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.

Happiness is...

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

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

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

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

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

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

This week in diabetes

A few observations from the past week:

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

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

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

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

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

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

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

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

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.

Here we go again...

She's doing it again.

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

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

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

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

Around and around and around we go...

One Twenty Seven

Today after work, I tested Isabella’s blood sugar, like I always do. For the last two months her glucose has been stubbornly in the 300s, maybe with an occasional dip into the high 200s. Today: 127

Now, I don’t know why today it’s 127. But it’s because of these random low numbers that I keep subjecting my cat to the twice-daily blood-letting. 127 means no insulin – at least not right away. If I hadn’t tested and I just shot her up with 1.7U (this week’s preferred dose), she might have gone low enough to be hypo and need treatment. Or she might have dipped low and her pesky liver would get all excited and send out glucose (or make some other organ send out glucose, I can never get that part straight). Her liver always sends out too much, and she goes crazy high for days on end. I hate that.

So, 127 warrants special consideration. Do I skip a dose, and wait until tomorrow and see where her number is? That’s a very safe course, but it has its drawbacks, the main one being that I lose the overlap of insulin doses that I’ve so carefully cultivated. (Cultivated to no avail, apparently, judging from her recent streak of high glucose.)

Do I wait a while, see what her glucose is in a couple hours? That’s a good plan, but a late shot screws up her schedule. Or, do I pick a token dose, shoot her now, and hope it’s not too much? Nah. I’ve done that before with less-than-optimal results.

The hell with the schedule. I fed the cats and figured I test her again when I got back from swimming. But since Isabella was standing in the kitchen expecting an injection at the usual time (expecting a treat, more like), I gave her a treat and poked her with a capped syringe. A little placebo, just in case.

Four hours later: 177. Hmmm. That’s a surprise. I expected much higher, based on elapsed time since her last dose and the meal. Did Mr. Pancreas decide to deal with her postprandial glucose spike? (If so, thank you Mr. Pancreas. Nice to hear from you from time to time.)

Now I really have to decide. Insulin or no insulin? She’s rising, but not skyrocketing. I don’t want to lose all traces of overlap. I also don’t want to spend a sleepless night with a howling hypoglycemic cat.

I gave her a half unit. And more food (in case Mr. Pancreas really is awake today.) Hopefully this decision won’t keep both of us awake all night.

Such is life with feline diabetes

Peaks & Valleys ... feline diabetes-style

I’m seriously frustrated with my vet. The cat’s vet, actually.

I took Isabella in for a check-up this week. I dreaded going because her blood glucose numbers have been high lately. Consistently high. I’ve spent the last month tweaking her insulin dose and getting nowhere. But, knowing I had an appointment coming up, I picked a dose and stuck with it for ten days prior to the vet visit. He (the vet) gets twitchy when I move the dose around.

I figured I’d go in, present her log of BG numbers, get scolded for a) tweaking the dose, and b) settling on a dose that’s too low, and then we’d agree to raise the dose and I’d be on my way.

What I had forgotten is that this vet isn’t used to seeing twice-a-day blood glucose numbers mapped out in a bar chart. While I’m able to focus on (and be ashamed by) the overall trend of numbers in the mid-300s, he fixates on the peaks and valleys of day-to-day variation. I see those daily variations reported by other kitty owners on the Feline Diabetes Message Board, so I know it’s not something unusual.

My vet, however, naively assumes that if I fed Isabella a strictly consistent number of calories each day, she’d respond with correspondingly consistent BG numbers. And! He wants me to feed the expensive prescription food (higher in carbs that what I’ve been feeding).

In the interest of decent relations, I’ve decided to compromise. I chose three flavors of grocery-store food. She gets three meals a day, so she will get those same three flavors, in the same order and at the same time, every damn day for the next two weeks. That will keep her calories consistent from day-to-day – both overall and within each insulin cycle. At the end of the trial, I’ll plot out her daily numbers so he can see that the same level of variation crops up even when calories are the same.

Unless, of course, he’s right and she suddenly smoothes out and start showing a predictable response to the insulin. It could happen, but I ain’t betting on it.

And, in the meantime, I’m going to interview other vets. It’s a big town. There’s got to be someone around who can work with a home-testing owner of a diabetic cat.