Sunday, July 29, 2007

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,

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.

Monday, July 23, 2007

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.

Saturday, July 21, 2007

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.

Sunday, July 15, 2007

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.

    Friday, July 13, 2007

    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.

    Monday, July 9, 2007

    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.


    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'.

    Wednesday, July 4, 2007

    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.

    Sunday, July 1, 2007

    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.