Update on: Dosing advice for an unpredictable cat

[jmalasiuk]

This weekend's post: http://www.felinediabetes.com/FDMB/threads/dosing-advice-for-an-unpredictable-cat.131951/

So, I've been injecting Tonka with 1.75 units for the past three days, with no real change in his levels. In fact, he's more consistently high than usual - although we haven't had any blacks for those days, and tonight he's coming down at least a bit. We'll see where he is in another hour or two, which is when he seems to nadir. If his blood sugars are still over 200 at those two times, would you suggest increasing him by another 0.25 units, or waiting to see what happens over the next couple days?

I spoke to the vet about getting his dental done . She's reluctant to anesthetize him, since he's an unregulated diabetic, but agrees that if his teeth are in fact a chronic source of infection, which they could be, then that could keep him from regulating. So I'm going to bring him in for bloodwork and we'll see how his liver and kidneys are looking. Hopefully all will still be good.

 

[BJM]

Yes, I'd increase; he's still over the renal threshold of roughly 240 mg/dL (13.3 mmol/L).

 

[Chris/China (GA)/Garfield]

Hi again Jordi!

Yes, I'd go up to 2 units for the AM dose tomorrow and hold it for at least 4 -6 cycles

It is possible to "fast track" Tonka and increase every 4 instead of waiting 6, but you'll want to ask for advice at that time and see if it's still a good idea

Hope the dosecrease helps!

 

[Wendy&Neko]

If you don't see anything below 200 by tonight, I think you are fine to increase in the morning.

It seems some vets are really reluctant to anesthetize unregulated diabetics. Neko had her first dental and 4 days of anesthesia for stereostatic radiation therapy for her acromegaly when red was still her favourite preshot colour. The other thing to consider is seeing if there is a dental vet specialist in your area. I went with a specialist for Neko's last two dentals, because she has a heart murmur and the specialist does extra monitoring during the operation. It costs a little more, but the specialist managed to save a tooth the first time that the regular vet was going to pull.

 

[jmalasiuk]

Thanks for the responses everyone.

Tonka's vet is very good with him - I like that she has concerns and weighs the options. But we're going to get the bloodwork done and figure it out from there. From what I know of it, if his organs have been affected by the diabetes already, waiting for regulation isn't going to make them any better. It'll just stop them from getting worse, so unless something shows up that indicates that it would be particularly dangerous to anesthetize him right now, we'll probably take the chance.

 

[Sienne and Gabby (GA)]

FWIW, it is standard practice to get blood work prior to a dental or any surgery (human or feline). You don't want to perform an operation if there's an infection or any other treatable problem. I would hope that Tonka's organ systems aren't effected by the diabetes. He hasn't been diabetic for all that long.

 

[jmalasiuk]

So Tonka is up to 24.6 (443) this morning., after he'd finally started to drop a touch (down to 15.2 (274) last night at +5.5, which is about his average time for his nadir. I increased him to 2 units this morning (not too worried about him dropping since he's so hi right now, and he takes a while to come down from that) but wondering if I should have held the 1.75 units for a couple days longer, to see if this was just a rnound and he was still settling down to what he'd normally be at that dose. Thoughts?

 

[Wendy&Neko]

The protocol allows enough time at each dose to see what it's really doing. Tonka only got to yellow on 1.75U and the protocol says to increase after 6 cycles if that's all you see. It allows for more time at a dose if you are seeing blue or green. Your goal, if you are interested in remission, is to try to get Tonka to green as quickly and safely as you can. The sooner a newly diagnosed cat can start spending time in normal numbers, the higher the chances of going off insulin.

Good luck with the increase.

 

[jmalasiuk]

Okay: up to 2 units twice a day,starting this morning. And of course he's still high, but hopefully a couple days at this dose will bring him a bit farther down. I think 4 cycles won't be enough time to tell in his case, since he typically seems to wait until the end of the third day to even start to come down, but 3 days from today will put us close to the weekend so I can increase then, if needed (most likely will be) and can keep a closer eye on him.

Went in for his bloodwork tonight - not a happy cat. Poor guy.

 

[julie & punkin (ga)]

good job getting the pm cycle tests in last night. I agree with everyone else - it looks pretty clear that this dose was only getting him into the mid-200's. I'd go ahead and increase as soon as you feel that you safely can. Holding doses too long that aren't getting a cat into normal numbers (50-120 on a human glucometer) can cause glucose toxicity, which means increasing the dose even more to overcome it. Of course when you're working, you have to hit the balance that works for you.