(from Mark’s website www.zanshin.net)

For the past twenty months Nekko’s diabetes has been under control.  Sibylle and I have eased into a pattern where she administers the AM shot, and I take care of the PM shot.  The last several spot checks of her blood glucose levels have been good, and the blood glucose curve we had performed in March was excellent.

This afternoon, for no immediately apparent reason, Nekko went into insulin shock or hypoglycemia. Fortunately, since this is the week between her spring lessons and the start of the summer program, Sibylle was home today.  She noticed that Nekko was behaving oddly, and was being very vocal.  At one point Nekko tried to throw up, and then Sibylle saw that she was arching her back and she noticed a tremor in Nekko’s paws. Cats mask their pain and illness; showing weakness in the wild invites predators.  Sibylle’s instinct that something wasn’t quite right was well founded.  We had been told that should Nekko ever have too much insulin in her system, for any reason, to give her some syrup, as the glucose will be absorbed by the mucous membranes in her mouth immediately.  Sibylle did smear some syrup in Nekko’s mouth before rushing her to the vet’s.

By the time she reached the vet’s office, Nekko had started to convulse, stiffening and arching in the carrier.  The doctor immediately started a dextrose IV.  The initial blood sugar reading was below the lowest detectable level.  There was no sugar in her blood stream.  Nekko was hypoglycemic.  Fortunately, thanks to Sibylle’s quick action and thinking, Nekko will be okay.  We will return to pick her up for the night in a couple of hours, and then tomorrow take her in for a new glucose curve.

While we’ve been waiting Sibylle has done some research into insulin shock, both in people and in felines.  Everything we’ve read indicates that the course of action our doctor is suggesting is the right one.  That for some reason she suddenly had too much sugar in her blood stream.  Either her pancreas has started producing insulin again (not unheard of in felines), or she didn’t eat sufficiently following her last shot.  We have noticed an increased aggressiveness towards our food in the last several days.  Last evening, as she was trying to eat a piece of cheesecake, Sibylle had to fend Nekko off several times.  Not at all Nekko’s usual behavior.  In light of this afternoon’s episode, it appears that Nekko’s system may have been changing for several days now.

We’ll know more tomorrow evening.

(the following posted by Sibylle, the next day)

Dear Nekko,

We dodged this one.

Less than 24 hours after what the vet called “episode of hypoglycemia” you are back to your normal self.  Your fur feels soft again, your pupils respond to light, you move around with curiosity, exploring the basement and the fresh air that came in through the patio doors.  Of course I am keeping a close eye on you today, taking note of every bite you eat, every sip of water.

After having been out and about for the morning, you are now on the futon, taking a well-deserved nap.

I just wish you had been able to talk, yesterday.  Say something to the effect of “Hey there, I don’t feel so good.  Could you perhaps check it out?”  But of course, that wouldn’t have helped.  Your symptoms were so subtle at first, and then, even when they were not subtle anymore and it had become clear that something was wrong, I still didn’t know what and why and, of course, what to do. 

When my son Chris was perhaps 3 years old, his older brother whacked him over the head with a wooden toy.  Not terribly hard, but hard enough to cause a small cut, about half a centimeter long.  Wounds on the head bleed profusely and Chris’s wound was no exception.  Within seconds there was blood everywhere and Chris who at first just cried because it hurt started to scream once he saw all that blood.  A couple of minutes and lots of cool water later, the bleeding had slowed to a faint trickle.  Once it stopped completely and I had had a chance to clean the wound and examine it more closely, I saw that it wasn’t too bad, but I took Chris to the ER anyway. (Of course, these things tend to happen on weekend evenings …).  It was a good half hour from Herington to Ft. Riley and by the time we arrived there, Chris had fallen fast asleep in his car seat, and the wound had pretty much closed.  I apologized to the doctor for taking up ER space and time for such a minor thing but he reassured me that it was better to be safe than sorry (I like safe), cleaned the wound one more time and sent us on our way back home.

See, that was easy:  hit over the head => cut => blood. 

You on the other hand just suddenly let out a blood curdling scream and then tried to vomit.  I thought, tried to explain, that perhaps your trying to vomit had perhaps squeezed your windpipe/vocal chords, perhaps, which would force that sound out of you.  I sat next to you on the floor, wiped off the white foam that you had brought up, and petted you.  After a few minutes, two or three, you seemed fine.  Nothing unusual.  You have vomited before (you never seem to produce anything but a tiny bit of white foam). 

Sometime later, you walked over to your favorite spot by Mark’s desk chair.  You lay on your side – normal, or at least not unusual.  Then you let out another cry.  This one didn’t sound too different from what you sometimes do at night, when you howl for no apparent reason; and when we get up to check on you, you look at us, “What?  What??” and walk away.  I again sat with you, and when I petted you, under the chin and your back and belly, you purred.  You seemed ok. 

Then, slowly, things turned from “ok” to “something’s not quite right”:  your head was propped against one of the wheels of the chair which looked uncomfortable, but you didn’t move.  You started to meow more frequently and moved in a way, while still lying on your side, that just looked like you were uncomfortable.  I thought you might be perhaps constipated, or had eaten something that didn’t agree with you (no idea what that would be because you only eat cat food).  I decided to offer you a piece of cat treat (“crunch lovers”) which you eagerly took.  Weird.  But not really worrisome. 

To be on the safe side (I like safe), I looked up the website for our vet at Arborcreek, to have the phone number handy, in case I should need it.

And then, it went fast from “something’s not quite right” to “something is wrong, very wrong”.  You seemed to have tiny muscle spasms here and there, you started to arch your back, you didn’t really respond to me, your pupils were awfully big, and you started to meow and cry more frequently.  I thought that if those little spasms were a sign that your insulin was somehow perhaps out of whack, I’d get you a bit of maple syrup (the only syrup we have).  I dribbled some over my finger and smeared a tiny bit on your mouth.  You sniffed it and almost chewed off my finger trying to get the last bit of it.

 I called the vet, and while being put on hold, twice, I retrieved the carrier from the basement and found out that I was able to squish that phone between shoulder and ear while putting socks and shoes on, all at the same time.

By the time the assistant came back to the phone to tell me that the doctor recommended that I just bring you in, I had already decided to take you in regardless of what they’d say. 

In the car, I was trying to keep one hand on you in the carrier, trying to comfort you by gently touching and sometimes just resting my hand on your belly.  I knew I had to call Mark and was trying, somewhat frantically, to think of what to say.  I didn’t want to worry him, knowing that he was either still at work or just leaving, but I had to – somehow – explain why I was taking you to the vet, and that I wanted him to meet us there.  I decided to say, in my calmest voice possible, that you were acting kind of weird and that I was taking you in to have them take a look at you.  Mark immediately, with alarm in his voice, asked, “weird, how??”  He knew that I wouldn’t take you to the vet unless something was wrong. 

By the time we arrived at the vet, you were unresponsive and convulsing already.  A few minutes later, you had a full-blown seizure.  It was not a pretty sight.  They immediately drew some blood and then took you back to start an IV to get some fluids into you, and some dextrose.  The assistant who had drawn the blood was trying to get blood from the syringe onto the fancy gadget that reads blood sugar levels.  She was getting frustrated and went back to tell the vet, “I can’t get it to read!” 

I knew that I would crash and cry once Mark got there, possibly unable to talk, so I sent a short “she’s ok” text message to let him know.  You weren’t really ok yet, but it looked like you were at least not going to die.  He responded with “almost there”. 

The vet came out to tell me that my hunch that your insulin was somehow out of whack was probably right, your blood sugar was so low that the machine didn’t detect any (it detects above 50). 

When Mark arrived, I crashed and sobbed, probably from relief that one, you were probably going to be ok, and two, because I wasn’t alone anymore.

When we went back, several hours later, to pick you up, the vet had decided to wait two weeks before doing the glucose curve.

At home, we monitored your every move – you seemed ok.  Once Mark went to bed, I gave him once-a-minute updates, “she’s moving a bit” and “she just ate a few bites” and “she just peed” – after which you went into the bedroom from where Mark updated me, “she just jumped on the bed!”

You lay down, in the middle of the bed, next to Mark, where you eventually rolled over and stayed with us for most of the night.  Mark and I didn’t mind one bit having to give up one half of the bed.  Eventually you did get down.

At 3:55 a.m. you came back, jumped up and came to see me. (How did you know that Mark was asleep but I wasn’t?)  You looked at me, and I so wished I could read your mind.  Were you thinking, “hey there, just checking so see if you’re ok and to let you know that I’m ok.”  Or did you think, “you know, I am starting to feel funny again.  Think you could do something?”  You seemed ok, though, and after a few minutes turned around and jumped off the bed again.

You picked the right Tuesday, Nekko.  Any other Tuesday, I would have been gone to teach.  Any other Tuesday, we might not have dodged this one.

Good timing, girl.