Thursday, May 31, 2007

Stick a fork in me

Sometimes I just want to be done with this diabetes thing.

Like when the alarm goes off at 6am. Every day. No matter what.

Or when I’m almost out of insulin and wondering if there’s enough left to get to the next credit card billing cycle before having to spend the hundred and fifty bucks for more.

Or when the meter reads 350.

Or when Isabella wakes up in the middle of the night and scratches the dresser.

Or when I prick her ear and her head shake flings blood all over the walls.

Or when I have to leave a party early to give her a shot.

Or when I have to factor the expense of a pet sitter into the cost of a vacation.

Or when I look at the spreadsheet of blood sugar readings and realize that I’m getting nowhere.

Or when I have to buy test strips. With no insurance.

Or, when the cats turn their pink little noses up at whatever food I’ve served.

Sometimes I just feel so done. But I’ll never quit, not as long as Isabella needs the juice.

Monday, May 28, 2007

The many faces of time

I’ve been noticing lately how I think differently about time depending upon what I’m doing.

Holiday time
This holiday weekend, for instance, was all about days. Days and days without work (four of them, to be exact). Days of glorious weather. Days without commitment. I cared little about the hour, because I had all these days stacked up, without much I needed to accomplish. Those days are drawing to a close now, but I assure you, I was successful in accomplishing very little.

Project Time
My latest freelance job seems to be about weeks. I was given a deadline five weeks away. Five weeks is a freelance lifetime! Those weeks had much to do with why I did so little in the last four days.

Workout time

In the pool for a swimming workout, I focus on seconds. The coach assigns sets with time intervals. I calculate quickly: can I swim that distance, in that stroke, in that amount of time? Will I have any seconds left over to catch my breath before I have to do it again?

Work time
At work, like everyone else, it’s hours and days. How long until that doctor comes in to pick up the research he requested? How many days ‘til the weekend?

And woven throughout everything else, there is …

Diabetes Time
I rarely glance at a clock without at least subconsciously calculating how long it’s been since Isabella’s last insulin injection. Is she close to peak? Does she seem to feel how she should at this point in the insulin cycle? Is she sleeping too hard? Is she restless? Is she whining because it’s actually time for food, or is she low?

One thing that I’m only now beginning to trust is that Isabella’s insulin, PZI-Vet, doesn’t really start to have an effect on her blood sugar until about four hours after the injection. So, when I test her glucose before her shot, I have to guess what her sugar will be in four hours and shoot a dose appropriate for that number.

Today was the first time I consciously did that. She was at 156 (nice!) this morning, 12 hours after her last shot. She had eaten, which was going to cause her sugar to spike up. So I gathered my courage and gave her a full dose – not the halvsies I normally would have chosen. I tested her three and a half hours later, and sure enough she was in the high 200s. The PZI would kick in against that number and (fingers crossed) bring her back down into the 100s for a good part of the day. She’d probably hit her lowest point at about 9 or 10 hours after the shot, and start creeping up as the insulin wore off … just in time for the afternoon injection to start taking effect.

If I guessed all this correctly, her blood sugar should be between 150 and 200 when it’s time to inject her in a little while. Then again… she’s a cat. Her blood sugar could be anything. Stay tuned.

Tick Tock, Tick Tock … time passes

And the results are in: 357. So much for my predictions about smooth insulin cycles and likely blood sugar readings. Sigh. Why do I even try to guess?

Friday, May 18, 2007

Under the Influence of Insulin

Today’s paper carries an article about the arrest of a diabetic man who caused a horrific car accident while in the throes of hypoglycemia. He is charged with “driving under the influence of insulin.” No kidding. The prosecution alleges that he injected himself with too much insulin about 2 hours before the accident. What is unstated is that the driver should have known better.

Two young people were killed in this wreck and seven other people were injured, including the diabetic driver. I remember the wreck – it was quite a headline-maker for several days. A day or so after it happened, the driver’s diabetes was implicated. I remember being glad that it wasn’t some stupid drunk and feeling sorry for the driver. I never thought him to be negligent. And this was before Isabella was diagnosed and before I learned so much about the literal ups and downs of diabetes.

Now, reading the article about his arrest and the intention to prosecute him for manslaughter, I am appalled. How ignorant. But I’m also realizing just how little people who don’t live with diabetes know about the disease – ironic, since seven months ago I was right there with them.

I can rapidly catalog what I “knew” before Isabella introduced me to diabetes:

Hypoglycemia: There was a girl in my 7th grade homeroom who was diabetic. I was jealous because she had standing permission to eat a snack whenever she needed it.
Fake sugar: My grandfather became diabetic late in his life. He had to eat nasty sugar-free candy. My mother made two pumpkin pies every Thanksgiving: one regular and one made with sugar substitute. I never tried Grandpa’s pie.
Injections (1): Beth, my step-grandma, injected his insulin. Later, I injected her with procrit. The experience of giving injections to a human made poking a syringe into my cat a breeze.
Injections (2): I once happened upon a co-worked with a syringe. To my questioning look, he replied “I’m diabetic.” I can’t clearly recall if he had been injecting his arm or his torso. If it was his arm … well, maybe he ain’t diabetic after all.
Pumps: I used to swim with a gal who is diabetic. She had a pump. We never really discussed her diabetes, except that she once told me she had trouble keeping it under control.
Possible eye troubles: Nina Courtlandt, a character on All My Children, was diabetic. She was constantly threatened with blindness, collapsing at inopportune moments, and the like. I’d guess that she wasn’t too well controlled, either.
Poor circulation & wound healing: The woman who had this job before me is diabetic (Some would say I stole her job. Let’s not go into that now.) She is morbidly obese and has the gnarliest-looking feet I’ve ever seen. Several years ago she needed surgery for a broken ankle. When the surgical wound wouldn’t heal, her foot was very nearly amputated.

And that’s about it. A patchwork of exposures and experiences that add up to not a whole lot. I’ll bet that my catalog is very similar to what the average guy knows – and that the average guy could easily believe that the diabetic driver involved in that crash “should have known better.”

It’s only because of my cat that I realize the true trickiness of diabetes. Every day I’m glad when Isabella greets me at the door, because I know that there’s always a risk of finding her hypoglycemic, or worse. Her blood glucose is up and down. And I know from reading the blogs of human diabetics that people contend with the same ups and downs and that even experienced diabetics are caught off guard.

I hope someone in the District Attorney’s office comes to their senses and drops this case before it goes to trial. And I hope that driver fights the charges with everything he’s got.

Friday, May 4, 2007

Here we go again...

She's doing it again.

My diabetic cat is giving me high blood glucose numbers. As in nearly 400.

After several weeks of staying in the 200s or lower, I had the audacity to think that maybe I'd found the right dose: 1.7 units BID. Not 1.6 units. Not 1.8 units. But 1.7 units.

Now those dreaded high numbers are showing up again. High numbers can mean she's not getting enough insulin. Or high numbers can mean that she's getting too munch insulin. With Isabella, at this dose, I'm guessing that her body has decided it's too much. 1.7 is three tiny drops away from 2.0 units. The only thing that's been consistent about Isabella's diabetes these past months is that 2.0 units is too much. So, when I start getting close to 2 units, I pay very close attention - to the cat and to the numbers.

Sigh. I'll give her a half dose this evening. I'll bet that her blood glucose drops like a rock. And I'll bet that if I stick with the smaller dose for any length of time, her numbers will start creeping up and her dose will start creeping up until I'm back to 1.7 units. Where we'll stay until her body decides it's too much.

Around and around and around we go...

Tuesday, May 1, 2007

No Tresspassing?

It was what, two weeks ago, that I blogged about how I get blood from Isabella for her twice-a-day glucose tests?

Well, toss all that out the window, because things have changed. We have a new system now and it’s a lovely thing indeed.

A few weeks ago I started wondering why the folks on the Feline Diabetes Message Board always instruct newbies to poke between the vein and the outer rim of the cat’s ear. It makes sense to avoid the vein (pricking it releases a gusher of blood that’s nearly unstoppable. One shake of the cat’s head … and you’ll be wiping blood from the walls and every other conceivable surface), but why restrict the poke-able area to that tiny 1/8th inch margin? What about the rest of the ear? That whole, juicy part in the middle?

I’ve wielded the lancet freehand this whole time because I can’t accurately aim the lancet-launcher-pen thing at that teeny little margin. And, as I described before, Isabella finds my poking technique to be harsh. So you can understand why I was eyeing the middle of Isabella’s ears like a land-owner might survey an adjoining off-limits property.

Finally, I just asked the question. I posted a message to the Board asking why. Why not use the whole ear? Guess what: no one had an explanation. Not one single response had a reason that was good enough to convince me that it was anything other than “that’s just the way we do it.”

It was as if fences were torn down and the No Trespassing signs burned. I marched into that un-poked territory with great confidence – and – the lancet-launcher thing. Now that I didn’t have to aim so bloody carefully (oooo, that’s a bad pun!), I could use the launcher that Isabella so clearly preferred. No more shrieks from the cat. Blood drops are easily obtained and the whole process now takes about a minute.

I don’t have to wrap her in a blanket. I just plop her on the couch and she sits.

For freehand I was using a fine-tip lancet, the smallest I could find. With the launcher, I moved up to a fatter tip, but Isabella’s discomfort is still dramatically reduced. She flinches a little, but doesn’t move or run away. The whole change is so cool. I’m glad I broke tradition and tore downs those fences.

Only one thing hasn’t changed: I still wear leather gloves. It is, after all, Isabella, she-devil of diabetic cats.