Austin had gone into the hospital with a bad respiratory infection and his vet, Dr. Candace Remcho, whom Austin loves, noticed he was drinking an enormous amount of water and peeing even more. A blood glucose check revealed a sugar of nearly 400 when it should be around 100. We tried him on a diet of Hill's W/D to see if his blood sugar would come down but a recheck of his glucose showed this wasn't working.

Yep, you guessed it. We get to give insulin shots twice a day. I'm a physician so this isn't a big deal for technique, but schedule-wise, it is horrible. Travel is also a big part of our life, so although Austin has never been boarded before, he'll have to go to the vet when we are out of town. Right now the local cat-sitters aren't up for giving insulin shots. So much for that FREE KITTEN we got almost 12 years ago! Austin & Eugene are my kids though. I feel very strongly that if you take in an animal, you are obligated to it much like a child.

Austin gets his very first insulin shot

Austin is now doing very well on 2 insulin shots a day, back to his playful self. At his last checkup, his blood sugars were all great so it will be 4 months before he has to spend another day in the hospital getting blood checks. He is very blasé about his shots, much to my amazement.

July 14, 1996: So much for that 4 month check up.

Austin has been doing very well until a few days ago when I noticed that he was in the litter box a lot, straining to pee with no results. His bladder wasn't full by physical exam so I didn't suspect a urinary blockage. He "just hasn't been right." How many of you cat owners take your cat to the vet for this keen observation? I often do. I had been worried that when I came home for lunch each day Austin would not get up to greet me as usual.

A quick trip to the vet reassured me that Austin had a bladder infection and he was given some antibiotics. After the diagnosis of cystitis, I attributed Austin's marginal listlessness to the infection. WRONG.

I either wasn't properly cautioned about hypoglycemic signs or refused to hear the information (probably the latter) because I'm still in denial about Austin's illness and its life-shortening effects. And of course, I am a physician; therefore, I should have been more cognizant of what was going on. The vet probably didn't want to insult me by telling me what should have been obvious. Don't make the same mistake I did and have your cat suffer from it.

This morning shortly after 4 a.m., Eugene awakened Paul (Dad) by crying incessantly. Usually, if Gene wants to go out, he use that charming feline technique of casually raking the mini-blinds by Paul's head a few times. Paul didn't think too much about the difference in wakening techniques until Gene lead him downstairs to a dark corner of the living room where Austin was lying nearly comatose, totally unable to move, but still breathing. I scooped up Austin as he began to have a seizure and Paul paged the vet. Although all the vets at our clinic, Paw Prints, are wonderful, Austin especially loves Dr. Candace Remcho, and I was relieved to hear she was on call. She of course immediately suspected severe hypoglycemia (low blood sugar) and told us to rub honey on Austin's gums. (Karo syrup or maple syrup are also concentrated forms of sugar and will work, too.) Austin did not respond; in fact, he lost all control of his head and his eyes glazed over. I thought he was dead but then he had another seizure and seemed to wake up a bit. We quickly dressed and met Dr. Remcho at the clinic. On the way Austin had a third seizure and again seemed to die but then took a big gasp of air just as I was about to start CPR. My only consolation was that if Austin was to die, he would die in my arms, knowing how much I love him.

Austin was totally limp and barely breathing when we got to the clinic. Dr. Remcho wasn't optimistic at first. Austin's blood sugar was only 32, with 25 being "consistent with death." He was given more concentrated sugar and an IV was started. It's not an easy task to start an IV on a human with low blood pressure and I was very impressed that Candace got an IV in Austin's tiny, collapsed vein as he was on the verge of death. Within 10 to 15 minutes Austin was able to shakily attempt to stand up. We stayed for awhile but realized we were probably interfering, so we gave our love to Austin and left him to the capable hands of Dr. Candy.

	Dr. Remcho called us early in the afternoon and told us Austin looked much better but his blood sugar was still only 53 (100-150 would be a goal). Austin is still in the hospital and I am a wreck worrying about him.
Eugene hugs Austin after one of his insulin shots

Retrospective Notes:

I was not properly prepared for hypoglycemia signs, primarily because of denial about Austin's illness. Cats tend to show hypoglycemic signs late, unlike dogs and humans. If your cat becomes listless or has other subtle behavior or eating changes, pay attention. Have the cat's glucose level checked. I am appalled at myself that Austin went to the vet, was diagnosed with an illness and never had his blood sugar checked. Did he have cystitis or was his volume status/blood pressure so low that he wasn't producing urine? If your cat gets sick, have his blood glucose checked, too.

Another approach would be to use kitty urine glucose sticks to see if the blood glucose is going too high and then "spilling" over into the urine. Urine should not have any glucose in it. Note that these strips will NOT tell you when the blood glucose is too low, as happened to Austin.

Update! Austin is alive! He stayed in the hospital a couple of days and came home pretty weary but as loving as ever. In fact, he didn't want to leave my lap. He didn't perk up very fast; I guess near-death experiences can do that to you. We kept him off his insulin but on his diabetic diet and he went back to the vet a week later for a day of glucose checks. His blood sugars were good, so he is now officially a non-insulin dependent diabetic. Apparently, a small percentage of cats do this. The other less pleasant alternative is that he may have pancreatic cancer. (The pancreas is the source of insulin.) Unfortunately, there is no way to easily diagnose this and no treatment, so we just have to live with that concern. Austin in the meantime is pretty much back to his old self 3 weeks after his incident and we are trying not to spoil him too much.

Without Eugene waking us up, I have little doubt that Austin would have died. Eugene isn't a very smart cat, but he obviously loves his brother and is smart enough to get us for problems. He has been very distraught all day with Austin at the vet. I hope he doesn't think Austin has died.

Paul and I love both of these little guys so much. Gene is Paul's special buddy and Austin is mine, but neither of us can bear the thought of losing either one of them.

By the way, Gene got his favorite and rare treat, tuna, for being a hero. He would also like to say that he's tired of Austin getting all the attention by being a wimp and that if you want to know what a REAL CAT is like, check his personal home page.

Austin continues to do well on his diabetic diet although he has gained a little weight, now weighing 14.8 pounds. I think as the fall rains come on and it gets cooler, he gets less exercise and eats a little more. Austin goes to the vet once a month to have a series of his blood sugars checked. He is staying in the 85-170 range, so his sugar is a little high during the day, but not bad enough to go on insulin. I am encouraged that he looks so well and hasn't lost a lot of weight, so I think he must not have pancreatic cancer.

Retrospective Notes:

I plan to take Austin in once per month for a day of glucose checks. My vet has a very reasonable charge for this and convenient drop off/pick up times. Besides, they make such a fuss over him at the vet, Austin seems to LIKE these monthly visits. Still, I wish I had the courage to do "paw sticks" on Austin and use a home glucometer to keep track of his blood sugars. Anyone out there doing this?

I did hear from someone about kitty litter strips for checking for sugar in the URINE (see Testing Feline Urine Glucose). Guess I could use regular human dip sticks, too, if I could get Austin to improve his aim in the litter box!

I have now also heard from Virginia Baxter and Julie Paque about using ear sticks for home BLOOD glucose monitoring.

Austin had a glycosylated hemoglobin checked a week ago and the results are finally back. He has a level of 2.6% which is considered "moderate control." If a cat is on insulin, the goal would be a glycosylated hemoglobin of less than 2.5%. Austin has just been on his diet. His sugars have been slowing creeping back up, and on December 4 his series at the vet were in the 300's and his weight was down slightly to 14.4. His skin has started to bother him again and in the last 2 weeks he has had noticeable polydipsia/polyuria. I'm getting tired of changing that litter box everyday! Five months off insulin. Dr. Remcho thinks it's time to go back on, but we are going to start very slowly at 1 unit per day. As discussed in the Diabetes News section, Austin's pancreatic cells are now suppressed so we want to give them time to readjust to his lower blood sugars. We'll try just watching his PD/PU to monitor him. Here we go again..

Austin got started on 1 Unit of Ultralente a day and improved a little. I've become much more attuned to his drinking and urinating habits and he continued with a lot of PD/PU after 3 weeks of insulin, so taking a deep breath and remembering what the LA endocrinologist recommended, I moved Austin up to 2 units a day. And he's doing great! He's gained some weight, his once beautiful & bushy tail is sprouting hairs again, and he is so much livelier. Dr. Remcho called last week wondering what was going on and one of the veterinary techs asked after him, but I haven't taken him back for another glucose curve. I suspect he is running a little high on his blood sugar but he just looks so darn good. He has started coming in and sitting on my lap while I work on the Feline Diabetes web site. Every now & then, he pushes a few keys for me. And we talk about every email and hug each other when some not so good news comes in about one of his diabetic friends. I would have never believed a silly little cat could provide so much companionship.

Dr. Remcho, Austin's vet, has left several messages on my answering machine asking about him. I finally connected with her this week and told her how I was trying to monitor Austin by his PU/PD but that he didn't seem to be doing quite right. He has been pretty listless the last 2 weeks and has even quit sleeping with me (my RIGHT armpit has been his bed for years!) and he is looking a little ragged. Guess he isn't grooming much, another bad sign. He seems skinnier than ever and by my crude scale weighs only about 12 pounds, down another 2.5 lbs. Austin was a 16-17 pounder before this all began and weighed 14.4 two months ago.

We are also worried because Austin seems to be having some problems with his hind legs giving out on him at times and his balance on uneven surfaces has been very poor. His eyes seem cloudy, too, and he startles easily now. If I move too fast, he will run in fright from the room. This is just not like Austin, who is always calm and dignified. To the vet tomorrow and maybe some of these concerns will be resolved.

Dr. Remcho also has a cat with diabetes, Smokey. She told me that Smokey is off insulin now but the bad news is that he has a palpable mass in his pancreas. This is probably cancer, and nothing can be done for pancreatic cancer in the cat. Poor little Smokey and poor Dr. Candace. She lost one of her dogs last year and now Smokey.

Austin went to the vet this morning. He only weighs 11.2 pounds. Ouch! Dr. Remcho called me this afternoon and wants to keep Austin overnight for some more testing. She was concerned that Austin didn't even complain during his nail trim (it usually takes two people and involves Austin biting rather nastily, the only time he isn't just the sweetest cat in the world) and didn't even care about her world-class tummy rubs that he usually adores. She said 11.2 pounds wasn't a bad weight for Austin but unfortunately he has lost a lot of muscle mass and tone with that weight loss. This muscle loss is probably responsible for his rear leg problem, not neuropathy as I feared. Guess we will have to put him on an exercise program! I forgot to ask her about his eyes. Unfortunately, his blood glucose ran very high all day (he had his 2 units of Ultralente insulin at 7:15 am) with the lowest reading being in the high 300's. I feel like a terrible mom. I should have kept taking him in each month. My husband thinks we should now start doing home glucose checks like so many other people do. I realize that I am still in denial nearly one year after Austin was diagnosed. I want him to be well and live many more years and in an attempt to not dwell on his illness, I have been ignoring it too much. Oh, little Austin. I was so hoping you would be home today. I had put a chair out on the porch so we could sit in the sun and enjoy this rare beautiful February day. Instead, you are in the hospital, in a cold little cage. Thank goodness all the Paw Prints staff make such a fuss over you. I know you won't be too lonely.

I brought Austin home this weekend and I think he has now forgiven me for leaving him at the vet. We will try him out on 4 units of Ultralente, still just one time a day. :-) Dr. Remcho has asked that I bring him back in 2 weeks, saying that monitoring the PU/PD is fine once Austin is stabilized on his insulin, but not such a good idea before that to rely on that method alone. Austin does not have cataracts but has "dyslenticular sclerosis." This is a progressive loss of vision associated with aging. I do not know if the diabetes is accelerating it. Dr. Remcho says there is good penetration of light through the lens though, so it isn't too bad right now.

Austin's renal (kidney) function has also been a concern since diabetes can damage the kidneys. Dr. Remcho checked the urine specific gravity and it was 1.030, good for a cat, so Austin's kidneys are concentrating his urine as they should be. Apparently, a urine specific gravity of more than 1.040 would indicate possible kidney damage and the vet would have checked a blood test for the kidneys.

And Paul, Eugene, and I are ecstatic that Austin is back home and appears to feel so much better!

Note: I guess I remembered the info from the vet backwards. Heard from a vet on 2/22/98 who corrected me (see next paragraph). Again I remind everyone that this is my PERSONAL homepage, and my PERSONAL diary that I have chosen to share with you. I am not giving veterinary advice or information. I will reserve my comments about the last sentence in this vet's email.

"I was reading through the report on Austin's urine specific gravity and it was stated the his USG was 1.030 and this was good----wrong!!! The normal specific gravity for a cat should be greater than 1.045 or so. Concentrated urine is good! When a cat begins to show signs of renal disease the specific gravity decreases. I would consider a cat with a specific gravity of 1.030 to be dilute and consequently showing definite signs of kidney disease. The problem with message boards on the internet is that they can present misinformation, as is the case in this instance. --Dr. Ellen Guttormson, DVM"

Austin has been looking great. Still some polydipsia but the polyuria is much improved. What a relief: I think we were spending more on kitty litter than insulin, syringes, and vet combined! Dr. Remcho wants to check a glucose curve again tomorrow, so back to the vet he goes.