High Glucose After Teeth Extraction

[Jo_]

(Creating a new post since the topic is not related to the previous conversation)

When Dexter had is DKA eppisode and was in the hospital, they mentioned that he would need dental cleaning. We are hoping that it helps lowering his numbers.

Because he gets a bit feisty in the vet and has had issues with being under in the past, we had to wait to schedule it since they wanted to do it not only with the dental specialist but also the anesthesiologist.
It happened on the 13th, so 10 days ago.

He unfortunately had to remove 3 teeth. We were kind of expecting some tooth extraction, since he already had a broken canine when we rescued him (we've asked multiple times in the vet if it required treatment, but the vets never suggested it).

He was sent home with antibiotics (for 6 days) and Metacam (the painkiller, for 5 days). He seemed to be in some pain when we got him off of the Metacam, so on the 8th day we gave 2/3 do a dose and on the 9th day we gave 1/2 dose.
He's kept his appetite and energy the whole recovery and the gums and stitches seem good (no swelling, no bruising).

I just wanted to ask someone has gone through the teeth extraction process, how long until you actually saw the numbers go down and if we should start considering a dose increase.

 

[Sienne and Gabby (GA)]

A couple of questions...

• Did the vet get post-procedure x-rays? I'm assuming if there was a veterinary dentist doing the procedure they did. If not, you may need x-rays since it's possible that a tooth fragment was left.
• From your note, it sounds like there are stitches. Have the stitches been removed yet?
• Is there any indication that Dexter is having any oral discomfort?

Anything that can cause an inflammation can cause blood glucose numbers to be elevated. To be honest, it looks like Dexter's numbers are pretty much the same as before the dental. I would not expect a dramatic change in numbers so soon after a dental. Remember, Dexter was likely dealing with dental pain even with pain meds. (If you've never had a tooth pulled, there's discomfort for quite a few days.) Things like stitches are an irritant and can also have an effect on Dexter's numbers.

If this were my cat, I'd increase the dose.

Also, if you're following TR, please be attentive to when to evaluate the effectiveness of the dose. With TR, you evaluate the dose every 3 days/6 cycles and increase if your cat isn't in normal numbers. The longer you leave your kitty in higher numbers, the harder hit may be to get the numbers lower.

 

[Jo_]

After the procedure, they took x-rays and checked him thoroughly. Dexter is a sweety, but in the vet would be impossible to do anything to him without anesthesia and the veterinary dentist suggested not repeating the x-rays to not increase the stress for him.
Unless we noticed swelling or issues with eating or other behaviors.

He was stitched, yes. According to the dentist, they fall on their own so there's no need for him to go there to remove.

After I picked him up on the 13th, he was trying to rub his face everywhere. But that is supposed to be normal from what I read and it lasted only 1 or 2 hours. Other than that, he moaned a bit when eating or being picked up on the first day without the pain killer. Today he didn't have any and he's not showing any signs of discomfort when eating.
He has always been a bit of a loud breather and this past 4-5 days it's been a bit louder than usual, but the dentist warned us that the canine they removed was close to the airways.

I'm really not expecting to all of the sudden see just blues and greens
It's just that I showed the general vet his values on the day of the extractions and she suggested to hold on to 3 units for longer and see, but I also feel like he may need a tiny bit more insulin to help that process.

Regarding the measurements, since the numbers have been quite high, we decided to relax with TR for at least the first 7-10 days after the procedure, just to let him rest and get better without the added stress.

 

[Sienne and Gabby (GA)]

One other comment....

Many of us will ask our vets to not use Metacam for pain management. All of the nonsteroidal anti-inflammatory meds can cause kidney failure in cats. In fact, Metacam has a black box warning about it. My vet has it written all over my cats' charts that it shouldn't be prescribed. I typically ask for buprenorphine.

All of that said, Metacam is widely used outside of the US. The prescribing practices are different though. Outside of the US, they do not prescribe as large of a dose.

 

[Jo_]

my heart just sunk a little...
He weighs 4.66kg and they prescribed 4.5 (the syringe's unit is kg)
They gave him buprenorphine when he was recovering from pancreatitis in December... I'll keep that in mind if he needs it in the future

 

[Sienne and Gabby (GA)]

He wasn't taking it for more than a couple of days. It was routinely prescribed for chronic conditions like arthritis or for a longer post-surgical recovery. I'm sure Dexter will be fine.

 

[Jo_]

He was on it for 7 days in total. Fingers crossed it's not enough for such an extreme reaction.

Thank you for warning me!

 

[Panic]

One other comment....

Many of us will ask our vets to not use Metacam for pain management. All of the nonsteroidal anti-inflammatory meds can cause kidney failure in cats. In fact, Metacam has a black box warning about it. My vet has it written all over my cats' charts that it shouldn't be prescribed. I typically ask for buprenorphine.

All of that said, Metacam is widely used outside of the US. The prescribing practices are different though. Outside of the US, they do not prescribe as large of a dose.

One of our Canadian DCIN staff just lost her baby a couple months ago to acute kidney failure from being prescribed Metacam. We were already aware of the black box label so she made sure to use a more appropriate dose but it didn't matter. She was given the injectable and then take home meds and she stopped eating almost immediately, found out a few days later what the cause was and tried fluid therapy but she didn't make it. Only 18 months old. The manufacturers covered expenses and offered to do a necropsy (I don't know if she agreed). I did see on the FDA website that they no longer recommend any oral Metacam to felines, only a one-time injectable.

Not bringing this up to scare you, Jo, especially if Dexter has been fine, but after the experience I wouldn't even entertain a one-time dose with any of mine.

 

[Jo_]

One of our Canadian DCIN staff just lost her baby a couple months ago to acute kidney failure from being prescribed Metacam. We were already aware of the black box label so she made sure to use a more appropriate dose but it didn't matter. She was given the injectable and then take home meds and she stopped eating almost immediately, found out a few days later what the cause was and tried fluid therapy but she didn't make it. Only 18 months old. The manufacturers covered expenses and offered to do a necropsy (I don't know if she agreed). I did see on the FDA website that they no longer recommend any oral Metacam to felines, only a one-time injectable.

Not bringing this up to scare you, Jo, especially if Dexter has been fine, but after the experience I wouldn't even entertain a one-time dose with any of mine.

This just sent me down an awful rabbit hole of stories about metacam...
I feel so stupid for not researching and just trusting blindly

I think I'll have to call the vet and have them do at least bloodwork on him to check his numbers...

He has a really good appetite and he's playful like normal.
He's drinking a bit more water, but that started before the surgery because of the high glucose...

Other than the louder breathing I mentioned earlier, he is pretty much his normal self

 

[Panic]

This just sent me down an awful rabbit hole of stories about metacam...
I feel so stupid for not researching and just trusting blindly

I think I'll have to call the vet and have them do at least bloodwork on him to check his numbers...

He has a really good appetite and he's playful like normal.
He's drinking a bit more water, but that started before the surgery because of the high glucose...

Other than the louder breathing I mentioned earlier, he is pretty much his normal self

I really don't think you have anything to worry about at this point, Metacam gets prescribed willy nilly and most cats are fine, and Dexter sounds fine. You can find horror stories for literally every drug on the market. And don't feel stupid, most of us trust that our doctors aren't prescribing anything dangerous and don't bother to check (though there's nothing wrong with checking for your own peace of mind). You'll be hard-pressed to find a vet who won't prescribe Metacam to cats, it's very commonly used.

 

[Bron and Sheba (GA)]

I know there are bad stories about metacam but I used metacam for Sheba for almost 2 years and it was a game changer for her. So there are some good stories. The correct dose needs to be given. I live in Australia and it is used a lot.

 

[Jo_]

The syringe's units are in kilograms, which probably helps avoid overdose, and he was dosed just a bit below his weight.

The scariest part is that there is literally a website called metacamkills....... with a corresponding Facebook page.

Unless nothing else works for him in the future, it's going to be a no for me.
Buprenorphine has a much smaller side effect list and none of them is life-threatening

 

[Sienne and Gabby (GA)]

Jo --

Are you certain that the syringes units are in kilograms? Kilograms are weights. They are not volume measures. Insulin syringes measure amounts in units. Most other syringes measure in milliliters or cc's.

Some vets won't prescribe buprenorphine because it's a narcotic. It's become widely available (i.e, Suboxone) though.

 

[Jo_]

That is what the vet told me and it is written in the syringe

Maybe I should have also mentioned these are needleless and given orally

 

[Chris & China (GA)]

I believe Metacam comes with it's own oral syringes and the dosage is based on weight so that's how the syringe is marked.

Like this would be for a 3kg cat.

 

[Larry and Kitties]

All of that said, Metacam is widely used outside of the US. The prescribing practices are different though. Outside of the US, they do not prescribe as large of a dose.

This UK document says the short term maintenance dose of Metacam in 0.005 mg/kg
https://www.noahcompendium.co.uk/?id=-44759
This US document gives the same maintenance dose.
https://www.animalwised.com/metacam-for-cats-dosage-uses-and-side-effects-5388.html

If I crecal the problem in the US was that there was one concentration used for dogs and cats, 1/5 mg/ml whereas in other countries there was a 0.5mg/ml concentration for cats and the higher 1/5 mg/ml for dogs. There was problems in the us of giving accurate cat does with the 1.5 mg/ml concentration. Now in the US th ere is a 0.5 mg/ml concentration labled for cats while the 1/5 mg/mg concentration labeled for dogs. Metacam is supposed to dosed using the special syringe marked in weight. Thus it was easy to overdose a cat using the 1.5 mg/ml concentration. The maintenance dose for dogs is 0.1 mg/kg and thus it was easy to use the incorrect part of the dosing syringe when there was only one syringe used for both dogs and cats.