A Letter to Isabella's Pancreas

This is a post I wrote on the Feline Diabetes Message Board a few months ago. Since I'm in a creative drought I'm re-posting it here - with a nod to Kerri at Six Until Me, whom I stole the idea from in the first place.

To Isabella’s Pancreas:

I just wanted to introduce myself. I’m the person who’s taken over for you since you decided to put your feet up and take a break. Now, I realize that a pancreas is busy. You have lots to do – what with secreting digestive enzymes, producing insulin, and heaven knows what else. And I have to thank you for keeping up that digestive work. Good going! But you’ve completely quit the insulin business, and this has caused both me and Isabella quite a lot of distress.

I know you’re not completely to blame. I admit my role in this. I took you for granted. I abused you. All I gave you to work with for the better part of 11 years was high carbohydrate dry food. I apologize – I really do. I didn’t know any better and I’m sure you got exhausted trying to keep up. I didn’t mean to wear you out and I promise – promise! – you will never again see more carbs than you can handle. I’ve learned my lesson. From now on I’ll treat you with the respect you deserve.

Because I know you’re in there. I see signs from time to time that you’re putting out a little insulin on your own. Do you do it to toy with me? Is it payback for all those years of kibble? Or are you really trying to get back on the job, but still need a little help? If you just need a boost, I'm here for you! (You have to admit I’ve done your job quite handily for the last year. And just look how perky Isabella feels.) I'm willing to work with you on this and I think we can get back to how things were. But better! All low carb, no kibble. And I’ll never take you for granted again.

Please, just tell me it’s not over.

Signed,
Your Stand-In
Nancy

PS: as a side note, since when is it OK to quit part of your job? Do you think I can go to work one day and just announce to my boss that I’ll no longer be responsible for half my duties so she should hire outside help? I’m thinking no. If I did that, well, we could all just kiss that expensive PZI goodbye and then you’d be out of your whole job, my friend. Give that some thought

Snooze

My father asked me to drive him to the airport earlier this week. No problem, I assured him, what time?? He hemmed and hawed. Well, the flight leaves at 8:30 … how about 6:15? In the morning? Yep, 6:15 am. No problem, I still assured him, knowing that my cat demands her breakfast at six sharp. I’ll be up already.

So we agreed, he would come to my place at 6:15 (I live closer to the airport), leave his car there, and I’d drive him to catch is flight. No problem.

Travel day arrives and I’m awakened, not by the alarm (which I’d forgotten to set), not by Isabella, who for the first time in her gluttonish existence, was content to wait for me to wake up to get her meal, but by my poor Dad, knocking loudly and ringing my doorbell. Oops.

In my defense, he arrived early – it was only 6:03. But still, I swear Isabella was sitting on the bed laughing at me. That’ll teach me to depend on a cat as a backup alarm.

I say Glucose, You say Glucosa

I spent the past weekend on a 3-night cruise to Ensendada, Mexico. My cousin organized the trip in honor of her youngest son’s 21st birthday, and my sister and I basically invited ourselves along. (The birthday boy and I do share the same birthday though, so I figure that lent some legitimacy to horning in on his celebration.)

I lined up the pet sitter, packed way too many clothes for three days, and set off for the pier, leaving feline diabetes behind for a few days.

Well, almost…

You see, one feature of Ensenada is pharmacies. Farmacia. They are everywhere, as prevalent as ABC stores in Hawaii or Duane-Reade in New York. Big signs proclaim ready access to antibiotics, geriatrics, and Viagra. No prescription necessary, just some dollars. If somehow you manage to miss the signs, there are helpful young men outside promising that you can find “everything” in their particular farmacia. Just step inside!

Since my sister, her husband, and I had some time to kill after an ATV tour of Ensenada’s dusty outskirts we wandered the main drag in town where it dawned on me: Maybe those pricey test strips would be cheaper south of the border. We stepped into the first farmacia.

Now, I don’t speak much Spanish (full disclosure: I don’t speak any Spanish) but here in Ensenada, where cruise ships full of Americans arrive on a daily basis, the locals make a point of speaking English. So, in this farmacia I asked for blood glucose test strips. In return I got a blank look, along with a pen and paper, where I wrote

Blood glucose test strips “Freestyle”

Ah! Glucosa!

Si, I replied.

“No, no.” said the pharmacy clerk, “Go to Farmacia del Sol, across the street.”

“Muchas gracias”

My sister spotted Farmacia del Sol on the far side of the busy boulevard, but we were headed to the shopping district, populated with dozens of other pharmacies, so we turned in the opposite direction.

Two or three pharmacies later, I was convinced that Mexican diabetics must somehow manage without testing, because none of the pharmacies carried test strips. One man assured me it would be very difficult to find them. In the fifth pharmacy (yes, my sister and her husband are very patient with me) I asked “But, what do diabetics do??” And I was told to go to Farmacia del Sol. They were guaranteed to have what I wanted. In the meantime, did I need any antibiotics?

Since it was on the way back to the ship, we did, in fact, stop in Farmacia del Sol. And there, in a glass case, was a display of One Touch Ultra meters and test strips, along with one box of Ascensia Contour strips. No Freestyle – but if you recall, my horde of meters includes several One Touch Ultra Minis. For the right price, I’d ditch the Freestyle in a heartbeat.

When it was finally my turn (after a fellow cruise passenger got her hands on some discount birth control pills) I found they had no Freestyle strips. The price of the OneTouch strips?? About $55 for 50. Yikes! The meter companies obviously have no problem using their greedy tactics beyond the US borders. No Mexican test strips for me.

But I didn’t come home empty-handed: I veered from my test strip quest long enough to bargain a street vendor down to $15 for two pairs of silver earrings.

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.

Let’s play … JEOPARDY!

What has Isabella’s diabetes done for me lately? Well, it’s turned me into a cesspool of trivia, for one thing. I can spout off facts about things most people never give any thought to. Useful? Maybe not. But in my fantasy life, all that minutia could translate into big bucks, given the right situation.

Such as … say, an appearance on a certain game show?

(Cue theme music.)

Alex Trebec: Good morning. Today’s contestants are a homemaker from Memphis, Tennessee, a writer from Chicago, Illinois, and the owner of a diabetic cat, from San Jose, California. Welcome everyone. Now, let’s play JEOPARDY. Writer will start us off.

Writer: I’d like “Pancreas Facts” for $100

Alex: The answer is: “The hormone that lowers blood sugar levels.” Cat Owner?

Cat Owner: What is insulin?

Alex: Correct for $100. Your choice of category?

Cat Owner: I’ll take “Neurology” for $400.

Alex: The answer is: “The neurologically-active form of a common vitamin, sometimes used in mega-doses to treat neuropathy.” Cat Owner, you’re first on the buzzer.

Cat Owner: What is Methyl B-12?

Alex: That’s right! You’ve got $500 and you can choose the next category.

Cat Owner: OK, let’s try “Diet Fads” for $500

Alex: The answer is “This popular low-carb diet has been adapted as a species-appropriate diet for felines.” Homemaker, you’re first.

Homemaker: What is The Zone?

Alex: Nooo, I’m sorry. You’ve moved into negative territory. Cat Owner?

Cat Owner: What is Atkins, or “catkins?”

Alex: Right again! You’re firmly in the lead with $1000. And we have time for one more question. Cat Owner, the category, please.

Cat Owner: Let’s go back to “Pancreas Facts” for $500

Alex: And it’s a Daily Double. Cat Owner, you can wager up to $1000.

Cat Owner: Let’s make it a true Daily Double, Alex. I’ll bet the whole $1000.

Alex: And the answer is: “These clusters of cells scattered throughout the pancreas are responsible for the organ’s endocrine functions.”

Cat Owner: What are … Islets of Langerhans?

Alex: Correct! Congratulations, Cat Owner. Your winning total is $2000 and you’ll be invited back for our Tournament of Champions in the spring. Writer, Homemaker, you had a formidable opponent today, and I thank you for playing.

(Camera fades as musical theme plays.)

How do you define “others?”

I got a consumer survey in the mail yesterday. I’m a sucker for surveys. Those guys call on the phone? I’ll talk to them. Survey in the mail? I’ll complete it and return it. I’m the perfect target for marketing people who want data.

I opened the survey and searched carefully though all the bits of paper in the envelope, Sometimes there’s cash in there, as an incentive. No greenbacks in this one, just vague promises of “valuable coupons” and a chance to win $500. I know it’s dodgy, but like I said, I’m a sucker for this stuff.

Settling in at the kitchen table, I spread the survey form open in front of me. Then, damn it, went in search of my reading glasses. OK. They want to know if I buy various types of products (Air freshener? Denture cream?) and how often. Sometimes, the folks behind this want to know about specific brands. All in all, it’s a bunch of check boxes and not too much strain on my brain. I grab a pen.

Isabella, sensing that my attention had shifted away from her, hopped up on the table to rectify that. She laid full out on the survey. Purrs. Head butts. Annoyance! I worked around her as best I could until even she didn’t care what I paid attention to and she left.

Oh – look there! Does anyone in the household suffer from diabetes? There’s a column for “you” and a column for “others in house.” I check “others.” What type of diabetes? Well, Isabella is probably Type II, but if I’m going to get coupons in the mail, I don’t want them to be for stuff like glipizide, so I check Type I. I indicate that she takes insulin “2 or more times per day” and uses a meter “Other” than AccuCheck or OneTouch. Sweet. Bring on the money-saving coupons! How about a lifetime supply of strips? Oh yeah, I’d switch meter brands in a heartbeat for a lifetime supply of strips.

Finishing up, I fill out a bit of demographic information. I’m single, no kids, and I live alone. Uh oh. Do you suppose the folks at Survey Central will notice the discrepancy? I live alone, and yet “others” have diabetes. Can’t go back and change it, I used a pen. Next question: Do I have pets? Ah! Yes, indeed. I check “cat” confident that if I’m ever called before the Survey Ethics Committee I can point out that my cat is an “other” in my household.

Done. I seal the survey in the return envelope and put it out for the morning mail. Now I’m just hoping for some free strips.

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.