How long on antibiotics before a reduction in BG likely?

[jmalasiuk]

I'll probably be posting on the Lantus and Levimir board eventually, but this is still a more general question.
For background: Tonka's blood sugars have been consistently high the past couple weeks. Well, more than that, but more consistently high lately than before. I haven't been able to get him down to a decent level yet (mainly because I can't be around to monitor him enough during the day and I'm afraid of dosing him too high since he seems to keep rebounding whenever he even approaches a decent level - which is a lifesaver when he is legitimately low, but makes getting his levels down to where they should be very challenging). Previously, though, once we switched to all wet food, even 1 unit of Lantus was enough to send him down to a decent level at nadir as long as he wasn't being stubborn (his rules seem to change daily), and 1.5 units generally had him crashing in between rebounds.
Our vet suggested that it might be an infection since his teeth are quite bad for tartar fright now and prescribed antibiotics (AventiCLAV), which he's been taking since Saturday evening. We're waiting to see if his levels will reduce.
Does anyone know if it takes diabetic cats longer than average to recover from an infection (if that is what is going on with him)? He's down a touch, but I haven't noticed any really noticeable change in his blood sugar levels since Saturday (his spreadsheet is attached in my signature). Normally, antibiotics seem to have a rapid initial effect on an infection and just take a while to completely clear it out. Would even the tail end of an infection keep his blood sugars elevated?
I'd like to increase his insulin since he's so consistently high right now, but because I'm away for 12 hours at a time during the day, I'm afraid to do so if it is an infection that is causing the elevated levels and the antibiotics eventually kick it out of his system and he comes down. As noted before, not so long ago, 1.5 units was most defintiely too high a dose for him (he was down below 2.0 [36] a couple times at that dose and his activity and diet was all about the same as it is now).
(I'm really hoping to get him regulated in the next couple months - would have been nice to have done so before this, but life has not co-operated - since as of April or May, I'll probably have to be leaving him the care of my cat-sitter for extended periods again, and won't be able to monitor him well enough to figure all this out and keep him safe; so the sooner I can get his sugars under control, the better).

 

[BJM]

If you have the right antibiotic for the infection, you may see improvements within a couple days.
If you have the wrong antibiotic for the infection, you may see nothing.
If you have a resistant bacterial infection, it may take longer, and higher doses of the right antibiotic, to quell it.
... which means check with the vet!

Was a culture and sensitivity done to identify an infection and what might treat it?

 

[jmalasiuk]

No culture done. I sent in his spreadsheet 10 days after his last vet visit and she sent back her advice. From his elevated readings and having seen the tartar on his teeth about 3 weeks ago, she was guessing that he might have an infection and prescribed the antibiotics in case that was what was going on. I think she's trying to save me the expense of having to come in too often, and had seen that his gums were inflamed last visit so figured that an infection was a safe bet. I know it's not good to treat with antibiotics more than necessary, but since there was at least some infection (based on the gums), I figured it was worth a shot.

 

[BJM]

If his gums are painful, that too will increase the glucose (stress). and he needs a dental asap.
If they are NOT painful, teaching him to accept tooth brushing may help resolve some of the tartar and infection. Cat Info has some info on dental care.

 

[jmalasiuk]

He doesn't seem to have any trouble eating so I'm hoping that means his teeth aren't causing him pain. But being on all mushy wet food, it doesn't require as much tooth impact, so I guess that's not a good indicator (my older cat, Teeger, has had many of his teeth removed and seems to just inhale his food quite happily). The vet wasn't concerned enough about his teeth or gums to recommend a dental last visit - just noted that they were getting to the point that he would probably need a cleaning in the future. If dental problems cause diabetic cats so many more issues than the non-diabetics, though, I'll just have to find the funds to get his teeth done this spring if he doesn't need it sooner.

Thanks for the links to the tooth brushing. I tried the tooth brushing several times in the past and could get absolutely no cooperation from either of the boys (I adopted both of them as adults, and they were pretty set against this new idea). Mind you, Tonka is feeling pretty un-energetic these days, with his high blood sugars. It might be time to try it again, since he has less fight in him right now (poor guy - this will be a completely unfair advantage.. he likes to be ornery when it comes to such things).

Any thoughts on whether or not it is safe to increase his dose in the meantime? I don't want him to start crashing if the antibiotics do kick in, but it's not even guaranteed that it's an infection causing the highs. And if it is an infection, higher blood sugars probably make it that much harder to get rid of the infection since the organisms seem to thrive on sugar. I'll be contacting the vet tomorrow, but just wondering if anyone had seen this sort of thing and had experience with how quickly they do come down once an infection starts to heal. If it is an infection causing the highs, then the 1.5 units he's already on will likely be too much

 

[BJM]

If you want to increase per the protocol, do so when you can monitor the nadirs over the next 3-5 days. That way, if something drops dramatically, you can intervene.

 

[jmalasiuk]

Is monitoring the evening nadir enough? I can get that (or very close to it) since I'm up quite late more often than not, but daytime nadirs are limited to weekends.

 

[jmalasiuk]

That said, I just took his reading since he was looking around for more food, and he's come down to 9.9 [178] from 21.0 [380] in the last 3.5 hours. Which is considerably more than he's dropped in that amount of time the last couple days. Guess we'll give it a bit more time and see if he really is getting the chronic highs out of his system.