May 1996 Chapter 1 -
Austin Is Diagnosed
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.
Retrospective Notes: Our vet is great, but I now think 4 months
is too long for a newly diagnosed diabetic to go without a check
up. I wouldn't let a human diabetic go that long, and as you will
see, that wasn't a good plan for Austin. Monthly check-ups are a
pain for everyone, but best for your new diabetic.
2, In Which Eugene Saves His Brother's Life
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
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
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
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,
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 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
9/28/96 Chapter 3,
In Which The Parents Relax A Little
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.
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
4, In Which The Honeymoon Is Over
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.
Chapter 5, In Which Austin Takes a Downturn
February 19, 1997
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.
February 20, 1997
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
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.