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.