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.

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.

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.

The Raised Eyebrow

A co-worked invited me to dinner today, as a thank you. Since I’m always up for a meal, never mind a free meal, we set about choosing a day, time, and place. I suggested a time that would allow me to run home, feed the cats, test Isabella and give insulin and still easily get to the restaurant. My friend suggested an earlier time that worked out better for her, and pre-diabetes, would have worked out great for me too.

Since the negotiation was entirely by email, I paused and mentally hemmed and hawed. Should I insist on my time? Should I explain about the cat? Should I shut up and just let Isabella stew in her sugary juices for an extra 90 minutes? After a bit of waffling, I decided to let the cat marinate and schedule dinner for the time that worked best for my hostess. I wish I could say that the fact that I’m the guest was the tipping point, but it wasn’t.

It was the potential of the raised eyebrow.

If you have a diabetic cat, you know what I’m talking about. It’s the look you get when you tell someone that your cat needs insulin.

By injection

Twice a day.

That’s enough to send most folks over the edge and set them thinking that I’m either quite crazy or quite brave – and that’s before I mention the ear pricks for glucose tests. Add that little piece of information into the mix and if the arched brow hasn't made an appearance yet, it’ll pop up now for sure. That’s when I see them mentally scratch “brave” from the list and settle happily on crazy.

Oh, sure, there are a few people who are devoted to their pets that ask a few questions and nod as if it’s the most natural thing in the world to poke your cat until it bleeds a couple times a day. Others think they couldn’t possibly do it. Some are amazed that I’d go to such lengths for a mere animal. (People who have met the snarky little Isabella are likely the most amazed of all.) And there’s the contingent that thinks I’m nuts. A “cat lady.” Sort of sad and weird.

Sometimes I just don’t want to deal with the eyebrow, so I keep my mouth shut. But other times, I admit, Isabella’s diabetes is a tool. If this dinner drags on, or is deadly boring, I won’t hesitate to excuse myself, with the explanation that my cat needs her meds.

I don’t think Isabella would mind.

One year of diabetes --- by the numbers

Today marks the one year anniversary of Isabella’s diabetes diagnosis. We’ve gone through a lot in the past year, that cat and I. She has shown enormous patience and adaptability (plus a good measure of her usual snarkiness) and I have learned to let go of the idea that I can bend this disease (or this cat) to my will.

The past year breaks down like this:

739 injections (plus 16 more from the pet sitter). Miraculously, I’ve only been bitten a couple times – when I tried to shoot without having Isabella’s face firmly planted in a food bowl. Every once in a while I forget who I’m dealing with, but she reminds me.

773 blood glucose tests (requiring far more ear pokes!). Oh, the horrors Isabella endured. One day I chased her frantically around the house with a lancet and the meter. If anyone had witnessed that, the cat would have been removed from my care and I would be under psychiatric observation.

3 vials of insulin (we’re working on number four). The first one cost $150. The second and third, about $100 each. Number four? $41. Yippee!

2 fur shots. That’s not bad, actually. Shots, I can handle. It’s all the other stuff that’s a crap shoot.

Highest blood sugar reading: 487 (July 19th). That’s even higher than the vet’s reading when she was diagnosed. I’m doing a great job, aren’t I??

Lowest: 38 (September 3rd). Isabella does this just to show she can. Or to highlight my incompetence, one or the other.

6 vet appointments. I’ve already tallied up those costs. Let’s not revisit that just now.

2 vets. The first one, I firmly believe, thinks I’m a complete nut case. The current vet may share that opinion, but she hides it better.

1000+ cans of cat food (for both cats). How many of you carry a teeny, tiny shortened version of Janet’s food list with you at all times? I deleted the brands that cost too much and the varieties too high in carbs, eliminated extraneous columns, printed the resulting much-smaller list doubled-sided, and shrunk it down so it fits in my wallet. You’ve all done that, right? It’s not just me?

1 time Isabella yanked the strip out of the meter with her teeth. Now I can say for sure that kitty saliva on a test strip causes an error message on the meter. I’m going to start charging her for the strips when she pulls stunts that wreck a test strip. It’s coming out of her college fund.

One year. In the early days I was convinced I could get Isabella regulated and off insulin. Now I’m only convinced that I don’t know what I’m doing. Sometimes I’m discouraged, sometimes realistic, sometimes resigned. A month ago my cousin asked Isabella’s age. When I told him twelve, he replied “She could live for years.”

If I do my kitty pancreas routine adequately, she will. Yep, she will.

The ties that bind

One thing about feline diabetes is that it requires a commitment. My cat, previously so self-sufficient, now needs a pancreatic stand-in - and that's not a job that allows vacation days. Because Isabella's pancreas has put its feet up and retired, I, or someone else, has to be at the ready with insulin at least twice a day.

When the Isabella's vet broke the diabetes news, I swear I felt a tether wrap around my ankle. It tugs on me when I'm out of the house with insulin time approaching and it wakes me up early every morning. For the first three months, that tether, and Isabella, ran the show. The thing is, tethers make me wiggly and restless. I needed to wrest control out of Isabella's furry little paws and reclaim my independence. I needed to feel like I could go somewhere if I wanted to go. I needed to untie the tether.

I did untie it. Lots of times. I've traveled more this year than ever before, and I'm not done yet. I started slowly - a weekend in Santa Cruz with high school friends. Several weeks ahead of time, I started searching for a pet-sitter. First I asked a friend who lives quite close and who had administered sub-q fluids to her own cat. Insulin would be a piece of cake for her, I thought.

Well, not so much. Turns out she could barely stand dealing with needles for a cat she knew, and Isabella doesn't exactly have a stellar reputation for friendliness among my friends and family. She declined. I asked the techs at my vet's office. Nope. I turned to the internet, where I found several local sitters who would happily come by -- to the tune of 25 bucks per visit. $50 a day for pet-sitting is not in my budget.

Then I found Katy. Young, but insured and bonded. And familiar with administering insulin. Best of all, I could afford her. So I set her up to come that weekend I was in Santa Cruz, transferring responsibility for the tether to her. Of course I clutched my cell phone all weekend, especially near the times I knew Katy should be tending the cats, and I worried like crazy. But it went fine.

So I tried again, venturing a little further afield to my sister's house for an overnighter. Then a trip to southern California, followed by another trip to southern California. The tether slips off easily now. So easily that I've planned a weekend at a writers' conference, a weekend cruise, and a trip to New York -- all before Thanksgiving.

I'm glad I found Katy. She's a full partner in Isabella's diabetes, because she lets me have a life. She's willing to take the tie that binds me to the insulin bottle and the cat and wear it herself for a while. Sure, it costs me some money, but the freedom I gain is priceless.

This week in diabetes

A few observations from the past week:

1) Last night Isabella was driving me nuts at about 2am. She does this sometimes - wanders in and out of the room meowing, scratches at the dresser, climbs all over me and wants to knead at my neck, paws at the covers, bites, and is generally a pain in the ass. I usually ignore her. Last night, I decided to test in case she was low, even though she was 12 hours past her last shot and has been generally unresponsive to insulin all week.

This is the first time - first! - I've ever gotten out of bed in the wee hours to test the cat. I told her it had better be worth it. In the end I don't know if it was or wasn't. Blood sugar was 350+, so I gave her a shot. And now I know for sure she will misbehave in the middle of the night when she's not low (thus reducing even further the likelihood I'll get out of bed to test her in the wee hours).

2) If anyone was out on my street at 2am, they got a nice view of my nearly naked self filling a syringe in the kitchen.

3) The fact that I will now test Isabella while nearly naked is the best testament to how far we've come in the hometesting routine. I used to don protective clothing. Now, clothing is optional.

4) I've noticed (again!) how reactionary I am to the cat's blood glucose levels. I find it very hard to stick to a scale if I think the scale isn't working. And if one test gives me an unexpected number, then I think the scale isn't working. Isabella's numbers are unexpected almost all the time. Therefore... well, you see the problem. My behavior is probably why vets freak out at the idea of owners hometesting.

5) I've also noticed that when I sit down to enter numbers into the spreadsheet or my profile at FDMB, the numbers usually aren't as bad as I thought (in the moment) and it's obvious that I have impulse control issues when it comes to reacting to single numbers.

6) I've started crushing a methyl B-12 tab into Isabella's food at each meal in case the problem she has with her hind end is neuropathy. Ever since I started this, Casey waits until Isabella takes a break from eating and then commandeers her food bowl. Isabella then eats from Casey's bowl. I'm not sure why I try.

7) It's closing in on a year since diagnosis, and Isabella's numbers are no better. But she seems happier, so I guess that it's worth it. Someone, please tell me that it's worth it.

Don't try this at home

I just did something really stupid.

I had Microsoft Money open to balance my checkbook when I thought: hey, I wonder how much I've spent on the cat since she was diagnosed?

Some things are better left alone, know what I mean?

But what's done is done and I may as well blog about it. So here it is, in all its glory, the current total of what I've spent since that fateful day last September when Isabella was diagnosed as a real "sweetie:"

Vet expenses: 1286.92

Insulin: $349.50

Syringes, lancets, test strips & miscellaneous: $350.87

Food & litter: $477.38

Pet sitter: $116

(Notice there's no category for meters. Though my current stockpile of blood glucose meters has reached the embarrassing total of eight, I haven't paid for any of them. At least something about feline diabetes is affordable.)

For a grand total of: 2508.67

By way of comparison, and because I'm obviously a glutton for punishment, I also checked the amount spent during the previous two and a half years:

Vet expenses: $1276.56 (cancer surgery)

Food & litter: $430.13

Total: $1706.69

Isabella's little bout of fibrosarcoma two years ago almost disguises the fact that I've spent more on food in ten months than I did the whole previous 30 months. Of course, that dry food may have been cheap but it's the cause of this whole diabetes gig in the first place.

Yes, feline diabetes can be spendy, but I think I'm doing a pretty good job of keeping costs down. I shop hard for cat food bargains, I buy supplies online, get free shipping when I can, and I try to minimize vet visits. In the early days of diagnosis, I was at the vet so often my credit card company would call and check on Isabella if they didn't see any veterinary-related charges for a while.

OK, I'm kidding. But that's how it felt.

My constant effort to sniff out bargains is why I get boxes this size from the online diabetes supply house, Hocks.com:

I'm buying syringes by the case to save on shipping.

Now my curiosity has been satisfied. I know what Isabella's diabetes has cost, financially, anyway. So what did this exercise teach me?

Leave the report function of Microsoft Money the hell alone. And I still have to balance my checkbook.

Sometimes, you've just gotta laugh

Feline diabetes is a big disease. After it invades your cat, it invades your life - leaving almost nothing untouched. It can be tragic, frustrating, annoying. It can be the dull ache behind your temples or the nagging in your gut. It's always there, no matter where you are, so you just deal with it.

Along with the dull ache, though, kitty diabetes bring lots of opportunity to laugh. Stuff happens. Sometimes we can laugh at the stuff right away. Other times it takes a while. One of the joys of the Feline Diabetes Message Board lies in the sharing of the stuff. Interspersed with the tragic and the mundane is the hilarious -- stories that have made me laugh so hard my gut ache was replaced by a side ache.

So that we never forget that having a sugar cat around the house isn't all bad, I've gathered a few of my favorite posts from FDMB.

• Kristine describes the scene of her first injection for newly-diagnosed Harley. Ah, the memories!


• Rule number one for feline diabetes is: the cat must eat. So, what does one do when the cat in question decides to turn his pink little nose up at the prescription diet recommended by the vet? Well, one can change foods... or one can outsmart the cat, like Rocky's Dad.


• Rule number two is that the cat is supposed to eat low carb. And no, chocolate chips don't count, even if they are stolen from the fridge on the sly in the middle of the night.


• Dog food doesn't count either - no matter how hard the cat tries to look like a dog.


• Finally, since these are cats, there are sometimes other challenges that come along with the package.

If anyone has other favorite funny stories about diabetic kitties, send me a link and when I get enough, I'll post another compilation.

Tight Regulation ... or not

I’ve been toying with the idea of trying Tight Regulation (TR) to keep Isabella’s numbers lower overall. TR involves shooting insulin as needed, rather than on a twice-a-day schedule. So, if she’s rising 6 hours after her last shot, give insulin at that time instead of letting her blood sugar keep rising and then trying to drive a much higher number down. It also involves developing a dosing scale based on BG number (sliding scale).

It makes a lot of sense. It also requires a lot more ear-poking and a certain amount of guts. I decided to try it last Wednesday for the first time. Isabella’s last dose of insulin was at 4pm Tuesday, so when I tested her at 6:30 am Wednesday more than 14 hours had elapsed.

Her BG was 81.

No shot. I waited around, balanced my checkbook, did some laundry. Two hours later: 94. Still no shot. Finally, an hour after than she was up to 141 or thereabouts so I gave her one unit. (Usual is 1.8 units. I don’t have a scale developed yet.)

Finally, I could go about my day! I tested her 6 hours after the injection: 168. Two hours after that: 131. Finally, at 9pm, 12 hours after her morning insulin, she was at 297, earning her 2nd dose of the day. So much for extra insulin.

I tried again on Saturday. She got her morning dose, a test six hours later, and one more test an hour after that. She was high enough at the 7-hour mark to get a 2nd shot. The real test came around bedtime, when I should have checked her again to see if she needed more insulin to see her through the night. But I was sick and I just didn't feel like testing. So I blew it off, and I've not tried again since.

Sigh. Maybe I’m not cut out for tight regulation after all.

Report on the New Vet

Isabella saw the new vet last Tuesday. Oh My Goodness – what a difference. I brought lots of BG charts for her – showing the kitty’s response to various insulin dosages. To me, they all looked the same: jagged peaks and valleys of un-regulation. The vet looked them over and then looked at me.

“Actually, these look pretty good.”

Huh? I was stunned. Old Vet would have chastised me and implied that I was lying about her food intake or something. New Vet said “This is a cat. She’s not going to follow any rules.” New Vet was able to see an overall lower trend on the higher doses and encouraged me to try going to 2 units. I’m scared of 2 units – since Isabella has always gone low on that dose -- but I’m giving it some thought.

Other things from New Vet:
- New insulin. They dispense BCP instead of PZI Vet. Much cheaper! Though they had to order U40 for me since they normally dispense U100. I’ll wait until she’s been on the BCP a while before trying the 2 units, I think
- She’s not a believer in tight regulation. She’s a “manager,” not a curer. That’s OK, though. At this point I feel confident enough about what I’m doing to try some things below the radar and report to her.
- She only wants to see occasional BG charts via fax and the actual cat every six months, unless something urgent arises.
- She has a sense of humor and she’s not afraid to use it.

Overall, a huge improvement and I’m thrilled. I finally feel like I have a partner in this feline diabetes thing. Whew!

Vetting a new vet

Isabella has an appointment on Tuesday with a new vet. I have high hopes that this one will be a little more clued in about managing feline diabetes than her current vet.

No that the usual guy is bad – not at all. It’s just that I’m the only client he’s ever had who uses hometesting to monitor blood sugar. He can’t look at the numbers I give him and make sense of them because he just doesn’t have the experience. He needs to see my numbers, and urine test dip sticks, and blood tests for fructosamine levels and see how they all relate in order to learn. But I can’t afford to be his learning curve – those fructo tests cost 70 bucks a pop. Seventy of my bucks.

So I asked around for vet recommendations. The first place I called is not accepting new clients. The second, though, sounds pretty good. The front office gal told me that they have “dozens” of diabetic clients (it’s a cats-only practice) and that they teach owners to hometest. One of the three vets in the office sees all the diabetics. Then I talked to the vet and she basically passed my interview. So Tuesday the Isabella and I will visit to see how I like her in person. I’ll bring some blood glucose numbers and talk about curves and dosages.

I really hope I like her, and the clinic. Isabella is eight months into her diabetes experience and she’s not regulated at all. I really need some help understanding if regulation is a possibility and what I need to do to get there. I need someone to talk to who doesn’t think I’m a micro-managing head case. I need a veterinary partner.

And yet I feel very guilty about ditching the old vet. I dread the thought of calling and asking for copies of Isabella’s records. It seems like passing judgment (“Thanks, but you’re just not good enough for me.”) I’ll do it though. Because my cranky little diabetic deserves a doctor who knows what’s what.

Stick a fork in me

Sometimes I just want to be done with this diabetes thing.

Like when the alarm goes off at 6am. Every day. No matter what.

Or when I’m almost out of insulin and wondering if there’s enough left to get to the next credit card billing cycle before having to spend the hundred and fifty bucks for more.

Or when the meter reads 350.

Or when Isabella wakes up in the middle of the night and scratches the dresser.

Or when I prick her ear and her head shake flings blood all over the walls.

Or when I have to leave a party early to give her a shot.

Or when I have to factor the expense of a pet sitter into the cost of a vacation.

Or when I look at the spreadsheet of blood sugar readings and realize that I’m getting nowhere.

Or when I have to buy test strips. With no insurance.

Or, when the cats turn their pink little noses up at whatever food I’ve served.

Sometimes I just feel so done. But I’ll never quit, not as long as Isabella needs the juice.

The many faces of time

I’ve been noticing lately how I think differently about time depending upon what I’m doing.

Holiday time
This holiday weekend, for instance, was all about days. Days and days without work (four of them, to be exact). Days of glorious weather. Days without commitment. I cared little about the hour, because I had all these days stacked up, without much I needed to accomplish. Those days are drawing to a close now, but I assure you, I was successful in accomplishing very little.

Project Time
My latest freelance job seems to be about weeks. I was given a deadline five weeks away. Five weeks is a freelance lifetime! Those weeks had much to do with why I did so little in the last four days.

Workout time
In the pool for a swimming workout, I focus on seconds. The coach assigns sets with time intervals. I calculate quickly: can I swim that distance, in that stroke, in that amount of time? Will I have any seconds left over to catch my breath before I have to do it again?

Work time
At work, like everyone else, it’s hours and days. How long until that doctor comes in to pick up the research he requested? How many days ‘til the weekend?

And woven throughout everything else, there is …

Diabetes Time
I rarely glance at a clock without at least subconsciously calculating how long it’s been since Isabella’s last insulin injection. Is she close to peak? Does she seem to feel how she should at this point in the insulin cycle? Is she sleeping too hard? Is she restless? Is she whining because it’s actually time for food, or is she low?

One thing that I’m only now beginning to trust is that Isabella’s insulin, PZI-Vet, doesn’t really start to have an effect on her blood sugar until about four hours after the injection. So, when I test her glucose before her shot, I have to guess what her sugar will be in four hours and shoot a dose appropriate for that number.

Today was the first time I consciously did that. She was at 156 (nice!) this morning, 12 hours after her last shot. She had eaten, which was going to cause her sugar to spike up. So I gathered my courage and gave her a full dose – not the halvsies I normally would have chosen. I tested her three and a half hours later, and sure enough she was in the high 200s. The PZI would kick in against that number and (fingers crossed) bring her back down into the 100s for a good part of the day. She’d probably hit her lowest point at about 9 or 10 hours after the shot, and start creeping up as the insulin wore off … just in time for the afternoon injection to start taking effect.

If I guessed all this correctly, her blood sugar should be between 150 and 200 when it’s time to inject her in a little while. Then again… she’s a cat. Her blood sugar could be anything. Stay tuned.

Tick Tock, Tick Tock … time passes


And the results are in: 357. So much for my predictions about smooth insulin cycles and likely blood sugar readings. Sigh. Why do I even try to guess?

Here we go again...

She's doing it again.

My diabetic cat is giving me high blood glucose numbers. As in nearly 400.

After several weeks of staying in the 200s or lower, I had the audacity to think that maybe I'd found the right dose: 1.7 units BID. Not 1.6 units. Not 1.8 units. But 1.7 units.

Now those dreaded high numbers are showing up again. High numbers can mean she's not getting enough insulin. Or high numbers can mean that she's getting too munch insulin. With Isabella, at this dose, I'm guessing that her body has decided it's too much. 1.7 is three tiny drops away from 2.0 units. The only thing that's been consistent about Isabella's diabetes these past months is that 2.0 units is too much. So, when I start getting close to 2 units, I pay very close attention - to the cat and to the numbers.

Sigh. I'll give her a half dose this evening. I'll bet that her blood glucose drops like a rock. And I'll bet that if I stick with the smaller dose for any length of time, her numbers will start creeping up and her dose will start creeping up until I'm back to 1.7 units. Where we'll stay until her body decides it's too much.

Around and around and around we go...

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.

Judge thyself not…

Sometimes, it’s really hard to avoid taking Isabella’s blood glucose numbers personally. Really, really hard.

As I’ve blogged before, when Isabella was first diagnosed as diabetic I naively assumed that it would be a simple matter of insulin in, blood sugar down. Higher number, more insulin; lower number, less insulin.

But it’s not like that at all. Well, it is sort of like that – insulin does cause blood sugar to go down...most of the time. And higher numbers do warrant more insulin...except when they signal a need for less insulin. But never -- never -- can I absolutely rely upon a linear dose response. I can’t plug 1.7 units of PZI into my cat and know that it will knock her blood sugar down 150 points, with the nadir coming at 8 hours after the dose. “Predictable” and “diabetes” have nothing in common.

It’s taken me a while to truly understand that though. Isabella got her first insulin seven months ago. The very day of her diagnosis, I discovered the Feline Diabetes Message Board, a marvelous community of diabetic cat owners. I learned more from the folks on the board than I ever will from the vet. These people are living it, day after day. There’s always someone online who knows what you’re going through. It’s a fantastic place of shared knowledge and camaraderie.

It’s also a place where the success stories are front and center. Tales of cats needing insulin for only a couple weeks before becoming diet controlled abound. It’s a very encouraging thing for the newbies to talk to folks whose cats are happily eating low carb and off insulin for months or years. It’s easy to assume that your cat will be the same. Then as the weeks slog by and the glucometer keeps spitting out ugly numbers like 372, it’s even easier to assume that you are a failure.

I have hit the wall of failure many, many times in my travels in the land of feline diabetes. I have seen those ugly numbers on the meter and crumpled into a little pile of self-loathing. For months I was certain that each change in Isabella’s dose would be the magic change. Her numbers would drop! She would be regulated! Or, maybe, she would go off insulin altogether!

But test after test would reveal that no, her numbers are still all over the map, she’s not regulated and she probably never will be regulated. I was a mess. Every high reading was another black mark. I would enter those horrid numbers into a spreadsheet and plot the graph of failure. I was ashamed to go to the vet.

Two things have helped me to gradually let go of that shame. The first was the vet, who pointed out more than once that Isabella really looks good. Her weight is stable. Her fur is silky and shiny. She’s eating a normal amount, peeing a normal amount, and is not sucking water from the bottom of the bathtub. “Look at the whole cat, not just the numbers.” This is very, very good advice.

The second was that I realized that among all the folks on the message board who have fabulous success treating their cats, there are many more who quietly plod along, day after day, struggling with stubborn highs, freak lows, and infuriating variability, just like I do. My cat is not the only one. I am not the only one. I am not a failure. We are all doing the best we can.

Now, when I see a good number (which, for me, is anything in the 100s) I’m happy that Isabella is probably feeling pretty good that day. When she’s in the 300s, I give her extra chin scratches and let her sleep. A number is just a number. Not a judgment.

How to get blood from a cat

As I’ve said before, a major element of managing Isabella’s diabetes is testing her blood sugar before each insulin injection. If you’re familiar with feline diabetes, you may have seen this video, where Mark demonstrates a blood test on his cat Buddy. Pretty straightforward, right?

Sure, for Mark and his robo-cat.*

Around here, the twice-a-day blood tests have a slightly different look. Oh, the basics are the same: I use a glucometer, a lancet, and there is definitely a cat involved. But I have to add two other tools for my own safety: a big blanket and leather gloves.

Isabella, you see, isn’t too fond of the tests and she shows her displeasure with her teeth. Her sharp, flesh-tearing teeth.

The routine goes something like this:

I feed the cats (I learned pretty quick not to try the blood-letting on a hungry cat) and while they eat, I prepare the testing supplies. I get a test strip and put it in the glucometer almost far enough to turn it on, uncap a lancet, and lay the blanket open at the end of the couch. When the cats are done eating, Isabella comes to me expectantly. That’s when I get out the treats (bonita flakes) and the rice sock, which I warm in the microwave for 15 seconds, as I put on a pair of leather gloves with the finger tips cut..

I carry the treats & sock to the couch, with the cat trotting happily behind. I pick up Isabella and plop her (purring!) onto the blanket, where she sits as I wrap her like a little fur-filled burrito, leaving only her head showing. (Note: her head is where her teeth are. Hence, the gloves.)

Now the fun begins. Using the warmed rice-filled sock, I rub one of her ears to get the blood flowing, while also giving Isabella lots of chin and cheek scratches. She purrs, eyes closed. Drop the sock, grab the lancet, poke the ear. Isabella screeches as if I’ve sliced her entire ear off with a dull blade, and jumps – often getting partly free from the blanket – and bites whatever part of my hand she can get hold of. (She could get out of the wrapper at any time with minimal effort. It only sorta restrains her.)

I continue rubbing her ear, from bottom to top, hoping to bring a drop of blood to the tiny hole I’ve just made. Isabella growls. With luck, a big enough drop forms and I push the test strip fully into the glucometer, get the blood and a satisfying beep from the meter. If not, another poke, another screech and more rubbing. At the end, there are always bonita flakes for Isabella (and for Casey, who learned that if he hung around while his sister was abused, he would get rewarded. As if watching her abuse wasn’t treat enough.)

Most of the time, the process works. Sometimes after I wrap her, Isabella just calmly walks out of her restraint. Sometimes, her ear just won’t bleed. Sometimes – like last night – she’s just so feisty and vicious AND her ear so bloodless, that the whole process is a waste. But the majority of the time the deed gets done.

I don’t know why other folks can poke their cat and the cat doesn’t flinch. Maybe I’m just clumsy and heavy-handed. I’ve tried the lancet-launching pen and Isabella doesn’t feel a thing. But I find it hard to aim and hard to get a drop of blood, which leads to longer restraint, many more pokes, and, overall, a more stressful effort. So I’ll stick with my routine, as I’m sure, others find what works best for them.

After all, there are many ways to get blood from a cat.




*No offense Mark – your video is fantastic and I’m jealous of your well-behaved cat.

One Twenty Seven

Today after work, I tested Isabella’s blood sugar, like I always do. For the last two months her glucose has been stubbornly in the 300s, maybe with an occasional dip into the high 200s. Today: 127

Now, I don’t know why today it’s 127. But it’s because of these random low numbers that I keep subjecting my cat to the twice-daily blood-letting. 127 means no insulin – at least not right away. If I hadn’t tested and I just shot her up with 1.7U (this week’s preferred dose), she might have gone low enough to be hypo and need treatment. Or she might have dipped low and her pesky liver would get all excited and send out glucose (or make some other organ send out glucose, I can never get that part straight). Her liver always sends out too much, and she goes crazy high for days on end. I hate that.

So, 127 warrants special consideration. Do I skip a dose, and wait until tomorrow and see where her number is? That’s a very safe course, but it has its drawbacks, the main one being that I lose the overlap of insulin doses that I’ve so carefully cultivated. (Cultivated to no avail, apparently, judging from her recent streak of high glucose.)

Do I wait a while, see what her glucose is in a couple hours? That’s a good plan, but a late shot screws up her schedule. Or, do I pick a token dose, shoot her now, and hope it’s not too much? Nah. I’ve done that before with less-than-optimal results.

The hell with the schedule. I fed the cats and figured I test her again when I got back from swimming. But since Isabella was standing in the kitchen expecting an injection at the usual time (expecting a treat, more like), I gave her a treat and poked her with a capped syringe. A little placebo, just in case.

Four hours later: 177. Hmmm. That’s a surprise. I expected much higher, based on elapsed time since her last dose and the meal. Did Mr. Pancreas decide to deal with her postprandial glucose spike? (If so, thank you Mr. Pancreas. Nice to hear from you from time to time.)

Now I really have to decide. Insulin or no insulin? She’s rising, but not skyrocketing. I don’t want to lose all traces of overlap. I also don’t want to spend a sleepless night with a howling hypoglycemic cat.

I gave her a half unit. And more food (in case Mr. Pancreas really is awake today.) Hopefully this decision won’t keep both of us awake all night.

Such is life with feline diabetes

Food spikes

The results are in. (Drumroll, please.)

Serving Isabella the same food at the same times every day did not smooth out her blood glucose numbers. She's still up, then down. Up, then up again, then down. I have to admit to feeling smug about this. I gave the report to the vet, along with a 12-hour BG curve, and said I thought a dose increase was in order. The curve (in which the poor cat’s blood glucose is tested every two hours for twelve hours to see how the insulin works) was intended as evidence that her overall numbers are still too high.

The vet’s response? He wants to run an expensive blood test. Which will tell him … (dramatic pause) …that her overall blood glucose is still too high. Not on my dime, darlin’. He also wants me to test her urine glucose.

Now, here I’ve presented him with the BEST information you can get, short of continuous glucose monitoring, and he wants info from less-revealing testing methods. I give up. Obviously he is just not interested in learning from the blood glucose numbers.

To that end I collected the phone numbers of three veterinarians recommended by friends. All have (or had) cats. None diabetic, but I’ve got to start somewhere.

Vet number one is not taking new clients. Vet number two is taking new clients and has a huge diabetic clientele. Further, they encourage it and teach owners to test blood glucose at home. This information I got from the front office gal. The vet was (is?) supposed to call me so I can ask more specific questions. Alas, she has not called. So …. I’m not impressed with that. Perhaps I need to make an appointment. I haven’t called vet number three, since the second sounded so promising.

I’m changing vets regardless. If I can’t get Isabella’s glucose down with insulin, she’s going to need other tests to figure out what’s going on and I’d like those tests to be done by someone I have more confidence in. I owe a huge debt of gratitude to my current vet, who removed Isabella’s cancer two years ago, but he’s not cutting it with the endocrine disease. We all have our strengths.

Que sera, sera.