Wynken, upcoming dental (a.m. Dose advice)

Good morning,
I haven't posted for a while. I've been somewhat frustrated by not being able to get my kitty regulated We've had some promising times, and then we have some not so promising times.

Wynk is doing better, I would say, on Levemir than he used to be doing on Prozinc, tho.

He's feeling good and eating well and not drinking a ton, even though BG has been high.... I do check blood ketones periodically when he's running especially high, and don't see any.

I took him into his regular vet (clinic) for a periodic wellness examination and blood work on Friday. He always gets a very thorough exam. It surprised me when the vet said "he is badly in need of a dental". She always checks this and the last couple times she has said "not too bad". Otherwise she thought he seemed great, and we will get the blood work back Monday. In a way, I hope that this bodes well for us! I mean, maybe I'll get better regulation after his mouth has been attended to… ?

So, Monday morning I'm going to try to get him scheduled THIS Wednesday for dental surgery if they have an opening. They monitor them the whole time, and especially the diabetics. This is done at a sister facility, and not by his regular vet, although she has recommended someone very good at that hospital.

This will be his first dental while he's been on Levemir. His last full dental was a couple of years ago (he sometimes has had some "hand scaling" done while awake, because he's a good boy & lets them!)

So, a couple years ago, I'm trying to recall, but I don't think I gave him any Prozinc insulin at all the morning he went for his cleaning... since he didn't eat (of course).

On Friday, when we were talking about scheduling this… his regular vet told me that on the day of his dental I should "maybe give him half a dose". She said this by way of general advice… shes a good vet, but is not the most knowledgeable about insulin... She was just trying to guide me in the way she would guide someone who's not home testing.

So, help me out.... what is recommended for him, on the morning of his dental? I plan on checking his blood sugar at 7 AM, before we leave the house. I wonder if I'm thinking right when I think that there will be a depot, and I shouldn't give any insulin at all?

We've been dancing around a dose that was slightly more than one unit and then down to half a unit and back up to three quarters of a unit, here recently.

Thoughts? TIA

 

Some vets advise skipping some advise a half dose. I always skip myself irrespective of what the vet says - I'd rather be safe than sorry.

Sending vines for a good dental.

 

I've always skipped the morning dose, too. And the evening after the dental, you will need to be careful as well.
Sending perfect dental vines to Wynken.

 

I skipped the AM shot for each of his dentals . Although I used to refer to him as 'Mr. 300' back then, his BG went quite low from the anesthesia.

If you want to see details check out his ss - dental 1 was 12/8/2008
Dental 2 was 5/29/2009.

 

I was told to skip the morning of the dental. Since Max wasn't eating well that night he got a reduced dose then too but if he was eating he would have gotten his normal dose that night.

 

I am the oddball. When Bubba had his dental done back in Sept. 17th, his vet said to give 1/2 his normal dose. But he was on ProZinc then so that could be the difference.

 

Thank you all !!
This corroborates what my gut was telling me to do. Which is Skip! Thanks again!!

 

Neko has had many anesthesia's since becoming diabetic, both for dentals and radiation therapy (poor poppit!). She's always had 1/2 dose in the AM, except the one time she gave me a very low blue that morning so I went with a 1/4 dose. Depending on which induction drug is used for anesthesia, it may or may not lower blood sugar. What is used in Canada generally doesn't, but that drug is newer to use in the US. At Wynken's current high numbers, I wouldn't be too worried. The other consideration is how much and when they let you feed. The majority of vets say no food after midnight, but Neko's veterinary dental specialist said up to 1/3 of food until 6:00 AM, so I knew she's have some food in her.

For the evening, it's a good idea to test as soon as he comes home, then again at PMPS, so you know whether his blood sugar is coming down. Some people skip in the evening too, depending on how well he's eating. For Neko's first dental the vet suggested 1/2 dose in the PM, but since then we've always done full dose with no ill effect. Also be cautious on food when he comes home, no matter how hungry. Just a small tsp every 20-30 minutes. Anesthesia can upset the GI system too, but the small bits will tell you how well he'll eat his dinner.

 

When Bubba had his eye removed, on October 29, he was allowed to eat his normal food amount as long as it was canned food and if he ate it by 6 am because his surgery wasn't until 9:30 and the vet said that food would be digested (dry food is a different story) He also had his full amount of insulin that morning because he was hanging in high yellow numbers. While he was at the vets that morning his BG went up to 441 so there was no problem with him being too low. ECID and I guess EVID

ETA: It sounds like my vets were on the same page as Wendy's vet.

 

Neko's dental vetty also does his operations later in the day after the morning consults. I've read a 6 hour fast recommended. You do want a vet that will monitor BG several times. Neko got down to 76 on the AT after the 1/4 dose that one time. But went up again as soon as anesthesia was given.

 

Interesting.

You guys have given me a lot to think about. I take all my cats to this hospital for dentals and I know they get done and over with early in the day ( because after I drop off at 7:15 and go to work they call me when they're done and recovering. It's slways pretty fast.)

They will monitor his BG a lot. I am going to feed him at 7p as usual and let the auto feeder give him his normal 11pm blob of Weruva. But the 3am slot will be empty. My vet actually says no food after 9pm but I'm sure a tiny dollop of wet food at 11pm is a nonissue.

I think I'm going to skip that morning... OR if he's high up in the 350+ range before we leave the house, maybe a token dose like 0.25u or less. Given what @Bobbie And Bubba related, maybe I will take in a syringe for them, pre-loaded with another 0.25u... In case he goes or stays high... would that be good?

Thanks again!
Cara

 

I wouldn't bother with taking along the extra syringe. And then your PS timing would be off with two shots and different nadirs. They'll have R insulin there which they can use if they think his numbers are too high for the day.

 

Yeah I agree, another shot of Lev by the vet would cause two nadirs and it could get crazy. Yeah they can give him a shot of Novolin R, a short acting insulin if they need to. Fingers and Paws crossed that you get an appointment on Wednesday. Please keep us posted. I have missed you Cara!

 

Thank you both, @Wendy&Neko and @Bobbie And Bubba

His sugar is thru the roof. Gotta get him in ASAP!

 

Wow! Great news this morning - they can get him in tomorrow!!! His bloodwork cams back perfect (other than glucose of course).

Gosh he's been high, over the last couple days . I went up to 1u this morning because he's been SO high and flat.

How soon after the dental do I expect improvement? I'm thinking of dropping back to 0.75u tonight, then NOTHING in the a.m. (Of course) then only giving 0.5u starting with his fuds tomorrow after I get him home.

???

 

Great news about the dental appointment! Since you increased the dose today, I would keep the dose the same tonight. With Lantus being a depot insulin, consistency with the dose is important. I am not if you are following TR or SLGS so depending on which protocol or method you are following will tell you how long to hold the new dose.

Tomorrow, morning when you skip for the dental, if you decide to shoot later when you come home, it will mess up your 12/12 shoot time. If that is not okay with your schedule, I would just wait till your regular PM time to shoot regarding the below that Wendy had mentioned in a previous post. As per Wendy:

For the evening, it's a good idea to test as soon as he comes home, then again at PMPS, so you know whether his blood sugar is coming down. Some people skip in the evening too, depending on how well he's eating. For Neko's first dental the vet suggested 1/2 dose in the PM, but since then we've always done full dose with no ill effect. Also be cautious on food when he comes home, no matter how hungry. Just a small tsp every 20-30 minutes. Anesthesia can upset the GI system too, but the small bits will tell you how well he'll eat his dinner.

I did not skip in the evening after dental because Bubba ate so well.

You could see some New Dose Wonkiness with this increase and he could go higher at first usually in the 2nd cycle after the increase.

 

Thanks Bobbie. I guess you're right about holding the dose tonight. I know that Lantus and Levemir are depot insulins, but I do not completely understand what that means, although I've read a TON. I actually didn't think I wanted to build much of a depot for him in advance of this procedure.

I had really only planned to give him a boost up to one unit for one or two doses… And then reassess where he needed to be, dose-wise afterward.

Because I'm anticipating (HOPING!) that the dental's going to help with his blood sugar being regulated… I was planning on watching his sugar like a hawk (you know, the way you regulars in the forum do!)...And decreasing as soon as I saw a low nadir. Im always confused about the terminology… Is this a dose-crease? Or earned a reduction, or whatever. I hate myself that I'm not in here enough -- can't post every day.

He has shown me several times that slightly more than one unit is too much for him. I'm SURE that there have been times when I've given him right at one unit or slightly more and he has had a low (for HIM -like 150) that I didn't measure because it happened while I was sleeping…and then he has bounced from that.

He's also shown me that going up and/ or down by a quarter unit is sometimes too much and sometimes not enough. So I have been making my own way… Using calipers and making decisions using my gut and knowledge of Wynken, along with everything that I've read since he was diagnosed four years ago. Lev has been better ( more predictable) but I've been fighting either bouncing, or perhaps difficulty from this bad dental issue… Maybe a little of both.

Therefore, I'm embarrassed to say that he's not really on either protocol. Then again, I've noticed that nearly all of the kitties are on SOME variation of a protocol and not on exactly TR or SLGS. (i.e. "Do not copy dosing!")

Wynk has been on PLR (poor, loose regulation). LOL.

...Maybe that's about to change.

I just ran home on my lunch hour and he's over 400. Bummer.

Also, I never intended to change his shot time tomorrow night. I just meant that I was gonna watch the readings when I get him home and shoot him at the regular time, with his food..... which is all my schedule will allow.

I am very much looking forward to actually measuring parts of his cycle where he is *lower* than other parts of his cycle. A nadir!? Won't that be novel! It only happens occasionally, now

Thanks again. This has been so very frustrating.