Dental appointment help with insulin dosage

[tessa's mom]

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.

 

[Chris & China (GA)]

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,

Sorry nobody saw this until now!

When was that? If it's on your spreadsheet in the "remarks", she never got high enough for concern. While we never want to see ketones, on the Nova Max, 2.4-2.5 is the point where you need to get worried and get to a vet ASAP.

When China had all her dentals, I got the same instructions, but my shot time was 6am and I didn't want them giving her insulin after her dental so I "accidentally forgot" to bring it in. I'd put a can of her food in the carrier and just tell them I had the insulin ready but walked out without it.

If you do take it in, I'd tell them to give 1.0 or 1.5 because you're 100% right that most vets don't understand that .25 and .75 measurements are possible. Make sure they note the time they give it. You'll either have to work your way back to your usual shot time by 15 minutes per cycle or 30 minutes per day, or you could skip the PM shot and start over the next morning at your normal shot time.

I'm pretty sure they will need to at least do a short term anesthetic. Cats won't open wide and stay still so they can get good x-rays.

Newer anesthesia protocols for diabetic cats actually recommend a small meal in the morning and 1/2 dose of insulin ....and the cat should be first on the schedule but if your vet expects her to be fasted, it's better that you do so there are no surprises.

 

[Bron and Sheba (GA)]

I agree with Chris. The amount of ketones you have recorded in the remarks column of the SS is of no concern. Most cats will record a few ketones on the blood ketones meter. Good luck with the procedure.

 

[tessa's mom]

Sorry nobody saw this until now!

When was that? If it's on your spreadsheet in the "remarks", she never got high enough for concern. While we never want to see ketones, on the Nova Max, 2.4-2.5 is the point where you need to get worried and get to a vet ASAP.

When China had all her dentals, I got the same instructions, but my shot time was 6am and I didn't want them giving her insulin after her dental so I "accidentally forgot" to bring it in. I'd put a can of her food in the carrier and just tell them I had the insulin ready but walked out without it.

If you do take it in, I'd tell them to give 1.0 or 1.5 because you're 100% right that most vets don't understand that .25 and .75 measurements are possible. Make sure they note the time they give it. You'll either have to work your way back to your usual shot time by 15 minutes per cycle or 30 minutes per day, or you could skip the PM shot and start over the next morning at your normal shot time.

I'm pretty sure they will need to at least do a short term anesthetic. Cats won't open wide and stay still so they can get good x-rays.

Newer anesthesia protocols for diabetic cats actually recommend a small meal in the morning and 1/2 dose of insulin ....and the cat should be first on the schedule but if your vet expects her to be fasted, it's better that you do so there are no surprises.

It was on April 25th, I have it under labs. She had 15 mg/dL in her urine which does seem to be in the beginning of the danger zone, it would be the same as the "small" amount on ketone urine sticks. She did get fluids that day during her cleaning which likely kept her out of the danger zone but that stressed the hell out of me.

I am sending the insulin with instructions to not give after 8am and an explanation as to why (the next dose might act like an increase which might make her go low overnight when no one is awake). I trust my vet to do what I asked of them and my paper says if they do give insulin that her dosage is 1.5u and explains how to use the pens with a syringe because they've probably never come across that.

I think you're right that that they'll need to sedate her at minimum so it's fairly unlikely that they'll give her insulin.

 

[tessa's mom]

I agree with Chris. The amount of ketones you have recorded in the remarks column of the SS is of no concern. Most cats will record a few ketones on the blood ketones meter. Good luck with the procedure.

Quoting you to let you know that the number was under labs. It was 15 mg/dL on the day of her dental cleaning (April 25th). I'll add it to the remarks column as well so it's easily visible in the future.

 

[tessa's mom]

Update: They did not give insulin because they did not get started today until after 8am and they followed our instructions.

They did not have to do sedation or anesthesia because the original clinic was able to get into their server and view the x-rays from the post-extraction x-rays taken on April 30th. There were no signs of root fragments or missed problem teeth on those x-rays. The vet said she looked over Tessa's mouth today and she believes that the problems she has been having are from lip entrapment. She said a callous is forming so hopefully her pain will be gone very soon but if it does not get better we can bring her in again.

She also said that Tessa already has gingivitis again and it's only been a little over a month since her cleaning. She said it's still mild but that we may want to consider full mouth extraction if it continues to get worse. She said that every 6 month cleanings are another option we can try in the meantime.