BG is rising post surgery!

Discussion in 'Prozinc / PZI' started by Tina R, Nov 22, 2019.

  1. Tina R

    Tina R Member

    Joined:
    Dec 27, 2017
    I’m a bit of a mess right now. Gracie’s BG started creeping up, as did her fluid intake.

    I took her to the vet who wanted me to start insulin again. Since blood work came back normal. I asked to do her dental first and let’s see what happens. I had an appointment in December but she was able to move things around to get it done today.

    She had an emergency and didn’t come in today. The other vet did the surgery. Her BG was 390. They asked if they could give insulin & I agreed. Turns out they don’t carry Prozinc, so they gave her .5u of Vetsulin. Her BG keeps increasing! +1 was 590. I know some of it is high is due to stress, but Geezus!

    I’m about to lose it. Why is it increasing?

    It is appropriate for me to go down there & test her BG myself? No, but I want to!
    I also want them to give her more pain meds. How do I ask? It’s only for Gracie. I want her and expert her to be pain free.
    I’m also assuming she is in pain since it’s post procedure.

    Note: They gave her Bupe prior to surgery.
     
  2. Noah & me (GA)

    Noah & me (GA) Well-Known Member

    Joined:
    Dec 3, 2016
    I'm not certain of this but switching between insulins is not always the best idea just because they're out of one kind.
    Don't lose it yet, someone else will give you a better answer soon.
     
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  3. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Breathe. Right now, Gracie is reacting to vet stress and surgery stress. Get her home and start testing again.
    Do ask about pain and any other meds before you pick her up in case the vet is gone for the day.

    Rover could not have surgery so I have no firsthand experience. Tagging
    @Sienne and Gabby (GA)
    who might still be online, and
    @MrWorfMen's Mom
    who knows about Prozinc and Vetsulin.
     
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  4. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Deep Breathes.
    Let me clearly understand.
    Gracie has dental surgery and her BG was 390. Was that before the procedure or after?
    0.5 dose of Vetsulin was given. Again was that before or after the procedure?
    BG was 590 an hour after the shot of Vetsulin. Was that reading taken at the vet's office?

    If you don't know the timing of all of this, I would call the vet clinic and get a complete and thorough timeline on what was done when. Since they gave her insulin, you need to know exactly when so you can test her and make sure she stays safe.

    Gracie is in no immediate danger because of the high BG. The elevated BG is probably a combination of stress, maybe some discomfort and perhaps she dropped lower at some point from the Vetsulin and she is bouncing now. Without knowing the exact timing of all this, it's hard to speculate. But if they gave Gracie insulin, then they should have been checking her BG regularly since she hasn't been on insulin.

    Have you checked her BG at home? If not I would do so to see if it has come down at all.
    Dental issues can cause elevated BG so her BG may have been a little elevated from her normal but it seems odd they would suddenly give her insulin for a single elevated BG test.
     
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  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    There could be a couple of reasons you're seeing a rise. Anesthesia lowers BG. As the anesthesia wears off, numbers may rise. The stress of the day is likely also contributing.

    Do you know if they fed your kitty? If they did, what did they feed her? Chances are it wasn't something low in carbs.

    Did Gracie have any extractions? Having teeth pulled is painful. Pain may also be contributing to elevated numbers.

    Were there ANY other meds administered during the dental. If extractions were done, did they get post-procedure x-rays?

    Now that Gracie is home, how is she acting? While numbers may be high, they don't tell the entire story. What's her behavior like? And if they did do extractions, you may want to get some baby food -- all meat and broth, no veggies (especially not onion). Most cats love the stuff and it's easy on the mouth.
     
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  6. Tina R

    Tina R Member

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    Dec 27, 2017
    Gracie is not home yet. They are not releasing her until at least 3 pm. Allegedly they have not fed her yet...I left her Nulo there and asked that she be fed that if she is hungry.

    Gracie had 1 extraction. The tooth was fractured.

    390 was pre-surgery @ vet.

    .5u was given @ vet after the first reading.

    590 was @ vet post-surgery.

    BG at home has been in the low 300's which prompted a vet visit.

    I called them about 20 mins ago and it dropped some...shes at 493. They want me to give Insulin at home if the numbers are still high. My Prozinc is expired-->2yrs old. There are floating proteins on top. Should I ask for a new script, or try the Vetsulin

    Pre-surgery she was given Bupe at the vet to help relax her

    They gave her a shot of Antibiotics during surgery to prevent infection. It started with a C.

    I demanded (well asked strongly) that they check BG every 30 mins if she was given insulin, and the tech either didn't follow my directions or failed to relay the message. I will be having a chat with him when I get Gracie. I'm not a happy camper.

    Pain meds: They said they will send me home with Bupe, but I am concerned about the pain right now. Bupe does not last all day. I told them she needed another dose if they are keeping her until 3pm. They said they would talk to the doctor to see if they could.
     
  7. Lisa and little

    Lisa and little Member

    Joined:
    Sep 24, 2018
    Can’t comment on what is going on but wanted to say my thoughts are with you and Gracie. Believe me I k ow how stressful this is. Once you get her home and can test regularly you can make a better decision about insulin. It’s possible her BG was elevated initially due to the bad tooth. I’d get her home and test her for a bit so that things have time to settle back down. While we all hate high BG levels now that the bad tooth is gone, it may resolve itself as she starts to heal from the procedure Deep breaths and hugs to you both.
     
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  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Well, I personally think it was not necessary for the vet to give Gracie any insulin given dental discomfort could be in part the source of the BG elevation along with vet stress. By all means BG warrants closer monitoring to make sure it comes back down but giving insulin today seems like a trigger finger reaction possibly caused by the knowledge she is diabetic.

    I'd want to know if they checked BG during surgery. Since anaesthetic usually lowers BG (vet should have known that), I still have to wonder if BG dropped at some point and the high BG now is a bounce response.

    If I were you, I'd monitor Gracie on a daily basis for a couple of weeks until she has fully recovered to see if her BG returns to normal range before restarting insulin.
     
  9. Tina R

    Tina R Member

    Joined:
    Dec 27, 2017
    SS updated. I've tried my best to get some extra numbers in while I am home.

    I have a hard time believing she was in the 500's. If I were to get that number and was at home I would have double-checked. I know they didn't. They charged me $24 per BG check. Is this normal? Meh.

    I don't think this vet is very experienced with FD. Her specialty is Brachycephalic Dogs. It's not to say she is not smart and well educated, but I think my regular vet has the experience and she is not as pushy. She checked in with me this morning and told me I could hold off on insulin if I wanted and see how the next week or so goes...but did encourage BG checks.

    I doubt she checked BG during surgery. It seems like it was done just before and 2x after.
    She didn't seem to think Gracie needed pain meds either. She seemed to think that the Bupe injection she received when she arrived at 8 am was still working when I picked her up at 3. I am skeptical and asked her to get another injection, but they didn't do it because I showed up.

    Lucky for Gracie...I had leftover Bupe at home. Obviously I don't want her drugged, but I want her comfortable.

    Is 0.1 the regular/standard dose for cats?



     
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I am delighted to see that lovely 191 on Gracie's SS. Looks like she bounced yesterday along with stress and is coming down. Hopefully in the next few days she'll be back to normal BG levels. Fingers and paws crossed. Keep us posted.

    Why the vet didn't send you home with some pain meds is unbelievable. It's been so long since I've used Bupe, I'm not sure about the dose. Isn't there information on the vial/container you have? I suggest you post a new thread with a title of "? Dose of Buprenorphine" (use the "?" prefix) to get some feedback from folks who have more experience with it than me.
     
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  11. Tina R

    Tina R Member

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    Dec 27, 2017
    Ahhh yes. If only she stayed at that number. She creeped back up yesterday night and this morning.

    I left for work this morning, so I am unable to test until tomorrow when I return. Ugh. I’m so bummed. I’m worried, but not overly worried. The worst case scenario is I have to start giving insulin again. I don’t blame myself, but it is frustrating. She’s been eating LC and her last dental was less than 6 months ago. Unbelievable.

    I already scheduled her next dental...3 months out.

    Something else that I failed to mention (well forgot to mention) is when her labs came back her gallbladder (GGT) was elevated. Her liver was fine, so my vet was not worried, but wants me to recheck in 1 month. Now, I can’t help but wonder if it’s her gallbladder. Apparently she is just barely above normal limits.
     

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  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Right now Gracie is recovering from surgery so just keep monitoring her. Those numbers may come down yet. As for the elevated GGT, I presume you have not seen any change in Gracie's appetite or anything to suggest she might be having discomfort in her abdomen. One thing the vet might want to check if GGT is still up and BG hasn't come down, is for pancreatitis which is often seen in diabetic cats. They can do a quick snap test in office to see if there is need to investigate that possibility further. Generally though, if pancreatitis flares up, the cat will be lethargic, have loss of appetite and just generally feel unwell so it's doubtful that's the reasons if there are no other signs. Fingers crossed the elevated GGT was just a temporary blip.

    Keep us posted.
     
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  13. Tina R

    Tina R Member

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    Dec 27, 2017
    My old vet “assumed” she has Pancreatitis. She never did a test to confirm, but she treated her like so. There were times when she would not eat. I’ve never investigated it though. She just gave her meds for it. Cerenia and another one that started with an M and Bupe. Who knows if she did.

    In terms of her appetite...it’s hard to say. She can be persnickety. There are times when I feel like I am running a full kitty cafeteria. In the back of my mind...I do wonder if it is due to the Pancreatitis flare, or if she is just being a cat. This behavior is not frequent, but when it happens...it usually lasts anywhere from 2-4 days.
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Some cats have chronic pancreatitis which flares occasionally. It's possible that is what is elevating the GGT. Just keep an eye on her.
     
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  15. Tina R

    Tina R Member

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    Dec 27, 2017
    Will do. Thank you. :)
     
  16. Tina R

    Tina R Member

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    Dec 27, 2017
    SS is updated and insulin has been started. I’m going to try to get a curve on Saturday when I am home all day.

    For the “newbies” who aren’t familiar with my schedule I cannot give insulin 2x daily. Usually 1x daily and 2x daily a couple nights a week. I know it is not ideal, but I’m doing what I can within my limits. This is not due to financial restraints, but my own schedule between school and work cause limitations.
     
  17. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Did you manage to get a curve on Saturday? :)
     
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  18. Tina R

    Tina R Member

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    Dec 27, 2017
    Oy. I'm actually really embarrassed to admit this. My meter went MIA. I remember using it Friday morning. When I went to get a second reading I could not find it. I left it alone and assumed I would find it after work. I knew I wanted a curve, so I decided to leave early for work and buy a new ReliOn meter to avoid the headache of trying to find it after work. I bought it and come Saturday morning my strips did not fit the new meter.

    I gave up and resorted to my AT meter, but guess what? I couldn't find my strips. I usually keep all my supplies in one spot, but I recently did some rearranging and apparently misplaced a few items. I was over it and frustrated. I finally did some digging around and found out that I could get the correct meter on ADW. I put the order on Saturday.

    Now, I am left with...do I shoot? I assume no, but I do worry about the inconsistency.
     
  19. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I know this isn't funny but I had to laugh at the comedy of misplaced stuff that befell you. I also laughed at the re-organizing causing stuff to go missing. Been there...done that.

    A suggestion.... run to the store and get strips for the new Relion you purchased. You'll have a back up meter and just pack everything into the same drawer or box or whatever. Never hurts to have a 2nd meter around in case a battery runs down. I always kept spare batteries in with my testing stuff as well, just in case.

    I personally don't recommend shooting without knowing what BG is but that is really your decision. I wouldn't however skip shots for too long. As it is you aren't able to shoot twice daily consistently so it's even more important to get insulin shots done when you can.
     
  20. Tina R

    Tina R Member

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    Dec 27, 2017
    I actually ordered strips online for the wrong meter. Yes, Walmart was out. I really can't believe it. Well, I can.

    The "new" (correct) meter should be here today. I paid for extra fast shipping. Don't ask me how much I paid. I'm hoping to get a test in tomorrow...since the meter will likely arrive while I am at work this afternoon.

    I shot twice (and took a chance) but haven't today.

    Stay tuned for numbers tomorrow. :)
     
  21. Tina R

    Tina R Member

    Joined:
    Dec 27, 2017
    New meter came literally minutes after I posted that. And new meter was in fact the wrong meter. I’m so frustrated....the company sent me out a new one that should be here Friday, but I pickup my backup meter strips today at the store.

    I feel like I should have went to the pharmacy and picked up a new meter, but they are so expensive and some of them require a doctors authorization.

    November was pretty expensive for me. Partly due to the unexpected dental and insulin purchase. I feel cheap saying that, but everything adds up.
     
  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    We all know how expenses can add up and you seem to be having a lot of bad luck with the shipping which only adds to the horrendous costs. You can only do what you can do. The point is you are working to get it sorted out. Fingers crossed this fiasco is behind you very soon.
     
  23. Tina R

    Tina R Member

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    Dec 27, 2017
    Meter arrived. Was able to get some numbers yesterday.
     
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Try to get a test every night before bed at least. Many cats go lower overnight and Gracie's pre-shot last night was considerably lower than AMPS so BG could have dropped as low or lower than it did during the day. Early night test can clue you in to whether it will be an active cycle or not. TEsts around +2/3 post night shot, that are same or lower than pre-shot suggest the cycle may be active and getting another test in would be advisable.
     
  25. Tina R

    Tina R Member

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    Dec 27, 2017
    Ugh. So, here is the downfall. I’m only home 2 nights a week (Friday and Saturday). I work nights, but this week (due to the holiday) I am actually home 3 nights this week.
     
  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Ok so turn things around and get those extra tests on the day cycle before you hit the sack when working nights. Then get the night test if possible on days off. You just have to figure out what will work for your schedule. You need to get some mid cycle tests even if they aren't in exactly "ideal" hours to see what Gracie is up to. All data is good data.
     
  27. Tina R

    Tina R Member

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    Dec 27, 2017
    I must apologize for my lack of response. I've been off my FD game for awhile. I will get in the swing of things again.
    I updated my SS.

    I switched where I was injecting her too. She has a fatty tumor on her neck and I increased her insulin, as I thought the dose needed to be increased. I think the insulin was not absorbing very well. Now she gets it in her leg.

    I will be doing a curve on Saturday. I have cleared my schedule for this. I have 2 extra meters with strips as a backup too. Nothing will stop me.
     
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    While humans use their legs for insulin shots, it's not one of the sites recommended for cats. With cats, I would think you risk hitting muscles which could make the uptake of the insulin much faster. Here are sites used by vets for insulin shots.
    cat_injection_site_selection_graph_wider.jpg
    Looks like 1.25u is pulling numbers down to low levels you may not have caught with your recent testing. That 77 at PMPS on the 24th while a safe BG, suggests BG may have dropped lower earlier in the cycle and that the 1.25u dose may be too high. I'd stick to 1.0u right now until you determine how low that dose is taking BG.
     

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