Dear Mom

Sometimes, you have to let your cat be a cat. One of my favorite things off the Feline Diabetes site.

Dear Mom,

I know it's only been a couple of days, but there are a few things I'd like to tell you.

First of all, you really do have to calm down, because you're stressing me out.

Please at least let me get all the way out of the litter box before you start to inspect it.

Don't stare at me while I'm eating. It makes me nervous. I need a little privacy please.

You really don't have to follow me from one room to the next. I'm not doing anything that I haven't done a million times before. I'm still trying to catch those pesky fish that live behind the glass. I'm chasing the dust bunnies under your desk. I'm waiting to catch Libby (drooler) off guard so I can smack her and run. I'm doing all those catly things I've always done. I don't need a perpetual audience.

Just because I'm sleeping, doesn't mean that you need to wake me up and check on me every five minutes. I'm a cat. I sleep.

I feel hot because I've been lying in my favorite sunny spot in the office. Yes, that really is the only reason.

I know it would make you feel better if I slept in your bed with you, but it wouldn't make me feel better. I've never done that before, so it would feel funny to start doing it now. Besides, I really like my bed. I've had it a long time, you know.

It doesn't mean that something is wrong with me just because I don't want to play. Don't you remember the rules? When you want to play with me, I want to ignore you and treat you with disdain. I want to play with you when you are reading the newspaper or attempting to drink your first cup of coffee. This has always worked for us, so why would I want to
change that now? So if I don't want to play with you, it doesn't necessarily mean that I don't feel good. It means that I'm just being the Rainbow I've always been.

Stop lecturing (boyfriend) every time you leave the house for five minutes. He has read everything you have. He was there at the vet's when you picked me up. He knows all the signals/symptoms of hypo, and he knows what to do. He knows where the syrup is. How could he not, since it's now in every room in the house. Remember when you told me that you would trust him with your life? Well trust him with mine. He loves you, and he won't let anything happen to me.

You know that pounding headache you've had since last Sunday? It might go away if you'd chill out just a little bit.

And lastly, every single sound I make need not be analyzed for meaning. Just because I speak to you, it doesn't mean I'm sick or hurting or getting ready to go hypo. I've always been a very vocal kitty. Sometimes a meow really is just a meow.

Love,

Your Sugar Cat

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Written by Laura and Rainbow. We couldn't agree more with its sentiment.

Insulin Primer

Confused?

I don't blame you.

There are several types of insulins that may be prescribed by a vet for your cat's diabetes. On FDMB we sometimes see really strange advice from vets and we see newly diagnosed cat's parents confused about what they just brought home. You can find a more involved primer on Feline Diabetes which I highly recommend you read when you are calmer. But for a short, sweet rundown, here is a short, sweet primer:

Humulin R - Extremely fast acting insulin. Used usually only as a bolster for a cat with unusually high hard to drop numbers in conjunction with another insulin or for ketone cases AT the veterinary's in an effort to get a drop as one part of helping with ketones in DKA. EXTREME CAUTION. Experienced and RARE, CAUTIOUS use only. Only active for about 3 hours but causes FAST drops. Any vet prescribing this should be considered extremely suspect in their experience of feline diabetes (or any diabetes). Use as a bolus should ONLY be undertaken by an extremely experience user and extremely carefully. Very rare need. There, did that scare you? Good.

If the vet gave you this I cannot emphasize enough to find a new vet. This is NOT an insulin that should be prescribed to a new owner. Or actually for anything other than the rarest of circumstances.

Pearl says you may proceed now.

Humulin N (u100)- Often prescribed by vets who may not be used to using newer synthetic insulins or used to treating feline diabetes. Longer lasting than R but tricky for cats. Cats process insulin pretty quickly so this insulin usually has a quick onset and hits the nadir in about 4 hours. MUST be given after feeding because it is fast. Some cats do well on it, usually when a cat parent can really test, monitor and get to know how the cat eats and processes it with the food. Can be used but it's, I think, finicky to use in a cat.

Here is a good primer on how to use with your cat's diabetes. Many cats, it's just not enough. Since it is out of the system eight hours or less, even twice a day dosing is probably going to leave your cat without enough coverage at least half of a day. Also, if you have a vomiter, can be really tricky and leave you worrying about hypo if you can't get the cat to eat again. Or if the cat vomits and you've left for work, again you risk hypo with no one at home to help. Would not ever be my choice of insulin but it works for some.

Vetsulin (u40)- This insulin had some major manufacturing problems several months ago and even the manufacturer sent notices to all vets to change to other insulins. I don't know if they fixed it but it was never great for cats as it was a dog insulin. Vets used it for lack of other insulins but honestly, almost no cat did well on it. If a vet has some lying around and gives it to you, insist on another insulin or find a new vet.

PZI (varying strengths - check with vet and vial) (Protamine Zinc Insulin)- There are only two sources now that I am aware of that produce this insulin. There is BCP PZI by a compounding pharmacy out of Texas. We used this a while. It works better in some cats than others. I didn't find it to be the best for Pearl. Longer lasting than N, probably 5 to 6 hours to nadir, so around a 12 hour cycle. Many vets are leary of it because it is pounded in their heads that compounded insulin is inconsistant. I don't know for sure that is true, but this insulin is more affordable than the other PZI and some cats do great on it. Service in our experience was terrific and fast fast fast. May be worth a try for some. There is also the new ProZinc that replace the Idexx PZI (which was, indeed, a very consistant, good manufactured PZI but was discontinued by the manufacturer for .... well, reasons that are debated). I don't know much about it. Never used it. More people are coming home with it. I'm sure it's pricey but probably works fine. Again, testing and knowing your cat will be key to success as with all insulins. If a cat is not doing well on it, a switch to one of the following insulins should be considered.

Lantus (glargine) (u100)- An excellent long last insulin. This insulin is often great to use, especially in newly diagnosed cats. This insulin, with careful blood monitoring at home with a glucometer and a switch to low carb we food can often result in remission for many many cats. IMO, some vets do not realize that the Queensland protocol says to dose by ideal weight, not the current weight of the cat, resulting in beginning doses that are too high. Nothing against them. Vets are not all versed in specialties, but they do miss this. Not only does beginning with a too high dose risk a hypo of a cat under a new, inexperienced parent but it could also cause chronic rebound which the vet then sees as "not enough" reaction from the insulin and they increase the does, compounding the problem until one day a crisis point is reached and the cat bottoms out and hypos or has other problems from the high blood glucose numbers. In my opinion, the *best* starting dose for any insulin is to begin on the low side and increase. This protocol is very good at describing how and when to change doses in conjunction with home testing.

The awesome thing about lantus and the following insulin, levemir, is that they have a long, slow effect on blood glucose numbers. Instead of the sharper V shaped curves of the shorter insulin there are nice gradual lowerings, in more of a shallow U form. This means, once you get experienced at using this, you can often get a cat on nice mid normal range numbers form most or even all of the day. This is also probably why remission can happen so well on it. It gives the pancreas the rest it needs to repair. The flip side of that is you MUST be testing or one day you could come home to a hypoing cat. Pearl did fantastically on this for over a year, but then did begin to have trouble. I don't know why, but I've heard of this happening with some cats. Others use it fine for years. We switched to the PZIs but then when levemir began being used and people had great results I finally switched to that. Lantus can be purchased in pens or cartridges

that can be used like vials but bring the cost way down because it is much more efficacious for longer.

Levemir (u100)- Uses the same protocol as glargine. Works similarly. I find it is more stable (I never have a vial poop out on me like I did with Lantus). Everything said above about how Lantus works applies here to. I love it. We get the pens:

(only pens, not cartridges, are available in the U.S. but they all can be used with syringes, just like a vial so it's all good), which while it is a higher cost outlay to do, lasts well over 5 months (unless you have a big gulp kitty (rare) or an acromegaly cat rare but less rare than vets have been saying. If your cat is needing ever higher doses of an insulin and the vets are puzzled, even if they say it's too rare to check out, check it out. Make them test. Especially if you have a cat that looks like it has kind of oversized features. It's just not as rare as many believe.) This brings the cost down to probably the most affordable insulin. In my opinion, also the best.

All insulins really require home blood glucose monitoring to get the best results. There is just no doubt about that. Even if your cat has been on insulin 10 years, test. Just the other day a cat who had been getting flat normal numbers on a certain dose of Lantus for YEARs had a hypo. The owner had grown lax in testing because numbers just stayed the same. The cat was in dire shape, her meter was dead and by the time she found batteries and tested the cat was down to a 19 mg/dl reading. That is DEADLY. She caught it in time and using the tools from a Hypo Kit and knowing how to treat a hypo her kitty recovered. Mostly a cat with that number and those symptoms needs the ER immediately!!! So, never doubt testing before shots, even when you get the same ol' same ol'. Treating your cat with insulin and not testing is not unlike, as some have said, driving with a paper sack over your head that has a couple of slits cut out. You may get along but you sure can't see any approaching dangers and your luck could run out very quickly and tragically.

I hope this helps some newly diagnosed parents figure out the mysteries of what the heck the vet just handed you and what it means.

Pancreatitis Sucks

It really does. Pearl has had bouts off and on for years, but they seem to get more chronic as she gets older. She has issues, as you know from the blog and I think we can add teeth to that, which doesn't help.

Major things to know about pancreatitis in cats is that 1) it's really common. Probably more common than is diagnosed and 2) vets are beginning to agree that pain management is probably a key thing in controlling it. Here are some GREAT reads to share with your vet if you are facing this issue. Yes, I know, Idexx has interests here, but the roundtable link is I think particularly frank and good. I'm always at war with my distaste for Big Pharma and my need for some of their products.

I keep pepcid a/c on hand too as it seems to help. (NOTE: ONLY regular pepcic/famotodine, NOT the complete or advanced kinds). This is one case where it is actually a good reason to use it for a cat. Some people jump on it too quickly but I don't think you can for panc attacks (or as I accidentally texted to my sis "pancake attack").

Luckily, the last bad attack, my vet gave me two little vials of buprenex for pain so I had some on hand which was great at 3 a.m. when she was yowling from discomfort. It's easy to give, tasteless and seems to provide great comfort quickly. Sometimes vets are very cagey about giving that out though. Some don't even have it. If you have a pancreatitis prone kitty, see if you can get your vet on board with having a little vial on hand for emergencies. I can only offer luck there on your relationship with your vet.

One thing I have learned from many people with pancreatitis prone kitties is that food is in the category of "Each Cat Is Different" or ECID. What works for one may not work for another. For Pearl, w/d by Hills works pretty well. It's not a great food, IMO, as many but when she gets poopy and pukey it usually helps. I also like to get her Earth's Best Chicken and Brown rice or Chicken and Squash baby food. For her low fat, high fiber helps. But you may have to experiment. You can find lots of info in the FANTASTIC JANET AND BINKY'S FOOD PAGE.

Water, water, water. De-hydration makes you feel YUCK anyway. It will add to the situation here, so try to get them that water anyway possible.

Well, for what it is worth, there are some tips. Good luck to anyone searching "cats" and "pancreatitis". I feel for you and your kitty.

Relax with Kitty Knits!

Treating diabetes in our feline friends can be very overwhelming and stressful, particularly at first. And even as you get into a routine, random, unexplainable spikes and worries can cause we caretakers to freak out occasionally. It's important to remember to breathe and take time for yourself. Do things that calm you. I can think of few things better than needlework. Recently, I took up crocheting and it is just a fabulous way to relax. Next I am taking knitting lessons and I can't wait to try patterns from the fantastic new knitting book
Kitty Knits by Donna Druchunas!

Donna has some of the most adorable projects for both you and your cat I've seen. I asked Donna a few questions and she very graciously granted a little interview:

So, have you always had cats?

No, actually. We had a cat for a short time when I was a kid, but usually we had dogs. I got the first cat that actually belonged to me just before I got married in 1990. His name was Kittens (mostly because we never got around to finding him a real name), even though he was pretty big. Since then I’ve always had cats. I can’t sleep without them walking around in the bed.

How did you come to live with Uno and Deedee?

Before I had Uno and Deedee , I had Sparkles and Tipper. They both died of unrelated cancers a few years ago and I was lonely. Both of my current cats are adopted from the humane society.
Deedee (picture right, Donna and Deedee) was a tiny, scrawny thing when we found her waiting to be adopted. She was really timid and afraid and it took her a while to relax after she moved in with us.

When I found Uno (left) a few months later, I’d gone with my mom to help her find a cat, and Uno stuck his paw out of the cage and patted me on the head when I walked by. I went home and told my husband that I’d found what I wanted for Christmas! And we went back and adopted Uno that afternoon.

You have some really lovely patterns! These are just great. Where do you get your inspiration from?

I don’t know. I just like to make things up. Since I love cats, I am
always looking at pictures of cats and buying things with cat motifs on them. So when I decided to work on this book, I just started making little sketches of projects that I thought would be fun to make and to have. I also wanted to make a range of projects using different techniques, so there’d be something for everyone, instead of just using my favorite techniques.

Do the cats every bother your work? I know mine like to use my beds before they are even done. Sugar loves to watch the yarn move ever so slowly. Pearl is just irritated I am not paying attention to her.

My cats love to lay on UFOs! Fortunately they don’t bother my yarn any more. Uno used to use balls of yarns as attack toys when he was a kitten, but he doesn’t bother with that now that he’s older. They also love to sleep on the rugs I made for my first book, The Knitted Rug. Their
favorite yarn is mohair, so I made them their own mohair blankets a while ago, to match a sweater I was working on. I was going to include the patterns in the book, but there wasn’t enough room and we decided to cut it because the other projects were much more “cat” intensive!

Uno and "The Cat Afghan"

So is this a kind of departure for you from your regular work on knitting? What are some of your other patterns based on?

Most of my other work is based on inspiration from historical or cultural textiles from other parts of the world. It was fun to take a departure from that on Kitty Knits, but you’ll see that I did include a few pieces that follow that theme. The lace scarf includes the Peruvian cat motif designed by Dorothy Reade, who was very influential in the development of the patterns used by the Oomingmak knitters in Alaska, as I discussed in Arctic Lace. The chullo cap is also based on traditional Peruvian designs. And the Scandinavian colorwork sweaters are based on traditional knitting patterns as well.

Deedee and Felted Catnip Mice

How long have you been working with yarn?

Pretty much for my whole life, although I did take a break from knitting and crochet for about 20 years (from 15 to 35)! I am glad that I learned to do so many different things when I was young, because that makes it easier for me as an adult. I can go back to things I learned a long time ago and explore them in more depth without having to start learning the skills from scratch. I really admire new knitters who come to this craft with no childhood background using knitting needles! Getting grown up hands to learn how to make stitches is no small feat.

Thanks again for inviting me to join you for the day. It’s been a pleasure visiting your blog.

The Yarn Continues

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Originally uploaded by chupie

Long time no post. Things seem to be going well until just recently. And so the yarn continues. Recently, Pearl does not seem to be using her insulin well again, and I have actually had trouble with insulin leaking back out after shooting. I think there is some scar tissue building up in the scruff area. So, we are using a new area. It's more sensitive and it's almost like starting over again. The good news is, she is doing better, the bad is that I feel like a newbie, like I have lost my shooting technique. But we go on. Pearl plays. She loves her kitty beds which I've been crocheting (she didn't even wait for this last one to dry before trying it out.)


She enjoys torturing Sugar, and Sugar semi-enjoys being tortured. And I do the best I can. And you can't feel too bad when you see how silly she can be.

Pearl is also an Asthma Kitty

Pearl's diabetes was kicked off by prednisone being given for asthma. She was most likely predisposed to diabetes because the pred pretty much kicked in the BGs immediately. But it took me about 3 months to figure out that it was the pred. Many cats that have steroid induced diabetes may not become full diabetics. So we got her off of pred and I ordered an aerokat. It's based on the idea of a child's mask and chamber to deliver inhaled meds. A great great resource, and the first place you should visit if you find out your cat has asthma is Fritz the Brave's site. Dr. Padrid is the noted vet that helped pioneer using inhaled meds. His protocol is located on the site and you can print it out for your vet. That's what I did. They were happy to try something new. There is also a great message board for Feline Inhaled meds that you can find there and subscribe to (it's a Yahoo group). I took a period of time getting Pearl used to the mask.

While I was waiting for it to be delivered, I took an empty toilet paper roll and would place it over her nose and mouth and remove it right away and give a treat. I would increase the time I held it and always treat. She looked at me like I was nuts, but the treat was A-OK so she cooperated. When the Aerokat came, I first put the mask in a bag of catnip hoping to get rid of some of the plastic smell. I would lay it on the floor by her food dish each meal so she got used to seeing it in connection with FOOD. Then I smeared food on it and let her lick it off. Then just as with the toilet paper roll, I would put the mask over her nose and mouth, briefly, and then treat. This was a bit scarier than the empty toilet paper roll, but we extended the time over a couple of days and she became fairly relaxed with it. Hey, she got a treat so, whatever, she thought.

Then I tried the flovent. For the first few days, I would shake the cannister (always shake before you puff) and hold my hand over the open end of the mask, puff it into my hand and then move the mask onto her face. Probably didn't get full doses doing that but it made the transition more smooth. She got used to the smell of the flovent and didn't have that puff sound quite so close. After probably 4 days, I just started putting the mask ON her to puff. We now puff once a day. Pearl is a moderate asthmatic, so she does well on one puff of 110mcg Flovent a day. I keep albuterol on hand in case she does have a cough, but we have not had to use it often. She did get wheezy on me in the cat box the other day, so I used it, but normally the flovent keeps her well controlled. Miss a day and not so much.

Here is a little video of Pearl getting her flovent puff. I wish I had a better video camera, but I think you get the idea.



If you take the time too desensitize your cat, you will do fine, and your cat will have MUCH better controlled asthma without nearly as much danger of systemic steroid troubles. Personally, I believe even mild asthma should be treated. I got Pearl when she was 6 years old and she had a habit of coughing with no hairballs EVER, and sometimes heaving up a clear mucous after a coughing fit, after she ate, but with no food coming back up. This happened a couple, three times a month. I just didn't know. 2 years later we went to get xrays because it became more frequent. The lungs looked ok, but we got distracted by finding arthritis in her knee. I didn't pursue the coughing. Fast forward to two years ago. One Sunday, Pearl had 5 coughing fits between 8 am and 3 pm and by then I could hear a wheeze. I took her to ER where, because she was having attacks THAT DAY the xrays showed pretty classic signs. She started on pred and the coughing wheezing stopped pretty much immediately. I took the xrays to my vet the next day and she agreed it could be, but she also saw something with the heart she didn't like. The ultrasound guy was coming that afternoon for a cat with a thrombosis (who sadly didn't make it). He found Pearl did have a mild mitral insufficiency in her heart chamber. Her heart was FINE in the first xrays I got when she was 8 and she had been coughing since before I got her, so we do not believe the asthma cough is anything but asthma. However, we did put her on 1 enecard pill and 1/4 lasix a day. Who knows if it helps, but it doesn't hurt.

Pearl got the really short stick on the genetics draw. But we are coping pretty well.

Is it easy to test a cat?

Well, not always at first, although, ECID (each cat is different). However, most cats adapt well, and are extremely cooperative. I made these two videos on July 4 to show you how Pearl comes to her testing station and gets a blood test.






In the beginning, the key is to warm the ear first with either a sock that has rice in the toe and is heated a few seconds in the microwave, or with Pearl, I used a damp washcloth in a baggie, heated just 13 or so seconds. I always tested it on MY ear to make sure it was not too hot. I had to hold it on the ear a good 20 to 30 seconds. That did the trick. Believe it or not, after a while you do not need this. The ear learns to bleed.

Another good pointer is to provide a firm surface under the ear. I use my finger. I have rarely poked through. When I tried to use the surface of a rice sock, it gave too much. I like using the device but some people prefer to free hand with a lancet. They hold it at a 45 degree angle; somewhat like sewing. For me, I cannot poke fast enough. But whatever works for you. Try both ways.

Like anything, this takes practice, but once you get a routine down, it's about as much trouble as brushing your teeth and takes considerably less time!