New question regarding antibiotics/teeth and nausea

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Striffy’s Momma

Striffy’s Momma

Member Since 2023
Striffy's BG numbers continue to be very high. I know she is having some type of problem with her teeth and read on this message board that tooth problems can lead to higher BG levels. I also read a thread that said due to the age and/or health of their cat they were doing "pulsed" antibiotics.

I called my vet's office and asked if this would be an option for Striffy. They said yes, however, she was given a long lasting antibiotic when she was in hospital May 11. So, me being the over thinker, thought wow, I wonder if this had anything to do with her ongoing nausea? She is no longer nauseated and is eating well again without the help of Mirataz (which apparently also causes nausea). I do not want to ruin her eating streak because then we will really have a heck of a time getting the insulin in her again.

The vet also offered pain medication. It's hard for me to say how much pain she may be in and if it warrants medication. Last night was the first night I actually saw her paw at her face-which tells me that yes, there may be some pain. I have seen her have trouble chewing for a long time now. She eats pate food and still tilts her head and chomps like it hurts and she eats dry food (which I am weaning).

Now I am torn. Should I do the antibiotic and the pain meds or just the pain meds? Or no pain meds? I have actually seen glimpses of my healthy cat again and not just a sickly kitty. She seems to be doing better "emotionally" but the glucose number is crazy. I also plan to do a BG curve this weekend. I do not want to ruin our little bits of progress.
 
If your kitty has a dental inflammation or infection, the antibiotics may help with the pain. OTOH, pain meds will also address the discomfort. A lot depends on what pain meds, though. Either antibiotics or some pain meds can cause nausea or loss of appetite due to a GI upset. I'm also very careful about what pain med I'll give my cat. I will not use NSAIDS (nonsteroidal anti-inflammatory meds) since they can cause kidney failure in cats. No more than 3 doses (e.g., Onsior) may be OK but more than that isn't recommended. (For cats outside of the US, the dosing protocol with NSAIDS is different -- they use lower doses so there's less of a problem.) Generally, I'm a bigger fan of buprenorphine. Some vets are not happy about prescribing it though since it's an opiate.
 
Diane Tyler's Mom said:
Hi it's important that you get some tests in after AMPS and PMPS tests
We have absolutely no idea how the insulin is working and can't determine when an increase or decrease is needed, so if you can do that it would be great :cat:
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I completely agree! I have planned to do that this weekend as I'll be home and available. After I do the testing should I move those types of questions over to the Prozinc area? Thank you!
 
I tested every two hours after AMPS. I will need to do PMPS testing on another day. I noticed that her bg was better than it usually is and I think it's the dry food. I read Lisa dvm's post about dry food and I think from now on I will try canned food in a timed feeder during the day. She was pretty hungry throughout the day because I'm sure she's used to snacking.

Does anyone have any suggestions regarding her insulin dosage and her curve? Or should I do more testing first?

PS: I did not start antibiotics just yet. I have a scheduled phone call with the vet on Monday. They prescribed Clindamycin 1.2cc twice a day for one week each month.
 
Striffy’s Momma said:
I tested every two hours after AMPS. I will need to do PMPS testing on another day. I noticed that her bg was better than it usually is and I think it's the dry food. I read Lisa dvm's post about dry food and I think from now on I will try canned food in a timed feeder during the day. She was pretty hungry throughout the day because I'm sure she's used to snacking.

Does anyone have any suggestions regarding her insulin dosage and her curve? Or should I do more testing first?

PS: I did not start antibiotics just yet. I have a scheduled phone call with the vet on Monday. They prescribed Clindamycin 1.2cc twice a day for one week each month.
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Going to tag a prozinc user for you , nice to see those blue BG'S today
You don't have to do a full curve at night just try to get a few tests in after the PMPS test
@Suzanne & Darcy
 
Striffy’s Momma said:
I tested every two hours after AMPS. I will need to do PMPS testing on another day. I noticed that her bg was better than it usually is and I think it's the dry food. I read Lisa dvm's post about dry food and I think from now on I will try canned food in a timed feeder during the day. She was pretty hungry throughout the day because I'm sure she's used to snacking.

Does anyone have any suggestions regarding her insulin dosage and her curve? Or should I do more testing first?

PS: I did not start antibiotics just yet. I have a scheduled phone call with the vet on Monday. They prescribed Clindamycin 1.2cc twice a day for one week each month.
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That is a good pulsed dosing regimen. I have used similar in my cats who cannot undergo anesthesia.
 
Beautiful cycle today with blue nadirs. So we will continue to hold this dose for the time being and let things stabilize. Please try to get a night time test if at all possible since many cats tend to drop lower at night. We need to see what happens at night. What time will you go to bed (how many hours after the evening shot?)
 
I have just finished reading through your introductory post. I’m trying to get up to speed. Can Striffy have a dental procedure to clean his teeth and have any necessary extractions? Or does he have kidney disease or a heart condition that would preclude anesthesia? If so, I have recommended the pulsed dosing of Clindamycin to several people on this Board with similar problems. It really did help.
 
Suzanne & Darcy said:
I have just finished reading through your introductory post. I’m trying to get up to speed. Can Striffy have a dental procedure to clean his teeth and have any necessary extractions? Or does he have kidney disease or a heart condition that would preclude anesthesia? If so, I have recommended the pulsed dosing of Clindamycin to several people on this Board with similar problems. It really did help.
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Thank you for responding. I think it was one of your posts I read that talked about pulsed antibiotics-so I really appreciate that. My vet thinks that Striffy has some sort of underlying issue but she doesn't know what... As far as I know she doesn't have kidney or heart disease. She just hasn't acted "normal" for a month or two and doesn't seem to be in the right condition to undergo anesthesia. My vet recommended euthanasia but I declined. I'm kind of on my own at this point, but the vet does listen to my suggestions and ideas and is still willing to help.

I did a PMPS +4 and we were at 248. I would like to eliminate dry food and see if that helps any. Her numbers have been so high that it makes me very worried for her so I was glad to see the lower numbers during the curve. Is there hope they will level out? And why does it take so long?
 
Hello again. I’m sorry that you are going through this with Striffy, and I know what that is like when vets start suggesting euthanasia. I’m glad that you didn’t listen to the vet. Let’s see if we can’t help her to feel better. It could just be the diabetes that is taking its toll on her and that, when you get it managed better, she will feel better.

What signs of nausea is Striffy showing? Is she just licking the top of the food and walking away? Is she making unusual sounds when she eats? Tooth grinding? I believe you said she turns her head when she eats? I know that, in my own cats, that has been a sign of a tooth problem. Also, some of my cats that have missing teeth will do this (from previous dental extractions or just from natural tooth loss that I wasn’t aware of until I looked in their mouths.)

I saw that some anti-nausea medication was suggested to you. Some people use Cerenia and that can help some cats and is useful if vomiting is present, but the most effective anti-nausea medication is a human medication that is used in cats a lot — Ondansetron. I get a written prescription for 4 mg “orally dissolving tablets” from my vet and have it filled at a pharmacy. The tablets are small and I just pill them in the normal way using a piller so that they won’t taste the nasty tablets. You could try this and see if it helps Striffy.

You had blue nadirs yesterday with your curve so that is good. That means that you should not change the dose at this time. If Striffy goes below 90 then you should reduce the dose down to 1.25 units. The dry food will make Striffy’s numbers higher also, so if you plan to try to eliminate the dry, watch closely for her blood glucose numbers to go down — it’s likely she will need less insulin if not eating dry food.
 
Striffy’s Momma said:
I was glad to see the lower numbers during the curve. Is there hope they will level out? And why does it take so long?
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Try to be patient. I do understand that worry. She hasn't been diagnosed until recently so it hasn't been that long yet. You also had better numbers during your curve yesterday. I do have a question. I was looking at your comments about food. Are you saying that you didn't give any food to Striffy during the curve yesterday? (except for licking a little food at each test?) It is not necessary to withhold food during a curve -- but I wanted to see if that was what you meant. If you want to get an accurate picture of what happens on a daily basis, then feeding as you normally do would be appropriate. If you want to see how things go with only low carb wet food, then do that. If you want to see how she does with the DM dry and the other food (LC wet?) that you feed.

That brings me to the subject of feeding schedules. Is Striffy just free fed normally or do you put food down only at certain times? I'm already assuming you are giving a low carb treat at test times, of course, so I'm just asking about the rest of the time. I'm sure that you already know that Striffy should not eat for two hours prior to the AMPS and PMPS tests, so that you have a BG value that is not elevated by food. We also don't generally recommend feeding after a cat's typical nadir because it can shorten the duration of the insulin. For some cats who are very thin and very hungry and need to gain weight, etc. some small very low carb wet food can be given. Don't stress about this right now, but I'm just trying to give you some guidelines for as you go along... things that can help the cycles to go better. You already know that feeding low carb wet is best so I won't harp on that. I'm sure you will do your best to transition. Transitioning slowly and watching carefully with tests, as I already mentioned, is the safe way to do things.

How did Striffy behave yesterday during the lower BG numbers? Did you notice any change in behavior? Some cats do not feel well when they are first getting closer to more normal, healthy BG numbers. I do hope that won't be the case for Striffy, but I just wanted to mention it in case you had noticed anything. On the other hand, we have cats on ProZinc who get the zoomies and seem to feel really well when in lower BG numbers. It takes time for them to adjust to all these changes though.
 
To answer some of the questions: Striffy turns her head to the side and grinds her teeth when eating and sometimes drinking. I will try to see if there is a veterinary dentist. We live in a rural area so that would mean a car ride at least two hours away and I'm not sure I want to stress her that much right now. I think that's a great idea to look into, though.

I did not feed her during the curve thinking it would give me "clean" results. It's definitely not realistic to withhold food from her all day, every day. She has two meal times and grazes on dry food in between. She has never had a huge appetite at one sitting. I would like to set up my timed feeders during the day to put out small amounts of wet food she can snack on. The good news is she used to be a Temptations junkie and since getting sick has not wanted any. I don't think she'll be hard to transition to all wet food as it's something she's always had for breakfast and dinner. I have been picking up the food bowls each day a few hours before AMPS and asked my husband to pick up her bowls a few hours before PMPS.

Striffy is a small kitty and I think her weight has always been roughly 8lbs. Right now she is less than 6lbs. She is not showing signs of nausea at this time. She was showing those signs when on the Mirataz but I think she's been off of that for a week or more. Her appetite is back but I didn't want to ruin our streak with antibiotics. If she starts to show signs of nausea I will ask for the Ondansetron. I've had to take that myself in the past!

Yesterday, with the lower BG numbers, I felt she was acting more like herself. Her eyes were clear and she looked more alert. She hasn't quite felt like playing but we try a little each day. In my other thread another user mentioned that her cat seemed to feel ill after receiving her injection and we are experiencing the same thing. Striffy will nap for a bit and want to be alone but then a couple hours later she improves.

I really, really appreciate this community and all of the caring responses, ideas and knowledge that have been shared with us. Thank you all so much for providing hope and encouragement.
 
The reluctance to eat was most likely caused by dental pain. The antibiotics could help with that. Also some Buprenorphine. I have never had trouble with my cats losing their appetite on Clindamycin — nor have we had diarrhea. In May, three of my cats have had dental cleanings and extractions. All three were on Clindamycin prior to and after the dental. We haven’t had any problems My only caution when using Clindamycin (or any pill for that matter) is to make absolutely certain that Striffy eats enough wet food after you give the pill to ensure that the pill doesn’t remain in her esophagus — otherwise she could get serious damage to her esophagus. I am sure that you probably never “dry pill” a cat, but I wanted to be sure since there have been documented cases of esophageal injury to cats from Clindamycin that wasn’t given properly (either with a water bolus or food.)

I have never had nausea with Mirataz either. The trans dermal Mirataz? I have had cats who are really sensitive to it though. I never give more than half or one third of the length of the strip that is suggested on the box (which I believe is 1.5 inches long.). Some years ago when Mirataz first became available, I gave the full amount to my cat; she became very aggressive with the other cats. Some cats will also become very vocal and restless. I usually dose it every other day and not every day. You aren’t currently giving it to her, but I just thought I would share my experience with it.
 
How is Striffy doing? I've looked at the spreadsheet. Please always try to get a nighttime test before you go to bed to make sure that there hasn't been too big of a drop and so you can make sure to test later or set an alarm, if necessary. Many cats do drop lower at night.
 
Striffy is making good progress. Although her numbers are still higher than I would like to see, she seems to be going in the right direction. I will most definitely add the nighttime test to our routine and I appreciate the tip!

Some of her improvements are: she is more alert, her eyes are clear and bright, I saw her grooming (!!), she "chased" a bug and she played with me for a minute, and she gave love nibbles to wake me up. She also has a nice appetite and she's not begging for water all day and night (partly from removing dry food from her diet, I'm sure).
 
Striffy’s Momma said:
Striffy is making good progress. Although her numbers are still higher than I would like to see, she seems to be going in the right direction. I will most definitely add the nighttime test to our routine and I appreciate the tip!

Some of her improvements are: she is more alert, her eyes are clear and bright, I saw her grooming (!!), she "chased" a bug and she played with me for a minute, and she gave love nibbles to wake me up. She also has a nice appetite and she's not begging for water all day and night (partly from removing dry food from her diet, I'm sure).
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Oh, I like that photo of Striffy! I see you are in Georgia too (like me). Anyway, you are definitely making progress! If you can get a nighttime test and we can hold this dose for maybe a couple of more days, we will see if it's safe to go to 1.75 units. She's been on this dose for a while now. I'd like to see the night number and also to see what happens over the next couple of days (since the blues.) The really important thing is how she is feeling. That makes me happy and makes me smile.
 
Suzanne & Darcy said:
Oh, I like that photo of Striffy! I see you are in Georgia too (like me). Anyway, you are definitely making progress! If you can get a nighttime test and we can hold this dose for maybe a couple of more days, we will see if it's safe to go to 1.75 units. She's been on this dose for a while now. I'd like to see the night number and also to see what happens over the next couple of days (since the blues.) The really important thing is how she is feeling. That makes me happy and makes me smile.
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Do you think it's safe to up the dose to 1.75? I will say I'm a little nervous because there's such a fine line (or no line) on the syringe between 1.5 to 2. She is definitely feeling better than before and getting back to her old self but she still seems a little down. She's eating well and not drinking or urinating as much.
 
Yes. Your nadirs are over 150 so you should be able to increase to 1.75 now. Just eyeball as best you can to get between the 1.5 mark and the 2 mark. It is a tiny difference. Keep up the good work getting tests! I’m really happy to see the night test too. Well done. It does sound like her clinical signs are improving and she’s starting to feel better. :cat:
 
Suzanne & Darcy said:
Yes. Your nadirs are over 150 so you should be able to increase to 1.75 now. Just eyeball as best you can to get between the 1.5 mark and the 2 mark. It is a tiny difference. Keep up the good work getting tests! I’m really happy to see the night test too. Well done. It does sound like her clinical signs are improving and she’s starting to feel better. :cat:
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Thank you so much for your help and encouragement! I love watching her improve! :)
 
I forgot to put my insulin in the refrigerator this morning and it sat out all day. Should I give a dose and get a new bottle tomorrow? Or just throw it away?
 
Hi! I hope y’all are well! It’s been a while. It’s probably okay. You can try it and see. Or if you are uncomfortable you can try a new vial. You will not hurt Striffy either way. It would be very hard to tell if the insulin was bad based on numbers because you don’t have many mid-cycle tests so you may not be able to tell if the insulin has gone bad.
 
Hi and thank you for the quick reply! We are doing great and hope you are as well. The insulin looked normal so I went ahead and gave her a dose. I will check her later to make sure it’s working properly. On a side note, I struggle with giving many mid cycle tests because I have a tendency toward obsessive compulsive disorder and I’m trying not to go there.

I do have another question, though. I’ve been scheduling my activities around her food and insulin schedule, which is fine and easy enough on most days. However, I do have an event coming up that starts after work and will have me getting home at least 4 hours after her scheduled shot. I would think she could miss a shot but when her sugar gets too high she starts a cycle of drinking too much water, vomiting and not eating because she’s thirsty. It takes a few days to get her back on track. Do most people just skip events that interfere with the schedule?
 
Well, different people take different approaches to events when they cannot be home at the usual testing/shooting time. One thing you could consider (if you do not want to skip insulin all together and send her into very high numbers). Is to adjust her shot time by 30 minutes a day. I don't know if this will work because it sounds like you will not be home between the end of your work day and when the event begins? But you can adjust her shot time, if that's possible. It sounds as though you would have to make her shot time later in the morning and then it would be later in the evening? I don't know if four hours would be "do-able" but perhaps 2 hours? Then her shot would be only two hours late in the evening instead of 4 (so 14 hours after her morning shot instead of the usual 12 hours.) When is the event (how many days from now?) And what day of the week would it be on? (Dare I hope it would be on a Monday so that you could have adjusted her shot time a bit over the weekend?)

But really, you need to sometimes take some time for yourself. If this is something that is important and you need/want to do it, then just do your best, don't feel guilty, just get out with people for a while. It's okay!
 
Thank you so much. I really appreciate this answer! The event isn't until Sept. 1 but I have been fretting so much I couldn't get out of my head and figure out the solution. I can work with gradually adjusting her schedule.
 
Striffy’s Momma said:
Thank you so much. I really appreciate this answer! The event isn't until Sept. 1 but I have been fretting so much I couldn't get out of my head and figure out the solution. I can work with gradually adjusting her schedule.
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That’s fantastic! You can adjust her shot time by 30 minutes a day without really messing things up. Since you are worried about becoming obsessive about testing, do you think one mid cycle test a day would be possible on days you’re at home? Around +6- ish? She looks like she needs more insulin bit I would hesitate to increase without some idea of her nadirs.
 
I can definitely do a +6 on the weekend. She went hypo for like a minute once and since then I don't think I've had a good handle on her dosage. The good news is she's a very happy cat and quite tolerant of me doing the things I need to do.
 
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