04/06 Shmee AMPS 194, dental work scheduled

Previous condo: http://www.felinediabetes.com/FDMB/...-208-amps-323-vet-update.193676/#post-2165633

Good morning and happy Friday,
If you missed my condo yesterday his liver levels are back to normal, yay!
His dental work (lesion found, one or more extraction needed) is also now scheduled for the soonest they could: May 3rd.

Response to @Stacy & Asia from last night: I confirmed this morning when I talked to the vets office on the phone that they are doing X-rays before the dental work ("radiographs" on the estimate). The estimate is for two extracted teeth even though we found one lesion, so she is expecting to probably find another with the X-rays.

Question: Since I have learned the last few days (in prior condos) that some cats react better to insulin once they have had their dental work done, I am now thinking about his dosing. Since the procedure wasn't able to be scheduled until a few weeks from now, he will then already be up to 5.75 units by then if I follow my pattern and increase every 3 days. I do not want to give him too much insulin after the dental work though, just in case his body reacts better to it. I was thinking I can start to slow down and increase (if needed) every 4 days instead of every 3...? That way he would only be at 5 units by then. Maybe even every 5 days? But I don't want his numbers to get too high... Hm. Thoughts?

 

So glad they are doing X-rays prior, I can't tell you how many times I've read around here things like "vet looked at teeth and said they are fine". Some things you can't see with the naked eye and especially when there are other factors like advanced age or infection present, it's always prudent to rule out teeth issues if possible.

For now, you would change nothing, keep on keeping on and increase as warranted following TR. The goal is tight regulation and healing numbers and it takes however much insulin it takes, especially with complications like teeth problems, you dose around it. We certainly wouldn't want to run him high for weeks and create glucose toxicity just because you know his insulin needs could decrease some time down the line.

I know where you're coming from, I like to have a plan in place and think in advance too, but as I'm sure you'll learn soon enough around here, cats and diabetes are somewhat unpredictable. It may look like an increase is needed and shot time is 6 hours away and bam! a lime green number comes up and you decrease instead. So while you can try to have a general idea of what you do in certain situations, you can't really make decisions about it until you get there.

We have guidelines for what to do insulin wise, presurgery and also what to do after, but it doesn't really impact what is happening right now. You really have no idea if he will get up to 5.75 before the surgery, his dose could be 2 units by then, there's just no telling. Right now, you're trying to get Shmee in normal numbers and we can deal with dental time when it's much closer.

 

That is another situation you can deal with when it is near, say a week away. We have guidelines for reducing the dose in advance (like a few days in advance at most) when you need to be away, but again, you want to aim for as close to a therapeutic dose as you can get in the meantime.

 

Ok thank you for all your input Stacy! FYI to others that may see this I accidentally deleted that post, but yes I am nervous about leaving Shmee home with DH during my time in MN but I understand that I need to stay consistent regardless of future events, so I think I will stick with every 3 days like you suggest, unless someone else has a differing opinion and we can discuss it more.

 

Agree with Stacy! I used to give the normal shot right up to the day I left on vacation. I would instruct the cat sitter on dosage at that point in time as I could see what the dose was doing and more able to predict a good vacation dose.

My civvie went into a dental surgery with mild tartar and 1 small lesion (cavity) at the gum line. With X-rays - that tooth and 2 more had total re-absorption/partial absorption on the roots and were not salvageable and were extracted. 1 more that 1 root was reabsorbed it the other root looked ok so we are hoping to save that tooth.

She was in way more pain that I figured.

With FD kitties I think it is even more imperative to keep up on the dental health if they are physically able to do the surgery.

 

I agree with what's been said on the dosing around the dental. Let Shmee tell you if a dose is too much. If he has extractions, his insulin needs may actually go up for a while after surgery. Inflammation can increase blood sugar numbers. Once the inflammation goes down in 7-10 days, the numbers may come down.

 

Sounds good yes I think I will follow your opinions and stick with the 3 days. Thank you, it just makes me so nervous to think he may go too low... But once it comes for vacation and dental time I can work on the change in dose then.

Are the guidelines written anywhere that I can read about, or should I just ask around a week before the dental and see what peoples opinions are according to his numbers at that time?

 

I would post your vet's suggestions for reduced dose before the dental. Most often it's 1/2 dose the morning of the dental. But otherwise we don't reduce in advance of a dental. I think what Stacy was suggesting was reducing in advance of your vacation. In that case, post for a vacation dose a couple days before you leave.