The End

Isabella died on Sunday September 21, 2008.

I've been waiting for the right time and the right inspiration to write this final entry but I don't think that time will ever truly come. So today, on the day that I buried Isabella's ashes, I am closing this blog.

I want to be clear about one thing: diabetes was not the cause of her death. Although I don't specifically know why she declined over her last ten days, I do know it wasn't diabetes. Because she was walking with so much discomfort, and eating so little, and in the end, breathing with such difficulty, I speculate that the cancer, though small at the surface, was likely doing unseen bad things. It may have spread to her lungs. I don't know and never will.

What I do know is that Isabella was a cat who lived life on her own terms. She had her ideas about how things would be and was not shy about letting me (or anyone) know when something wasn't to her liking. She bit me many, many times. I would have preferred some other means of communication (litter box hieroglyphics, anyone?), but that was Isabella. She didn't care one whit about how someone else felt - she cared first and only about herself.

Isabella behaved uniformly horridly to anyone who came to the house. She glared at, hissed at, swatted, and occasionally sank her teeth into my friends and family. No one, and I mean no one, could understand why (or how) I treated both cancer and diabetes in my mean kitty. My father took particular delight in antagonizing her. He'd gleefully thrust out his scratched and bitten forearm: Look what your cat did to me! I'd just roll my eyes. Certainly after more than a decade he knew better. Sometimes I thought Isabella was more well behaved than he.

Under her snarky, cantankerous, feisty attitude, Isabella was a very loyal kitty. If I was home, she was with me or at least nearby. She slept on my bed every night with only two exceptions: right before she was diagnosed with diabetes and right before she died. Her loyalty bloomed early in kittenhood - once leading her right into the refrigerator when I opened it. Unlucky for her, I didn't see her climb in. Lucky for her, I did miss my little velcro kitten in short order (where'd that cat go?) and opened the fridge to find her sitting next to the cottage cheese like it was the most normal place in the world for her to be. Her habit of walking through any door I opened taught me to account for all cats before leaving the house - and many times saved her from closet and cupboard incarceration.

Isabella lived her nine lives well. She beat vaccine-associated fibrosarcoma for more than three years. She laughed in the face of diabetes. And she escaped the wrath of the many, many people she abused, some whom would have abused her in return had I ever turned my back.

Through her personality Isabella taught me tolerance. Through her diabetes I learned patience and how to let go of things I could not fully control. (OK, if I'm being honest, maybe not so much on curing my inner control freak). Isabella also led me to the wonderful and wise community of the Feline Diabetes Message Board, where lots of other control freaks (admit it, people!) struggle, and laugh, and learn about caring for a diabetic cat. I am grateful for the guidance and friendship I found there.

Isabella, my little punkie, you were demanding and uncompromising for every minute of your 13 years. I loved you and I will miss you forever.

Sometimes, she was just so darn cute.

Impaled

Isabella's been having a tough time the last few days (and consequently, so have I, dammit). I took her to the vet, practically a drive-by, to have blood drawn. In and out. No appointment necessary. No big deal. Or so I thought.

Then the next day she stopped eating and started looking all mopey. Now I admit it takes me a while to catch on, but I finally noticed the pattern: go to vet, cat gets sick. Three out of the last four times. I sort of assume that the stress makes her (as yet undiagnosed) chronic pancreatitis flare up. This time I didn't worry so much. As part of a conversation with the vet about how to possibly prevent this in the future I picked up a bag of fluids. A cat that won't eat can quickly become dehydrated, so it's a plus to have to fluids on hand just in case.

But I figured that she'd snap back quick and the fluid, tubing, and needles could stay tucked in the bag in the closet.

Wrong again. Four days later Isabella had still eaten very little despite the staggering array of options I put before her at every opportunity. She looked like crap. The bag of fluid sat untouched and I had to admit the truth: I was chicken. I knew she needed an infusion. I knew it was supposedly pretty straightforward. And in the name of all things holy, we know I've poked literally thousands of holes into that cat already. What was the big deal with one more?

The problem was this:

This 18 gauge harpoon is the tool I was given to get the fluids out of the bag and into the cat. Oh. My. God. I could not imagine poking that thing-- the size of a screwdriver for pity's sake -- through Isabella's skin and living to tell the tale. Much less getting her to sit quietly with it jammed between her shoulder blades for as long as it took for the fluid to infuse.

I repeat: Oh. My. God.

But I kept looking at my miserable cat and knew that I had something that would make her feel better close at hand. So I sucked up the courage and I did it. I set up the tubes and the fluids and harpoon. I arranged the cat. And I rammed that baby home. Isabella uttered a small squeal of protest, and then settled down and just waited. Didn't move, didn't cry, didn't even try to hurt me.

The fluid took about a minute, possibly the longest minute of my life, to flow in. When it was finally done. I pulled out the needle, so anxious to un-impale my cat that I forgot to turn off the fluid. The free needle sent a stream of lactated ringers across the walls, Isabella's back, and my front as I fumbled to find the squeezy valve. Isabella, naturally, tried to flee the deluge, and in my haste to get out of her way, I shoved the uncapped, very sharp, very thick needle into my thumb, adding blood into the mix of fluids flying about. Getting the fluid stopped at last, I yanked the needle off the tubing and sent it flying out of the bathroom and across the hall where it promptly disappeared. Nevermind that a minute ago it was a big as a fence spike, now that uncapped 18g needle was perfectly invisible.

Sigh. In the end, I think Isabella came out more unscathed than me. And I'm not looking forward to next time, even though I've now got some smaller needles.

Piece of cake

Today on the Feline Diabetes Message Board I commented that taking care of Isabella's diabetes is a piece of cake. That may come as a surprise to people who are new to the diabetes game. It can seem overwhelming at first. It was overwhelming at first, but now, after two years, I've got it down. It's part science, part art, part obsessive-compulsiveness, but you too can manage your kitties diabetes and have a life. A regular life. Really!

Here's how diabetes fits into my day:

6am: wake up! Feed cats (OK, I admit I don't like this part. I never get to sleep in, even on the weekends. That sorta sucks.)
6:30ish: test Isabella's blood glucose and give insulin. This takes maybe five minutes. Less if I get blood readily. There are still times that she just won't bleed in spite of poking her full of tiny holes. And yes, she sits there and lets me poke the holes.
7:00am: off to work for me, off to naps for the kits.
4:15pm: home from work and feed cats again. If I'm smart, I pee before I leave work because they get really cranky if I run to the bathroom before popping the lid off the cat food.
4:30pm: test Isabella's blood sugar. This test is really just to satisfy my curiosity.
6:30pm: test blood sugar and give insulin. This is the test that matters because it tells me that she's OK to get insulin - not too low in the sugar department.
9:00pm: one last meal for the cats. This is the one that lets me sleep all night without listening to whining. Brilliant!

That's it. No big deal at all. If I'm home I may test her more just to see what's happening, but it's not required. I can and do shift her shot times if I have to be somewhere, but for the most part she stays on an every-twelve-hours insulin schedule. When I travel, I hire a sitter to come twice a day to feed and give insulin. I've asked the sitter to keep the 12-hour schedule, but I honestly don't know if she does. I just try not to worry about little things like that because Isabella has always done fine when I've gone away.

I admit that I lost plenty of sleep at first. I admit that I used to wait until the stroke of 6:30 before giving insulin (what if I was 10 minutes early? Or late? Gasp!) And I know I'm lucky to have a pretty predictable schedule that allows for a tidy routine. Some people have more chaos to work around. But regardless, taking care of feline diabetes takes about ten minutes a day. It really is a piece of cake.

Ten-hut!

I've definitely been doing this diabetes stuff too long. How do I know? I know because I'm not even paying attention to what I'm doing any more.

This morning I almost gave Isabella a shot of insulin in her ear instead of using the lancet to test her sugar.

Hello! Not a lot of sub-q space there.

Diabetes by Committee?

I was scanning through the hundreds and hundreds of messages in the Lantus insulin section of the Feline Diabetes Message Board and was struck (again!) by the breadth of support there. There is always someone around to lend a hand or an idea when things are going badly or to stay up all night with someone whose cat is skirting the edges of hypoglycemia.

Jiminy, I don’t even stay up all night with my own cat. She is so on her own between 11pm and 6am. Short of bitch-slapping me back into consciousness, there’s not much Isabella can really do to get my attention while I sleep. So if she has any sense at all she’ll schedule her lows for waking hours.

Yikes! Digress much?

Anyway, as I was saying, there’s lots of support on FDMB that to an outsider might look like diabetes management by committee. Caregivers report their cat’s BG numbers, trends, anomalies, and ask What should I do now? And then the opinions and suggestions start flying.

Shoot now!
Wait 30 minutes!
Raise the dose!
Lower the dose!
Try a new insulin!
Feed high carb!
Feed low carb!
Do the happy dance!
Pour yourself a drink!
Try a belly rub!

It’s crazy, comical, confusing, and ultimately, helpful. In the end only one person – the one with the cat and syringe – can decide the course of action. For myself, I know that I usually have an idea what I want to do and someone is bound to back me up. But if no one does – then I know I jolly well better listen to what the FDMB committee is saying. On account of they are really smart people.

How many holes?

You know the Beatles song A Day in the Life? The one with the line: now they know how many holes it takes to fill the Albert Hall? That’s been my theme song the past little while, much to Isabella’s dismay.

You see, Isabella is doing really well on Lantus, her new insulin. Her blood sugar has been consistently lower than ever, sometimes staying in non-diabetic ranges for hours at a stretch. I know this because I’ve been testing her. A lot. Which involves poking holes; many, many holes. Maybe not enough to fill the Albert Hall, but plenty.

Back in my apathetic days (yeah, three weeks ago) Isabella barely had to endure two tests a day. That was no big deal. I’d get the testing supplies ready and the cat would come voluntarily to give blood. I didn’t call her. I didn’t bribe her. She just showed up when she heard the vial of strips pop open. It was good.

Now? Well, I think I’ve over done it a bit. Maybe ten tests in one day is too many. (Gee, ya think?) Part of the problem is that sometimes her blood sugar is too low for her to get a shot, so I have to keep testing so I know when she can have insulin. And part of it is that I just get a kick out of seeing those pretty numbers.

Sadly, Isabella isn’t getting the same amount of kick out of letting me see those pretty numbers. Half the time when I pop open the vial and get out the meter I don’t hear the jingle of her bell as she saunters toward me. Nope. I’m greeted with silence. She’s the one who’s apathetic. She cooperates fine once I’ve drag her furry butt to the testing spot. It hasn’t gotten ugly, as I know it could. But I’m treading on thin ice here. I have to find a balance between data gathering and kitty happiness.

I think I can do that, even before I fill the Albert Hall.

Cancer report

Diabetes isn’t the only area of Isabella’s messed up life that’s going well. Her cancer is growing so slowly that it’s almost a non-issue. I think there are three tumors at the moment, the largest about the size of a small grape. None are visible just by glancing at her. But really, the happy thing is that she’s not experiencing the explosive growth I know fibrosarcoma is capable of.

Doggone diabetes

I work at a hospital, so I have lots of interaction with medical people. (Disclaimer: I am not a medical people.) About a year ago, the director of the ICU was in my office asking for information about something or other to do with diabetes. Better regulation of hyperglycemia in critical patients or something of the sort, I don't specifically remember. Bottom line is that in talking to him about what sort of information he needed I was asking about basal versus short-acting bolus insulins, dosing scales, and the like. He paused and looked at me.

"You seem to know a lot about diabetes."

I said, "Well, my cat is diabetic so I've gotten to know a bit about various insulins and how they work."

That, of course launched the usual "Cat's can get diabetes?" discussion, plus a lot of more technical questions about how I manage her and whatnot. This particular guy is, I'm completely convinced, a classic case of adult ADD, so it really was mostly him talking, very quickly.

Fast forward to about six months ago. I run into the same guy in the hallway.

"Nancy! You'll never guess!! My dog is diabetic!" He seemed absolutely thrilled.

Now I know nothing about doggie diabetes, but I've gotten the impression they're easier to deal with than cats. (Figures. Dogs are simple; cats are complex.) Even so, I assumed that Rover would need a low carb diet and insulin, so I asked if he was using Vetsulin (a veterinary insulin used in both cats and dogs, but it works better in dogs) and if he was testing Rover's blood sugar before giving each dose.

"No! I told the vet I would just use R!!" (Humulin R, or "regular" insulin - it has a quick onset and short duration.) "I can take the expired R for free out of the ICU!! And I just monitor her behavior! You know!! I'm really in tune with how she feels so I can totally tell if she needs more insulin or less by how she's acting and how much she's eating and drinking!!! She's doing just great!!!"

Yeah.

Like I said I know nothing about doggie diabetes so I just nodded and said it did indeed sound great and got the hell out of the way. That guy is like a hurricane. I hope his diabetic dog really is doing just great.

(Random editorial note: I sat down to write a post about something else entirely, and suddenly I was writing about this, something I've haven't thought of in months. Odd.)

Another note: I ran into the diabetic doggie guy again. He is using NPH insulin, not R. My bad.

It’s Day One All Over Again

I’ve finally done it. I’ve finally made the switch from PZI insulin to Lantus for Isabella’s diabetes.

I had been all set to talk to the vet about changing when Isabella’s cancer came back. That really threw me – all of a sudden I wasn’t sure I should bother trying to learn a new insulin if she was just going to die anyway. So I hesitated. I procrastinated. I stopped caring about her numbers.

Then someone on the Feline Diabetes Message Board said something that really hit home:
Don’t bury your cat until it’s dead.

The comment wasn’t directed at me, it was in someone else’s discussion. But I realized that I had done exactly that. I had given up on Isabella’s day-to-day disease because of something that might not be a problem for months and months. I had, in effect, buried her already.

Talk about a wake up call.

So I called the vet and got a prescription for Lantus. Today Isabella got her first taste of this spendy, recombinant DNA human insulin analog. In humans, Lantus is intended for once-a-day dosing. Cats, being the metabolic overachievers that they are, still need it twice a day. But only twice a day – unlike PZI and some other insulins, which cats can use up and spit out in a handful of hours. So Lantus will suit my inherent laziness very well indeed.

Hopefully it will suit Isabella too. I’d like to see her blood glucose numbers come down and for her to feel better. It would be good to see her put on some weight too (though that might be an uphill battle, what with the cancer and all).

Regardless, Isabella is now getting the Cadillac of insulins for her diabetes, and I’m a newbie all over again.

Confessions of a Diabetes Slacker

Once upon a time, it was all I could do to focus on anything but Isabella’s diabetes. I worried about it all day. I surfed the web and asked questions on the Feline Diabetes Message Board. I tested her relentlessly. I obsessed over her blood sugar, made spreadsheets and graphs and scales of insulin doses.

But no more. Something has changed.

Isabella now gets tested twice a day before her shots. Maybe three times if I’m feeling really perky. I’ve quit trying to find the perfect dose and have settled on a fine dose, with minor tweaking according to her sugar level. I write down each blood test in a little notebook, along with the date, time and dose, but I haven’t touched a spreadsheet in months. And graphs? They’re history.

Depending upon who you ask, I’m either behaving more normally or being recklessly irresponsible. Near as I can tell, Isabella’s diabetes is exactly the same as always. I still get reading in the 300s. And 200s and 100s, with no apparent rhyme or reason. I wouldn’t be at all surprised to get a report that her fructosamine level reveals “poor control,” just the same as when I was obsessing.

I don’t know if I’ve given up because I’ll never get the upper hand on this damn diabetes, or have given up because the cancer will certainly win in the end, no matter what I do.

Poor Isabella. She’s on the losing end of all of these equations.

How to negotiate with a cat

Taking care of Isabella’s diabetes is, and always has been, an exercise in compromise. Isabella is a headstrong cat. She knows what she wants and she’s determined to get it. She knows just as clearly what she doesn’t want. For my part, there are things that I want and don’t want too. Sometimes those two worlds collide, and if not managed properly, it gets ugly.

What Isabella wants, mainly, is food. What she doesn’t want is to wait for it.

What I want, mainly, is to test Isabella’s blood sugar before her shots and to sleep all night. What I don’t want is to fight with her on these two issues.

That’s pretty straightforward.

When Isabella was diagnosed the vet tech suggested that I give Isabella her insulin shot while she was eating – a great idea! Then I found FDMB and decided to start testing her blood sugar before every shot. The advice was to test, then feed and shoot while eating, right in line with the vet office idea.

Unfortunately, this plan didn’t coincide with Isabella’s ideas. She was perfectly happy accepting her shot while she ate. But there was a serious problem with her meals being delayed for a blood test.

A very serious problem, indeed. So serious that I took to wearing protective gear to test my hungry kitty. At first it was leather gloves. Those gloves pissed off Isabella as much as the delayed meal. My cat gets a great deal of satisfaction from sinking her teeth into flesh and the gloves took away the fun. Once she figured that out, she starting aiming her bite toward my wrists and forearms. So I started wearing a long-sleeved fleece jacket, elastic at the wrists snapped firmly over my tender tissue. The result: I was protected for the most part, but Isabella was a snarling furball of ravenous fury. The blood tests were an ugly wrestling match and I was completely stressed out.

Until it dawned on me: Feed her first; test her after.

This little compromise made my cat cooperative and blood tests much simpler. Of course I still have to give her food (in the form of tuna flakes or temptations treats) while she gets her shot, but both of our needs are being met with this system. What a relief!

I feel just as strongly about sleeping as Isabella does about eating. I don’t care when her stomach alarm goes off, I’m not getting up and she’s not getting fed, until my alarm rings. We both had to compromise for this one: First, instead of two feedings a day, I split it up into three, the last being close to bedtime. I needed to top off her tank to have a prayer of a peaceful night. But she has to accept that I decide when it’s time for breakfast. After two years, that’s still a struggle.

Take this morning for instance. At about 5:30, Isabella felt she had waited long enough. Sun’s up! The lady should get up too! She pranced up the length of my body.

Mrrrowww!

I opened an eye and peeked at the clock. Too early. Isabella saw my eye open. She poked at me with a paw. I pulled the covers over my head and turned onto my stomach. Ahhh, quiet.

Then…

A tickle of whiskers as Isabella shoved her head under the sheet.

Mrrrowww!? Another gentle poke with a paw. Does she never learn? Two days ago this behavior got her banished from the bedroom. (Oh that was a glorious day! When I got up she triumphantly ran down the hall toward the kitchen. I even more triumphantly slammed the bedroom door and went back to bed. I slept an extra half hour just to show her.)

Today however, I had to go to work so when the alarm rang at 6am, she got her breakfast. Isabella felt like a winner. I felt like a winner (sort of).

Ours is a fragile compromise, more of a stalemate than an agreement. I suspect that if Isabella had opposable thumbs things would be much different, but for now, it’s working.

Google and The Blog

One of the fun things Site Meter does while tracking my blog traffic is show how people got here. For instance, I know that a few people read posts via a site feed like RSS. A few follow the link from my signature line on the Feline Diabetes Message Board. Some come from AOL search or MSN search. But the vast majority -- truly the bulk of people who land on this blog -- get here because of a search entered in Google.

And I can see what they searched on.

I suppose the intent of this feature is for Search Engine Optimization (SEO), where the truly traffic-motivated plant keywords in their blog (or whatever) in order to maximize the number of readers, ultimately leading to fame and, no doubt, fortune. Me? I just like to see what search led people to my little blog. I ain't optimizing, I'm just curious.

This post is an exploration of the top 10 Google searches that lead to this blog. On account of I'm so nice, I'm even going to answer the questions:

Number Ten: Where to get methyl B12, and how much to give
I buy mine online from Vitacost. It's also available in health food stores and such. As for how much -- Isabella gets 5mg per day, smooshed up in her food. I understand that any excess is harmlessly excreted in urine -- but I haven't verified that.

Number Nine: There's a lump on my cat.
Bummer. Mine too. Take yours to the vet - pronto.

Number Eight: What happens if I skip an insulin shot?
One shot? Fluffy will probably feel like crap and have pretty darn high blood sugar. More than that? You're risking seriously life-threatening complications such as ketoacidosis, which requires hospitalization and intensive treatment to fix - assuming it can be fixed. Skipping shots is not to be recommended. It's cruel to Fluffy and can be very, very devastating to your bank account.

Number Seven: What feline blood glucose reading is normal
I can just imagine the scenario that leads up to that question: Owner and cat are at the vet, where the owner is told "Fluffy's blood sugar is 8592. She's diabetic, here's some insulin." The owner is left stunned and wondering, well, just how diabetic exactly, is my little Fluffy? Is 8592 just a little high, or a lot high? Just what is normal? Here's the answer: normal is about 60-100. Fluffy definitely needs that insulin.

Number Six: What kind of glucometer to use on a diabetic cat, and where do I get it?
Any kind of meter that works on humans will work on your cat. It doesn't need to be fancy. The most expensive part is buying the strips for the tests (because, no, your health insurance will NOT cover strips for your cat, even if you think it should), so keep that in mind. The blood sample size needed varies among meters - so keep that in mind too. You might want to balance cheap strips and size of blood sample. Me? I pay $$$ for strips that take the tiniest sample of blood. If you've ever met my cat you understand why.

Number Five: My diabetic cat is ______.
Fill in the blank with any number of symptoms of hypoglycemia: limp, shaking its head, howling... Yikes. All I can say here is that if your cat is diabetic one of the first things you should do is learn the symptoms of hypoglycemia and how to treat it. Print this out and put it on your fridge. Have the phone number of an emergency vet handy. Keep Karo syrup or other high-carb food available and have a plan on how to get said sugary food into your hypoglycemic cat. And, for pete's sake, read Number Six (above) and Number Two (below) and learn how to test your cat's blood sugar.

Number Four: Why is my diabetic cat barfing
Sadly, I don't have an answer for this one, but that fact that's it's this high on the list shows that I spend way too much time discussing Isabella's intestinal issues.

Number Three: I need a spreadsheet to track my diabetic cat's blood sugar
Yay!! You can use Excel, or if you prefer an online option, try EditGrid or Google Docs. It doesn't need to be fancy. Ask the members of the Feline Diabetes Message Board, and someone will no doubt send you a template to get you started.

Number Two: How to get blood from my cat
Short answer: poke its ear. Longer answer: watch this video - it's a great demonstration of how to do it.

And the Number One search that leads people to this blog: What kind of treats should I give to my diabetic cat?
Well, they should be low carb. Something like bonito flakes (found in asian groceries) or freeze-dried fish or meats (found in pet stores, where you can spend lots of dollars for a few precious ounces of nasty-smelling chunks that will make your cat dance in circles of joy.) Experiment. See what your cat likes. Cook up a chicken breast now and then and put it in the fridge for Fluffy. She'll love you!

Lastly, the search that just plain made me laugh out loud: Feline Diabetes Message Board crazies
Hey! We are not! Well, maybe a little, but we try to hide it in public.

Dilution

A few days ago I prepared to test Isabella as usual. I got out the meter and lancet-clicker, put a test strip in and then something distracted me. I turned back to find Isabella messing around with the test strip - not with her paws, but with her mouth.

Drat.

I pushed it into the meter, expecting an error message (she's pulled this trick before) but all was well. So I assumed that she hadn't actually gotten hold of it and proceeded with the test. Except that when I touched the strip to the blood drop, it looked sort of funny. Runny. Kind of thin.

The meter calculated and then spit out this result: 28

Spit indeed. Isabella smirked at me (I swear it) as I yanked out the strip and got a new one. New poke. New blood. Ah ha - not runny this time.

The new result: 317. And now I know what cat spit does to a blood glucose test.

What to do?

I'm a little aggravated by a phone conversation I just had with my vet's office. Maybe my expectations are too high ... well, let me lay out the situation so you can judge for yourself.

The Basics:

Isabella is diabetic. Isabella has a recurrent vaccine-associated fibrosarcoma which seems to make her limp. Isabella's vet (Dr. H) prescribed metacam, an NSAID, for pain. This drug can be quite hard on kitty kidneys, so she first did a blood test to verify that Isabella's kidney function looked OK, and then asked that I bring her back in for another blood test after two weeks on the drug to make sure that things weren't going south. So far so good.

Four days later:

Isabella got sick. I stopped the metacam (in case that was the cause) and took her to the vet for fluid-fluffing, etc. This time I saw Dr. S (for the first time) who a) said don't bother wit the metacam, and b) very, very strongly encouraged surgery - repeatedly if necessary - for her tumor. (We can take it out every 4-6 months for quite a while.) These two docs clearly have very different approaches. That's OK - it's good to get a variety of viewpoints. I'm not a fan of the serial-surgery idea, though.

Two more weeks:

Isabella is feeling and acting all perky and normal again, so I decide to re-start the metacam for a couple reasons: 1) she's still limping, and 2) there's some discussion among some vets that anti-inflammatory meds might slow tumor progression. Hey - that's worth a shot! So I start it up again, which also starts the clock ticking on Dr. H's request for a blood test after two weeks on the med.

And another two weeks:

Ding! Time for a blood test. We scamper over to the vet for the blood draw (no appointment necessary!). When I get there, I say I need a blood test because she's on metacam. Blank looks from the front office staff. To check her kidney values, I further explain. Oh! OK - that's a full blood panel, and $90. (Yikes!!! I sure hope I don't have to do this every two weeks.) The cat is whisked away and her blood is letted (can I say it like that?) and I'm told to call tomorrow for results. While I was waiting I noticed that they had a new associate listed on the business cards - Dr. M.

Today:

I call for the blood results and am told the doctor will call me back. When the call finally comes, it's the new associate - Dr. M. (Sigh - where's Dr. H???) The call goes something like this:

Dr. M: Hi It's Dr. M from the Cat Hospital. I'm calling about Isabella's blood test results. I'm concerned - her blood sugar is quite high.
Me: Well, she's diabetic.
Dr. M: Yes, I read the chart and saw that. Is she on insulin?
Me: Yes - she's on PZI; has been for two years. (which is no doubt in the chart...)
Dr. M: She doesn't seem to be regulated.
Me: Sigh. No, she's never been regulated. It's a challenge.
Dr. M: Feline diabetes is a tricky disease...
Me (hoping to get to the point): The reason for the blood test is that she's on metacam. Do her kidney values look OK?
Dr. M: Oh yes, everything looks good. Kidney and liver functions seem fine.

(we discuss a bit about how often to re-test, after I explain WHY she's on the metacam and how much she's getting - which is also in the chart.)

Dr. M (coming back around to her agenda): We might need to adjust her insulin dose.
Me: I test her blood sugar and mess with the dose. I've never been able to regulate her. Do you have any experience with other insulins, like Lantus?
Dr. M: Yes - Lantus is a good insulin. The problem with human insulins is that we're at the mercy of the market. Several human insulins that worked well for cats have been pulled off the market. So we like to stay with veterinary insulin.

(At this point I resisted the urge to point out that veterinary insulins are just as subject to market pressure as anything - wasn't PZI completely unavailable for years? Didn't Idexx just announce that they're not going to make it anymore??)

Me: Since she's been so hard to regulate I've been thinking about a change, but then the fibrosarcoma came up, and I can't decide if it's worth messing around with.
Dr. M: If everything's been done with PZI, Lantus would be the next thing to try.
Me: Well, I'll think about it some more. And I'll bring Isabella in for another blood test in three months.

That was it. On the plus side - there's obviously another vet in the practice who's quite interested in diabetes. And she's heard of Lantus (yay!). On the down side -- hello!! Did you read the chart???

I know they're very busy. I know she probably had a stack of callbacks she wanted to get through on a Friday night. But really - next time, start out with the reason for the test (metacam / kidney values) and then move on to your other agenda.

I think I'll talk to Dr. H about Lantus. What have I got to lose?

Just Call Me Nancy Drew

I solved a couple mysteries over the past couple days. First was The Messy Wall Mystery. The second was The Riddle of the Rotund Kitty.

You see, as Isabella has dropped weight over the past year, the formerly slim Casey has plumped up like a Ball Park frank. (New nickname: Rotundo.) I've cut his food ration and given the extra to Isabella to no avail - she's still scrawny and he looks ready to burst.

On top of that, the wall by Isabella's bowl is flecked with bits of food. And the floor is gross. Casey's area is neat and tidy. I clean up after Isabella but soon it's all icky again. I normally fill their bowls and leave them be, so I had no idea what went on in there while they ate. But since I'm really getting concerned about Casey's weight, I decided to sit down and watch. What I saw made me understand why I've got a fat cat and a big mess. Here's the routine:

The bowls are full and both kitties dive in with gusto. Casey is like a hoover. He can polish off his ration in under a minute. He devours every bit and then licks the sides and bottom of the bowl spotless. Isabella, on the other hand, is very diligent but slower. Much, much slower. Once Casey is done with his meal, he sidles up close to Isabella. Her face is in deep, leaving little room ... but there's just enough space for a little white paw to sneak in and flip! a hunk of food out. Some lands on the floor. Some hits the wall. Some is still on the little white paw. The stolen bits are gobbled up and the little white paw goes sneaking in again and again, Isabella paying no attention at all to the intrusion.

Eventually, Isabella steps back to take a breather. Never mind that she's been eating for ten minutes, there's still at least a third of her meal left in the bowl. This is the moment Casey's been waiting for. As Isabella rests and licks her lips, Casey dives in and polishes off what's left.

Yikes - it's laundry room larceny going on right under my nose. Casey is a thief and he leaves a huge trail of evidence. He's clearly addicted, so it's up to me to put a stop to the pilfering.

I'm now the food monitor. I serve up the meal, and sit down on the step and watch. Casey knows darn well he's not supposed to steal and watching him trying to resist is hilarious. He sits by me, but his attention is on Isabella. Soon, he s t r e t c h e s out his neck toward her bowl. Then a paw. Like I won't notice! I drag him back. When Isabella takes her break, Casey makes a dive for the goods, but I snatch up the bowl until she's ready to eat again.

I'm not thrilled about this new routine. I suppose I could separate them, but I dread the drama that would accompany such a change. So I'll just play cop until my little furry thief is reformed. Or forever - whichever comes first.

Talk the Talk

Like many things, feline diabetes comes with its own lingo - words and phrases that might be confusing to strangers but make diabetic cat owners nod knowingly or laugh out loud. I've taken a stab at compiling a list of these words along with definitions. Did I miss anything?

Baileys scale: A guide to how many shots of Baileys Irish Cream it will take to cope with the cat's antics, ranging from one shot for a normal day to the whole bottle - for those times when... well, you can read it yourself. (A tip of the hat to Jenn, who devised the scale, and to Chris, who taught all of us that there is no apostrophe in Baileys.)

BAM!: Straight-in injection method used with short needles. No "tenting" of the cat's skin - just a direct stab-and-go.

Bean: Human being / cat owner. The cat's having a good day; her bean, on the other hand, is a wreck.

BGPs: Short for Big Girl Panties. A phrase used to encourage owners to stop being scared about making a change to their cat's therapy - more insulin, less insulin, new insulin ... whatever. Put on the BGPs and raise his dose.

Cauliflower ear: The dreaded result of poking the cat in the ear too many times. There are no actual documented cases of cauliflower ear; it's just one more thing for diabetic cat owner to torture themselves about.

Fur shot: Insulin injection that somehow ends up on the outside of the cat rather than on the inside. Grrrrrrrr.

Gusher: An ear poke that hits directly on the vein producing a nearly unstoppable flow of blood. Especially messy when cat shakes its head or runs freely around the house, trailing blood in its wake.

Honeymoon: The much hoped-for revival of the insulin-producing capabilities of the kitty's pancreas, eliminating the need for injected insulin. Can be elusive, and signs of the cat packing its bags for a honeymoon trip are spoken of in whispers with liberal application of anti-jinx. AKA "da fallz:"

Insulate: To inject insulin. Isabella's blood glucose was 237, so I insulated her with 1.6 units.

Kitty crack: Dry food. Much craved by many diabetic cats to a degree that mimics an illicit street drug.

Shoot the cat: Give insulin injection. As in: I've gotta get going; it's time to shoot the cat. Usually gets a double-take from outsiders.

Tunarita: Low carb drink for diabetic cats, used for celebrating low blood sugars (fictitious, of course). As in: Tunaritas all around! Isabella is at 93 today.

Vampire Club: A members-only organization for diabetic cat owners who have successfully gotten blood from their cat for a blood glucose test.

The Good Ole Days

I never thought I'd see the day when Isabella's diabetes seemed the least of my problems. Well, her problems, technically - but let's not quibble over semantics.

I may have mentioned in passing that Isabella had a bit of cancer a while back. It was a vaccine-associated fibrosarcoma, a tumor that develops at vaccination injection site. In her case, the tumor was high on her right leg, just about where the rabies vaccine was typically administered. It was just a wee little thing, maybe the size of a garbanzo bean when it was removed, but nonetheless the prognosis for this type of cancer is (in a direct quote from her pathology report) "guarded."

The lousy prognosis isn't so much that the cancer will kill the cat, it's much more a case of the cancer just keeps coming back. Take it out; it pops up again. There's only so many times it's reasonable to cut a chunk out of a kitty, so what happens is that owners finally give in, the tumor keeps growing and gets to a problematic size (I'll spare you the gory details) and the cat is put down.

When Isabella's cancer popped up, I told myself she got one shot. One surgery. I wasn't going to keep slicing into her. That was three years ago - and I had all but stopped thinking about it coming back. After all, I had the whole diabetes gig to keep me occupied. But a few weeks ago I had to finally admit that the little lump near the base of her tail wasn't my imagination. It was back. I took her to the vet, who agrees with me. Now I must decide - schedule surgery or let nature take its course?

Not an easy choice. It's something that has to rumble around inside my head for a bit. But one thing was sure, suddenly, her diabetes seems so inconsequential.

Then Isabella stopped eating. Yep - my little hoover of a cat, my cat who lives from meal to meal, my cat who wakes me up before the alarm lest breakfast be one minute tardy, went off her food. Now, even the cancer seems inconsequential.

I've put out food of every variety imaginable. Open cans of cat food with just one dollop removed litter the counter. Isabella sniffs, then turns away. Sometimes she eats a bit then returns to her bed looking miserable. What the heck!?

Back to the vet, who found nothing of significance and had no real recommendations. He fluffed her up with fluids, gave her an appetite stimulant injection and sent us on our way. Isabella ate a bit, then went back to looking miserable. She added in a bit of vomiting, just to spice things up. Was this how it was to be? Was my cat with multiple major problems going to waste away for no apparent reason?

This morning I spotted a question on the Feline Diabetes Message Board - what to do about a cat not eating? I scanned the suggestions and ran across an option I hadn't tried:

Dry food.

I had offered Isabella multiple varieties of canned food. I had warmed it. I had sprinkled it with cheese. I had added tuna flakes. But I hadn't broken out the dry food - the bain of the diabetic cat. The only reason I had any dry food in the house was that I hadn't gotten around to tossing out the prescription stuff the vet sold me the day her diabetes was diagnosed. It was sitting inside a plastic bin on the top shelf of the laundry room closet.

I pulled the bin down. Untouched for more than a year, it was the same container where I had stored the kibble pre-diabetes. Isabella is very familiar with the bin. To her, the bin, filled with kibble, is a sort of kitty nirvana, a sea of yumminess. And the sound of me pulling that bin down brought my inappetant, lethargic, miserable-looking cat running - yes running.

Needless to say, she's getting kibble if she wants kibble. For her, it's back to the good ole days. For me, I have a feeling it's going to be a very tough summer - and that I'll be looking at her "only diabetes" period as the good ole days.

Ohm .... Ohm .... Ohm ....

I have mentioned once or twice that Isabella’s personality is a bit challenging. Some may say that’s an understatement. I just like to call her quirky. Whatever the label, Isabella is a cat who knows what she wants, and even more importantly, what she doesn’t want.

As a general rule, what she doesn’t want is anyone else in her house. Or anyone else touching her. She’s pretty good at letting people know when they’ve overstayed their welcome with snarls, growls, hisses, and smacks – claws extended.

Despite her less-than-sunny personality, Isabella sometimes gets gifts from my friends and family. For instance, several years ago my sister presented Casey & Isabella each with their own Christmas stocking filled with kitty goodies. Among the booty was a catnip-filled mini stocking, which Isabella loves and carries around the house with her to this day.

But Isabella’s best-ever gift came from my best friend’s young daughter. She had tried valiantly to make friends with my snarky cat, to no avail. Ever the optimist though, Christianne wrapped up an aerosol can of Feline Calming Spray (“the calming pure essential oils of lavender and peppermint can help with nervousness”) along with the accompanying note:

(My camera truly sucks at closeups, so I’ll translate. It says: To Nancy’s mean kitty Isabella. With love (and hope) from Christianne.

The spray, of course, had no effect. But you’ve got to love little kids.

Stalking Casey

Casey is my other cat. The one you don’t hear too much about. The innocent bystander. The civilian. The one with normal blood sugar.

Normal blood sugar. Oh, how I wonder what normal blood glucose looks like in a normal cat. Lately, I’ve been wondering that a lot.

I guess things with Isabella aren’t exciting enough, so I’ve been looking at Casey’s tender, un-poked little ears with longing. Would he let me? Could I get blood out of those? His ears are always so warm… The blood flows out of warm ears so easily…

The problem, I feared, was that Casey was an eyewitness to the early, gut-wrenching efforts to test Isabella. Those were, uh, dramatic, times, and poor little Casey would make himself scarce whenever the meter and lancet appeared. Nowadays, they both come running when they hear the snap! of the test strip vial (can you say bonito flakes?) but Casey, like an elephant, never forgets.

Nonetheless, this past weekend I decided to give it a go. I knew he’d never just sit in place like Isabella, so I planned to poke, then scrape the blood droplet onto my fingernail and set him free. Piece of cake.

On Saturday I told him what I had in mind, picked him up, and carried him to the couch where I test Isabella. He squirmed; I lightly restrained. He feinted left; I talked sweet to him. He ducked under my arm, hopped to the floor and looked back at me as if to say “you’ve got to be kidding.” That was that.

Alrighty then, I’d have to come up with another approach. On Sunday, I saw my chance. The little guy was taking his midday snooze on a chair. He was relaxed and warm. I grabbed the lancet pen, crouched down, and grasped his as-yet-unmolested right ear. Poke! Casey flinched, but wasn’t distressed. Alas… no blood. Again: poke! Bigger flinch this time (and now I’ve got his full attention) but still no blood. I figured I could get maybe one more poke done before he’d flee the scene so I quickly cocked the pen and pressed it to his ear. I was right: now I had no blood and no cat. (Along with a much greater appreciation for how easily Isabella’s ears bleed.)

Undaunted, I tried again tonight. Same scene: Casey snoozing in the chair. Different reaction: as soon as I leaned over him and touched his ear, he flattened them and gave me the stink eye. I determinedly unfurled an ear and whipped out the lancet pen, and Casey, just as determinedly, shot off that chair and out of the room.

But he paused long enough to look back at me: you’ve got to be kidding.

Score: Casey -3; Me – 0

And that, I think, is that.

Something You’ve Never Seen Before

The web is a resource for all the strange-but-true things in the world, and then some. Today, for you crafty types, I present something I’ve never seen before: a complete digestive system created entirely by knitting.

From tongue to anus, it’s all there. I especially like that bright green gall bladder (because gall bladders really are green). And the pancreas – how can such a pretty little specimen cause so much trouble?

My knitting skills are rudimentary at best, but I may just see if I can conjure up a pancreas for Isabella. Why not? I’ve tried writing letters, poetry, and Christmas carols to bring her lazy islet cells back to life. How could a knitted endocrine organ be any worse?

(More pictures and patterns are here.)

BGPs

I’m at a crossroad with Isabella’s diabetes. It’s been nearly 18 months since diagnosis, and her blood glucose is really no better now than it was the first day. I’m seriously considering a switch to a different insulin – Lantus – to see if that will help. Unfortunately, I can’t just go to the drugstore and get Lantus; it requires a prescription. A prescription requires the vet’s OK, which makes me anticipate all the questions the vet might ask before she agrees to write that prescription.

Such as:

Have I really done all I can with the PZI?

The truth is, I’m not sure if I have done everything. I have not seriously tried aggressive dosing with Isabella. I lean heavily toward the timid when it comes to injecting insulin, but lately there’s been this little voice whispering (OK, screeching) in my ear: Try higher doses. Don’t be such a weenie. She’ll be fine, and (gasp) maybe even improve for a change.

In other words: buck up baby and try something new.

In the PZI insulin group on the Feline Diabetes Message Board, braving the higher doses is known as putting on the Big Girl Panties – or BGPs. (In my mental picture, the BGPs are silky nylon and feature rows of ruffles across the backside. Much like the pair that was given to me for my 8th or 9th birthday by up-the-street neighbor Denise M. They were red, for pete's sake, and yes, I opened them at a party. Yes, in front of all my friends. The humiliation is only just now starting to fade. So, a side question to Denise’s mother,who I feel certain is the truly responsible party here: What on earth were you thinking?)

But I digress.

I decided yesterday that the time had come to pull on the BGPs and wear them proudly. In the morning, I gave Isabella 2.6 units – her current “normal” dose. I tested several times throughout the day to see how she responded to the insulin, and the answer was: she didn’t. It was like nothing was there. So, after seven hours of nothing, I shot her again, this time with three units. (Never, in my wildest dreams did I ever think I’d give a dose that big.)

Well? What happened??

Her blood sugar went up. And then up come more. Screw it. Off came the BGPs, ruffles and all. I waited until this morning to give another dose – this time only 1.6 units.

The result: all day I’ve been watching her blood sugar drop, just like it’s supposed to. To me that means my plain ol’ cotton panties are just fine, thank you very much.

Let's Hear It For Innovation

A few weeks ago I was at work surfing craigslist for jobs* (show of hands: who else looks at other jobs while at work?) when I saw a listing for a company that is developing a non-invasive blood glucose monitor. I’m sure I’m not remotely qualified for whatever opening they were advertising, but boy, the idea of testing Isabella’s blood without actually having to see Isabella’s blood is mighty exciting. For two seconds, I dreamed of getting free prototypes to test. Of convincing the company that there’s a whole diabetes pet market they could exploit, and on and on.

That got me thinking about how diabetes technology has changed so much and how our little four-legged diabetics get to benefit from innovations made on behalf of humans.

For instance: not so long ago the only way human diabetics could monitor their blood sugar was by peeing on a test strip. Then came portable blood glucose meters (the early models of which, near as I can tell, required the user to practically sever a finger to get enough blood for the test). Those meters got smaller, faster, and required a smaller blood sample as time went by, putting them into the mainstream of human diabetes management. Bye-bye urine strips for first-line monitoring.

In the veterinary world, I’m not sure that home urine testing was ever the norm, but it was – and is – certainly used by some people to monitor their cat. (Here Isabella, pee in this cup…) It’s a tricky business that means you have to catch the kitty doing hers. Understandably, many folks balk at the idea.

Finally, in 2000, some smarties in Switzerland published an article about poking a diabetic cat’s ear for blood testing, noting that the technique could be used at home. Yay!! Since then, more articles have been published and the Canadian Veterinary Association has even stated that home BG testing should be part of standard therapy.

Still, the blood-letting aspect of testing puts a lot of people off. It puts off more than a few cats, too, I’m sure. That’s why I watch with interest for non-invasive methods. A non-invasive BG monitor was approved by the FDA several years ago, but it obviously didn’t make a big splash or diabetics all around would be sporting the wristwatch-type gizmo.

So we’re still waiting. There’s one under development that clips to an earlobe (hey – we’re all familiar with ear-testing!). I think the new technology focuses on shooting light through the skin or something. Infrared? Near infrared? Do I care? Not really: I just want to know two things: When? And will my cat’s fur mess up the reading?

Perhaps the next fashion trend for diabetic cats will be the shaved ear. Oh, I’d do it. You bet I would. Could taking a razor to my cat be any harder than getting her to to pee in a cup?



*Note for Mary, who I know will read this: don’t worry, I’m not really looking for another job, just keeping an eye on the landscape, if you know what I mean.

Life in Dullsville

Since I try to have a new entry in this blog once a week or so, I’ve been searching my brain and my life for something to write about. A couple of weak ideas came up, but nothing that really resonated, which made me mentally complain about how dull things are. My feline diabetes life is currently so routine that it’s unremarkable. But on the drive to work this morning, it dawned on me: Dull is good. Dull is stable. Dull is proof that the cat’s diabetes doesn’t run my life.

The way things are right now is the way things were before Isabella was diagnosed: Predictable. Steady. And so I’d like to offer up my boring life as a testament to those who are new to feline diabetes that it really does get better. Really.

In the early days, Isabella’s disease dominated my days and nights. There was so much to learn. Like how to give shots or what food and treats she should eat. I had to learn a whole new way to shop. Testing her blood sugar was such an ordeal I was literally sleepless with dread -- afraid of being maimed with each attempt, but scared to give insulin without knowing her BG level. I was constantly vigilant about her condition, concerned about hypoglycemia. I worried all day while I was at work.

Gradually, though all the new things became habit. Even the blood glucose tests settled into an easy routine. I found a pet sitter I trust and I’m able to get away without (much) worry. I learned to trust myself when choosing an insulin dose and to have confidence that I’ll know what to do if Isabella does have a problem.

Oh, I’m still vigilant. I still assess how the cat is doing each time I look at her. I’m always aware of where she is in the insulin cycle, if she's eating and peeing normally and if she's smacking Casey around like usual. And I’m nowhere near happy with her blood glucose levels overall. Isabella still trends way too high and no tweaking of dose or timing seems to change that -- so I’m seriously thinking about changing to a different type of insulin. (That ought to shake up the routine a bit!)

Overall though, it’s Dullsville. Boring, blah, same ol’, same ol’, and that equals good news in the land of Feline Diabetes . Newbies, take heart -- if I can get to Dullsville with a ornery cat like Isabella, you can get there too.

Getting Started

I wrote a while ago about my growing collection of glucose meters. I’ve planned all along to donate them to my vet for her to give to people just starting out. A consolation prize, of sorts. Your cat has an expensive, chronic disease. Here’s a parting gift.

Anyway, with that in mind, I typed up a little information sheet called “Feline Diabetes Hints, Tips, and Tricks.” I sewed up some ear-warming rice bags (in very pretty purple fabric) and I gathered up some cute little gift bags.

Then I discovered that not all of the meter kits met my very stringent standards: Three of my spare kits did not come with a starting supply of test strips.

Now, understand that the test strips are the priciest part of diabetes management. (Well, except for trips to the emergency vet, but we won’t go into that just now.) Odds are that the person who receives this wee kit will get it along with a rather big vet bill, so the last thing I want is for them to have to run to Walgreens and fork out another 50 or 100 bucks to get going.

That means, by my standards, three of my spare kits are useless and only one was up to snuff. I didn’t want to bring the vet only one kit, that seemed cheap. So I went back into hunting mode and scored two more meters – with strips – the last of which arrived in the mail last weekend.

Now I’m good to go. I have three fully-equipped meter kits. I have three rice bags. Three “tips & tricks” sheets. Two cute gift bags.

Uh oh. Two.

It turns out I have standards about the bags too. I want nice plain bags in a solid color. No holiday motif. No birthday hats. No fish. Rummaging through my supply of bags I turned up a two-tone silver bag that will have to do. It’s not the same size as the others, which bugs me, but I’m trying to cope.

Now, each bag is cheerfully marked “Diabetes Starter Kit” and stocked with the stuff. They sit lined up and ready to go to the vet’s office tomorrow.

In the meantime, does anyone want a glucose meter kit without strips? I might just have something you’d like…

The Five Stages of Feline Diabetes

Elisabeth Kubler-Ross introduced the world to the five stages of grieving in her 1969 book On Death and Dying. According to her theory, anyone dealing with grief or tragedy goes through the stages of Denial, Anger, Bargaining, and Depression on the way to landing in the world of Acceptance.

Feline Diabetes is like that, and then some.

The average person, upon learning their cat is diabetic, cycles through Kubler-Ross’s five traditional stages quite rapidly. So rapidly, in fact, that the entire process takes place at the vet’s office upon getting the bill for diagnostic tests, insulin and other supplies:

Denial: That’s not my cat. I’m here to fix the copier.
Anger: She wasn’t diabetic when she got here! What the heck happened in that back room?
Bargaining: How about foot massages for the entire staff in exchange for the insulin?
Depression: Let me find my credit card…
Acceptance: All right, give me the pen. I’ll sign.

At this point, the owner has passed through the standard stages of grieving the loss of a once-healthy pet and accepted that a cat with a high-maintenance chronic disease is glaring out from its carrier. Now it’s time to embark upon the wild and woolly journey through the Five Stages of Feline Diabetes. These stages, though well defined, may be encountered in any order, cycled through repeatedly, and even overlap.

Panic: In the early days, panic comes with the mere idea of perforating the cat with a needle. Later (when shots are so routine the caretaker can talk on the phone, inject the cat, and make dinner simultaneously) panic rears up whenever the kitty does anything unusual. Eat too much? Too little? Not at all? Barf? Look cross-eyed? Too friendly? Standoffish? Sleeping in a weird place? These, and a million other cat tricks, can – and will -- set off the panic alarm. Get used to it.

Sleeplessness/Obsessiveness: The more you know about what can go wrong with a diabetic cat, the easier it is to fret about its condition at any given moment. That leads to an endless cycle of poking the cat with a lancet to get blood for tests and poking the cat with a finger in the middle of the night to make sure it’s just sleeping. Cat not on the bed? Get up, find it, and poke it wherever it lies. Or go sleep where it’s sleeping. Whatever your approach, you will never get an uninterrupted night of sleep again. Poke.

Giddy Optimism: A routine blood glucose test that delivers an unexpected result – say a blood glucose reading of 75 (normal!) – will catapult you into the realm of hope and confidence. Two good readings in a row set off dreams of regulation or remission. Sadly, this stage is generally very short lived because a high reading or two will slam you right into …

Despair & Self-Loathing: The cat’s blood sugar is high; then it’s low. There’s no rhyme, reason, or pattern to insulin response. What worked today doesn’t work tomorrow and in fact, may never work again. And it’s obvious that the reason your cat is so darned hard to manage, is because you, the owner and primary caretaker, are an idiot.

Adult Beverages: When the insulin seems to have no effect and the cat barfs on the comforter for the fifth time this month it’s time to enter the stage where wine is a friend and Baileys Irish Cream is soothing security blanket. So start another load of laundry and rest easy knowing that tomorrow you get to do it all over again, most likely with the same frustrating lack of results.

And there you have it, the Five Stages of Feline Diabetes. These were developed without any of the pesky scientifically-valid research methods that Elisabeth Kubler-Ross had to monkey with, but, I assure you, with a liberal application of Adult Beverages.

Whose Diabetes is it, Anyway??

You’d think after all this time treating Isabella’s darn diabetes, that I’d be able to separate my ego from her blood sugar. You’d think that regardless of the number her meter spits out I could dispassionately respond with an appropriate insulin dose. You’d think I’d be over wanting her to be regulated or wishing she needed only a tiny little bit of insulin. You’d think that I’d stop, already, with the internal competition I’ve set up with the other diabetic cats.

You’d think, but you’d be wrong.

Somehow, Isabella’s diabetes has become my diabetes and the other cats are the yardstick I use to measure how well I’m doing. Never mind that every cat responds differently to insulin, food, and other factors – if one cat only needs 7/10 unit per dose, then Isabella should need only 6/10. If another cat goes 37 hours without a shot, then Isabella should go 48.

Makes sense, right? My cat is better than your cat, and I’m better than you. Right?

Nope. Not so much.

My cat is her own little furry enigma and I’m no better than anybody and probably a lot worse than most. If I have to beat something, it should be the diabetes itself, not the other cats. At first, it was like that: me against the disease (with the hapless Isabella stuck – literally! - in the middle). I was sure I could win. I was sure my cat would go into remission. But after months and months, I had to bow in defeat to her lazy pancreas and find another way to feel like a winner.

And so it began, my secret competition with the other diabetic kitties. There are dozens of competitors on the Feline Diabetes Message Board, all unwittingly providing me with hundreds of ways to win every single day. You cat’s BG was 312 this morning? Hah - Mine was 311! Your cat went to 42 with no symptoms? Sucker! My cat got as low as 37 and didn’t bat an eyelash. You had to shoot 2 units? Too bad - my awesome cat only needed 1.6 units. This is all I need to draw the mantle of victory around my shoulders.

I know it’s sad. Pathetic, really. But the knowing doesn’t stifle my idiotic need to win a race that no one else is even running. At least I'm smart enough that I don't publicly post my gleeful retorts ... so far, anyway. But be forewarned: if you publish your cat’s diabetes information on FDMB, I’m gonna beat you!

How Diabetes Changed My Cat

Diabetes has imposed subtle changes in my life and lifestyle, and it's also left its mark on Isabella. A few observations on how she's changed since her pancreas went on strike:

1) She doesn’t smell as nice any more. I used to call Isabella my “good-smelling cat.” I’d bury my nose in her fur and take a big whiff -- she just had a nice scent about her. Sort of like fresh laundry, only more cat-ish. Then, six months or so before she was diagnosed, I noticed she didn’t smell as nice. She didn’t smell bad, just not good like before. I even teased her: Casey's gonna be the good-smelling cat. (Unlikely- his scent is rather musty). Being on insulin has not restored her good smell status, which is sort of sad.

2) She’s not a fatty. Isabella lost some of her rotundiness before diagnosis. OK – I admit it: she got downright boney. Insulin therapy plumped her up and her weight went back to normal. Not fat, not skinny, just normal. She looks good (though she still has that hangy skin flap on her tummy).

3) Her coat is silkier than ever. This, I’m sure, is a direct result of changing her diet from dry kibble to canned. Both cats have gorgeous, soft fur.

4) She has vague issues with her hind legs. I suppose it’s a minor case diabetic neuropathy. She walks a little low in the back, not all the way down on her hocks, but not up on her toes, either. Some days are worse than others. I’ve been dosing her with 5mg of methyl-B12 for about six months and have seen some improvement. My yardstick is not how she walks, but how she jumps – and darn it she’s started getting on the kitchen counter again lately. I sure didn’t miss that habit!

5) She responds to new sounds: The beep-beep of the microwave when I heat her ear-warming rice bag. The clinking sound of the syringes, kept in a mug in the cupboard. The sound of lid the coming off the box that stores her testing supplies. The snap of the test strip vial. Any of these will bring Isabella trotting – because she knows that treat can’t be far behind. For the record, Casey comes trotting too, since he gets also treats.

Except for the change in her weight, no one else notices these subtle shifts in her condition and her habits. To the outside observer, Isabella looks like a healthy – though cranky – little cat. And that’s a good thing.

The Raised Eyebrow

A co-worked invited me to dinner today, as a thank you. Since I’m always up for a meal, never mind a free meal, we set about choosing a day, time, and place. I suggested a time that would allow me to run home, feed the cats, test Isabella and give insulin and still easily get to the restaurant. My friend suggested an earlier time that worked out better for her, and pre-diabetes, would have worked out great for me too.

Since the negotiation was entirely by email, I paused and mentally hemmed and hawed. Should I insist on my time? Should I explain about the cat? Should I shut up and just let Isabella stew in her sugary juices for an extra 90 minutes? After a bit of waffling, I decided to let the cat marinate and schedule dinner for the time that worked best for my hostess. I wish I could say that the fact that I’m the guest was the tipping point, but it wasn’t.

It was the potential of the raised eyebrow.

If you have a diabetic cat, you know what I’m talking about. It’s the look you get when you tell someone that your cat needs insulin.

By injection

Twice a day.

That’s enough to send most folks over the edge and set them thinking that I’m either quite crazy or quite brave – and that’s before I mention the ear pricks for glucose tests. Add that little piece of information into the mix and if the arched brow hasn't made an appearance yet, it’ll pop up now for sure. That’s when I see them mentally scratch “brave” from the list and settle happily on crazy.

Oh, sure, there are a few people who are devoted to their pets that ask a few questions and nod as if it’s the most natural thing in the world to poke your cat until it bleeds a couple times a day. Others think they couldn’t possibly do it. Some are amazed that I’d go to such lengths for a mere animal. (People who have met the snarky little Isabella are likely the most amazed of all.) And there’s the contingent that thinks I’m nuts. A “cat lady.” Sort of sad and weird.

Sometimes I just don’t want to deal with the eyebrow, so I keep my mouth shut. But other times, I admit, Isabella’s diabetes is a tool. If this dinner drags on, or is deadly boring, I won’t hesitate to excuse myself, with the explanation that my cat needs her meds.

I don’t think Isabella would mind.