? 2/22 Dimmu AMPS: 328. Dose adjustment for dental x-ray.

Yesterday

Good morning!

We found a dental specialist and got an appointment tomorrow to have his dental issues checked. The vet will need to anesthetize him to take x-ray. She asked me to not feed Dimmu in the morning and only give 1/2 of his morning insulin dose. Is this a good idea? Looking at his numbers, it's unlikely he'll go hypo without food. But just to be cautious, should I skip the shot all together? And If I reduce/skip, does the 3.5U cycle count reset?

I really hope some proper dental work will help bring his numbers down.

Have a nice day, kitties and beans!

 

I'm probably on the overly cautious side in part because Gabby could be very unpredictable. If it were me, I'd be inclined to skip.

Typically, with TR, this would reset the the cycle count. I've not been following Dimmu closely, though. If there's an experienced member you're been working with, I'd ask about fast tracking this shot and consider increasing since it would only be one cycle away from when you would increase.

 

@Sienne and Gabby (GA) , thank you. I called the vet to double check again, and she assured me 1/2 dose will be ok and she'll do anther BG test when we are there, I am still not convinced, though. I am also inclined to skip.

Will ask @Wendy&Neko for fast tracking.

It's a beautiful day, cold, but very clear. I am gonna take a walk to ease my nerves. Dentals (and anaesthesia) are scary.....

 

My vet had me skip when Max had anesthesia for his dental. I hope he will do whatever work needs to be done so you won’t need to go through this twice. Betty vines.

 

My biggest concern is that anesthesia can lower BG numbers. Dimmu hasn't been on Lantus all that long so there's no way to have a baseline for how the depot may respond to a reduced dose especially in light of anesthesia. Some vets do encourage a reduced dose and others will tell you to skip. Since this isn't a "one size fits all" situation, I think it's a matter of what you're most comfortable with.

 

Do you know if the dental specialist will be monitoring his BG's? Most specialists will. Neko had dentals both by her regular vet, and by the specialist. Almost every time she had anesthesia, I shot half dose in the morning. One time I did a fur shot (so effectively no insulin), and she was firmly in the reds when I got home. Another time she gave me a low blue and was dancing for a reduction, so I gave a token dose. The dental specialist was monitoring and she got lower than I like her to be at the vet, though still safe. They weren't worried because they find that the induction process increases the BG's. And sure enough, 15 minutes later her BG had doubled. I think whether you shoot half dose or less can depend on the AMPS number you get.

The type of anethesia induction drug the vet is going to use makes a big difference on the later effects on the blood sugar. In Canada the more common drug used is alfaxalone, which is gentler and did not lower Neko's BG. Alfaxalone just came into use recently in the US so more people here have experience with other drugs which can lower the blood sugar and not all vets use it yet. The BG lowering effects are more important in considering what dose to give in the PM after anesthesia. If you test the blood sugar when you get home, then again at PMPS, you may get an idea if his numbers are going down. If he's on the way down, and not feeling like eating, then you might want to be more conservative with dose in the PM.

Do try feeding small watered down amounts of food when you get him home, spread about 20 minutes or so apart. Anesthesia also has GI impacts and you don't want him throwing up. But it'll be good to test how hungry he's feeling and whether he wants to eat.

As far as dose goes, I would wait for any increase for the day after tomorrow so any dental effects are out of the way and you know he's going to eat well. Post tomorrow, so we know how he did on the dental, and we can look at timing of the increase.

Good luck!

 

Thank you guys so much.

The dental specialist will be monitoring his BG's, too. I pressed again today to ask whether she's gonna use ketamine, but she didn't want to give a definite answer until she checks him tomorrow. I am guessing she might use ketamine as sedatives, which seems like the general practice here in Benelux. If so, should I try to avoid it at all cost? Dimmu has had ketamine before, but it was 2 years ago, and there's no knowing if he was diabetic then.

I will check his AMPS and if it's still in the usual mid-high pink, I will give him 1.75U. I don't expect anything lower to be honest, it's like I am shooting water in the last couple of days.

Thank you for the heads up about post anaesthesia, Wendy.
I was already wondering what to do with his PM shot tomorrow. Will post again tomorrow.

Have a nice evening, everyone.

 

Neko's internal medicine vet was trained in Belguim and I was pretty happy with his knowledge. Maybe your vet will be up to date too.