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.

Hometesting Lesson

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

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

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

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

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

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

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

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

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

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

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

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

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

This week in diabetes

A few observations from the past week:

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

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

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

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

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

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

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

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

How to get blood from a cat

As I’ve said before, a major element of managing Isabella’s diabetes is testing her blood sugar before each insulin injection. If you’re familiar with feline diabetes, you may have seen this video, where Mark demonstrates a blood test on his cat Buddy. Pretty straightforward, right?

Sure, for Mark and his robo-cat.*

Around here, the twice-a-day blood tests have a slightly different look. Oh, the basics are the same: I use a glucometer, a lancet, and there is definitely a cat involved. But I have to add two other tools for my own safety: a big blanket and leather gloves.

Isabella, you see, isn’t too fond of the tests and she shows her displeasure with her teeth. Her sharp, flesh-tearing teeth.

The routine goes something like this:

I feed the cats (I learned pretty quick not to try the blood-letting on a hungry cat) and while they eat, I prepare the testing supplies. I get a test strip and put it in the glucometer almost far enough to turn it on, uncap a lancet, and lay the blanket open at the end of the couch. When the cats are done eating, Isabella comes to me expectantly. That’s when I get out the treats (bonita flakes) and the rice sock, which I warm in the microwave for 15 seconds, as I put on a pair of leather gloves with the finger tips cut..

I carry the treats & sock to the couch, with the cat trotting happily behind. I pick up Isabella and plop her (purring!) onto the blanket, where she sits as I wrap her like a little fur-filled burrito, leaving only her head showing. (Note: her head is where her teeth are. Hence, the gloves.)

Now the fun begins. Using the warmed rice-filled sock, I rub one of her ears to get the blood flowing, while also giving Isabella lots of chin and cheek scratches. She purrs, eyes closed. Drop the sock, grab the lancet, poke the ear. Isabella screeches as if I’ve sliced her entire ear off with a dull blade, and jumps – often getting partly free from the blanket – and bites whatever part of my hand she can get hold of. (She could get out of the wrapper at any time with minimal effort. It only sorta restrains her.)

I continue rubbing her ear, from bottom to top, hoping to bring a drop of blood to the tiny hole I’ve just made. Isabella growls. With luck, a big enough drop forms and I push the test strip fully into the glucometer, get the blood and a satisfying beep from the meter. If not, another poke, another screech and more rubbing. At the end, there are always bonita flakes for Isabella (and for Casey, who learned that if he hung around while his sister was abused, he would get rewarded. As if watching her abuse wasn’t treat enough.)

Most of the time, the process works. Sometimes after I wrap her, Isabella just calmly walks out of her restraint. Sometimes, her ear just won’t bleed. Sometimes – like last night – she’s just so feisty and vicious AND her ear so bloodless, that the whole process is a waste. But the majority of the time the deed gets done.

I don’t know why other folks can poke their cat and the cat doesn’t flinch. Maybe I’m just clumsy and heavy-handed. I’ve tried the lancet-launching pen and Isabella doesn’t feel a thing. But I find it hard to aim and hard to get a drop of blood, which leads to longer restraint, many more pokes, and, overall, a more stressful effort. So I’ll stick with my routine, as I’m sure, others find what works best for them.

After all, there are many ways to get blood from a cat.




*No offense Mark – your video is fantastic and I’m jealous of your well-behaved cat.