Howard’s Glucose Rollercoaster

I’m still catching up with some things I meant to post about last year/earlier this year but haven’t gotten around to yet.   So, here’s the story of Howard’s glucose rollercoaster.  

The day after Duke died, I couldn’t find Howard when I got up, which was unusual.  Howard is generally very enthusiastic about breakfast and greets us when we get up most mornings.  If he doesn’t do that, there are a couple of places he likes to sleep, and he can usually be found in one of them.  Finding Howard isn’t usually difficult, so I knew something was wrong.

I found Howard in the cat room (where we keep their food, litter boxes, and lots of random things).  He was behind a laundry hamper, half in the closet, not moving.  He wasn’t exactly asleep, but he wasn’t fully awake either.  I picked him up, and he felt colder than he should have.

I gave him corn syrup, per Dr. D.’s instructions.  She told us from the beginning of Howard going on insulin to rub corn syrup on his gums if it ever seemed like his glucose was too low.  I wrapped him in a blanket, put him in a carrier, and called Dr. D.’s office to say we were on the way.  

Dr. D. was off that day, so Howard saw Dr. L.  They did a glucose test right away.  Howard’s was 20.  It should be between 120 and 300.  They also checked his temperature.  It was 98.  It should be between 101 and 102.  

Dr. L. started Howard on a glucose IV (one of the vet nurses used to be a paramedic, and she was able to get his IV in right away) and warm fluids.  They also used some type of warmer on Howard that blew warm air under his blankets.  

Howard perked up relatively quickly, and they offered him food, which he very enthusiastically ate.  Dr. D. came into the office in the meantime (she seems to come in most of the time when she’s supposed to be off).  Dr. D. and Dr. L. decided they wanted to keep Howard for the day so they could closely monitor his glucose.  He dropped (though never as low as 20) several times throughout the day, so they recommended that we transfer Howard to the 24-hour/emergency vet since their office isn’t staffed at night anyway, and with it being December 22nd, they weren’t going to be open much longer.  

So, I picked Howard up and took him straight to the 24-hour vet.  They were extremely busy, so by the time a vet came in to talk to me (nurses had been in and out checking on Howard), it was the night-shift vet, Dr. H.  We’ve seen Dr. H. before, and we really like him.  I’m always nervous at the 24-hour/emergency vet because we’ve had a few vets that really seemed like they went into the wrong line of work.  But Dr. H. has always been awesome.  I was so relieved to see him that I almost cried.  

Dr. D. and Dr. L. had apparently passed on that Duke had just died the day before because Dr. H. mentioned that right away.  I had told Dr. D. and Dr. L. that Howard had been eating a lot of Duke’s food over the past few weeks.  Duke wasn’t eating much and was losing a lot of weight, so we were trying a lot of things to get him to eat.  He liked chicken and rice, so we mixed chicken and rice with his food.  He still wasn’t eating all of it, and Howard was helping himself to Duke’s leftovers.  Most cats would have just eaten the chicken.  Howard isn’t like most cats.  He was eating the dog food, the chicken, and the rice.  Obviously, after Duke died, we didn’t set his dinner out, so Howard had no dog food or chicken and rice that night.  

Dr. H. said that normally stress and grief tend to raise glucose, but in some unusual cats, it can lower it.  Everyone agrees that Howard is an unusual cat!  Dr. H. said that in addition to the stress and grief of losing Duke, Howard was probably picking up on us being sad and stressed and the extra stress of Duke being sick right before and Nick having COVID.  All of that,  plus not eating dog food, chicken, and rice (which would tend to raise his glucose), probably led to the crash.  

Dr. H. suggested a FreeStyle Libre monitor for Howard.  If that sounds familiar to you, it’s the same one that’s used for humans.  It’s a continuous glucose monitor.  There’s a little sensor (we’re told people usually put it on their arm) and a monitor that scans and records it.  For pets, they like to put it on their back, near their shoulder blades; basically somewhere that they can’t mess with, and it’s not likely to get caught on anything.  They shave a little patch of fur and put it on.  

Here's a picture of Howard with his sensor when I got to visit him while he was in the hospital.  He didn’t seem bothered by it at all.

With the Freestyle Libre, they were able to check Howard’s glucose without doing an ear stick.  He was pretty sick of being stuck by then, and you really can’t blame him.  Most of the time, you can scan him without even waking him up.  They checked Howard’s glucose every hour for the first 24 hours.  Dr. H. had me bring in his food and insulin and let me bring in his blankets. 

The plan was to give Howard a very low dose of his insulin once his numbers stayed at a high enough level for long enough, then make sure he didn’t go too low again.  It took a few days to get there, but Howard came home on Christmas Day.  Definitely the best Christmas present we’ve ever gotten!  

Here’s a picture of Howard under the Christmas tree the day he came home.

Initially, they wanted us to scan Howard every two hours.  It worked out well that we were off/home for Christmas because that was rough.  Once Dr. D.’s office opened back up the day after Christmas, she took over managing Howard and had us email the numbers from the scanner every day.  For a while, he was getting one unit of insulin about every 36 hours, then 24 hours, then 12 hours.  We kept up every two hours of scanning for several days.  Dr. D. finally told us to stop before we wore ourselves out.  

The sensor lasts somewhere between ten days and two weeks, so Howard has had several sensors.  We all wanted to make sure he wasn’t headed for another crash.   Howard was the first kitty at Dr. D.’s office to have a sensor, but now she has lots of patients with them.  Howard, the trendsetter!  

Eventually, Howard started getting really agitated over having the sensors put on, so we all decided on a break.  He was running a little high, but Dr. D. thought that was better than risking another crash. 

Howard had his regular checkup in late June, and his glucose was high, so we opted for another round of Libre sensor monitoring. 

A few weeks ago, his glucose started fluctuating wildly.  It would drop down as low as 60, then within a few hours shoot up to over 400, then drop again.  

Dr. D. believes that Howard is experiencing Somogyi swings.  You can read about it here, but the short version (at least for cats) is that somehow, the insulin contributes to the body, causing itself to drastically raise and lower glucose levels.  So, we took Howard off of insulin, and his glucose has stayed much more stable.  Howard has diabetes and asthma.  The diabetes is likely caused, or at least contributed to, by all of the steroids to control his asthma.  But, since breathing is vital, we can only limit the steroids so much. We’ve also lowered his steroid dose a little more.  It may have to go back up in the fall (allergy season) and/or if he starts having breathing problems.  

During all of this, Howard also started experiencing severe gastrointestinal issues.  Dr. D. isn’t quite sure why, but thinks it may be due to an injection of a newer drug to help with arthritis.  The G.I. issues Howard was having are one of the rare side effects of the drug.  So, we’ve opted not to continue using that one.  He’s currently on some medicine for his stomach and has started talking probiotics.  Fortunately, all of the medications can go in Pill Pockets or be mixed with food, so Howard doesn’t mind taking them. 

Howard is also starting to have some kidney issues, likely caused by a combination of age and diabetes.  It’s not terrible yet, but we don’t know how long that will last.  He’s seventeen, and I know we’re lucky to have had him this long, but it still feels like being punched in the gut to think about his time being limited.  I feel like I don’t know how to exist in a world where I’m not Howard’s mom.  I had Howard before I met Nick.  Nick and I are coming up on sixteen years together in September, so Howard has been in his life for a long time, too.

Dr. D. offered us a referral to the specialist, but after talking with her, we’ve decided not to go that route.  Howard is very patient and good at the vet, but he seems to be reaching his limit for how much poking and prodding he’s willing to put up with.  And, in talking with Dr. D., there’s not a fix for the kidney issues that are coming.  There are only short term solutions that likely come at the cost of creating other problems to manage.  It really feels like we’d be doing it for us, to buy ourselves more time with Howard (which is so incredibly tempting) at the cost of his quality of life.  

Because of that, we’re not pursuing treatment of the kidney issues.  We’re managing the diabetes and asthma as best and least invasively as we can, and we’re honestly evaluating Howard’s happiness and quality of life.  Right now, he seems happy.  At seventeen, he’s not very active, but his behavior hasn’t changed.  One of the vet nurses described Howard as a watcher and said he likes to be in the middle of the room and watch everything that’s going on.  That’s very accurate.  He spends most of his time on the fluffy cat bed in the living room, keeping an eye on everyone’s comings and goings.  He cuddles with Frankie, and he’s very enthusiastic about his food.  He seems happy and doesn’t appear to be in pain.  He still wants us to pet him every time we walk by, which we’re more than happy to do.  

Howard’s quality of life seems good for now, so the plan is to keep his as happy and comfortable as possible for as long as possible, and love him as much as we can while we can. Howard still loves to cuddle with Frankie, is very enthusiastic about his food, and loves to be in the middle of everything.