3/19/12 Max +8 127 Safe Teeth Cleaning Proced.?

Hello,

Max is severely constipated. I gave him subcu fluids at 5 am, and he's well hydrated now. He is having very, very hard, almost powdery poo, and he tried to go on the couch when it hurt too much in the box. Then he wanted to go outside.

I did give him only 2u when he registered 189 BG at AMPS.

***Edit: The vet said to reduce the dose to 1u. Is that too much?***

His gums are very red. Less than a month ago he had only one red spot by an upper rear molar. Does anyone has any information about this vet/dentist? His web site states that he works on zoo animals, too.

Brook Niemiec, D.V.M
San Diego, California Veterinary Dentistry
5610 Kearny Mesa Road, Suite B1
San Diego, California 92111
phone: 858-279-2108
web: Dog Beach Dentistry

Thanks.

Link to post on Lantus (Relaxed) http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=66615

Re: 3/18/12 Max PMPS 468 +2 451 +6 312 +8 345

No idea on the vet but ouch on those numbers Max.

If you edit your original post to put the question mark in (see the post icon bit just above the subject line) then people will know you have a question,

Re: 3/18/12 Max PMPS 468 +2 451 +6 312 +8 345

good morning, dale! here's your link from yesterday

sienne has some great information on what to look for when you're getting ready to have a cat's teeth cleaned. i'll let her know you're looking for that.

you can keep editing the subject line of this post and use it for today - that'll keep all your info in one place so you can find it.

Re: 3/18/12 Max PMPS 468 +2 451 +6 312 +8 345

Thanks Julie and Vyktor's Mum! Max looks exactly like Vyktor.

Re: 3/18/12 Max PMPS 468 +2 451 +6 312 +8 345

Well clearly he is just gorgeous then I will look forward to seeing his avatar. Vyktor had a dental last month and Sienne really helped me out to make sure I had all the info I needed for that. I was trying to find that post for you but no luck :sad:

Re: ? 3/19/12 Max PMPS 468 +2 451 +6 312 +8 345 AMPS 189 ?

Hi Dale!
Glad to see you made it over here. I hope you will get the feedback and help you need.

Regarding your subject line:
If you click on your condo and hit edit for the first post, you can change it to:
3/19 Max AMPS 189
* if you have a question regarding dentals or dose you could make it look like this:
3/19 Max AMPS 189 Dental question
OR
3/19 Max AMPS 189 Dose question

Above the Subject line you will see Post Icons. Click on the circle next to the ?.

I know it sounds picky and all, but it really does make it easier for others who are glancing through to see if you need help.

Did you shoot the 189 with a full 2U? That is the lowest known BG you have shot, isnt it? Can you please try to get a +1 and/or +2 to see which direction he is heading?

If you have questions through out the day, do not hesitate to post in this 'condo'. Someone is always around. :mrgreen:

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

Carolyn,

Yes, I gave him the full 2u at the AM shot time. Yes, it is the lowest PS; was that a mistake? I will check his BG as you said. We will be at the vet at +4.5 for the red gums and the constipation issues. My regular vet isn't there, and I'm seeing yet another vet - not the one who told me to give him 1u at +6.5 and then 2u at the next shot time.

Dale

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

no, it wasn't a mistake to shoot. we just always recommend that if you shoot a number lower than you've shot before, get a +1 and +2 to make sure max isn't diving.

if the +2 is close to the preshot, that's a good indication you'll have an "uneventful" cycle.

if either the +1 or +2 is significantly lower than the preshot, it's a heads-up that you have to monitor more closely in the next hours to catch the BG if it's falling.

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

No, not necessarily a mistake. You just need to monitor, so you know and can intervene if need be. If you get a number under 50, you would want to give him a tsp or so of High Carb food, then retest in about 15 minutes. Keep doing this until you see him rise a few times (I used to aim for 3 tests rising) above 50.

Something that might be helpful for you is to bring the test kit and some food to the vet. Test before you go, once you get to the vet (optional), and when you get home. SOme cat's will go high due to stress. Others will drop. I had one who dropped from vet stress, and always had to bring karo. She was a strange one. :roll: :mrgreen: It is just good data to have, and always smart to be prepared when travelling with a diabetic cat...especially around nadir time.

I am glad you are able to get him to the vet. I noticed you gave fluids yesterday? Make sure to ask the vet when/how much you should give. Fluids can be a good tool, but you want to make sure you are doing it under the instruction of the vet.

For constipation, a lot of folks use miralax.

Let us know how the vet visit goes, or if you need anything else.

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

Hi & Welcome--Both my cats have been constipated, and both were given Miralax=1/8tsp in the food everyday!
Moonie my FD cat is still on it & is doing great in that area--You can buy it in any drug store & it is very gentle--Hope you have a good vet visit--We have a procedure for giving our FD cats a dental, I am sure you will get a post about that from Sienne...Dentals are so helpful, & do bring our kitties back to their former selves....Those bad teeth could be infected & that brings their numbers up. also the pain factor--Cats do hide their pain..
Glad you got here--Good luck with the vet.
Just tell the vet--No Metacam(some cats have had dire results), and NO Covenia shots(it's a 2 week antibiotic) also dangerous for cats!! You can give ab's by mouth like we all do...

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

The vet prescribed 100cc subcu fluids 2x a week back in early February. It was too much, and Max would fill the litter box a few hours later. So, I started doing it only when he was dehydrated - using the scruff pull up method to check him. Two days ago, Saturday, the vet told me to give 150cc. I did in the afternoon. I tried to give him 100cc at 5 am, but I'm not sure how much he got because I was doing it by myself, and I could barely see the marks on the bag. It might have been 125cc.

What are the concerns? Potassium/sodium levels, I know. It must affect the insulin delivery when he is dehydration. Does too much hydration affect it, too? If so, does anyone know how?

He is walking very poorly today, but not on his hocks. His left tends to kind of go out to the side after he puts his weight on it -- as if he is about to twist his ankle.

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

dale i don't have experience with sub-q fluids, but have heard people say several times that it can affect blood sugar and not to give it on the same side as the insulin injection.

do you have him on methyl b-12 for the neuropathy?

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

max&emmasmommie said:

The vet prescribed 100cc subcu fluids 2x a week back in early February. It was too much, and Max would fill the litter box a few hours later. So, I started doing it only when he was dehydrated - using the scruff pull up method to check him. Two days ago, Saturday, the vet told me to give 150cc. I did in the afternoon. I tried to give him 100cc at 5 am, but I'm not sure how much he got because I was doing it by myself, and I could barely see the marks on the bag. It might have been 125cc.

What are the concerns? Potassium/sodium levels, I know. It must affect the insulin delivery when he is dehydration. Does too much hydration affect it, too? If so, does anyone know how?

He is walking very poorly today, but not on his hocks. His left tends to kind of go out to the side after he puts his weight on it -- as if he is about to twist his ankle.

Click to expand...

Dale,
the vet prescribed that dose to prevent dehydration. I probably would not wait until he is dehydrated to give fluids. At that point you are having to play lots of 'catch up' to get him hydrated again. If 100 seems too much, you could talk to your vet about splitting the dose to 50ml 2x/day twice a week. Or, 50mls e/o day.

Here is a great link explaining some of your questions and concerns about subq's
http://www.felinecrf.org/subcutaneous_fluids.htm

ECID with how it affects insulin. I always gave on opposite side, and would only usually see what could have been a related drop if I gave more than 75-100mls. I usually split them into 50-75ml sessions, 2x/day.

Re: 3/19/12 Max AMPS 189 +1.5 155 +2.5 92 Dental/Constipatio

Ok. Thanks, Carolyn, and thanks for the link. His BG was at 92 at +2.5. Let's hope he levels out.

At the time the vet prescribed the subcues, I was concerned about the CRF and the effect that has on potassium levels. It seemed to me after those tests came back "ok," that he would just pee out what he didn't need as long as I didn't really overdo it. Nonetheless, you are right, by the time there is an outward sign, it's a big issue.

I give the subcues into his scruff in the center as much as possible. However, once the needle's in there, he moves, and who know where it points. I'll pay attention next time.

Julie, no I haven't picked up the B-12 yet.

Dale

Re: 3/19/12 Max AMPS 189 Dental Question/Constipation

keep testing.
You are just hitting the onset of the insulin.

I can keep poking in to check on you. Might go hop in the shower in a sec....

Please do read that link I offered in the other post. In fact, anyone who see's it...its good info on the when/how/why of giving fluids. :mrgreen:

Re: 3/19/12 Max AMPS 189 +1.5 155 +2.5 92 Dental/Constipati

and if you are still here...maybe change your original subject line to
Max AMPS 189 + 2.5- 92

More folks may see and pay attention when they see that drop.

Re: 3/19/12 Max AMPS 189 +1.5 155 +2.5 92 Dental/Constipati

I see you have a 51 @ +4.

If this were my cat a 51 is close enough to a 50 and I would not need to see him/her go down any lower. I would give a tsp of High carb food and test in 15 minutes.

I know you are juggling a new baby, too while at home. If you could post your test after giving the HC that would be great. Myself and hopefully others will be watching.

Re: 3/19/12 Max +3.75 72 Dental/Constipation

I gave him .7 mL of Karo, and then he ate his Wellness. By luck, grandma is here right now with the baby. His score 15 minutes afterward was 72.

Re: 3/19/12 Max +3.75 72 Dental/Constipation

ok, good.

How much wellness did you feed him?

I think the food you were feeding him before is High Carb. In the future, all you have to do is offer a tsp or so of that and retest. You do not want to feed a lot because IF Max were to want to stay low for too long and got full, it would be difficult to keep his numbers up with carbs. Too much food could also make him vomit. I will find the link to Janet and Binky's food chart where you can look over various medium and high carb foods to buy for the future. A lot of cats are very appreciative of the one's with gravy.

You are going to the vet soon, but you also have not hit his probable nadir. I would check again in about 15-20 minutes because the karo does not last long in the system.

Awesome that grandma is there! Im sure she is just thrilled to hang with the kiddo!

Re: 3/19/12 Max AMPS 189 +3.75 72 Dental/Constipation

He probably ate about 2 ounces of the Wellness. Thank you, Carolyn. I'll get ready for the vet now, and I'll test him right after we get there.

Re: 3/19/12 Max AMPS 189 +3.75 72 Dental/Constipation

Keep up posted.

I wont be around this evening. I would recommend putting dose advice for PM in your subject line at some point. Probably well before shot time. Max did not go UNDER 50 which is what the protocol states for a dose reduction. I suggested stopping anymore of the drop because it was so early in the cycle, and I knew you have your little one to care for. I did not want you to get caught up in something else important and find him much lower.

Good luck at the vet!

Re: 3/19/12 Max AMPS 189 +3.75 72 Dental/Constipation

The vet we saw said to reduce the dose to 1u. Max gained 4/10th of a pound since March 8th. The said to consider feeding him Hills m/d again. (He said he's had a couple of diabetic patients go into remission on Hills m/d.) I will reduce the dose, but stay with Wellness for now. He also said that I may need to try Levemir instead of Lantus.

Thanks, Carolyn. That is interesting that the protocol does not call for a dose reduction. I gave him so little Karo, and he ate his Wellness without complaint. His BG rose just 15 minutes after the 51, and continued to rise slowly except for at 5.5 when it dropped a tiny bit to 74 from 79.

He had an enema at the vet, and even afterward his BG was only 81. I think I HAVE to reduce the dose after this near hypo incident simply because we are going on vacation. The pet sitter will only be here at shot time.

He was prescribed antibiotics- Clindamycin Hydrochloride Drops for his teeth, and Lactulose for the constipation.

Re: 3/19/12 Max Nadir +6.5 74 +8 91 Reduce Dose?

My post in Lantus (Relaxed) http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=66673

Can you ask your vet to suggest something other than Lactulose? It contains sugar -- not the best choice for a diabetic. As others have mentioned, many here use Miralax. Could you ask about that as an alternative?

Good plan to stick with the Wellness. M/D is too high in carbs.

If you're home, I would not reduce Max's dose to 1.0u. That's way too much -- you're cutting the dose in half. We recommend that doses are changed in increments of 0.25u.

This is information from the vet I use on dental procedures:
Comparing vet dental services
Dental/periodontal procedures

(FWIW, you can widen the comments column so you don't have such long cells. At the top of the SS are letters above the columns. If you move the cursor to the lines separating the columns, the cursor will change to an arrow pointing either left or right. Dragging the arrow will allow you to move the line/margin of the cell and widen it.)

Re: 3/19/12 Max AMPS 189 +3.75 72 Dental/Constipation

max&emmasmommie said:

The vet we saw said to reduce the dose to 1u.

Click to expand...

I am hoping others will comment on this before your shot time tonight. Sienne mentioned how we raise/drop doses by .25u vs full units. Think about when your vet said to raise it a full unit to 3. What kind of numbers do you think Max would have had today already dropping into the 50's on 2u. Those small increments make pretty amazing differences in cats.

Max did not hypo today. You caught a low number and took action to prevent the hypo. Most vets are not used to owners being aware and taking control like you did today. It only makes sense they would suggest such a large reduction.

Now comes the question of your vacation. This is where I hope others will chime in. Some people have 'no shoot' numbers for their sitters (today would be a great example), some reduce doses...not usually by 1 u tho. It is important to come up with a plan. Sienne, I think is really good with this and hope she will tell you how she goes about it when she is out of town.

Your vet suggesting levemir over lantus is unusual, but encouraging. It could be a great option. I would wait until you get back home from your trip to do that switch if you choose to do so. Keeping the wellness is a great idea. Since you switched foods completely, just yesterday (right?) it will be important to stay on top of his numbers. This could be making all the difference in the world.

max&emmasmommie said:

Thanks, Carolyn. That is interesting that the protocol does not call for a dose reduction.

Click to expand...

I vast majority of people here would not technically consider 51 a qualifying number for dose reduction per protocol. I come from a background of not wanting a cat that low for other health reasons . We will never know for sure, but I highly suspect Max would have gone lower had you not intervened @ +3(?). It would be wonderful to hear from others about this. I think if you were home and able to monitor/test A LOT, you could stick to the 2u and hope to catch the below 50 BG. If I were in your situation, I might consider reducing...but only .25u and continue to monitor. That is just me.

Here is the TR protocol, which is followed when you can test regularly:

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

Click to expand...

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

max&emmasmommie said:

He had an enema at the vet, and even afterward his BG was only 81.
He was prescribed antibiotics- Clindamycin Hydrochloride Drops for his teeth, and Lactulose for the constipation.

Click to expand...

Poor guy. :sad: Keep monitoring his numbers. If he has an a/b that is effectively clearing an infection, his bg's will likely go down some. Regarding the lactulose...I gave this to Latte because she would not eat reliably enough to get miralax in her food. I remember investigating how it might affect BG's and most on the board, as well as the vets said it should not. I tested often to see if there was a correlation with her numbers, but no answers were revealed. Remember tho, ECID and who really knows?!?! Miralax, from what I have seen in others is much more effective and works in a way that does not pull fluids from the body to be (I sure hope I am remembering all this right! ;-) ). It is also less sticky and invasive (you are syringing syrup into his mouth?). Point being, Miralax really is a better choice overall. Give the vet a call and ask if you could switch. It is an o/c drug, so you could easily pick it up at a local store.

One last tip... a +10 or +11 is often useful information. When you test at preshot, you will then know if Max is rising or dropping. This can help you decide if it is safe to give Max his shot. Here is a link regarding shooting low(er) number:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Okay...Im about to hit the sack here. Hope you guys have a wonderful night!!

Carolyn and Everyone,

Here is my NEW post on new question: What if Sitter Can't Test? elsewhere: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=66738, There is one in the other Lantus forum, too with a link from the opposite Lantus formun.

Wow, Carolyn. That was quite a bit of info for me. Thanks! You are so helpful, and I don't know what I would have done these past few days without you. I'm make sure to pay it forward!

I'm very worried that my sitter won't be able to test him. She's coming over tonight, and I'm going to try to teach her. I hope I can figure out what dose he should have while I am gone before Friday!

Last night, we gave him 1.75u at 9 p.m. His BG shot up very high in the night, and this morning it was over 400. Very discouraging. I gave him 1.75 again this morning. I think that because I am not awake to "make his food move" he doesn't eat at night. He ate at +5.5 because I tested him and scraped his food into a mound in his bowl. This may account for the lower BG reading at AMPS. I'm going to keep testing and try to see if this could be the case. Of course, he could be bouncing yet again. Sigh . . .

Yes, Carolyn, it was at +3.5 that we got the 51, and at about 3.75 I got the 72. So even that little bit of Karo, less than 1 mL, worked fast. I suppose I didn't need to give him that with a 51, but I freaked a little bit.

He just ate at +1.25, and he wants to go outside right now, but he's dehydrated again. So, we get to have some "fun." I hate this part more than anything else. Well, I suppose the enema was the worst, but I didn't have to actually give that to him; I just consoled him.

Dale

hi dale - what you are seeing is a bounce. max isn't used to being below 100, so when he hit the 51, his body reacted by releasing stored sugars and counterregulatory hormones. that sends his BG up, as it intended to do. the consequence is what we call a bounce and it can last up to 3 days. during that time, don't worry about the higher numbers and just hold the dose the same unless you see a number less than 50. it doesn't mean this new dose isn't enough. it just means you need to wait.

regarding the petsitter - is there any possible way you can teach him/her to test before you go? even if they can't get a mid-cycle, it would be great if they could at least test before they shoot the insulin.

if not, we can go to plan B and decrease the dose. but it's much better all around if testing is possible.

you might want to update the subject line to today's date, you could also ask for advice on the dose - otherwise people won't know you have a question. to do that, go to the first post of the thread, click "edit", change the subject line and then click "submit."