Periodontal Disease

Hello,

I'd welcome some advice please. My cat Benny is currently on Prozinc Insulin. Ten days ago, we had a Fructosamine test at the vets which showed Benny's glucose reading had increased significantly from 380 to 480 which puts him in the unregulated category again (He had been regulated for 14 months). I've been advised by the vet to increase the insulin from 5 & 4.5 IU to 5.5 & 5 IU per day and for another Fructosamine test to be completed in 3 weeks time along with home testing. On the day of the Fructosamine test Benny also underwent a procedure to remove quite a few teeth due to periodontal disease. I've researched on the internet whether Periodontal disease could cause the glucose numbers to increase and the answer appeared to be yes. The vet didn't mention this to me but did mention stress could be a cause, which is possible due to a change of circumstances at home. My question is, can cats' glucose levels increase temporarily then after removal of the cause (stress, infection etc ) reduce down again or is it once they are increased it is permanent? I'm concerned that Benny is getting towards the 6 IU of insulin which I seem to recall I was told he wouldn't be able to exceed due to body weight (or have I got this wrong??). Any advice would be appreciated.

 

Oh, poor Benny!

I'm glad he's gotten that dental work, hopefully that will help his periodontal disease. The pain/stress from that kind of thing can definitely raise BG numbers and even take a cat out of remission, so it certainly could be the cause of his losing regulation.

I think I'd be most worried that at this point he might be on too high a dose of insulin, and once his mouth heals and he's feeling better he might be at risk for hypoglycemia. 5.5U is a very high dose, and while we've seen cats on much higher doses (not sure what your vet means by an upper limit based on weight, I've never heard of that), I worry that in Benny's case it was really driven by the dental problems.

I see you've gotten your spreadsheet set up, guessing you're about to start home testing? We can definitely help with that, just ask! It's going to be the best way to figure out what Benny's new insulin needs are, so well done getting started with that.

Just fyi, I notice that you have set up the spreadsheet for the AlphaTrak meter. It's a great meter and your vet will like it because that's what they use and the numbers will be comparable, but the problem is that the strips are really expensive. Most of us here use human meters for that reason-- the numbers aren't quite the same, but mostly what you need to know are the cutoff numbers for "too low" and "too high" and then just which way the cat is going, up or down, so the absolute numbers aren't that important day-to-day. If your vet is insistent, some of us have both meters, using the human meter most of the time and then doing an occasional curve with the AT for the vet .

 

EVERYONE would LOVE to use the AT meter that would be ideal but no one wants to pay the price. (unless you have an unlimited bank account)
The human ones work. In fact this whole site is developed around using human meters. How I would have loved an AT meter back when Trouble was alive but having a high paying job, still couldnt justify spending this much for test strips.

 

I'm going to bump this to get more eyes on Benny. I am still worried about this ProZinc dose... Any updates, @Julie & steve j ?

 

Yes, any inflammation or infection can increase the blood sugars. Once the infection/inflammation is dealt with, the blood sugar numbers should come down, though it could take a while. For example, if a cat had a bad tooth removed, it can take 1-2 weeks for the inflammation to go down.

As for his dose, what food is Benny eating now? Has there been any change recently? There are definitely cats that need higher doses, my girl was one of them. There is no such thing as a maximum insulin dose. A cat needs whatever they need, many conditions can contribute to needing a higher dose. Dry food/biscuits or other higher carb food also contributes to a higher dose needed.

 

Thank you so much for your replies, they are appreciated. I'm having a bit of meltdown with it all at the moment. My circumstances have changed recently and I'm looking after Benny by myself. As I explained in my earlier thread, Benny had been regulated on 5.0 (day) and 4.5 (evening) for the past 14 months. The last fructosamine test in Feb confirmed good regulation (number was 380). His fructosamine number is currently 480 (poor regulation) which was taken on the day of the day of the procedure for periodontal disease 03/08/20. The vet at the time advised raising his insulin to 5 & 5.5. Because of my circumstances (that I struggle with daily testing being on my own and that I work Mon - Thurs) I increased his insulin to 5 & 5 ten days ago. He has been very out of sorts this last week and licking his lips a lot. The weather has also been very hot. I couldn't tell if he wasn't himself due to increase in insulin, complication with teeth or hot weather. I managed to get 2 readings on the alphtrak 2 last weekend (Sat & Sun)at approx 5 hours after insulin which were 22.6 & 22.5. This weekend just gone, I got 2 readings on the same day. One after 3 hours which was 20.3 & one again after 5 hours which was 21.1. I took Benny to see a different vet yesterday to see if I could get to the bottom of his lip licking and to speak about his diabetes. He took a reading, which was 5 hours after insulin and got 11.4!!! He told me that I had done the right thing not increasing to 5.5 and I wasn't to give him any more insulin than 5.0. He also had a much more laid back view of all the numbers (Fruc test 480 & Alphatrak 22.5, 22.6 etc). I realise that I need to get as many readings as possible but am struggling on my own. Each vet appears to have a different view point which totally muddies the water. I was shown to take blood from the top of his ear but the vet yesterday took it from inside his ear. Last night, I gave myself some time off worrying and only gave him 4.0 IU followed by 5.0 this morning. I've been at home with him today and he is like the the Benny I know, happy & fussy. Because of this I'm reluctant to go back to 5 & 5 but I know it probably is necessary. He appears to be losing some weight at the moment and if it is being caused by diabetes I need to get it right. I would welcome any help or advice as trips to the vet are very costly and sometimes confusing I just want for my boy to happy and for us to enjoy each other's company.

 

Sorry, forgot to mention Benny has a dry food diet. He eats Purina diabetic biscuits along with some tuna two times a day when insulin administered. He hasn't eaten as may biscuits since his operation. The vet did confirm that his mouth is healing nicely.

 

Awwwwww
I hear ya! But without any recording of these numbers its hard to give dosing advice. It "sounds" like the current does is working BUT BUT BUT who knows where that will take him tomorrow. I DO know there will be more responses for this situation you are in so hang on for more advice

 

One of 2 tings could be happening here. Either the dry food is keeping sweet Benny from going hypo or If it were to be removed his numbers would come down DRASTICALLY. Neither are a solution to diabetes regulation. I AM NOT an expert in dosing. So PLEASE hng on for more advice.
Hopefully we'll try to get this all sorted to give you better options.
jeanne

 

I agree with Jeanne. Removing the dry food while he's healing is likely bringing his insulin needs way down. Until you get the testing up and running (some initial tips to get started below), you might want to feed him some higher-carb wet foods to try to avoid hypoglycemia (none of the numbers you report are anywhere near hypoglycemia, this is just out of an abundance of caution).

The other thing going on that is concerning is the lip-licking. It's possible this is just him re-adjusting to his new mouth , and will go away as he heals. If it seems like he's eating less now, though, you will want to investigate further to figure out whether his mouth is actually bothering him (did they take x-rays after the extractions to make sure all fragments were removed?), or if he is feeling some nausea for some reason (lip-licking is a common sign). If he's on an antibiotic after his operation, some do cause nausea.

Testing tips:

Start with the larger size lancets (26 or 28 gauge), until the ears "learn to bleed" (grow extra capillaries) and you can move to the thinner ones (30 or 31 gauge).

You can do the inside or outside of the ear, whichever is easiest for you. The main thing is to try to avoid the veins. Here's a picture of the "sweet spot" we try to aim for on the outer edge of the ear.



Apply a bit of pressure to the poke site after testing to prevent bruising, and always, always give a treat to your sweet Benny (even if the test attempt wasn't successful-- you are building positive associations!).

Let us know if you have questions! I'm also going to tag @Deb & Wink for help with the Prozinc dosing-- as Jeanne said, we don't really have a lot of data here yet, but just to get some experienced eyes on Benny.

 

Prozinc doses should be the same, both AM and PM cycles. A cycle is a 12 hour period, from one pre-shot test, feed, shoot the insulin to the next pre-shot test, feed, shoot the insulin.

I can't really make any more comments on the dosing, without seeing some BG tests.

I see that you are in the UK. Thought you might be, since you used the word "biscuits" for the dry food.
Have you seen this thread, that has links to some UK specific information, including a food chart?

• UK Diabetic Cat Food Info (includes some supplies) and UK Cat Food List

That food chart is maintained by one of our members, @Elizabeth and Bertie.
Tagging her here, in case you have some other need for UK specific information, like a good vet or where to buy some of these supplies.

My best advice? Deep breathing exercises to help relieve the stress.
You'll get there.

 

Thanks Deb! Even this is important. Hoping Julie and Steve see this.

 

Hi, regarding the fructosamine test do just be aware that, while this is a great test for diagnosing diabetes, it is of quite limited value once a cat is on insulin, and can even be misleading.
The reason for that is that a fructosamine test just gives a sort of average of blood glucose levels over the preceding couple of weeks, but it doesn't give any detail...
For a cat who's not on insulin that is extremely helpful. But...once a cat is on insulin their blood glucose may fluctuate a great deal so knowing the 'average' isn't necessarily helpful in showing us how the insulin is working in the cat's body... The numbers 'may' be relatively stable, or there could be highs and lows, but the 'average' could be the same... This is why hometesting of blood glucose is so valuable: We can see what is happening to the blood glucose in real time.

I do realise that you are having difficulty with hometesting, and I sympathise. Some kitties are certainly harder to test than others. But I wonder if we can think of ways to make testing easier for you...
How exactly are you testing at the moment, can you talk us through that..?

I've only ever tested my kitties on my own. But in fact testing alone can actually be a big advantage, because cats can get quite stressed out by two people approaching them and trying to restrain them.
And in fact cats often don't need to be restrained. Basically, all that is needed is a way to keep the cat relatively still for the few seconds or so that it takes to do the actual test. And for many cats some form of 'distraction' works well...
My first boy was strongly food motivated, so I realised that I could crumble some treats for him and quickly test him while he was hoovering up the treat crumbs.
My current girl isn't particularly food motivated (and she absolutely hated having her ears touched at first), but she does love to be brushed. So, I found I could sneak a test into the middle of a little brushing session and she barely notices the test..

With both my kitties I dedicated time to getting them used to the sensations and sounds involved in testing, and got them to associate those things with something positive, with a reward.
For example, whenever I stroked them I also gave their ears a very brief stroke/massage as well. And I'd also go to wherever they were in the house, stroke them, hold or massage an ear for a second or two, immediately reward with a treat, and then just walk away. I set out to make 'ear touching' ordinary, and nothing to worry about...
Similarly, I'd click the lancing device near them (it can be used a bit like a training clicker) or rattle the test strip vial, and then immediately give them a treat.
I'd do these kinds of things maybe 6 or 7 times a day, every day, for at least a couple of weeks. It only takes a minute or two, only a few seconds sometimes. But it's the repetition that is key to success; repetition, repetition, repetition... Before long, I could touch the cats' ears without them reacting to that at all, and when they heard the sounds of the lancing device clicking, or the test strip vial rattling, they came to expect that they would soon get a treat...

It's also often helpful to test in the same place initially so as to establish a routine. I tested my first diabetic on a table top. So, at times when I wasn't testing him I'd just pop him on the table and give him a couple of treats and lots of praise. My current girl has a favourite armchair, so I get her to the armchair and give her a little brushing, and then a treat. It's helpful to make these places 'happy places' where nice things happen.
If you can get your kitty to your test spot, hold or massage an ear for just a second or two, and then give treats and praise, you really are most of the way to being able to test on a regular basis, and in a way that isn't stressful for human or kitty.