How long should I wait to see if dental work brings her BG back down?

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tessa's mom

tessa's mom

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Tessa went off the juice a little over a year ago and was doing great until I checked her BG 10 days ago and saw numbers in the low blues. I got her scheduled for a dental cleaning and they found that she needed several teeth removed. They didn't have any surgery slots long enough to comfortably fit her in so they referred us to another vet about 45 minutes away. Thankfully that vet got us in a couple days later and Tessa had 5 teeth removed.

She seems to be feeling better but the vet wants us to keep her in a cone until her recheck in 2 weeks so she's a bit stressed. She can't even figure out how to eat properly so we either have to hold a bowl up for her inside the cone or take the cone off and watch her while she eats.

Her BG steadily rose up until the day of the surgery but seems to have come down a little bit now and hopefully that trend will continue but I'm wondering how long we should wait to see if the dental work brings her BG back down to remission levels?

Both vets seemed completely unconcerned with her BG numbers but obviously I want her in the GOOD numbers, not the good enough numbers that vets look for. I don't want to rush into giving her insulin again (especially since I'll have to buy a fresh supply) but I also don't want to wait too long and let the high blood sugars hurt her. Any advice?
 
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My boy's numbers started to come down pretty much instantly after the surgery, albeit he was on buprenorphine, which I'm sure you're aware of being an incredibly potent opioid used for post-op pain relief. Bup is also known to decrease BG, although it may just be the fact that the glucose isn't running high due to the cat not being in pain.
His surgery was on the 4th of March, and he was steadily in the blues and greens from the 9th of March. Those 5 days, between the 4th and 9th, he did go low and bounce up to the yellows, but it's due to the limited amount of food he could eat. He finished the BID course of bup on the 11th, but the numbers still stayed in the blues and greens.

HOWEVER, I'd urge you to rinse the sutures after meals to prevent debris build-up, as that could cause bacterial growth and further complications. I personally do not recommend using Q-tips or anything alike to wipe the sutures, as it could cause pain and result in wobbly numbers. [Been there, done that, learn from my mistake :facepalm:]. Just draw some saline or filtered water [or even better - colloidal silver, if you have that to hand] to a needle-less [!] syringe and squirt it over the sutures.
Sutures can take up to 6 weeks to dissolve completely, but in my experience they take less. Given the above, and the fact that she had multiply teeth removed, I also wouldn't recommend to start brushing her remainder chompers until the sutures are completely gone.

Source: My sugar baby had four [!] dental procedures done in a span of 9 months, three of those [clearly not thorough enough, as they still warranted the fourth done at a specialist] were done back-to-back, monthly. His successful, and hopefully last surgery at the beginning of March finally now allows me to regulate him after over a year of struggle.

Edit to add:
1.) I have never heard of having a cone on them after dental either?! Cones are meant to prevent pets to lick sutures/wounds on their bodies?! And even so, those post-op suits are preferred over cones these days.
2.) I'm fully aware I may come across as a "trust me bro" source without a visible spreadsheet, for that I apologise, it is mainly due to us using an unconventional [per se] insulin PLUS we had a CKD scare around his last surgery, and our vet made us trial out renal food after his first POC, which gave us wobbly BG numbers for a couple of days due to their higher DMC%.

But the bottom line is: I'd give your girl 5-7 days minimum, but once her mouth is semi-healed, and granted there are no further complications e.g. infections, her BG should be back to normal.
 
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Deborah & Muffy(GA) & Wendall said:
Never heard of using a cone for a dental. Never. And I've had dozens of cats get dentals with multiple extractions. Please remove it as it's likely causing her more stress than anything else.
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This vet has additional training in dental procedures and we asked multiple times if it was truly necessary and she said that it was. She said a lot of cats paw at their faces as they heal (because it feels weird and itchy) and end up pulling the stitches. I don't feel right disregarding her instructions, at least not in the first few days when she's most likely to paw at her face and pull her stitches. We will give her plenty of breaks from the cone while we supervise her though and we likely won't go the full 2 weeks because it does seem a bit over the top.
 
Don Degludec said:
My boy's numbers started to come down pretty much instantly after the surgery, albeit he was on buprenorphine, which I'm sure you're aware of being an incredibly potent opioid used for post-op pain relief. Bup is also known to decrease BG, although it may just be the fact that the glucose isn't running high due to the cat not being in pain.
His surgery was on the 4th of March, and he was steadily in the blues and greens from the 9th of March. Those 5 days, between the 4th and 9th, he did go low and bounce up to the yellows, but it's due to the limited amount of food he could eat. He finished the BID course of bup on the 11th, but the numbers still stayed in the blues and greens.

HOWEVER, I'd urge you to rinse the sutures after meals to prevent debris build-up, as that could cause bacterial growth and further complications. I personally do not recommend using Q-tips or anything alike to wipe the sutures, as it could cause pain and result in wobbly numbers. [Been there, done that, learn from my mistake :facepalm:]. Just draw some saline or filtered water [or even better - colloidal silver, if you have that to hand] to a needle-less [!] syringe and squirt it over the sutures.
Sutures can take up to 6 weeks to dissolve completely, but in my experience they take less. Given the above, and the fact that she had multiply teeth removed, I also wouldn't recommend to start brushing her remainder chompers until the sutures are completely gone.

Source: My sugar baby had four [!] dental procedures done in a span of 9 months, three of those [clearly not thorough enough, as they still warranted the fourth done at a specialist] were done back-to-back, monthly. His successful, and hopefully last surgery at the beginning of March finally now allows me to regulate him after over a year of struggle.

Edit to add:
1.) I have never heard of having a cone on them after dental either?! Cones are meant to prevent pets to lick sutures/wounds on their bodies?! And even so, those post-op suits are preferred over cones these days.
2.) I'm fully aware I may come across as a "trust me bro" source without a visible spreadsheet, for that I apologise, it is mainly due to us using an unconventional [per se] insulin PLUS we had a CKD scare around his last surgery, and our vet made us trial out renal food after his first POC, which gave us wobbly BG numbers for a couple of days due to their higher DMC%.

But the bottom line is: I'd give your girl 5-7 days minimum, but once her mouth is semi-healed, and granted there are no further complications e.g. infections, her BG should be back to normal.
Click to expand...

Thank you! This is very helpful! I actually have some curved needle-less syringes around from when I got my wisdom teeth removed and that will be perfect to gently rinse out her mouth after meals.
 
Even when Neko had a bony growth removed from her jaw, she never had to have a cone after a dental. Her dental vet is a specialist, and even teaches about dentals at vet school. She too was on buprenorphine. When you are around Tessa, I'd remove the cone and see how she acts without it. You can get soft cones that would be easier for her. You can get cute ones that look like flowers, or a piece of bread. :p I have seen cats with face surgery (eg. eye removal) in a cone - a surgery suit wouldn't do it in that case.

Neko took about 7-10 days for the surgery inflammation to come down, and her resulting numbers. One time I had to increase after surgery, until the numbers told me her inflammation was gone.
 
Jess, my boy's last procedure was done by the current president elect of British Veterinary Dental Association. Nor any previous vets, nor he even mentioned anything about a cone.
He had a total of ten teeth removed, most was six in one go. My other cat had a total of eight removed, again, most was six in one go. Combined between the two, I have assisted them through SIX post-dental recovery periods, neither which required cones, nor did they ever, and I mean EVER tried to pull their sutures out.
My boy did start scratching his chin after about a week or so of the last procedure -only three were removed then-, but never inside his mouth. Similarly when we have a scab once the wound starts healing, it can become itchy, but in his case it was due to debris/food stuck in the sutures causing discomfort. Their mouths are constantly moist, so I would find it highly unlikely the gum would become itchy.
I'm not discrediting your vet, plus you know your cat more than anyone, so please do what you think is right for her. But I do think a cone is an unnecessary stressor for her.

Please note: We use dissolvable sutures in the UK. If it's different on your end, and they'll need to be manually removed, then by all means protect the area.
 
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Thank you all for the feedback! I do notice her grooming and rubbing her face more than usual when I give her cone-free time so I am going to stick with the cone for now at night and when I can't supervise her during the day but rest assured she's getting lots of cone-free time during the day! She actually seems pretty OK with the cone, she doesn't fight me when I go to put it on her which is still pretty surprising to me.

She got multiple pain injections (Onsior, buprenorphine SR, and Nocita) at the vet that are likely wearing out now but she doesn't seem to be in pain, hopefully it stays that way because they didn't give us any oral medication. She's eating well and is in a good mood. She is enjoying the extra attention and purrs as loud as possible and pushes her head into my hand when she's getting petted.
 
I spoke too soon. About an after after I commented earlier, I started noticing that Tessa's face was twitching. It was kind of similar to the type of twitching you see in a sleeping cat but she was wide awake. She wasn't acting like the twitching hurt but you know how cats can be with hiding pain so I'm not sure if it's pain related, a reaction to meds, or a side effect of getting teeth pulled. Luckily I noticed it before the vet closed for the weekend. Gave them a call and they prescribed Gabapentin. She's sleepy now but the twitching seems to have stopped.

I uploaded a video but not sure if it's working yet:


Has anyone ever seen anything like this before? It's entirely possible that she's done this before and I just never noticed it but it seems unlikely. She hangs out in my home office while I work pretty much every day.
 
I can't see the video, it says "publication in progress"? o_O
Has Tessa been on Gabapentin before and was she OK on it in terms of her BG?
 
Don Degludec said:
I can't see the video, it says "publication in progress"? o_O
Has Tessa been on Gabapentin before and was she OK on it in terms of her BG?
Click to expand...

Sorry about that, does this link work?


She has taken gabapentin a few times as a pre-vet visit medication but I don't remember whether it spiked her blood sugar, I think I only used it before her diabetes diagnosis. I didn't have much of a choice in medication because we called the vet right before they closed and they stayed open long enough for us to get there and pick up the medication. They're closed until Monday morning.
 
Yes I can see it. This is peculiar, because

1) I haven't seen anything like this before, until...
2) My (sugar) cat started to do the exact same thing and...
3) My vet isn't concerned about it one bit

Mine would purr, twitch, sometimes just on the head, sometimes the entire body*. I have showed the videos to my vet, and shared my suspicion of petit mals and/or myoclonic seizures, but she said they would be more frequent and severe. I usually make notes of the terms she uses, but I cannot for the life of me find the particular term she used to describe this phenomenon.
She explained to me it's similar to when e.g. your crush touches you unexpectedly and your body unconsciously reacts to it with a feel-good twitch/jump/shudder thing, exactly like those hypnic jerks before sleep you referred to above. Cats' skins are more sensitive than ours, so they don't need to be touched per se, they just do it sometime.
I'm not sure whether this is the case with Tessa too though. Is she purring on the video or is that the background/white noise I'm hearing?
My theory would be that she's more relaxed now that she isn't dealing with the constant dental pain, and that's why her muscles twitch. If you clench your muscles for a prolonged time due to pain, let alone do they become exhausted, but they adapt and take the 'clenched' state as the norm, thus when they finally relax they may twitch as it's "new" them and they instinctively want to clench again. Does this make sense?
*my boy has power purrs, when he purrs he purrs from the depths of his soul and his ancestors', which easily could warrant for his whole body jerks.

If I were you, I wouldn't unnecessarily administer meds to her and would hold off the Gaba until her dental POC and would explain the situation to the vet then, alongside showing the video, and ask for their opinion.
Please note that I'm incredibly biased about Gabapentin so take my advice with a pinch of salt. Cats usually take it well, but there's always one that does not - that one is my boy. /insert our horror stories here (spoiler alert: hyperglycaemia was one of them)
 
tessa's mom said:
Tessa went off the juice a little over a year ago and was doing great until I checked her BG 10 days ago and saw numbers in the low blues. I got her scheduled for a dental cleaning and they found that she needed several teeth removed. They didn't have any surgery slots long enough to comfortably fit her in so they referred us to another vet about 45 minutes away. Thankfully that vet got us in a couple days later and Tessa had 5 teeth removed.

She seems to be feeling better but the vet wants us to keep her in a cone until her recheck in 2 weeks so she's a bit stressed. She can't even figure out how to eat properly so we either have to hold a bowl up for her inside the cone or take the cone off and watch her while she eats.

Her BG steadily rose up until the day of the surgery but seems to have come down a little bit now and hopefully that trend will continue but I'm wondering how long we should wait to see if the dental work brings her BG back down to remission levels?

Both vets seemed completely unconcerned with her BG numbers but obviously I want her in the GOOD numbers, not the good enough numbers that vets look for. I don't want to rush into giving her insulin again (especially since I'll have to buy a fresh supply) but I also don't want to wait too long and let the high blood sugars hurt her. Any advice?
Click to expand...
The main thing that stood out to me is the cone. I had a cat who had a full mouth extraction due to stomatitis who went on to live many happy years. Yes, he was able to eat fine without teeth because he didn't need them to catch prey in the wild. He was provided with food :) That much being said, he didn't use a cone at any time.

Right now Pumpkin had an amputation surgery earlier in the year. I could not use a cone afterwards because the cone can cause depression and other problems that are stressful for the kitty. Stress can also raise blood glucose. My Vet recommended the doughnut collar and it worked out far better. It did not get in the way of his eating or drinking. Although, it did get dipped a couple of times in the water bowl, was just a minor inconvenience while he healed. Here is the link for that collar:

https://www.amazon.com/gp/product/B08ML4GK1M/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1

I was very concerned after surgery, Pumpkins numbers were elevated for a while. The Vet also understood the same concerns I had, but just said that although they were unusually high, it's ideal if they don't remain that way for prolonged periods of time, as in - untreated etc. And, also better high than low. Meaning, better high than hypoglycemic.
 
Don Degludec said:
Yes I can see it. This is peculiar, because

1) I haven't seen anything like this before, until...
2) My (sugar) cat started to do the exact same thing and...
3) My vet isn't concerned about it one bit

Mine would purr, twitch, sometimes just on the head, sometimes the entire body*. I have showed the videos to my vet, and shared my suspicion of petit mals and/or myoclonic seizures, but she said they would be more frequent and severe. I usually make notes of the terms she uses, but I cannot for the life of me find the particular term she used to describe this phenomenon.
She explained to me it's similar to when e.g. your crush touches you unexpectedly and your body unconsciously reacts to it with a feel-good twitch/jump/shudder thing, exactly like those hypnic jerks before sleep you referred to above. Cats' skins are more sensitive than ours, so they don't need to be touched per se, they just do it sometime.
I'm not sure whether this is the case with Tessa too though. Is she purring on the video or is that the background/white noise I'm hearing?
My theory would be that she's more relaxed now that she isn't dealing with the constant dental pain, and that's why her muscles twitch. If you clench your muscles for a prolonged time due to pain, let alone do they become exhausted, but they adapt and take the 'clenched' state as the norm, thus when they finally relax they may twitch as it's "new" them and they instinctively want to clench again. Does this make sense?
*my boy has power purrs, when he purrs he purrs from the depths of his soul and his ancestors', which easily could warrant for his whole body jerks.

If I were you, I wouldn't unnecessarily administer meds to her and would hold off the Gaba until her dental POC and would explain the situation to the vet then, alongside showing the video, and ask for their opinion.
Please note that I'm incredibly biased about Gabapentin so take my advice with a pinch of salt. Cats usually take it well, but there's always one that does not - that one is my boy. /insert our horror stories here (spoiler alert: hyperglycaemia was one of them)
Click to expand...

I think that's a good theory, it's better than anything I could come up with lol. Sometimes it does seem like she might be in pain when I see the twitching (I've watched the video over and over again, she isn't twitching today so far) but it's hard to tell for sure. Her eyes get a little bigger and she pulls her head away at one point. But it could have been a sudden itch or something causing her to do that, who really knows? She was purring during the video but there may have been background noise too since I run an air purifier in the room she was in.

I didn't see this before I gave her the gabapentin this morning but I'll monitor her closely to see if her BG gets too high.
 
Shell said:
The main thing that stood out to me is the cone. I had a cat who had a full mouth extraction due to stomatitis who went on to live many happy years. Yes, he was able to eat fine without teeth because he didn't need them to catch prey in the wild. He was provided with food :) That much being said, he didn't use a cone at any time.

Right now Pumpkin had an amputation surgery earlier in the year. I could not use a cone afterwards because the cone can cause depression and other problems that are stressful for the kitty. Stress can also raise blood glucose. My Vet recommended the doughnut collar and it worked out far better. It did not get in the way of his eating or drinking. Although, it did get dipped a couple of times in the water bowl, was just a minor inconvenience while he healed. Here is the link for that collar:

https://www.amazon.com/gp/product/B08ML4GK1M/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1

I was very concerned after surgery, Pumpkins numbers were elevated for a while. The Vet also understood the same concerns I had, but just said that although they were unusually high, it's ideal if they don't remain that way for prolonged periods of time, as in - untreated etc. And, also better high than low. Meaning, better high than hypoglycemic.
Click to expand...

She seems pretty used to the cone now but she is also happier with it off. I need to do some work today blocking off any place she could hide from me because I worry that she'll go hide somewhere and overgroom and paw at her face. Then I'll let her have free roam of the house with the cone off this afternoon and tomorrow during the day. The past few days I've just closed her in my office with me (where she spends most of the day anyway) while she has her cone-free time. If she does well with it off during the day then I might let her keep it off overnight but we'll have to see.
 
tessa's mom said:
I didn't see this before I gave her the gabapentin this morning but I'll monitor her closely to see if her BG gets too high.
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Looks like her BG is steady so far :cat:
Just do keep a close eye on her -as I know you do anyway-, especially regarding the twitching, because Gaba is obviously a human anticonvulsant, thus alters the electrical activities in the brain. It may be that it'll make Tessa not twitch at all now, which would be the best outcome of course. Would provide us with the explanation/conclusion that those twitches were indeed likely caused by pain. [Again, my Mister went the other way on it, but I'm going to spare you with my unnecessary horror stories. I just feel ought to point out to absolute any- and everyone, that those dreaded 'extremely rare 1 in 1,000' adverse side effects can happen, one of mine being the prime example.]

You could always assess her body language and facial cues regarding pain.

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Hi @tessa's mom, how is Tessa doing? Is she eating okay? What dose of Gaba is she on?

It's been a week since the extractions - are you planning to wait longer to see if her numbers come down before starting insulin?

I don't think the low readings you are getting on the ketone meter are a cause for concern by I'm going to tag @Bron and Sheba (GA) for confirmation.
 
Bandit's Mom said:
insulin?

I don't think the low readings you are getting on the ketone meter are a cause for concern by I'm going to tag @Bron and Sheba (GA) for confirmation.
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Many well cats that I have seen when tested with a blood ketones meter have a low reading of ketones…ie not 0
I would not be concerned about the ketones she has been getting so far, especially if she seems well and is eating well and not lethargic. But I would continue to monitor them and make sure she is eating well.
And if the BGs don’t come down to normal within the next several days you might have to think about recommencing a small dose of insulin.
 
Bandit's Mom said:
Hi @tessa's mom, how is Tessa doing? Is she eating okay? What dose of Gaba is she on?

It's been a week since the extractions - are you planning to wait longer to see if her numbers come down before starting insulin?

I don't think the low readings you are getting on the ketone meter are a cause for concern by I'm going to tag @Bron and Sheba (GA) for confirmation.
Click to expand...

Thanks for checking in! She's doing well - eating, drinking, peeing, and pooping normally and still very happy and purring loudly for pets and attention she gets from me and my husband.

She is on 50mg every 12 hours. She has 1 dose left, I'm not sure if we will ask for more but I'm leaning towards asking for more. She does appear to have some pain at times, sometimes when she rubs her face on something (even just my hand) she'll get a wide eyed look on her face and jerk her head to the side as if she had a jolt of pain. I've been keeping the cone on her at night so she can't rub her face when I can't watch her.

I don't want to hurt her so I won't try to trigger it but I'll record her later today and see if I can catch it on video.

She has a follow up appointment with the vet on Tuesday to check her healing progress, I was thinking if her BG doesn't drop by then then we will get her back on insulin. Would it be OK to wait that long?
 
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Bron and Sheba (GA) said:
Many well cats that I have seen when tested with a blood ketones meter have a low reading of ketones…ie not 0
I would not be concerned about the ketones she has been getting so far, especially if she seems well and is eating well and not lethargic. But I would continue to monitor them and make sure she is eating well.
And if the BGs don’t come down to normal within the next several days you might have to think about recommencing a small dose of insulin.
Click to expand...

Thank you! I will keep checking her ketones once or twice a day, the strips are so expensive but worth it for the peace of mind. She's not lethargic and is eating well. She excitedly gobbled her breakfast this morning and went rooting around for crumbs of her past meals if that tells you anything lol. She is a little piggy and if she ever goes off food, I know something is wrong and I get her to the vet asap.
 
Having a diabetic kitty who loves food is a real blessing. My Sheba always loved her food, so if she was ever off her food I knew something was wrong.
Remind me, did the vet put Tessa on antibiotics after the dental procedure.?
 
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Bron and Sheba (GA) said:
Having a diabetic kitty who lived food is a real blessing. My Sheba always loved her food, so if she was ever off her food I knew something was wrong.
Remind me, did the vet put Tessa on antibiotics after the dental procedure.?
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She got a Convenia shot on the day of her cleaning (13 days ago).
 
Bron and Sheba (GA) said:
That’s not the best antibiotic for teeth. She may need a more specific one if you think she is having issues still with her mouth.
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Yeah, I wasn't too happy about then using Convenia but they had already done it so there was nothing I could do to take it back. I'm going to ask them to default to liquid or pills that can be crushed. Tessa will take pretty much any medication if it's mixed with food lol. She's easy to pill with Pill Pockets but obviously I can't use those now that she's diabetic.

I did see a study where Convenia was tested on periodontal disease in dogs and it performed as well as clindamycin so that's promising at least: https://file.scirp.org/pdf/OJVM20120300004_84267326.pdf

And it was successfully used on a red panda with a dental abscess: https://bvajournals.onlinelibrary.wiley.com/doi/abs/10.1002/vrc2.475

But of course nobody ever wants to study cats :mad:

I took a look at her mouth this morning and everything looks good to me but I'm obviously not a vet. She is out of Gabapentin and we didn't call the vet to get more yesterday because we had some severe weather. She seems to be doing okay so far today without it but I will keep a close eye on her.

It is looking more and more like she's going to need insulin again which is fine with me but I think I'll hold off on requesting it until her appointment so I can show the vet all her BG readings. Being able to talk to vet face to face will make it easier to get her to write a prescription that will work with the $35 insulin coupon. When I call in for prescriptions things often get lost in translation.
 
Do you think Tessa still needs antibiotics? We seldom get that presrcibed here, even after multiply extractions, unless a) the cat is incredibly feisty and prevents the care givers to clean the healing mouth or b) there's a good reason to believe there will be/could be an infection, e.g. a cat that is prone to it.
I think [for what it's worth] that you'd know if Tessa had an infection that would warrant AB e.g. she would already have post-op abscess you'd likely have picked up on checking her mouth. Plus an infection [and the correlating pain] would likely reflect on her BG too. Again, source: trust me, bro :p [Mister was battling with reoccurring dental infections for about a year, warranting our spreadsheet to lit up like a Christmas tree :arghh:]
If you're worried, you could always try colloidal silver, which is antibacterial, anti-inflammatory, antifungal, anti-everything AND doesn't damage the stomach's microbiome, like most ABs do.
 
This might be a silly question, but has she been pooping properly since the surgery? I have noticed that Mister's BG is always a little on the higher end when he's constipated - which was often the case for a while post-ops.
 
Don Degludec said:
Do you think Tessa still needs antibiotics? We seldom get that presrcibed here, even after multiply extractions, unless a) the cat is incredibly feisty and prevents the care givers to clean the healing mouth or b) there's a good reason to believe there will be/could be an infection, e.g. a cat that is prone to it.
I think [for what it's worth] that you'd know if Tessa had an infection that would warrant AB e.g. she would already have post-op abscess you'd likely have picked up on checking her mouth. Plus an infection [and the correlating pain] would likely reflect on her BG too. Again, source: trust me, bro :p [Mister was battling with reoccurring dental infections for about a year, warranting our spreadsheet to lit up like a Christmas tree :arghh:]
If you're worried, you could always try colloidal silver, which is antibacterial, anti-inflammatory, antifungal, anti-everything AND doesn't damage the stomach's microbiome, like most ABs do.
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Don Degludec said:
This might be a silly question, but has she been pooping properly since the surgery? I have noticed that Mister's BG is always a little on the higher end when he's constipated - which was often the case for a while post-ops.
Click to expand...

Honestly I don't think she does need antibiotics. Everything looks good to me and I haven't noticed any signs of infection. Vets around here love the prophylactic antibiotics for some reason. If we hadn't told the vet who did the procedure that Tessa had already had the Convenia shot they would have given her antibiotics there too.

As far as poop goes it seems like she's pooping normally but I haven't actually watched her poop lol. I know when she poops though because she doesn't cover it but her sister always covers hers. I know she didn't poop for the first few days but after that I think she has been. I'll double check with my husband since he's been taking care of the litter boxes lately.
 
I think she's doing amazing, and considering that she's within one bracket all day [as in consistently in the blues, doesn't skyrocket into the yellows and pinks even after feeding] suggests after popping her back on a low dose of insulin she'll back in remission within no time ;)
 
tessa's mom said:
Yeah, I wasn't too happy about then using Convenia but they had already done it so there was nothing I could do to take it back. I'm going to ask them to default to liquid or pills that can be crushed. Tessa will take pretty much any medication if it's mixed with food lol. She's easy to pill with Pill Pockets but obviously I can't use those now that she's diabetic.

I did see a study where Convenia was tested on periodontal disease in dogs and it performed as well as clindamycin so that's promising at least: https://file.scirp.org/pdf/OJVM20120300004_84267326.pdf

And it was successfully used on a red panda with a dental abscess: https://bvajournals.onlinelibrary.wiley.com/doi/abs/10.1002/vrc2.475

But of course nobody ever wants to study cats :mad:

I took a look at her mouth this morning and everything looks good to me but I'm obviously not a vet. She is out of Gabapentin and we didn't call the vet to get more yesterday because we had some severe weather. She seems to be doing okay so far today without it but I will keep a close eye on her.

It is looking more and more like she's going to need insulin again which is fine with me but I think I'll hold off on requesting it until her appointment so I can show the vet all her BG readings. Being able to talk to vet face to face will make it easier to get her to write a prescription that will work with the $35 insulin coupon. When I call in for prescriptions things often get lost in translation.
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I’m glad you think she’s done well on the convenia. Hopefully things will settle down soon or she might need a little bit of insulin again to get back on track. I would test for ketones as a precaution while she has the higher BGs and no insulin and maybe ( hopefully not) still an issue in her mouth.
 
Bron and Sheba (GA) said:
I’m glad you think she’s done well on the convenia. Hopefully things will settle down soon or she might need a little bit of insulin again to get back on track. I would test for ketones as a precaution while she has the higher BGs and no insulin and maybe ( hopefully not) still an issue in her mouth.
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I've been testing ketones on a Nova Max Plus blood ketone meter. I have the numbers listed in the remarks section on her spreadsheet. The highest I've seen is 0.8mmol/L but the number this morning was 0.4mmol/L. I'm checking more often when the numbers are higher. I do have another ketone meter that I bought on Amazon but I'm not sure of its accuracy compared to the Nova Max Plus.

I found a chart that gives info on blood ketones versus urine ketones here:

http://www.diabeticcatinternational.com/knowledge/ketones/

This appears to be a reputable source but please let me know if I'm wrong.

Based on that source, the small numbers she's getting seem to be fine as long as she's acting normally. The 0.8 numbers she's had twice are somewhat concerning but since she's eating and behaving normally and the numbers came down, she's probably fine, right?
 
Sooo maybe Tessa was a bit constipated. She just pooped and it is a whopper of a turd lol. Other than being oversized it looks normal.

I asked my husband about whether there's been a normal amount of poop lately and he said there was less than usual. I asked him to please let me know that in the future.
 
Tessa had her follow up yesterday. It was at our normal vet's office but with a vet that I have never seen before. I googled her name and she works part time at the humane society (I assume doing spay/neuter surgeries) and also fills in as a relief vet for different clinics around town. She said that Tessa was healing nicely and saw no signs of infection and no reason that she should still be in pain and on gabapentin. She said that gabapentin may be the reason that Tessa's numbers are still high and advised that we give her 48 hours off the medication to see if her numbers come back down but more than likely she is out of remission. She gave us a new insulin prescription and my husband will pick up insulin after work today.

The vet recommended we start her off at 0.5u which sounds like a reasonable place to start but I'm not 100% sure and it's hard to find info on what to do with a cat who has been in remission and is back on insulin.

Tessa's numbers are even higher today so I don't think gabapentin was the problem. We're probably not going to wait the full 48 hours she suggested because things are getting worse and worse by the day. I'll probably give her the first dose tomorrow morning. I'd do it tonight but I can't stay up to check BG.

I can't shake the feeling that Tessa is still in pain though. She seems fine most of the time but she's definitely very uncomfortable when food gets caught in her stitches and I've noticed that when I give her chin scritches she gets this wide-eyed look on her face and her ear starts twitching a little bit. I feel like her jaw is still really tender at the very least. I know that diabetic cats heal slower than usual but I just can't shake the feeling that something is wrong. Maybe I'm just being my normal neurotic self though?
 
A few things from the top of my head:

  • Multiply teeth extraction can be hard on the jaws, especially if most of them were extracted from the same area [e.g. mainly from the bottom]. Maybe her jaw is still a little sensitive?
  • Could it be that the remainder of her teeth are irritating the gum line where the extracted teeth used to be, when she's chewing?
  • Did they do dental x-rays to ensure no root remnants were left behind?
  • Were they complete extractions or were there any crown amputations? If applicable, did they tell you which tooth's crown only was amputated?
  • Do you think Tessa maybe iffy about eating, because she started to associate food with feeling poorly re: her BG running higher?
  • Do you think maybe starting on 0.25 IU would be beneficial to ensure her safety re: not dropping too low, too quick?
 
Don Degludec said:
A few things from the top of my head:

  • Multiply teeth extraction can be hard on the jaws, especially if most of them were extracted from the same area [e.g. mainly from the bottom]. Maybe her jaw is still a little sensitive?
  • Could it be that the remainder of her teeth are irritating the gum line where the extracted teeth used to be, when she's chewing?
  • Did they do dental x-rays to ensure no root remnants were left behind?
  • Were they complete extractions or were there any crown amputations? If applicable, did they tell you which tooth's crown only was amputated?
  • Do you think Tessa maybe iffy about eating, because she started to associate food with feeling poorly re: her BG running higher?
  • Do you think maybe starting on 0.25 IU would be beneficial to ensure her safety re: not dropping too low, too quick?
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Lots of great points and questions here. She did get several teeth removed from the same area of her mouth, primarily on the bottom so both of your first 2 questions could explain some things. It's too bad we don't have a pet version of orajel and this is one of those times I really wish she could eat dry food because she never chewed dry food when she ate it before, she just swallowed it whole which bypasses the teeth completely lol.

They did do x-rays before and after. I was VERY clear that I wanted both done and they told us afterwards that they did both and that the teeth came out cleanly as well.

As far as I know they only did extractions. If they did any crown amputations they did not charge us for them so it seems unlikely.

She hasn't really been iffy on eating, she's been going at it full force. She just seems uncomfortable afterwards but she is not a happy camper if I try to clean her mouth with water from a needless syringe.

I'm definitely willing to start with 0.25u if that would be better. I still have my caliper measurements on the fridge from last time around so I'm good to go on pretty much any dosage lol.
 
Bron and Sheba (GA) said:
I think I would start at 0.25 units.
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Thank you. I posted on the Lantus ISG too because I wasn't really sure what to do. I'm planning on starting in the morning. I sent my husband with the prescription and a couple different coupon options, I'm hoping that the $35 one works but the prescription is very obviously for an animal so I won't be surprised if they don't allow it haha. I sent him with a pet specific coupon too.
 
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