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.

It’s Day One All Over Again

I’ve finally done it. I’ve finally made the switch from PZI insulin to Lantus for Isabella’s diabetes.

I had been all set to talk to the vet about changing when Isabella’s cancer came back. That really threw me – all of a sudden I wasn’t sure I should bother trying to learn a new insulin if she was just going to die anyway. So I hesitated. I procrastinated. I stopped caring about her numbers.

Then someone on the Feline Diabetes Message Board said something that really hit home:
Don’t bury your cat until it’s dead.

The comment wasn’t directed at me, it was in someone else’s discussion. But I realized that I had done exactly that. I had given up on Isabella’s day-to-day disease because of something that might not be a problem for months and months. I had, in effect, buried her already.

Talk about a wake up call.

So I called the vet and got a prescription for Lantus. Today Isabella got her first taste of this spendy, recombinant DNA human insulin analog. In humans, Lantus is intended for once-a-day dosing. Cats, being the metabolic overachievers that they are, still need it twice a day. But only twice a day – unlike PZI and some other insulins, which cats can use up and spit out in a handful of hours. So Lantus will suit my inherent laziness very well indeed.

Hopefully it will suit Isabella too. I’d like to see her blood glucose numbers come down and for her to feel better. It would be good to see her put on some weight too (though that might be an uphill battle, what with the cancer and all).

Regardless, Isabella is now getting the Cadillac of insulins for her diabetes, and I’m a newbie all over again.

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.