Possible dental abscess, first blue number ever with antibiotics

Katsallday

Katsallday

Member Since 2021
Hi guys, I had my soul kitty diagnosed with diabetes over five years ago unfortunately he is out of remission again but it’s only been five days and his numbers are lowering a lot. However this post is not about him. Ever since taking on my soul kitty’s diabetes I felt empowered to rescue other diabetic cats. One of those rescues has always been stable, but never in the blues. He is very young only five years old, he was rescued from a family that was going to euthanize him because of the diabetes. they had no vet work to give to me, but in the time I’ve had him he has remained stable in the yellows on four units of insulin, no matter what I try, he doesn’t budge. He’s also the most ketonic cat I’ve ever seen. if he doesn’t get his food, which is roughly double what a normal eats: four cans of Friskies a day, he will throw Crazy ketones. I have rushed him to the vet while he has had seven ketones on a blood meter and he had absolutely no symptoms of DKA so much so that the vet would send me home and just tell me to feed him even more so I think it’s possible that he has acro. He is young still so I’m just hoping.

Anyways, two days ago I noticed he had a big swelling lump on his face. Of course I rushed him to the vet. They believe it is an abscess from one of his molars. I have him scheduled for dental extractions Tuesday morning. I’ve been giving him the antibiotics that they sent me home with and this is the first time I have ever seen a blue number from him. I have had him for over two years and never once in my time with him, has he had a low blue. I’ve seen him go down to 180 once, but then he throws ketones. He was 112 at pmps with 0.2 ketones. This is the best I’ve ever seen him. Any ideas? Could he have just been filled with infection this whole time and I had no idea? No vet, check up has ever seen this dental issue until now AND he’s only 5, and he’s on a pretty high dose of Lantus that has never budged even with tr. I’d love some pre and post surgical advice too.

TLDR: young diabetic cat with an abscess is on antibiotic throws first “normal” number ever. Cat is scheduled for surgery in 27 hours and owner is terrified. Owner would love any ideas or help
 

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Dental inflammation and infection are one of the most common reasons for difficult regulation / remission relapse. We had something similar where we saw a really big improvement in Moonie's insulin sensitivity after her extractions. We had to be more careful and test more often as a result, so that we could keep her safe. Every cat is different so your mileage may vary - but either way, his quality of life will be so much better afterwards!

Good luck with the procedure tomorrow!
 
Also affirming that inflammation and dental issues is for sure a huge contributor to high numbers. Your kitty could indeed have been nursing inflammation for quite some time that only decided to abscess now. Pants had something similar happen in February-ish, but he had been nursing that inflammation on and off since at least September and it was unclear if it was dental or a side effect of his other health issues until it became an abscess. I'm not surprised a vet could have missed that, especially back by the molars -- my vet is a little more thorough than most due to Pants being FIV+ and at higher risk of stomatitis, which I dealt with for one of my other cats.

Even being fasted and still getting half his usual dose of insulin, plus going under anesthesia, Pants was still clocking high 200s to mid-300s throughout the day he got his abscessed canine extracted. No other teeth cleaning or x-rays, just the singular extraction. He was there for other procedures, but the vet school decided it was likely a major contributor to his chronic inflammation and high glucose, so it was determined urgent and pulled. I'm not certain what insulin dose (if any) the vet school gave him that night, but he didn't get higher than 150 all through the night at the vet school once his abscessed tooth was out. Even though he did rip out his catheter twice... :|

You may want to consult with your vet about the best protocol for diabetic and pain management following the surgery. He might not feel up to eating his usual amount of Friskies until he fully recovers, which may cause ketone problems. One of my kitties HATED buprenorphine and would not take it at all for pain management, we had to get topical opioids just to get him to eat until he was in a little better shape. But your kitty could also just go right back to his usual friskies routine, it's hard to say. His numbers may go down more after removal of the bad tooth, and that could be compounded further if he does not feel up to eating, so I would ask your doctor their recommendations for insulin dosing. You're going to want almost a flowchart of "If X blood sugar and ketones Y, do Z"


Pants had a dietary change, med change, and a ton of other health issues in the mix to complicate things, but fortunately no ketones. To give an example of the sort of guidance you'll want, here are my notes from when he got released after dental surgery (and concurrent bone marrow biopsy and spleen sampling):
-Continue insulin doseage from before surgery (1.5 units)
-If above 250, give regular insulin doseage (1.5 units)
-If below 250 but above 150, give half insulin doseage (.75 units)
-If under 150, confirm Libre reading with manual test.
--> if manual test is above 120, proceed with half insulin doseage (.75 units)
--> if manual test is below 120, do not administer insulin at all
-If 1 meal is missed/refused, give a half dose regardless of blood sugar (.75 units)
-If 2 meals missed/refused, call vet
-monitor ketones as needed/able (no history of ketones, determined low concern)
-switch him to non-prescription chicken and rice pate food as provided by vet school
MEDS:
-continue Doxycycline 60mg 1x daily, prednisolone 7.5mg 2x daily, Atopica 10lbs 2x daily, and allergy droplets 2x daily
-add Buprenorphrine .44ml 3x daily (or .44ml as able to, minimum of 8 hours apart. Okay to move doseage time +/- 1 hour at a time)
-->I confirmed with vet school he received the buprenorphine well before agreeing to move forward with this pain management plan. If uncertain, I would ask what to do if pain meds are refused, especially if it causes cat to refuse eating
-add Clavamox 1 tab 2x daily

Note: Pants was consistently mid-100s the first 24-48 hours, so I reached out to them again and they directed me to go down to 1 unit baseline doseage from there on out.
Also note: We have a unique situation where Pants always runs high due to his steroid prescription, so our risk of hypoglycemia is generally quite low. For this reason (and the fact that he hates them), I do not typically do manual tests on him unless there's cause for concern. I don't necessarily recommend the way we do it to anyone else, it's what has worked best for his personal balance
 
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Update: kitty is in surgery now. He is getting 5 extractions and they have to put in a tube to stay for a few days to drain the abscess. His bloodwork and pro bnp look pretty good thankfully. I appreciate you guys!
 
Let us know how it goes. Do expect high BG’s due to stress it will level off by morning
 
hes home and kind of looks like 2 face from batman. its actually nauseating, i feel so bad for him. the drain is leaking so much pus its horrendous. his ketones are only 1 even though he hasnt eaten for 22 hours. this is a very ketonic cat that will throw 3 ketones for being an hour late on food. the vet says he has never seen teeth so bad in such a young cat before. i really think he has acro :(
 
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