Vet visit last Friday

[Pam & Alley]

Alley has been climbing lately, and he has been scratching his ears a lot. He has had ear problems in the past so I took him to the vet. She put him on Gentizol (a steriod) one drop in each ear every 12 hours. She said he had a slight infection in his ears. Then she checked out his teeth because his breath has been unusually gross lately and found a cavity in the side of a back tooth, put him on Clavamox for 1 week and possibly extended to 2. He will have to have that tooth pulled which scares me to death because he had a very bad reaction in the past to being put under. I reduced his dose from .20 to .15 on the 17th because that is where he had the best response lately. I have been watching Marcy's posts concerning the new vial because mine is still over half full and one month older. Not sure the older vial is the problem.
ANYWAY, my question is, can either of these meds cause higher numbers? Not yet in panic mode ..today AMPS - 484 - going to let this dose settle until the first round of meds are done at the end of the week.
Any advice would be greatly appreciated.

BTW, my vet asked me to show her how I test his ear and other dosing questions...blew her mind that we microdose, she is really coming around nicely.

 

[Sheila & Beau GA & Jeddie GA]

I would wonder if the steroid could cause higher BGs even though it is topical - I would Google that and see if you get any info that way.

It does look like the higher dose is causing the higher numbers, they seem to coincide with each other. It's a good idea to not raise the dose on one high number as it could be a lone number caused by some stress or food or something.

However, it could also be the vial - how old is it? I just have no experience with vials so don't know how long they might last. There were some posts from vial users in Marcy's thread about how long they can use a vial. I would suggest you get pen-fills because I know they last for 5-6 months and even if you have to toss some it is way less than would be in a vial - so you are wasting less.

Be sure to test for ketones while he has these higher numbers.

 

[Pam & Alley]

Thanks Sheila, the vial was purchased 12-4-10. I asked the pharmacist today if it is still good and he said he did not see why not. There are two places only to buy insulin here, and neither place carries pens, but they could order them. I will Google the steriod question.
PMPS - 364 - only a 41 point drop in 4 hours.
Thanks again

 

[Vicky & Gandalf (GA) & Murrlin]

I would think the likelihood of a vial going south after 7 almost 8 months is pretty strong. Reason being is that you've stuck it way more times than we stick an average pen. While I believe Levemir is tremendously stable, it's just at some point it could loose effectiveness. Not necessarily go bad, but maybe just not work as well.

Teeth can definitely cause an issue. Not only do you have the bacteria, but that's gotta hurt! Pain alone can raise BG.

You may want to discuss anesthesia options with your vet. My vet uses a gas on Gandalf, which puts him out for a short period, not sure what it's called. He comes home almost as if he didn't have anything done. I think it's the same stuff they use to knock out uncooperative kitties, they have a big box they release it in, you can stick a whole carrier in it apparently. He had 2 lumps removed last january so it put him out long enough for her to do that, so should be long enough for an extraction.

 

[Pam & Alley]

Vicky, thanks, I asked her about the gas and she was hesitant about using it for an extraction. I will definetly push for it though. The only symptoms he had for the bad tooth was the terrible breath, which is now fine (or at least it doesn't knock you over!). He was 433 at AMPS today, at least 50 points lower than yesterday's number. He threw up on the Clavamox liquid twice, so I am trying for the pill and pocket combination today.
I guess I am so used to the vial that the pens confuse me a bit. Not sure how they work. I will find out all I can about them and order the pens, as that makes a big difference as this vial has been poked approx 500 times so far!
I know the more experienced advice givers are just a few of you on the Lev board, and most of the time you have your hands full with not only your own kitties, but everyone else's too. I read and learn from this board everyday, and it is reassuring that when a question comes up, you are all there for me. Bless you all for that.
Sheila, yes, you are right, the steroid I am using for his ears, even though topical, is entered through the ear canal and causes higher bg readings. It even says prolonged use can cause diabetes in non-diabetic cats!!! He is done with that tomorrow. Yay!

Thank you all
Pam & Alley

 

[Sheila & Beau GA & Jeddie GA]

The pens are like a long thin vial held in a pen "sleeve" with a pen cap. They have a tiny rubber diaphragm top very similar to a vial - just smaller. Just invert them, just like the vial, and stick the needle through the rubber diaphragm - just like a vial and draw the dose. The one thing they have that is different is there is rubber stopper at the other end of the cartridge that moves forward as you use up the insulin by vacuum suction so it keeps air out of the cart. Of course, you can't see it move each time, but over a week or two you can see the movement.

There are some pictures in this sticky on the lantus ISG. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151&p=873
In the middle photo (the lev pen) you can see the red stopper ab out 2/3's of the way toward the front of the cart.

 

[pamela and tigger]

Vicky, thanks, I asked her about the gas and she was hesitant about using it for an extraction. I will definetly push for it though. The only symptoms he had for the bad tooth was the terrible breath, which is now fine (or at least it doesn't knock you over!).

Am curious, what is she planning on using for the extraction then? Did she say? What did they use before that he had a bad reaction to - do you remember?

You can buy the cartridges from www.CanadaDrugsOnline.com.

They will want a prescription faxed probably which you can get from your vet and fax yourself, or maybe your vet will.

Ditto what you found out about the ear drops raising bg levels. I once had put a topical cream on some sores that Tigger had and didn't realize that the steroids in the cream would affect his bg levels.

 

[Pam & Alley]

Sheila, for some reason after seeing the commercials for the "flexpen" I thought you would dial up the amount you need and then get it out with the syringe. BUT I was sure they did not have microdoses that could be done that way, so I guess I thought the vial would be better. Will order the pens tomorrow, as I have a refill due on the vial and they said I could choose which one I wanted. Thanks again.

Pamela, she wants to put him under as she has a specialist that does only that (I know what they are called, just can't spell it right!) and he will be monitored by this person while she does the extraction. One of my other cats had an extraction 4 months ago. VERY expensive, but she is all I have in my area. She is coming around so much more than when I first went to her, now she listens to me about the wonders of Lev, but when I asked her about using the gas to put him under, she wasn't receptive. If Vicky had surgery on Gandalf only under the gas, then a tooth should be ok. She wants to do the full run of bloodwork before surgery, so I have time because he has to finish his antibiotics first.

 

[Sheila & Beau GA & Jeddie GA]

My vet has also suggested the gas for senior dentals. She said they give them a few puffs of it and monitor them so they don't come out of it too soon. It's supposed to be safer than anesthesia.

Yeah, the pens have that dial thing on them - just ignore it. It's supposed to be used with special needles designed for it, but you can't do less than 1u I think.