1.0u or 0.75u is fine. Remember, it will take about a week for the Lantus depot to stabilize.

 

Missy's numbers pretty bad today, keeps climbing ; wanted to wait 'till tomorrow to hear back from the IM but I feel like I should start with insulin right away.
I just found another small skintag on the top of her head/neck area: is that typical from diabetes or is it stricly related to Acromegaly? It so reminded me of how my Micio started...
Thinking about testing a syringe needle on Missy's scruff, just a poke with no air or any liquid inserted just to see her reaction...could that be a way to start?

 

Skin tags also happen with older cats.