Our cat, Smokey, came to us as a very tiny pet store reject of 5 weeks old.  He grew into a huge black panther of a cat who ruled our neighbourhood and home with an iron claw, and left us a few months ago after 20 years.  He was 12 years old when he was diagnosed, and lived 8-1/2 years with diabetes before he succumbed to renal failure.  The diabetes hampered his status as neighbourhood king but not his role as boss of the house.

I was overseas when Smokey began losing lots of weight and became very ill (Smokey was in Australia).  He was in hospital for over 2 weeks while they tried to stabilise him, and the prognosis was very poor. It cost my parents a fortune, and they were very uneasy about twice daily insulin injections, but despite the vets advice, wanted to keep him alive if possible until I could come home to say goodbye - he had been "my" cat since we were both tiny. He managed well on insulin at home, with only a few hypos in the first few months.  When I got home he ran to meet me.  I cried because he was so thin (he was previously a ball of muscle) and my mother cried because she'd been proud of getting him to put on so much weight.

We kept going with treatment and Smokey got better all the time.  He never regained his panther-like muscle tone, and stopped going out in the garden so much. He had been a real feral personality.  As a child I was the only person he would allow to occasionally pick him up, and he hated strangers. Now he was a real homebody.  He followed us around and demanded attention from everyone. But he would still put the claw in if we neglected his feeding and stroking.

Our vet had supplied us with an insulin pen (Novopen)- apparently given to them as part of a trial by a drug company. The pen was great- so easy to use. We used Mixtard 30/70 (biphasic insulin) which came in vials that you screwed into the pen, and you just dialed up the number of units before each dose. We kept the pen out of the fridge except in summer, but did find that the potency reduced towards the end.  A drug rep I spoke to said this may be because we weren't rocking the pen for long enough to stir it up before injection.

His doses ranged between 5 and 8 units twice daily.  We didn't urine test; just based doses on his behaviour- eating/drinking a lot, urine output, whether he hassled us for an injection (if we were late or missed one, he would come and demand an injection!). My father is also diabetic, so we used his blood sugar level (BSL) testing gear if Smokey was ill and we couldn't determine what dose to give him based on his behaviour.  We visited the vet only for vaccinations and if something was wrong.  There were a couple of experienced people who knew how to manage diabetes mellitus, but some really didn't have much practical experience with diabetes management. Also, every time he went in the hospital for tests etc, his BSL was really erratic, and they couldn't seem to manage it. He got very stressed away from home, so the adrenaline levels and the fact he wouldn't eat undoubtedly made it hard. The few times a vet made a home visit because we were worried, Smokey's BSL was perfect, so I think we did an OK job. My mother is a biochemist and I'm a final year med student, so we were comfortable with taking charge of things ourselves.

He did get some complications in his later years.  After about 5 years as a diabetic, he started showing "hock drop" when he walked, although he could get around without problems. Also he started to develop cataracts, and after he turned 18 his eyesight started to suffer, but it didn't distress him.

We've had some close calls.  About 5 years ago (aged 15) he developed a sore on one of his toes.  The nail was missing (his hind nails had stopped retracting) so we figured he'd caught it on something, and we bathed it and wrapped it up. But it just wouldn't heal.  The vet said it was a squamous cell carcinoma and he would eventually get metastatic disease (probably effecting the lungs) but it wasn't worth removing because he didn't expect Smokey would live much longer (being 15 years old and diabetic for 3 years). So we left it, but it became inconvenient for us to drain every morning, and he was tracking blood all over the house, so we talked them into removing the toe. He came through surgery with flying colours, and we had no more toe trouble.

The next thing was his teeth.  He developed an abscess on his chin and had to go to the hospital again. For a few years, the  vets had been unwilling to clean his teeth because of his age and health, but he ended up under anaesthetic anyway, and managed fine.

Then in the last couple of years he had 2 incidents where he became confused, walked in circles, distressed etc., but his BSL was fine.  The eventual diagnosis was TIA (transient ischemic attack), which is like a mini-stroke.  With each attack, we thought that was the end, but he recovered within a day with no residual neurological deficit.

This last year was the hardest.  Previously he'd been unlucky to have a hypo a year, and we always caught them early and treated him with glucose, before a trip to the vets was needed. But this year they became more frequent.  His mobility was starting to reduce (he also had a lot of arthritis) and he'd been sleeping on my brother's bed.  My brother worked on a computer most of the day, and Puss liked to have someone with him all the time. At first he would alert Mike with a certain Miaouw if he felt sick, but then he started having fits while sleeping - so he wasn't waking up with his hypos any more.

We reduced his insulin dose with some success, especially his evening one, but other things were ganging up on him too.  He was finding it hard with the combined hind limb weakness and arthritis to get up and down from beds etc., and sometimes wouldn't make it to his 4 litter trays.  He also had an enlarged prostate, which didn't help. He'd get really embarrassed at any accidents, and we started to question his quality of life.  He wasn't so bossy anymore, and had started to get distressed if he woke up and found himself alone -  he'd search the house miaowing until he found someone.

In the end the choice was made for us - his kidneys gave in. Ironically, it was his 10th major illness - his 9 lives had been used up - and he was put to sleep at home.  We all miss him, but I think he was glad to go- he knew it was his time and didn't fight like he'd fought everything before.

I hope this may help anyone having problems with coping with a diabetic animal- especially if they are in Australia. I have some hints about how to get cheap insulin and needles, and possibly insulin pens, so contact me if you'd like some support and information.

-- Contributed by Samantha 

Contributed October 2000
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