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.

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.

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.

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.

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.

No Tresspassing?

It was what, two weeks ago, that I blogged about how I get blood from Isabella for her twice-a-day glucose tests?

Well, toss all that out the window, because things have changed. We have a new system now and it’s a lovely thing indeed.

A few weeks ago I started wondering why the folks on the Feline Diabetes Message Board always instruct newbies to poke between the vein and the outer rim of the cat’s ear. It makes sense to avoid the vein (pricking it releases a gusher of blood that’s nearly unstoppable. One shake of the cat’s head … and you’ll be wiping blood from the walls and every other conceivable surface), but why restrict the poke-able area to that tiny 1/8th inch margin? What about the rest of the ear? That whole, juicy part in the middle?

I’ve wielded the lancet freehand this whole time because I can’t accurately aim the lancet-launcher-pen thing at that teeny little margin. And, as I described before, Isabella finds my poking technique to be harsh. So you can understand why I was eyeing the middle of Isabella’s ears like a land-owner might survey an adjoining off-limits property.

Finally, I just asked the question. I posted a message to the Board asking why. Why not use the whole ear? Guess what: no one had an explanation. Not one single response had a reason that was good enough to convince me that it was anything other than “that’s just the way we do it.”

It was as if fences were torn down and the No Trespassing signs burned. I marched into that un-poked territory with great confidence – and – the lancet-launcher thing. Now that I didn’t have to aim so bloody carefully (oooo, that’s a bad pun!), I could use the launcher that Isabella so clearly preferred. No more shrieks from the cat. Blood drops are easily obtained and the whole process now takes about a minute.

I don’t have to wrap her in a blanket. I just plop her on the couch and she sits.

For freehand I was using a fine-tip lancet, the smallest I could find. With the launcher, I moved up to a fatter tip, but Isabella’s discomfort is still dramatically reduced. She flinches a little, but doesn’t move or run away. The whole change is so cool. I’m glad I broke tradition and tore downs those fences.

Only one thing hasn’t changed: I still wear leather gloves. It is, after all, Isabella, she-devil of diabetic cats.