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.