It was clear that - only 3 months from the fourth anniversary of being officially OTJ (off the juice, in feline diabetes speak) - the introduction of dexamethasone by IV in the hospital and prednisone pills at home were going to wreak havoc with Scruffy's glucose levels. His last official lab test glucose level - on January 17th - was a lovely 51. (Which was actually a smidge lower than I would have expected. Maybe cancer does eat sugar?) From the introduction of steroids, on January 23, 2012, Scruffy's been around 200-250 each time I tested him. I bought urine test strips, and sure enough, there was glucose spilling into his urine.
It's been so long since I had to worry about any of this stuff, and my mind has definitely deteriorated in the last 4 years. But, I clearly can't risk DKA or further kidney damage from lack of treatment of diabetes.
I wanted to use Levemir again - a human insulin that produced the OTJ status the first time. It was gentle, long-lasting, didn't sting when injected, and gave him good control. My expectations and goals are totally different this time, though. I simply want him to be under the renal threshold. I'm not interested in doing a whole bunch of testing or fine-tuning dosages. I don't know how long I will have him here, and I don't want to make him any more miserable with treatments than he already is. He was such a good diabetic cat the first time around - more than 7,000 ear pokes and who knows how many shots, and he never protested. Except for the time I bought ReliON syringes.... he could apparently tell the difference between them and the BD's that I usually used. The most efficient way to purchase Levemir for use with a cat is in the form of a "pen," a measured cartridge that humans can use by dialing the size of the dosage they wish to give and allowing the pen needle that is attached to inject the insulin. Since this doesn't permit the tiny doses that cats generally require, we still need to use a syringe to withdraw the insulin from the pen and inject it into the cat. Levemir comes from the pharmacy in a box with five pens. Given the usual small dosages needed for treating a cat, five pens would last a very long time, and it's sadly unlikely that Scruffy would even be here long enough to use up that many pens.
So, I "networked" - asked a few very good friends if they might have any extra Lev pens, and was kindly offered four different pens by Pamela, Vicky, Melissa, and Dian. Two of them would require shipping, which makes it more difficult in the winter, but Melissa and Dian are within driving distance. Yesterday, Melissa and I met - and had a nice lunch at Cracker Barrel and a good visit - and she gave me a partial pen of Lev, a box of syringes, and a box of Kleenex to mop the tears that seem to appear unexpectedly and often. Tomorrow, I'll met Dian - more lunch and more understanding friendship! - and she has another partial pen. Of all the many pleasures Scruffy has given me over the eight years he's belonged to me, meeting and loving the special people from the Feline Diabetes Message Board is right up there on the top of the list. Crazy cat ladies - well, maybe. But smart, caring, thoughtful, wonderful humans - for sure. I have been so fortunate.
This morning, I tested Scruffy again. I'm really kind of quivery about this whole thing - I can't see well enough to fill the syringe, my math skills are so minimal I can't even figure out the dosage by the lines on the syringe - oh, and I really DON'T want to have to do this. But..... He was at 200. So, I fed him - and of course, today was the first day he wasn't determined to eat out of every plate on the floor. he did finally eat a little Gourmet Chicken FF and drink some lactose free milk, so I figured he was good to go. I oh-so-carefully drew just a tiny little bit of insulin into the syringe - as close as I could get to the first line on the barrel, which is some totally unknown amount, but presumably way less than a half unit. I made the tent, and poked poor Scruffy. He probably got next to no insulin, I don't know. At least, it was a first step, I guess.
At +3, he's 180. Not a lot of movement, lol. I'm not gonna keep poking his ear. If he pees, I'll check and see what the strip says. That's the best I can do for him, except to tell him again how sad and sorry I am that all this has happened to him. It's really not fair. I gotta go find Melissa's kleenex.