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.