Nagged into action

My cat is a nag.

I’m sure most cats are nags. Wanting to go out. Wanting to get fed. Wanting a belly rub. Isabella is a nag in those ways (except the belly rubs; she’ll take you out if you touch her belly. Casey is the belly-rub beggar around here.) and in one other way: she nags at me for her tests and shots.

The routine is to feed, then test and give insulin in the morning before work and in the afternoon when I get home. In the morning (after I’ve been nagged out of bed) I shower while the cats are eating. By the time I’m done, they’re done and Isabella is ready. Since I’ve got to go to work, I stay pretty much on schedule.

In the afternoon, though, I have to entertain myself while the cats eat. I open the mail, check email, change clothes, and lots of times I get distracted and delayed. Delays annoy my cat.

Yesterday I poked about doing this and that, then used the bathroom. As I sat on the toilet, Isabella came in and gave me a look. No noise, no meows, just a look. She conveyed her displeasure with my dawdling as effectively as a pointed glance at a wristwatch. Never mind the hundred times I’ve waited to test her while she cleaned her butt; heaven forbid I should clean my own.

Things being what they are, I apologized to Isabella and hurried to get the testing supplies and insulin ready.

She’s scary when she’s annoyed.

Diabetes Resume

I’ll bet you never realized caring for a diabetic cat has the same resume-building potential of a grad school education. Well, think about it. There are myriad high-level skills required to keep a furry diabetic going from day to day, and every one of them can be translated into a well-paying job. Just look at this list:

Budget Management: Isabella’s diagnosis meant all sorts of new entries on the Expense side of the household balance sheet, without corresponding increases on the Income side. One year later, I’ve still got the house, the creditors aren’t calling, and both cats are thriving. Is it such a stretch to think this sort of budgetary finesse could be applied to a job as the budget manager for, say, a small city or a Fortune 500 company?
Potential Salary: in 2006, the Budget Director for the City of San Jose earned just shy of $197,000.

Data Management and Interpretation: You’ve read about my spreadsheets. All those numbers and trends play a large part in the day-to-day decision making involved in feline diabetes care. Who else uses numbers and trends for daily decisions? That’s right – a stockbroker. Do I hear Dean Whitter calling?
Potential Salary: $131,290 is what those at the top of the middle 50% earn.

Diplomacy: Although I alone deal with Isabella’s diabetes on a day-to-day basis, I definitely need a knowledgeable veterinarian. Luckily, I’ve found one. Like all relationships, though, there are times when I don’t agree completely with the vet’s opinions (on, say, food) or suggestions (for lab tests). That’s where a healthy dose of tact comes into play. I’ve got to be able to disagree, ask questions, and make my own suggestions and maintain collaborative relationship. It can be tricky, but not, I imagine, any more tricky than the work done by the diplomats of the US Foreign Service.
Potential Salary: Senior Foreign Service officials earn $100,000.

Drug Delivery: I’m not talking about dark-alley felonies. Rather, I refer to the skill of safely inserting exogenous insulin into a creature with teeth and claws. It’s all about timing and distraction. I imagine it’s not unlike getting meds into a patient housed in a hospital for the criminally insane. On second thought – maybe that skill is best left off the resume…

Specialty Cleaning: It isn’t one of my favorite parts of kitty diabetes, but let’s face it: the disease involves a certain exposure to, ahem, bodily fluids. First, there’s the blood. Several times a day I perforate my cat to make her bleed. Sometimes the blood is easily contained, sometimes it gets flung far and wide. Then there’s the urine: it needs to be occasionally captured and tested for ketones. The capturing requires a certain intimacy with the cat; the testing, a certain intimacy with the urine. And then there’s the vomit. All cats puke; diabetic ones just seem to puke more, and they like to puke in the middle – middle of the night, middle of the floor, middle of the bed, etc. As Isabella’s personal handmaiden, I get to mop up all those fluids. Often. And that, I believe, qualifies me for a well-paid job as a crime-scene cleaning specialist.
Potential salary: Per the website HowStuffWorks.com “it's possible to reach six figures in a big city with a lot of violent deaths and meth labs” Cool.

So, if I ever get tired of my current job, I’ve got a few other options to explore, courtesy of my cat’s lazy pancreas.

The Church of Excel

Isabella's diabetes is all about data. Well, technically I guess Isabella's diabetes is all about her health, but managing the diabetes keeps me focused on numbers. What's her blood glucose? How long ago did she get insulin? How much insulin did she get?

I've got all those numbers jotted down in a little notebook that I keep near the diabetes box. Page after page of numbers, each one representing a kitty blood-letting session. (Side thought: I wonder how much blood I've pulled out of Isabella's ears in the last year? There's still a fair amount splattered on the walls...) Anyway, early on I saw those numbers piling up and realized I needed more than a paper-and-pencil system to keep track of it all.

And so, I became a worshipper at the altar of Microsoft Excel.

I set up a very simple spreadsheet: a column for dates, a column for the morning blood sugar reading, another for the afternoon reading, and a column for notes. Simple. Straightforward. From this simple spreadsheet I could generate those famous bar charts that drove Isabella's first vet crazy and bring her current vet so much joy:

And it was good.

But then my greedy heart wanted more. So I added colors to the columns, making the cells turn a pretty green when Isabella's blood sugar was under 100 and an angry red when she passed the 300 mark.

Again, it was good. I looked at my colorful spreadsheet and descriptive bar charts and felt joy and gratefulness in my heart.

We carried along in this way for many months, my spreadsheet and I, until a change of (dare I say it?) biblical proportions again made me question my faith.

I was testing Isabella more and more. Two columns of numbers wasn't enough and I was forced to cram extra test numbers into the "Comments" column. Entering data lost its appeal and I began to turn my back on Excel and rely upon my pagan notebook for everything.

The loss of faith was distressing. I searched the Help files looking for answers, wanting to find something that could bring me back to the altar. But my doubting heart and skeptical eyes did not light upon the truth and saw instead only the darkness of the simple, inadequate spreadsheet.

I did not approach the altar for weeks.

But I knew there were others who still worshipped at the church of Excel and so I reached out to the faithful among the members of FDMB. I asked them for guidance, to light my way on the path of diabetes data management.

And my call was heard. I received a new spreadsheet template like a gift from on high. This template has columns and rows for everything. It works as well for days when I test only twice as it does for days when I poke Isabella ruthlessly and repeatedly. It has a worksheet for curves.

But before I could truly enjoy the new spreadsheet, I had to pay penance. I had to sit silently to enter more than four weeks worth of data, contemplating my brief fall from grace with each number.

Now my sins are absolved, my data is up to date, and I've added the cool feature that makes the cells turn different colors depending upon Isabella's blood sugar reading. I am once again among the faithful gathered at the altar of Excel.

And it is good.

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.

Jingle Jangle

As I've mentioned several times, the Feline Diabetes Message Board is a site where knowledge and helpfulness abound. If there's something going on with your diabetic cat, you can bet that someone else on the board has seen it and can help you with it. 24 hours a day, there's someone around to offer advice, support, solace, whatever.

I like reading the board. I learn a lot and it can make me laugh. But there's one topic I avoid like the plague: the hypo watch.

A hypo watch happens when a member posts a message that their cat's blood sugar has dropped into dangerous territory, which is pretty much anything from the 40s on down. People from all over jump in to help, trying to make sure the person is covering all the bases - feeding the cat, testing often, watching for clinical signs, getting the car warmed up and ready to sprint to the vet if needed.

Hypos can come out of nowhere. It can be a cat whose insulin needs suddenly change: the dose that's been just fine for months is suddenly too much. It can be a mistake by a newbie or a substitute caregiver: remember Fuzz - accidentally given 20 units by a stand-in who read the marks on the syringe incorrectly? (Note: even three units is a big dose for most diabetic cats. I've never give Isabella more than 2 units.)

The mistakes scare me the most. When I read that Fuzz had been given 20 units, my heart collapsed. When I read recently that someone new to the board had given 4 units to her cat whose sugar was already at 40, I couldn't read any more. There are others and they all upset me.

Even though many, maybe even most, of these hypo watches end just fine - with help from the board the cat's blood sugar goes up and no obvious harm is done - I hate reading them. Fuzz survived his 20 units, as did the cat who was given more insulin when already low. I hate reading them because sometimes, the worst happens. And that reminds me that anyone can make a mistake. Anyone.

That's why I'm always very glad to hear the bell on Isabella's collar when I get home, even before I open the door. If she's jingling, she's okay.

Happiness is...

In the previous post of random observations from last week, I forgot to include the absolute high point. The pinnacle, as it were. Get ready to be astonished and amazed:

I found Fancy Feast at the Grocery Outlet for 33 cents per can. I bought everything they had. Hah! Take that, expensive-cat food-maker-people.

I want to be clear: that's the highlight of the diabetes week -- not my whole life. I like to think I'm doing a little better than that. But this blog is about the diabetic cat, so I try really hard to stay on topic.

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Isabella's sugar was 311 this morning. I can't figure out what is going on with that animal. Is she getting too much insulin? (Her high flat numbers indicate that's possible.) Is she resistant? Is she rebounding?? Does she actually need more? I don't know. I don' t know. I don't know.

When I see those high numbers (day in, day out) I have the urge to either plug her with a super dose (which I'd never do, but it's sooooooooo tempting) or to give her nothing and see what happens.

Today I did it. Or, didn't, rather. I skipped her shot even though her numbers are high. I'll see when I get home from work if that had any effect at all.

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.