The Emergency Room

I’m stepping back in time a bit to tie up some loose ends. Back on November 17 I started a post by saying that Isabella was sick and I was waiting for the vet to call, but I never reported the outcome.

At the time, I didn’t write about it because I was upset and worried. As days and weeks passed and everything returned to normal, I let it go. So, six weeks late, here’s Isabella’s story from November 17th:

The beginning is actually two days earlier. I took Isabella to her vet for a checkup. I thought she was losing weight in spite of a decent appetite. Her checkup was fine. She had lost about half a pound since her previous visit, but the vet and I decided that it was likely due to opportunistic food thievery by Casey (who was gaining weight as quickly as Isabella lost it.) We assumed that Isabella’s teeth bothered her, so she ate slowly, allowing Casey to steal her food, leading to one fat cat and one skinny cat. I scheduled an appointment for a dental.

Two nights later she threw up twice, then let me sleep late in the morning instead of standing on my head demanding her 6am meal. Unusual, but Isabella enthusiastically gobbled up her breakfast, so I mentally shrugged and went about the day. Until she puked up every bit of the morning meal. And then some water. And sat like a meatloaf with dull eyes. Even a thick-headed dolt like me could tell something was wrong, hence the call to the vet.

That was my first mistake. Not making the call, but waiting for a call back. A call that didn’t come until hours later. By 3pm Isabella looked like death warmed over and the regular vet’s office was closed for the weekend, leaving me no option but to take her to the emergency vet clinic.

The animal ER shares parallels with those in human hospitals: They are slow. Slow. Slow. There are families there who are living through a tragedy. The phone rings incessantly. People are grumpy. These things I understood as soon as I walked in.

I explained the problem to the intake person (inappetant, lethargic, diabetic cat; history of vomiting). She wanted to take Isabella for a blood glucose test, but I had just done one, so the kitty stayed with me, in her carrier. That’s probably the only thing I did right, keeping her with me while we waited.

The wait stretched to an hour, then were escorted to an exam room where we waited another half hour. At last, a tech came in and took Isabella’s vitals and asked the pertinent questions. I should say up front that I was pretty sure that she was having an attack of pancreatitis. The symptoms matched and it’s a common ailment for diabetic cats. So when the vet came in, did his exam and laid out the tests (blood test, pancreatitis test) and therapies (fluids, meds for nausea) he had in mind, I agreed to the plan. I left Isabella in their care for three hours while they did what needed to be done.

When she was ready to come home, I went back … and waited an hour before my credit card was billed and Isabella was brought to me.

That’s when I knew that I would never, ever come back to the emergency vet unless it was life or death. Isabella was completely, utterly freaked out. She was in a state that I’d never seen – not after any trip to the vet, or being spayed, or her cancer surgery. Wild eyes, panting, just this close to going over the edge. I don’t know what went on while I was gone, but it surely upset my little cat, and that upset me.

She did calm down when we got home. And she ate, without throwing up. Over the next couple days she perked up and everything went back to normal, meaning no more late sleeps for me, because Isabella is again on my head every morning begging for breakfast.

Reading back over my blog entries leading up to that day, I can see the trail of warning flags. I mentioned several times that she let me sleep late, or that Isabella had thrown up, or that I felt like things were just not right. Now that I’m more aware of the subtle signs I can watch for them and dose her up with Pepcid. Or get her in to see the regular vet – never again waiting until after hours for a call back.

The ER vet, by the way, did not have a diagnosis. The test for pancreatitis came back negative… but that was probably because he used a test developed for dogs. I got my money back for that one.

Just don’t tell ‘em it’s a cat

I just had my first experience with diabetes customer service.

Isabella’s blood tests have been really flat today. This-can’t-possibly-be-right flat. Her first test this morning was 279.
Followed five hours later with 271.
A couple hours after that? 283.
And just now: 283. Again.

I’ve seen her numbers stay flat before, but really, this was crazy. So out came the control solution to test the meter and the strips … and Bingo! Slightly out of range – the test number was too low. Then I realized that the solution had been opened far, far longer than its 90 day shelf life, so I rummaged around in my supply box and found a new bottle of control. Another test – and the new result was also out of range, this time too high.

Sigh. The control solution was not expired. The strips were not expired. The meter has new batteries. What the heck is going on??

Abbott Diabetes Care, the makers of my beloved Freestyle Flash, promises 24 hour customer service. I decided to call, vowing to answer only the questions asked without volunteering anything extra.

The first surprise is that I’m in their database. When, exactly, did that happen? They knew my phone number, address, even the serial number of my meter. Ohhh-kay. In the back of my mind I’m wondering if I’ve filled something out saying that I use the meter, or would I have said a family member? Don’t ask, don’t tell. Just stick to today’s situation.

I explain about my out-of-range tests. I tell Barbara, the nice gal on the phone, that I just opened a new control. I give her lot numbers for the strips and for the control solution. I answer her questions.

Did I shake the control vigorously before each test? I say: yes. I think: gosh, I don’t know, and shake the bottle vigorously (better late than never).

Would I run another test, please?

Of course. I laugh and say, it’s been high, it’s been low, do you want to bet that this one is in range?? (Ahem, now that the bottle is shaken.) Test number three was in range.

Wee!

It could be just about anything, Barbara says. Did you discard the first drop of control before you ran the tests?

I say: yes. I think: uh, probably not.

Shoot, says Barbara. We can’t tell if your meter is messed up, or the strips, or the solution. (I think: or it could be operator error…) I can send you a new meter and more strips. And replace your control. How many strips do you have?

I’ve prepared for this question. I tell her there are about 25 left in the vial I’m using, plus I have an unopened box of 50 from the same lot number. (Cha ching! New strips! For free!)

Barbara tells me that a meter, 100 strips, and new control solution will be sent out FedEx overnight. Except that with tomorrow being Sunday, and Tuesday being Christmas, I won’t see my bounty until Wednesday. I assure her that I’ll survive, and start to rise from my chair for the happy dance.

Her next words slap me right back down on my butt.

We’ll include a prepaid envelope for you to return that possibly-wonky meter and the possibly-wonky strips.

I say: OK, great. (Dang, I still woulda used those unopened 50… ) We wish each other the merriest of holidays and hang up.

So I’m not hitting the test strip Lotto after all. Odds are that Isabella’s numbers really are just as flat as the pre-Columbus earth, but I guess it’s better safe than sorry. I’ll crack open a new vial of strips from a different lot and send the probably-not-wonky strips back to Abbott, along with the meter. I’ll be sort of sad to see the meter go, since it’s the one we started this crazy trip with. It’s just a little piece of electronics, but I feel rather attached to it.

I now also know some of the questions customer service asks when there is a possible problem. It’s good that they don’t question the species using the meter, because somehow I don’t think Barbara would have ordered an overnight shipment of new supplies if she knew it was for my cat.

The Cat and the Christmas Party: a Limerick

I had a holiday party for some friends last Sunday. It went down something like this:

My cat, who likes things her own way
Watched my gathering friends with dismay
The hell with good cheer
I don't want you here
So she blocked the route to the buffet

Alright, the poem might be a slight exaggeration, but it’s pretty close. Isabella employed a several Mean Cat battle tactics during my holiday shindig. She started with some impressive stealth attacks from beneath the tablecloth-draped buffet. When that failed to deter my guests, she retreated to the laundry room and pulled few more weapons from her kitty armament: Mean Looks, Scary Growls, and Menacing Hisses. No one needed to go into the laundry room anyway, so this battle station served her well for quite a while.

After a time though, battle weary and overwhelmed by the increasing numbers of the enemy, Isabella was granted an armed escort (my arms) to Headquarters (the bedroom) where she was able to rest, watch the movements of the enemy, and hide under the bed as needed.

Isabella waited patiently until she sensed that the enemy was growing tired and perhaps a little drunk. Then, a second assault was staged from the back of the house. Some guests were challenged as they approached the bathroom (a tricky tactic indeed), others were verbally assaulted in the kitchen itself. As the evening grew long, Mean Kitty became bolder, to the point of smacking at anyone who dared cross her path.

In the end, Isabella triumphantly saw the last guest retreat from the battlefield and the house was once again, under her complete control.

None of this behavior has any direct relation to diabetes, she’s always been unwelcoming to guests. I do admit she has gotten somewhat worse in the past few years – more directly confrontational (ask my sister about that!). In the end, the party had very little effect on her blood sugar. Sometimes I think that terrorizing people is Isabella’s idea of a good time.

What’s on??

In my blog index, a section only I, as the blog owner, can see, are several “draft” posts. Most are just a title, something to remind me of an idea for a possible entry. Place holders of sorts. One of these draft entries says just “TV Guide.” It’s been sitting there for months, taunting me, challenging me to flesh it out. The idea – which seemed so fruitful when I saved it into the index – is to take the bits and pieces of my cat-related activities and distill them resemble television listings.

Today, for some reason, the post finally took shape. Somehow I managed to transform my mundane life into talk shows, comedy, drama, and even a little education. Cable channels, broadcast channels and community access – my “TV life” has it all. So sit down, grab your remote, and choose a show.


6am (NBC) Today: Segments include: using a cat as a substitute alarm clock and scheduling your morning routine to include pet care. Guest Dr. Phil gives tips on shaking off early morning surprises and moving on with your day.

10am (Animal Planet) Cats! Cats! Cats!: Blending up a healthful raw diet for felines and a review of species-appropriate canned food options.

11am (Community College Channel) Accounting 12A: Saving for unexpected expenses.

1pm (Community College Channel): English 4B: Creative writing for bloggers.

2pm (FOX) Montel: Therapists stage an intervention to help a guest with double addictions: repeatedly testing her diabetic cat’s blood sugar levels and drinking Irish Cream.

3pm (NBC) Ellen: How to choose a pet sitter for special-needs animals. Special guests: the Broadway cast of Cats!

8pm (NBC): The Office: The office is thrown into turmoil when internet access crashes due to Angela’s excessive posting to an online bulletin board for diabetic cat owners.

8:30 (CBS): Survivor: China: Survivors are challenged to restrain and test a hungry, grumpy diabetic cat. Winners receive dried tuna flakes.

9pm (ABC) ER: A pancreatitis attack threatens the health of a cranky middle-aged patient. A family member holds ER staff hostage after receiving a shocking bill for services.

10pm (FOX) 24: The drama continues as Jack runs an overnight blood glucose curve.

11:30pm (NBC) Tonight Show: In his monologue, Jay pokes fun at the lengths some cat owners are willing to go to for their pets. Guests include feline diabetes specialist, veterinarian Lisa Pierson.

Hometesting Lesson

A couple days ago, I met Mike, Jennifer, and their newly-diagnosed diabetic kitty Max. Max had a very rough introduction to diabetes – swinging from ketoacidosis (a life-threatening side-effect of uncontrolled high blood sugar) to hypoglycemia (complete with seizures) in the course of one week. If anyone needed to learn how to test their cat’s blood sugar – and pronto – it was these guys.

When Mike first posted on FDMB, members asked, as they usually do, where he lived. That turned out to be about 10 miles from me, so I got in touch with him and offered to come to his house with a meter kit and teach him how to perforate his cat. I still have a robust collection of meters at the ready, and I’ve poked thousands of holes in my own cat, apparently all the qualifications needed for this educational project.

We scheduled a time, I gathered the supplies, and set out. I did ask about Max’s personality – if he was anything like Isabella, I’d bring protective gear – but Mike assured me he was a sweetie.

And he was. A cute black & white long-haired model, Max was skinny, but seemed none the worse for wear after his ordeal. I introduced him to bonito flakes (on the advice of others on FDMB: make friends with cat before poking) and chatted with Mike and Jennifer about the general routine that I use to test Isabella. After we practiced using the meter on Mike (blood glucose: 99) we assembled supplies in the kitchen and got ready.

I held the wee Max in my lap and poked. Three heads bent close to inspect his ear. Nothing. (Max was completely cooperative.) Mike suggested testing the inner, un-furry side of the ear, and lifted the cat into his own lap.

Poke. Inspect. Ah! A little blood appeared and was sucked up into the test strip, but it wasn’t enough. Quick! Poke again! A bigger bead this time, enough to start the meter on its countdown.

The results of Max’s first test? Blood glucose: 59

OK then! Good thing I stopped by. Jennifer was set to give Max another dose of insulin in about an hour. With a glucose of 59, more insulin probably would have landed Max in the emergency room with his third hypo of the week. I talked to them about the importance of testing before every shot and having a “don’t shoot below” threshold. For instance, if Isabella’s blood sugar tests below 150 or so (a rare event, indeed), I don’t give her insulin. I wait until it’s high enough to justify an injection. They needed a similar plan to give themselves a cushion. They also probably needed to reduce Max’s dose, since he was still pretty low many hours past his last dose.

It’s a lot to take in when you’re new at the diabetes game. It’s even harder when the only message you’ve gotten from the vet is about the importance of sticking to a 12-hour injection schedule and always giving a consistent dose. Here I was, a total stranger, telling them that the meter trumped the vet, and they should listen to me. I think they understood. I hope so.

After I left, I remembered lots of things I forgot to tell them:
~ to give Max a treat after the test (the 59 completely distracted me!)
~ to apply pressure to Max’s ear for a few seconds to reduce bruising
~ that one day, sooner or later, they’d hit the vein and be wiping blood off the walls, cabinets, and floor. (They’ll figure out the importance of applying pressure when the cat is bleeding all over, that’s for sure!)

Then there was the stuff I deliberately didn’t mention:
~how my cat used to scream when I tested, I was so bad at it
~that I wore long pants, long sleeves, and leather gloves to avoid being maimed
~that I used to have to encase my cat in a blanket to get the deed done at all
That’s not the sort of information that builds confidence in the teacher, you know what I mean?

I haven’t heard from Mike or Jennifer since the lesson. Hopefully they’re using the new tools and Max is going great. Hopefully their vet agreed with a lower dose when they reported the 59. Hopefully, hopefully.

I just have to accept that I did the best I could.

Apologies

I want to apologize to all the spouses, roommates, brothers, sisters, and children of anyone who reads this blog and who has had to endure the singing of O Pancreas, over and over and over, for the past week.

Apparently, once the song gets in your head, it stays. And it has to be sung. Repeatedly.

Just ask my cats. Or poor Wally, in Minnesota who has listened to Dan.

I'm sorry. Really. But the damage is done and I can't take it back now.

A Christmas Carol

Thanksgiving is barely past, but we are skidding headlong into the Christmas season. So don’t blame me if I get a carol or two rattling around in my head. And, please, don’t blame me if, while I’m swimming, I start to change the words and make a carol about my favorite subject, the object of obsession, the source of great fascination and frustration… my cat’s pancreas.

It’s a completely normal and natural thing.

And so, with great pride and confidence that I am not, in fact, crazy, I present the song I hatched during tonight’s workout.

(To be sung lovingly and loudly to the tune of O Tannenbaum.)

O Pancreas

O pancreas, O pancreas,
Why did you have to leave us?
Since you’ve been gone we now rely,
On insulin called PZI
O pancreas, O pancreas,
Why did you have to leave us?

O pancreas, O pancreas,
Sometimes you rear your head
And when you do, blood glucose drops,
So I give food to make it stop
O pancreas, O pancreas,
Sometimes you rear your head

Try TID, try BID
Or change the dose, no guarantees
Tomorrow morn, she could be high
Or might be low, I can’t deny
That even now I have no clue
From day to day just what she’ll do

O pancreas, O pancreas,
Why did you have to leave us?

Statistical Obsession

I’m sitting here on a Saturday morning waiting for the vet to call me back. Isabella started vomiting last night and is really not well at the moment. So while I wait (and hope that it’s just a passing intestinal bug) I’ll document my growing obsession with my blog statistics.

Let me be frank: this blog is not exactly setting the world on fire. In fact, I’d like to thank everyone who reads it – the number may run as high as a half dozen. You all must be very optimistic that someday I’ll put something here that actually worth reading. It’s good to have hope.

While you’re hoping, let me tell you about my sad, sad fixation. I’ve signed up with a free statistical website called Site Meter. By putting a little bit of code in the blog layout, I allow Site Meter to monitor who’s coming to read, how long they hang around, how many and which pages they look at, etc.

So far, there have been 383 visits to my blog. Now, I know you’re thinking Yeah, and 350 of them are you, but I assure you, I’ve trained Site Meter to ignore me. It’s only watching you.

The longest visit was almost two hours. I feel pretty confident that was someone who clicked on the blog and then was rushed to the emergency room or something before they could click away. Even I realize that there’s not two hours worth of material here.

The vast majority of the visits log this duration: 0:00

That’s right. Not even one second. I never dreamed it was possible to click away that fast. But the folks who find this blog – well they manage it. Repeatedly. Ouch.

My favorite feature is the one that tells how the visitor found my site. Most of them say “unkown,” but now and then Site Meter admits that the blog appeared in a list of Google search results. My favorite search so far is this:

diabetic cat cranky

If that doesn’t exactly describe Isabella, I don’t know what would. And somehow it’s comforting to know that somewhere out there is someone else with a cranky diabetic cat, and that person found this blog to be worthy of 51 seconds of their time.

People with puking diabetic cats have been directed here by Google more than once. And now that I’ve used both “puke” and “vomit” in this entry, I’m sure that more will stop by in the future. Welcome!

Site Meter does more too, but I don’t want to freak you out. Rest assured, it’s not giving out your name or your email or anything. But it gives me enough stuff to simultaneously satisfy my voyeuristic needs and make me feel like a loser. Because let’s face it: visit durations of 0:00 are not exactly a raving endorsement.

Don’t Worry, Be Happy

We experience moments absolutely free from worry. These brief respites are called panic. ~Cullen Hightower

That quote sums up life with a diabetic cat. My life, anyway. Could be that I’m an anal-retentive control freak worry wart, or maybe all people with diabetic cats feel this way. The point is, I worry. At the beginning, it was constant. Now, a year into this adventure, the worry is toned down and yet always ready to spring forth in the form of panic at the slightest provocation.

For example: A couple months ago I was listening to the keynote speaker at a writers’ conference when a cell phone rang. It was my phone’s ringtone and it was about 6pm – the time I imagine the pet sitter will be checking in on the cats. In the two seconds it took to realize it wasn’t my phone, my level of anxiety skyrocketed from “bored” to “aneurysm,” completely mystifying my sister in law, who, I’m sure, has never seen such a reaction to a phone ringing.

Another example: This morning Casey woke me begging for breakfast. My sleepy brain spit out a few bits of reality:

1) it was Casey begging, not the gluttonous Isabella;
2) Isabella wasn’t on the bed like she usually is;
3) it was 6:15 – a full fifteen minutes late.

That last bit jolted me fully awake. Isabella’s internal time mechanism operates with a precision that rivals an atomic clock and she wants her meals served on schedule. This, coupled with the fact that I was expecting her blood sugar to be running lower than normal – well the picture my imagination painted wasn’t pretty. I shot out of bed and down the hall, veered into the living room and flipped on the light. No cat. (Except Casey, still begging.) Full panic now. “Where’s Isabella??!” I asked out loud, sort of high pitched and gulpy, conjuring images of seizures and a foaming mouth. I circled around to the kitchen, where Isabella was sprawled on the rug in front of the sink. Relaxed. She hopped up at the sight of me, stretched and sauntered to her bowl. Fine, not foaming. Elapsed time since Casey woke me: 15 seconds. Years taken off my life: at least six.

Yes, this is what it’s like with the worry toned down. You don’t want to know what a wreck I was the first few months. Really, you don’t.

Home Sweet Home

I just got back from a trip to the big apple. NYC. The most awesome place on earth. There was no point to the trip besides the fact that Virgin America had an airfare (San Francisco to JFK) that was too amazing to pass up. Never mind the million and one things I could do to improve my house (or my cat), I spent the money on a random trip to New York.

It was a short trip – only four days – but it was the sixth trip I’ve taken this year, and this one seemed harder on the cats than the others.

When I got home last night at two minutes to midnight, both of the cats’ bowls were full of food. Odd. Isabella and Casey are normally pretty enthusiastic eaters – Isabella in particular – and yet here were two bowls that seemed barely touched. A note from the sitter mentioned that she was concerned too; Casey hadn’t eaten his last three meals (which meant the fourth was rotting in the bowl). But both cats seemed basically OK so I decided the problem could wait until I had some sleep.

In my own cozy bed. With my cozy cat curled up next to me. Until …

Have you ever been awakened by the sound of a cat erupting? It’s not good. Isabella spewed the little she had eaten in no fewer than three places, including over the edge of the bed onto the floor (splash!). That woke me enough to a) wipe floor, b) peel the comforter out of the now-barfy cover, and c) add another problem to the list of things that I’d deal with after I had some sleep – now curled up tight in a little chilly ball in my no longer cozy comforter-less bed.

This morning I got Casey to eat with a bit of encouragement, tested Isabella’s blood sugar (it was not great but not awful), and started some laundry (bye-bye-barf), which took care of the obvious problems. But I’ve got the nagging feeling that all is not well with Isabella. She seems a little off, sort of depressed -- which means the next trip I take is probably going to be to the vet.

A Letter to Isabella's Pancreas

This is a post I wrote on the Feline Diabetes Message Board a few months ago. Since I'm in a creative drought I'm re-posting it here - with a nod to Kerri at Six Until Me, whom I stole the idea from in the first place.

To Isabella’s Pancreas:

I just wanted to introduce myself. I’m the person who’s taken over for you since you decided to put your feet up and take a break. Now, I realize that a pancreas is busy. You have lots to do – what with secreting digestive enzymes, producing insulin, and heaven knows what else. And I have to thank you for keeping up that digestive work. Good going! But you’ve completely quit the insulin business, and this has caused both me and Isabella quite a lot of distress.

I know you’re not completely to blame. I admit my role in this. I took you for granted. I abused you. All I gave you to work with for the better part of 11 years was high carbohydrate dry food. I apologize – I really do. I didn’t know any better and I’m sure you got exhausted trying to keep up. I didn’t mean to wear you out and I promise – promise! – you will never again see more carbs than you can handle. I’ve learned my lesson. From now on I’ll treat you with the respect you deserve.

Because I know you’re in there. I see signs from time to time that you’re putting out a little insulin on your own. Do you do it to toy with me? Is it payback for all those years of kibble? Or are you really trying to get back on the job, but still need a little help? If you just need a boost, I'm here for you! (You have to admit I’ve done your job quite handily for the last year. And just look how perky Isabella feels.) I'm willing to work with you on this and I think we can get back to how things were. But better! All low carb, no kibble. And I’ll never take you for granted again.

Please, just tell me it’s not over.

Signed,
Your Stand-In
Nancy

PS: as a side note, since when is it OK to quit part of your job? Do you think I can go to work one day and just announce to my boss that I’ll no longer be responsible for half my duties so she should hire outside help? I’m thinking no. If I did that, well, we could all just kiss that expensive PZI goodbye and then you’d be out of your whole job, my friend. Give that some thought

Snooze

My father asked me to drive him to the airport earlier this week. No problem, I assured him, what time?? He hemmed and hawed. Well, the flight leaves at 8:30 … how about 6:15? In the morning? Yep, 6:15 am. No problem, I still assured him, knowing that my cat demands her breakfast at six sharp. I’ll be up already.

So we agreed, he would come to my place at 6:15 (I live closer to the airport), leave his car there, and I’d drive him to catch is flight. No problem.

Travel day arrives and I’m awakened, not by the alarm (which I’d forgotten to set), not by Isabella, who for the first time in her gluttonish existence, was content to wait for me to wake up to get her meal, but by my poor Dad, knocking loudly and ringing my doorbell. Oops.

In my defense, he arrived early – it was only 6:03. But still, I swear Isabella was sitting on the bed laughing at me. That’ll teach me to depend on a cat as a backup alarm.

I say Glucose, You say Glucosa

I spent the past weekend on a 3-night cruise to Ensendada, Mexico. My cousin organized the trip in honor of her youngest son’s 21st birthday, and my sister and I basically invited ourselves along. (The birthday boy and I do share the same birthday though, so I figure that lent some legitimacy to horning in on his celebration.)

I lined up the pet sitter, packed way too many clothes for three days, and set off for the pier, leaving feline diabetes behind for a few days.

Well, almost…

You see, one feature of Ensenada is pharmacies. Farmacia. They are everywhere, as prevalent as ABC stores in Hawaii or Duane-Reade in New York. Big signs proclaim ready access to antibiotics, geriatrics, and Viagra. No prescription necessary, just some dollars. If somehow you manage to miss the signs, there are helpful young men outside promising that you can find “everything” in their particular farmacia. Just step inside!

Since my sister, her husband, and I had some time to kill after an ATV tour of Ensenada’s dusty outskirts we wandered the main drag in town where it dawned on me: Maybe those pricey test strips would be cheaper south of the border. We stepped into the first farmacia.

Now, I don’t speak much Spanish (full disclosure: I don’t speak any Spanish) but here in Ensenada, where cruise ships full of Americans arrive on a daily basis, the locals make a point of speaking English. So, in this farmacia I asked for blood glucose test strips. In return I got a blank look, along with a pen and paper, where I wrote

Blood glucose test strips “Freestyle”

Ah! Glucosa!

Si, I replied.

“No, no.” said the pharmacy clerk, “Go to Farmacia del Sol, across the street.”

“Muchas gracias”

My sister spotted Farmacia del Sol on the far side of the busy boulevard, but we were headed to the shopping district, populated with dozens of other pharmacies, so we turned in the opposite direction.

Two or three pharmacies later, I was convinced that Mexican diabetics must somehow manage without testing, because none of the pharmacies carried test strips. One man assured me it would be very difficult to find them. In the fifth pharmacy (yes, my sister and her husband are very patient with me) I asked “But, what do diabetics do??” And I was told to go to Farmacia del Sol. They were guaranteed to have what I wanted. In the meantime, did I need any antibiotics?

Since it was on the way back to the ship, we did, in fact, stop in Farmacia del Sol. And there, in a glass case, was a display of One Touch Ultra meters and test strips, along with one box of Ascensia Contour strips. No Freestyle – but if you recall, my horde of meters includes several One Touch Ultra Minis. For the right price, I’d ditch the Freestyle in a heartbeat.

When it was finally my turn (after a fellow cruise passenger got her hands on some discount birth control pills) I found they had no Freestyle strips. The price of the OneTouch strips?? About $55 for 50. Yikes! The meter companies obviously have no problem using their greedy tactics beyond the US borders. No Mexican test strips for me.

But I didn’t come home empty-handed: I veered from my test strip quest long enough to bargain a street vendor down to $15 for two pairs of silver earrings.

One year of diabetes --- by the numbers

Today marks the one year anniversary of Isabella’s diabetes diagnosis. We’ve gone through a lot in the past year, that cat and I. She has shown enormous patience and adaptability (plus a good measure of her usual snarkiness) and I have learned to let go of the idea that I can bend this disease (or this cat) to my will.

The past year breaks down like this:

739 injections (plus 16 more from the pet sitter). Miraculously, I’ve only been bitten a couple times – when I tried to shoot without having Isabella’s face firmly planted in a food bowl. Every once in a while I forget who I’m dealing with, but she reminds me.

773 blood glucose tests (requiring far more ear pokes!). Oh, the horrors Isabella endured. One day I chased her frantically around the house with a lancet and the meter. If anyone had witnessed that, the cat would have been removed from my care and I would be under psychiatric observation.

3 vials of insulin (we’re working on number four). The first one cost $150. The second and third, about $100 each. Number four? $41. Yippee!

2 fur shots. That’s not bad, actually. Shots, I can handle. It’s all the other stuff that’s a crap shoot.

Highest blood sugar reading: 487 (July 19th). That’s even higher than the vet’s reading when she was diagnosed. I’m doing a great job, aren’t I??

Lowest: 38 (September 3rd). Isabella does this just to show she can. Or to highlight my incompetence, one or the other.

6 vet appointments. I’ve already tallied up those costs. Let’s not revisit that just now.

2 vets. The first one, I firmly believe, thinks I’m a complete nut case. The current vet may share that opinion, but she hides it better.

1000+ cans of cat food (for both cats). How many of you carry a teeny, tiny shortened version of Janet’s food list with you at all times? I deleted the brands that cost too much and the varieties too high in carbs, eliminated extraneous columns, printed the resulting much-smaller list doubled-sided, and shrunk it down so it fits in my wallet. You’ve all done that, right? It’s not just me?

1 time Isabella yanked the strip out of the meter with her teeth. Now I can say for sure that kitty saliva on a test strip causes an error message on the meter. I’m going to start charging her for the strips when she pulls stunts that wreck a test strip. It’s coming out of her college fund.

One year. In the early days I was convinced I could get Isabella regulated and off insulin. Now I’m only convinced that I don’t know what I’m doing. Sometimes I’m discouraged, sometimes realistic, sometimes resigned. A month ago my cousin asked Isabella’s age. When I told him twelve, he replied “She could live for years.”

If I do my kitty pancreas routine adequately, she will. Yep, she will.

Let’s play … JEOPARDY!

What has Isabella’s diabetes done for me lately? Well, it’s turned me into a cesspool of trivia, for one thing. I can spout off facts about things most people never give any thought to. Useful? Maybe not. But in my fantasy life, all that minutia could translate into big bucks, given the right situation.

Such as … say, an appearance on a certain game show?

(Cue theme music.)

Alex Trebec: Good morning. Today’s contestants are a homemaker from Memphis, Tennessee, a writer from Chicago, Illinois, and the owner of a diabetic cat, from San Jose, California. Welcome everyone. Now, let’s play JEOPARDY. Writer will start us off.

Writer: I’d like “Pancreas Facts” for $100

Alex: The answer is: “The hormone that lowers blood sugar levels.” Cat Owner?

Cat Owner: What is insulin?

Alex: Correct for $100. Your choice of category?

Cat Owner: I’ll take “Neurology” for $400.

Alex: The answer is: “The neurologically-active form of a common vitamin, sometimes used in mega-doses to treat neuropathy.” Cat Owner, you’re first on the buzzer.

Cat Owner: What is Methyl B-12?

Alex: That’s right! You’ve got $500 and you can choose the next category.

Cat Owner: OK, let’s try “Diet Fads” for $500

Alex: The answer is “This popular low-carb diet has been adapted as a species-appropriate diet for felines.” Homemaker, you’re first.

Homemaker: What is The Zone?

Alex: Nooo, I’m sorry. You’ve moved into negative territory. Cat Owner?

Cat Owner: What is Atkins, or “catkins?”

Alex: Right again! You’re firmly in the lead with $1000. And we have time for one more question. Cat Owner, the category, please.

Cat Owner: Let’s go back to “Pancreas Facts” for $500

Alex: And it’s a Daily Double. Cat Owner, you can wager up to $1000.

Cat Owner: Let’s make it a true Daily Double, Alex. I’ll bet the whole $1000.

Alex: And the answer is: “These clusters of cells scattered throughout the pancreas are responsible for the organ’s endocrine functions.”

Cat Owner: What are … Islets of Langerhans?

Alex: Correct! Congratulations, Cat Owner. Your winning total is $2000 and you’ll be invited back for our Tournament of Champions in the spring. Writer, Homemaker, you had a formidable opponent today, and I thank you for playing.

(Camera fades as musical theme plays.)

How do you define “others?”

I got a consumer survey in the mail yesterday. I’m a sucker for surveys. Those guys call on the phone? I’ll talk to them. Survey in the mail? I’ll complete it and return it. I’m the perfect target for marketing people who want data.

I opened the survey and searched carefully though all the bits of paper in the envelope, Sometimes there’s cash in there, as an incentive. No greenbacks in this one, just vague promises of “valuable coupons” and a chance to win $500. I know it’s dodgy, but like I said, I’m a sucker for this stuff.

Settling in at the kitchen table, I spread the survey form open in front of me. Then, damn it, went in search of my reading glasses. OK. They want to know if I buy various types of products (Air freshener? Denture cream?) and how often. Sometimes, the folks behind this want to know about specific brands. All in all, it’s a bunch of check boxes and not too much strain on my brain. I grab a pen.

Isabella, sensing that my attention had shifted away from her, hopped up on the table to rectify that. She laid full out on the survey. Purrs. Head butts. Annoyance! I worked around her as best I could until even she didn’t care what I paid attention to and she left.

Oh – look there! Does anyone in the household suffer from diabetes? There’s a column for “you” and a column for “others in house.” I check “others.” What type of diabetes? Well, Isabella is probably Type II, but if I’m going to get coupons in the mail, I don’t want them to be for stuff like glipizide, so I check Type I. I indicate that she takes insulin “2 or more times per day” and uses a meter “Other” than AccuCheck or OneTouch. Sweet. Bring on the money-saving coupons! How about a lifetime supply of strips? Oh yeah, I’d switch meter brands in a heartbeat for a lifetime supply of strips.

Finishing up, I fill out a bit of demographic information. I’m single, no kids, and I live alone. Uh oh. Do you suppose the folks at Survey Central will notice the discrepancy? I live alone, and yet “others” have diabetes. Can’t go back and change it, I used a pen. Next question: Do I have pets? Ah! Yes, indeed. I check “cat” confident that if I’m ever called before the Survey Ethics Committee I can point out that my cat is an “other” in my household.

Done. I seal the survey in the return envelope and put it out for the morning mail. Now I’m just hoping for some free strips.

Nagged into action

My cat is a nag.

I’m sure most cats are nags. Wanting to go out. Wanting to get fed. Wanting a belly rub. Isabella is a nag in those ways (except the belly rubs; she’ll take you out if you touch her belly. Casey is the belly-rub beggar around here.) and in one other way: she nags at me for her tests and shots.

The routine is to feed, then test and give insulin in the morning before work and in the afternoon when I get home. In the morning (after I’ve been nagged out of bed) I shower while the cats are eating. By the time I’m done, they’re done and Isabella is ready. Since I’ve got to go to work, I stay pretty much on schedule.

In the afternoon, though, I have to entertain myself while the cats eat. I open the mail, check email, change clothes, and lots of times I get distracted and delayed. Delays annoy my cat.

Yesterday I poked about doing this and that, then used the bathroom. As I sat on the toilet, Isabella came in and gave me a look. No noise, no meows, just a look. She conveyed her displeasure with my dawdling as effectively as a pointed glance at a wristwatch. Never mind the hundred times I’ve waited to test her while she cleaned her butt; heaven forbid I should clean my own.

Things being what they are, I apologized to Isabella and hurried to get the testing supplies and insulin ready.

She’s scary when she’s annoyed.

Diabetes Resume

I’ll bet you never realized caring for a diabetic cat has the same resume-building potential of a grad school education. Well, think about it. There are myriad high-level skills required to keep a furry diabetic going from day to day, and every one of them can be translated into a well-paying job. Just look at this list:

Budget Management: Isabella’s diagnosis meant all sorts of new entries on the Expense side of the household balance sheet, without corresponding increases on the Income side. One year later, I’ve still got the house, the creditors aren’t calling, and both cats are thriving. Is it such a stretch to think this sort of budgetary finesse could be applied to a job as the budget manager for, say, a small city or a Fortune 500 company?
Potential Salary: in 2006, the Budget Director for the City of San Jose earned just shy of $197,000.

Data Management and Interpretation: You’ve read about my spreadsheets. All those numbers and trends play a large part in the day-to-day decision making involved in feline diabetes care. Who else uses numbers and trends for daily decisions? That’s right – a stockbroker. Do I hear Dean Whitter calling?
Potential Salary: $131,290 is what those at the top of the middle 50% earn.

Diplomacy: Although I alone deal with Isabella’s diabetes on a day-to-day basis, I definitely need a knowledgeable veterinarian. Luckily, I’ve found one. Like all relationships, though, there are times when I don’t agree completely with the vet’s opinions (on, say, food) or suggestions (for lab tests). That’s where a healthy dose of tact comes into play. I’ve got to be able to disagree, ask questions, and make my own suggestions and maintain collaborative relationship. It can be tricky, but not, I imagine, any more tricky than the work done by the diplomats of the US Foreign Service.
Potential Salary: Senior Foreign Service officials earn $100,000.

Drug Delivery: I’m not talking about dark-alley felonies. Rather, I refer to the skill of safely inserting exogenous insulin into a creature with teeth and claws. It’s all about timing and distraction. I imagine it’s not unlike getting meds into a patient housed in a hospital for the criminally insane. On second thought – maybe that skill is best left off the resume…

Specialty Cleaning: It isn’t one of my favorite parts of kitty diabetes, but let’s face it: the disease involves a certain exposure to, ahem, bodily fluids. First, there’s the blood. Several times a day I perforate my cat to make her bleed. Sometimes the blood is easily contained, sometimes it gets flung far and wide. Then there’s the urine: it needs to be occasionally captured and tested for ketones. The capturing requires a certain intimacy with the cat; the testing, a certain intimacy with the urine. And then there’s the vomit. All cats puke; diabetic ones just seem to puke more, and they like to puke in the middle – middle of the night, middle of the floor, middle of the bed, etc. As Isabella’s personal handmaiden, I get to mop up all those fluids. Often. And that, I believe, qualifies me for a well-paid job as a crime-scene cleaning specialist.
Potential salary: Per the website HowStuffWorks.com “it's possible to reach six figures in a big city with a lot of violent deaths and meth labs” Cool.

So, if I ever get tired of my current job, I’ve got a few other options to explore, courtesy of my cat’s lazy pancreas.

The Church of Excel

Isabella's diabetes is all about data. Well, technically I guess Isabella's diabetes is all about her health, but managing the diabetes keeps me focused on numbers. What's her blood glucose? How long ago did she get insulin? How much insulin did she get?

I've got all those numbers jotted down in a little notebook that I keep near the diabetes box. Page after page of numbers, each one representing a kitty blood-letting session. (Side thought: I wonder how much blood I've pulled out of Isabella's ears in the last year? There's still a fair amount splattered on the walls...) Anyway, early on I saw those numbers piling up and realized I needed more than a paper-and-pencil system to keep track of it all.

And so, I became a worshipper at the altar of Microsoft Excel.

I set up a very simple spreadsheet: a column for dates, a column for the morning blood sugar reading, another for the afternoon reading, and a column for notes. Simple. Straightforward. From this simple spreadsheet I could generate those famous bar charts that drove Isabella's first vet crazy and bring her current vet so much joy:

And it was good.

But then my greedy heart wanted more. So I added colors to the columns, making the cells turn a pretty green when Isabella's blood sugar was under 100 and an angry red when she passed the 300 mark.

Again, it was good. I looked at my colorful spreadsheet and descriptive bar charts and felt joy and gratefulness in my heart.

We carried along in this way for many months, my spreadsheet and I, until a change of (dare I say it?) biblical proportions again made me question my faith.

I was testing Isabella more and more. Two columns of numbers wasn't enough and I was forced to cram extra test numbers into the "Comments" column. Entering data lost its appeal and I began to turn my back on Excel and rely upon my pagan notebook for everything.

The loss of faith was distressing. I searched the Help files looking for answers, wanting to find something that could bring me back to the altar. But my doubting heart and skeptical eyes did not light upon the truth and saw instead only the darkness of the simple, inadequate spreadsheet.

I did not approach the altar for weeks.

But I knew there were others who still worshipped at the church of Excel and so I reached out to the faithful among the members of FDMB. I asked them for guidance, to light my way on the path of diabetes data management.

And my call was heard. I received a new spreadsheet template like a gift from on high. This template has columns and rows for everything. It works as well for days when I test only twice as it does for days when I poke Isabella ruthlessly and repeatedly. It has a worksheet for curves.

But before I could truly enjoy the new spreadsheet, I had to pay penance. I had to sit silently to enter more than four weeks worth of data, contemplating my brief fall from grace with each number.

Now my sins are absolved, my data is up to date, and I've added the cool feature that makes the cells turn different colors depending upon Isabella's blood sugar reading. I am once again among the faithful gathered at the altar of Excel.

And it is good.

The ties that bind

One thing about feline diabetes is that it requires a commitment. My cat, previously so self-sufficient, now needs a pancreatic stand-in - and that's not a job that allows vacation days. Because Isabella's pancreas has put its feet up and retired, I, or someone else, has to be at the ready with insulin at least twice a day.

When the Isabella's vet broke the diabetes news, I swear I felt a tether wrap around my ankle. It tugs on me when I'm out of the house with insulin time approaching and it wakes me up early every morning. For the first three months, that tether, and Isabella, ran the show. The thing is, tethers make me wiggly and restless. I needed to wrest control out of Isabella's furry little paws and reclaim my independence. I needed to feel like I could go somewhere if I wanted to go. I needed to untie the tether.

I did untie it. Lots of times. I've traveled more this year than ever before, and I'm not done yet. I started slowly - a weekend in Santa Cruz with high school friends. Several weeks ahead of time, I started searching for a pet-sitter. First I asked a friend who lives quite close and who had administered sub-q fluids to her own cat. Insulin would be a piece of cake for her, I thought.

Well, not so much. Turns out she could barely stand dealing with needles for a cat she knew, and Isabella doesn't exactly have a stellar reputation for friendliness among my friends and family. She declined. I asked the techs at my vet's office. Nope. I turned to the internet, where I found several local sitters who would happily come by -- to the tune of 25 bucks per visit. $50 a day for pet-sitting is not in my budget.

Then I found Katy. Young, but insured and bonded. And familiar with administering insulin. Best of all, I could afford her. So I set her up to come that weekend I was in Santa Cruz, transferring responsibility for the tether to her. Of course I clutched my cell phone all weekend, especially near the times I knew Katy should be tending the cats, and I worried like crazy. But it went fine.

So I tried again, venturing a little further afield to my sister's house for an overnighter. Then a trip to southern California, followed by another trip to southern California. The tether slips off easily now. So easily that I've planned a weekend at a writers' conference, a weekend cruise, and a trip to New York -- all before Thanksgiving.

I'm glad I found Katy. She's a full partner in Isabella's diabetes, because she lets me have a life. She's willing to take the tie that binds me to the insulin bottle and the cat and wear it herself for a while. Sure, it costs me some money, but the freedom I gain is priceless.

Jingle Jangle

As I've mentioned several times, the Feline Diabetes Message Board is a site where knowledge and helpfulness abound. If there's something going on with your diabetic cat, you can bet that someone else on the board has seen it and can help you with it. 24 hours a day, there's someone around to offer advice, support, solace, whatever.

I like reading the board. I learn a lot and it can make me laugh. But there's one topic I avoid like the plague: the hypo watch.

A hypo watch happens when a member posts a message that their cat's blood sugar has dropped into dangerous territory, which is pretty much anything from the 40s on down. People from all over jump in to help, trying to make sure the person is covering all the bases - feeding the cat, testing often, watching for clinical signs, getting the car warmed up and ready to sprint to the vet if needed.

Hypos can come out of nowhere. It can be a cat whose insulin needs suddenly change: the dose that's been just fine for months is suddenly too much. It can be a mistake by a newbie or a substitute caregiver: remember Fuzz - accidentally given 20 units by a stand-in who read the marks on the syringe incorrectly? (Note: even three units is a big dose for most diabetic cats. I've never give Isabella more than 2 units.)

The mistakes scare me the most. When I read that Fuzz had been given 20 units, my heart collapsed. When I read recently that someone new to the board had given 4 units to her cat whose sugar was already at 40, I couldn't read any more. There are others and they all upset me.

Even though many, maybe even most, of these hypo watches end just fine - with help from the board the cat's blood sugar goes up and no obvious harm is done - I hate reading them. Fuzz survived his 20 units, as did the cat who was given more insulin when already low. I hate reading them because sometimes, the worst happens. And that reminds me that anyone can make a mistake. Anyone.

That's why I'm always very glad to hear the bell on Isabella's collar when I get home, even before I open the door. If she's jingling, she's okay.

Happiness is...

In the previous post of random observations from last week, I forgot to include the absolute high point. The pinnacle, as it were. Get ready to be astonished and amazed:

I found Fancy Feast at the Grocery Outlet for 33 cents per can. I bought everything they had. Hah! Take that, expensive-cat food-maker-people.

I want to be clear: that's the highlight of the diabetes week -- not my whole life. I like to think I'm doing a little better than that. But this blog is about the diabetic cat, so I try really hard to stay on topic.

******************************

Isabella's sugar was 311 this morning. I can't figure out what is going on with that animal. Is she getting too much insulin? (Her high flat numbers indicate that's possible.) Is she resistant? Is she rebounding?? Does she actually need more? I don't know. I don' t know. I don't know.

When I see those high numbers (day in, day out) I have the urge to either plug her with a super dose (which I'd never do, but it's sooooooooo tempting) or to give her nothing and see what happens.

Today I did it. Or, didn't, rather. I skipped her shot even though her numbers are high. I'll see when I get home from work if that had any effect at all.

This week in diabetes

A few observations from the past week:

1) Last night Isabella was driving me nuts at about 2am. She does this sometimes - wanders in and out of the room meowing, scratches at the dresser, climbs all over me and wants to knead at my neck, paws at the covers, bites, and is generally a pain in the ass. I usually ignore her. Last night, I decided to test in case she was low, even though she was 12 hours past her last shot and has been generally unresponsive to insulin all week.

This is the first time - first! - I've ever gotten out of bed in the wee hours to test the cat. I told her it had better be worth it. In the end I don't know if it was or wasn't. Blood sugar was 350+, so I gave her a shot. And now I know for sure she will misbehave in the middle of the night when she's not low (thus reducing even further the likelihood I'll get out of bed to test her in the wee hours).

2) If anyone was out on my street at 2am, they got a nice view of my nearly naked self filling a syringe in the kitchen.

3) The fact that I will now test Isabella while nearly naked is the best testament to how far we've come in the hometesting routine. I used to don protective clothing. Now, clothing is optional.

4) I've noticed (again!) how reactionary I am to the cat's blood glucose levels. I find it very hard to stick to a scale if I think the scale isn't working. And if one test gives me an unexpected number, then I think the scale isn't working. Isabella's numbers are unexpected almost all the time. Therefore... well, you see the problem. My behavior is probably why vets freak out at the idea of owners hometesting.

5) I've also noticed that when I sit down to enter numbers into the spreadsheet or my profile at FDMB, the numbers usually aren't as bad as I thought (in the moment) and it's obvious that I have impulse control issues when it comes to reacting to single numbers.

6) I've started crushing a methyl B-12 tab into Isabella's food at each meal in case the problem she has with her hind end is neuropathy. Ever since I started this, Casey waits until Isabella takes a break from eating and then commandeers her food bowl. Isabella then eats from Casey's bowl. I'm not sure why I try.

7) It's closing in on a year since diagnosis, and Isabella's numbers are no better. But she seems happier, so I guess that it's worth it. Someone, please tell me that it's worth it.

Don't try this at home

I just did something really stupid.

I had Microsoft Money open to balance my checkbook when I thought: hey, I wonder how much I've spent on the cat since she was diagnosed?

Some things are better left alone, know what I mean?

But what's done is done and I may as well blog about it. So here it is, in all its glory, the current total of what I've spent since that fateful day last September when Isabella was diagnosed as a real "sweetie:"

Vet expenses: 1286.92

Insulin: $349.50

Syringes, lancets, test strips & miscellaneous: $350.87

Food & litter: $477.38

Pet sitter: $116

(Notice there's no category for meters. Though my current stockpile of blood glucose meters has reached the embarrassing total of eight, I haven't paid for any of them. At least something about feline diabetes is affordable.)

For a grand total of: 2508.67

By way of comparison, and because I'm obviously a glutton for punishment, I also checked the amount spent during the previous two and a half years:

Vet expenses: $1276.56 (cancer surgery)

Food & litter: $430.13

Total: $1706.69

Isabella's little bout of fibrosarcoma two years ago almost disguises the fact that I've spent more on food in ten months than I did the whole previous 30 months. Of course, that dry food may have been cheap but it's the cause of this whole diabetes gig in the first place.

Yes, feline diabetes can be spendy, but I think I'm doing a pretty good job of keeping costs down. I shop hard for cat food bargains, I buy supplies online, get free shipping when I can, and I try to minimize vet visits. In the early days of diagnosis, I was at the vet so often my credit card company would call and check on Isabella if they didn't see any veterinary-related charges for a while.

OK, I'm kidding. But that's how it felt.

My constant effort to sniff out bargains is why I get boxes this size from the online diabetes supply house, Hocks.com:

I'm buying syringes by the case to save on shipping.

Now my curiosity has been satisfied. I know what Isabella's diabetes has cost, financially, anyway. So what did this exercise teach me?

Leave the report function of Microsoft Money the hell alone. And I still have to balance my checkbook.

Grumpy optimist

Man, I've been grumpy and frustrated about Isabella's diabetes the last few days. Once again, her blood sugar is running high and my patience is running short. That poor kitty hasn't been under 200 since last Thursday - barely under 300, actually - and it doesn't seem to matter one tiny little bit what I do with the insulin.

I think the reason I get so grumpy is because I'm an optimist. Bah! you say - that doesn't make sense. But it does! The cat has had many really good days in the last several weeks. Double digits and pre-shots in the mid-100s. That kind of stuff gets me all smiley and hopeful. I'm not really thinking she'll go into remission, but I am thinking that I've finally figured out a decent dosing strategy.

Then this. Last Thursday she started out at 140. By the time I got home from work her blood sugar was 487 (an all-time high!) and it's been a triple-digit bitch ever since.

It's possible that Thursday's spike is due to rebound. I've read that when rebound happens it can be accompanied by excess cortisol and epinephrine which cause insulin resistance for several days. I've definitely been seeing resistance since then. So I guess I'll just optimistically assume that it's a freak event.

And to further help kick me out of my funk, I'm leaving for Disneyland tomorrow. That's right - the Happiest Place on Earth. The pet sitter can give Isabella her insulin while I cavort with Mickey and Goofey... and of course, Grumpy.

I deal with her numbers when I get back.

The fine print

It's finally happened. Isabella's diabetes has dealt me the lowest blow. A slap in the face, even. And I don't like it one bit.

It started innocently enough: A minor squint. A subtle shift to better light. Then I found myself struggling to see the minuscule drop of blood forming on Isabella's black ear. I turned the ear this way and that frantically searching for the telltale glint. The final blow was the syringe - those damned half-unit marks are so tiny. Surely no one could be expected to see them readily. (Never mind that six months ago I was able to.)

I knew I couldn't get help until I admitted I had a problem. So, I said it out loud: I need reading glasses.

Such ugly words.

Last Sunday I trekked to the drugstore display of magnifying readers. After much trying on of different brands, strengths, and frames I settled on these:


They're innocuous and the do the job. The first time I put them on, Isabella stared with wide eyes. "What's that lady up to?" The glasses have found a home snuggled inside the diabetes box. I use them only for blood-letting and syringe filling. OK, maybe I'll sneak them out when I have to use the phone book. But that's it. I'm not addicted.

If it wasn't for the damned diabetes, I wouldn't have reading glasses. And even though I know it was inevitable, even though I know I was able to go without for longer than most of my friends, even though I know it's not the cat's fault...

I'm blaming the cat anyway.

Cat 2.0 ... or how to build a better diabetic cat

Feline diabetes is, at best, an unpredictable disease. There's a saying on FDMB that "every cat is different," meaning that the way MY cat responds to insulin (or food, or the vet, or anything else) is different from how the diabetic cat down the street will respond to the same things.

In my house the saying is more like "every day is different." The cat doesn't vary, but everything else sure as hell does. I can never predict what Isabella's blood sugar will be at any given time. Same dose - different response. Full moon? New moon? Doesn't like the color of the curtains? What?????

Who knows? Not me, that's for sure.

That's why I present my ideas for Cat 2.0, a diabetic cat with all the helpful features their people would like to see, plus a few extras thrown in just for convenience.

Dry Food Aversion: Cat 2.0 will, upon becoming diabetic, develop an aversion to all dry food, except as needed to treat a hypoglycemic event.

Ears: Cat 2.0 will come equipped with ears that, when poked with a lancet, readily produce a suitably-sized bead of blood. Ears will also be resistant to bruising and scabbing.

Food Preferences: Cat 2.0 will instinctively understand that his person providing the best food available within the household budget parameters. The Cat will still demonstrate varietal preferences, but will never refuse food outright, unless frankly ill.

Hypoglycemia Alerting System: Cat 2.0 will come equipped with a signaling system to be used in case of hypoglycemia. The signal will not vary from Cat to Cat and will be used only when blood glucose is threatening to reach a dangerous low point, requiring attention and possible intervention from the cat's person. The signal will not be frivolously employed in the middle of the night just to see what happens. (Ahem...Isabella.)

Insulin Requirements: All Cats produced under version 2.0 will respond appropriately* to insulin as follows:

• Blood Glucose under 150: No insulin needed until next scheduled injection
• 151 - 200: 0.5 units
• 201 - 250: 1.0 units
• 251 - 300: 1.5 units
• 301 and up: 2.0 unit

*An appropriate response to insulin is defined as a 12-hour inverse curve with a peak time depending upon the insulin type. See Insulin Response for more information.

Insulin Response: Cat 2.0 will respond in a consistent manner, according to insulin type, as follows:

• R: Peak at +2; slow rise until +12
• N, NPH, Caninsulin: peak at +4; slow rise until +12
• PZI, Lantus, Levimir: peak at +6, gradual rise to +12

This predictability allows Cat 2.0's people to readily schedule injections and eliminates the need to test BG repeatedly to determine when the rise begins.

Pancreatic Activity: The pancreas installed in Cat 2.0 will never sputter. It will either work or it won't.

Cement Booties: Cat 2.0 will never gather spare litter on its paws. Cement booties are not sized to fit this cat.

Testing Collaboration: Cat version 2.0 will be a willing partner in matters of blood glucose testing. The Cat will demonstrate patience with people newly learning to test and will sit or lie cooperatively during the entire process. Testing Cat 2.0 will not require the use of the Vulcan Ear Grip, Blanket Burrito, or protective clothing of any kind.

Head-Shake Suppression System: As an adjunct to the Testing Collaboration feature, Cat 2.0 will come equipped with a Head Shake Suppression System which is automatically activated during the Testing procedure.

And while I'm at it, how about one additional feature not related to diabetes, but still very desirable:

Vomit Aiming: Cat 2.0 will consistently deposit all vomit (regardless of cause) only upon durable, easy-to-clean surfaces such as tile, vinyl, or linoleum flooring. No vomit will land on carpets, rugs, beds, or furniture of any type. Middle-of-the-night vomit will not be deposited in areas trafficked by bare feet.

And there you have it - my blueprint for a better diabetic cat. Until Cat 2.0 becomes available, I'll just have to make do with my old buggy and bitchy model.

Sometimes, you've just gotta laugh

Feline diabetes is a big disease. After it invades your cat, it invades your life - leaving almost nothing untouched. It can be tragic, frustrating, annoying. It can be the dull ache behind your temples or the nagging in your gut. It's always there, no matter where you are, so you just deal with it.

Along with the dull ache, though, kitty diabetes bring lots of opportunity to laugh. Stuff happens. Sometimes we can laugh at the stuff right away. Other times it takes a while. One of the joys of the Feline Diabetes Message Board lies in the sharing of the stuff. Interspersed with the tragic and the mundane is the hilarious -- stories that have made me laugh so hard my gut ache was replaced by a side ache.

So that we never forget that having a sugar cat around the house isn't all bad, I've gathered a few of my favorite posts from FDMB.

• Kristine describes the scene of her first injection for newly-diagnosed Harley. Ah, the memories!


• Rule number one for feline diabetes is: the cat must eat. So, what does one do when the cat in question decides to turn his pink little nose up at the prescription diet recommended by the vet? Well, one can change foods... or one can outsmart the cat, like Rocky's Dad.


• Rule number two is that the cat is supposed to eat low carb. And no, chocolate chips don't count, even if they are stolen from the fridge on the sly in the middle of the night.


• Dog food doesn't count either - no matter how hard the cat tries to look like a dog.


• Finally, since these are cats, there are sometimes other challenges that come along with the package.

If anyone has other favorite funny stories about diabetic kitties, send me a link and when I get enough, I'll post another compilation.

In the know? No.

Last Saturday was an interesting day, diabetically speaking.

Isabella started the day at 280-something. Pretty typical. I fed and shot 2 units as usual. Then I decided to test her three hours later. I hardly ever test in the early part of her cycle because I know she doesn’t start responding to the insulin until about 4 hours after the injection.

Turns out, I don’t know nothin’.

At her +3 test she was down to 108. The mathematically inclined can see right away that her blood sugar had dropped nearly 200 points already. The diabetically knowledgeable can see that the logical reaction to that is:

Uh oh.

There were many hours to go until Isabella’s insulin hit its peak effectiveness and only about 70 points between her and the dreaded hypoglycemia. Luckily, I didn’t have a lot to do on Saturday, so I stuck close to home and tortured my cat with a lancet pen.

+5: 55
+6: 48
+7: 58
+9: 62

Lovely double digits for many hours in a row. And a cat seemingly unaffected by these low numbers. Isabella was fine. A little annoyed by my constant poking, but fine from a diabetes standpoint.

At the time of the 62 reading, I fed the cats their afternoon meal and went to a movie. When I got home four hours later I tested Isabella one last time to see if she was ready for more insulin.

348.

Jeez. She was ready.

What a weird day. I don't know why she dropped so far so early. I don't know why she rose so high at the end. I don't know if she's been having a pattern like this as a regular thing since I increased to 2 units.

I don't know nothin'.

Boxed in

Jess recently wrote a post on Wilson's blog about her favorite diabetes tools. We all have our favs, that's for sure. I'm partial to the Freestyle Flash meter - despite its reputation of being wildly inaccurate at higher numbers - because it takes such a teeny tiny amount of blood. In the early days I was lucky to get any blood from Isabella at all (though she had very little problem getting blood from me) so just needing a speck was a great advantage.

Besides the meter, diabetes requires all sorts of things for ongoing management. A couple weeks into my kitty diabetes adventure, what became important to me was corralling all of the stuff that seemed to be accumulating on my kitchen counter. A box of syringes. Test strips. The meter and lancets. Etc. etc. Isabella's diabetes is a long-term thing and the kitchen counter wasn't going to hack it for long-term "stuff storage." I needed a way to organize it all so my house didn't start looking like a pharmacy.

Ah, eBay.

Years ago I bought a little hand-made wooden box to hold kitty brushes and nail clippers. I wanted them to be handy, but not just laying around. This box was the solution:



It works great. Everything fits, it's cute, and I can keep it right near where I do the nail trimming without it screaming "cat stuff" to everyone who walks through my living room. I surveyed my collection of diabetes supplies and knew I needed another box. So back to eBay I went, where I found this:



I keep the testing supplies there, next to the testing spot (which is also the nail-trimming spot). Again, everything fits: the meter and lancet launcher, loose lancets, strips & control solution, and some tissue bits in case I hit a gusher, and yet no one else knows all that stuff is sitting right next to the couch. It's perfect.

Syringes are kept in a coffee cup in the cupboard next to the fridge, which (of course) is where in insulin lives. I preferred the packaging of the syringes I initially got from my vet: bags of 10. Open the bag, voila! 10 syringes. The GNP brand syringes I now use come individually wrapped - a pain in the arse when it's time to restock the coffee cup.

The wooden boxes and coffee cup handily hold the day-to-day supplies, but I still don't have a good system for my backstock: the full boxes of syringes, the spare test strips, the (ahem) extra meters. Those things are piled haphazardly next to my computer in the "office." So far that's not bothering me. No one coming into the house really sees it, and I can readily see what I have and what I need to order.

I can also admire my growing collection of meters. In pretty colors.

A day in the life of a diabetic cat

1:17am: Hey! The lady's arm is out from under the covers. She knows that bugs me, but I can fix this. (CHOMP) Screech! "Punky! You bitch!" Ah, that's better. Me on top of the covers; her, underneath. Just how I like it.

3:44am: It's been a while since I slept on the couch. I know the lady worries when I'm not on the bed; she wants me nearby in case I go low or something. Too bad. I'm moving. She can sleep on the couch with me if she's so concerned. Besides, Casey is out there and I can smack him around a little before I doze off again.

5:15am: Must be getting near time to get fed. I'll move back to the bed and stare at the lady to see if I can make her wake up.

6:00am: (Alarm goes off.) Food! Food! Food! Food! Get up lady! Food! Food! Food! Don't go back to sleep! I'm right here!! Food!! Food! Jeez! You can pee later! Food!! OK OK!! Open the can! Hurry! Hurry!! Food!! Ahhhhhhhh.....

6:15am: That lady is still in the shower. I know she needs to test me, but I'll just lie down here for a minute. Here she comes. Yep, she's got the treats. Oh, she's getting out the stuff. OK, I'll wander over to the couch.

6:20am: This testing deal isn't so bad since the lady started using the clicker thing. But it sure was fun before when I howled and growled. She'd get so upset! I sort of miss the drama. (beep) OK, you've had your fun and got your beep. I'll take those bonita flakes now. Yes, in a special dish - it's what I deserve. And since you recognize that it's what I deserve, I'll pretend I don't notice that you're sticking me - again. That stuff is cold.

6:50am: Yaaawwwnnnn. Time for a nap. Bed? Or couch? Bed, I think. She'll be in to make the bed pretty soon, and I'll be in the way. Perfect.

2:00pm: Uh oh! Here comes a barf. Hurp-hurp-hurp-hurp-hurp. Ahhhhhhh. That's better. I'll move to the couch now.

4:20pm: I hear the car! I hear it! There she is! Hey lady!! Food!! Food! Food! Jeez! You can pee later! Food!! OK OK!! Open the can! Hurry! Hurry!! Food!! Ahhhhhhhh.....

5:00pm: I'm feeling pretty good. Full tummy. Great sleep. Oh look - the lady is washing the bedspread. She sure does that a lot. Well, time for a test. I wonder why Casey gets tuna flakes too, when I'm the one giving blood and getting a shot? I'll have to smack him around a little, just to even things up.

5:15pm: I'll just crawl up into the lady's lap while she's watching the news. I fit just perfectly. Yaaaawwwnnnnn. Time for a nap.

7:03pm: Wha?? Where'd she go? Oh, at the computer. No problem - I'll just lay down on her papers and nap there. I know she gets lonely if I'm not around. I can give my butt a good cleaning too.

9:00pm: Food! Food! Food! Food! C'mon lady! Food! Food! Food! You don't need to wait for a commercial! I'm hungry now!! Food!! Food! Jeez! Can't you tell time??? Food!! OK OK!! Open the can! Hurry! Hurry!! Food!! Ahhhhhhhh.....

10:22pm: Lady, puhleeze. Can't you tell I'm sleeping here? You move to he other side of the bed - I was here first. And make sure you don't leave any arms hanging out. You just keep all that stuff tucked up or you know what'll happen.