Stalking Casey

Casey is my other cat. The one you don’t hear too much about. The innocent bystander. The civilian. The one with normal blood sugar.

Normal blood sugar. Oh, how I wonder what normal blood glucose looks like in a normal cat. Lately, I’ve been wondering that a lot.

I guess things with Isabella aren’t exciting enough, so I’ve been looking at Casey’s tender, un-poked little ears with longing. Would he let me? Could I get blood out of those? His ears are always so warm… The blood flows out of warm ears so easily…

The problem, I feared, was that Casey was an eyewitness to the early, gut-wrenching efforts to test Isabella. Those were, uh, dramatic, times, and poor little Casey would make himself scarce whenever the meter and lancet appeared. Nowadays, they both come running when they hear the snap! of the test strip vial (can you say bonito flakes?) but Casey, like an elephant, never forgets.

Nonetheless, this past weekend I decided to give it a go. I knew he’d never just sit in place like Isabella, so I planned to poke, then scrape the blood droplet onto my fingernail and set him free. Piece of cake.

On Saturday I told him what I had in mind, picked him up, and carried him to the couch where I test Isabella. He squirmed; I lightly restrained. He feinted left; I talked sweet to him. He ducked under my arm, hopped to the floor and looked back at me as if to say “you’ve got to be kidding.” That was that.

Alrighty then, I’d have to come up with another approach. On Sunday, I saw my chance. The little guy was taking his midday snooze on a chair. He was relaxed and warm. I grabbed the lancet pen, crouched down, and grasped his as-yet-unmolested right ear. Poke! Casey flinched, but wasn’t distressed. Alas… no blood. Again: poke! Bigger flinch this time (and now I’ve got his full attention) but still no blood. I figured I could get maybe one more poke done before he’d flee the scene so I quickly cocked the pen and pressed it to his ear. I was right: now I had no blood and no cat. (Along with a much greater appreciation for how easily Isabella’s ears bleed.)

Undaunted, I tried again tonight. Same scene: Casey snoozing in the chair. Different reaction: as soon as I leaned over him and touched his ear, he flattened them and gave me the stink eye. I determinedly unfurled an ear and whipped out the lancet pen, and Casey, just as determinedly, shot off that chair and out of the room.

But he paused long enough to look back at me: you’ve got to be kidding.

Score: Casey -3; Me – 0

And that, I think, is that.

Something You’ve Never Seen Before

The web is a resource for all the strange-but-true things in the world, and then some. Today, for you crafty types, I present something I’ve never seen before: a complete digestive system created entirely by knitting.

From tongue to anus, it’s all there. I especially like that bright green gall bladder (because gall bladders really are green). And the pancreas – how can such a pretty little specimen cause so much trouble?

My knitting skills are rudimentary at best, but I may just see if I can conjure up a pancreas for Isabella. Why not? I’ve tried writing letters, poetry, and Christmas carols to bring her lazy islet cells back to life. How could a knitted endocrine organ be any worse?

(More pictures and patterns are here.)

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.

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.