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The Glucose Curve

In January of 2014, Butterfly, my ten year old Lhasa Apso, was diagnosed with diabetes. We went for monthly visits to a doctor she loved, and did twice daily blood tests and insulin shots, and we seemed to be making progress. But, over the summer, her doctor left the clinic and Butterfly’s sugar started to go up and down like a roller coaster. By the fall, nice doctor or not, we had to go back to the clinic for advice.

Butterfly was not feeling well.

Butterfly was not feeling well.

The doctor who saw Butterfly in October was a per diem, filling in for the day, and he was concerned about her sugar. He made me very nervous, despite his choir boy face and laughing Scottish accent and frequent stops to tickle Butterfly behind her ears, because he said there might be another underlying health problem. He wanted me to do a glucose curve at home: starting first thing in the morning, I would test her blood sugar every hour or two, until I couldn’t stay up any longer, then I should send the results to one of the regular vets, to see if they could recognize a pattern.

But she always loves those ear tickles.

But she always loves her scratchies.

The glucose curve day was, possibly, the best day of Butterfly’s life. Every time I went to take her blood, she made me chase her around the apartment first, and after each test she got another chicken treat. I had to break the chicken treats into tiny pieces to avoid an exploding Butterfly halfway through the day. And, of course, Cricket matched her treat for treat, and attempted to climb the bookshelf to reach the bag of treats when the pieces were too small for her liking.

Butterfly's tail is ready.

Butterfly’s tail is ready.

Cricket's tail is running away.

Cricket’s tail is running away.

Cricket and Butterfly, ready for their treats.

Cricket and Butterfly, ready for their treats.

By the last blood test, at two o’clock in the morning, Butterfly was wiped out and ready for bed, but still willing to grab a last chicken treat on her way down the hall.

We made an excel sheet out of her test results, with comments about her moods, and meals, and exercise, and pooping. The vet we sent it to was duly impressed, but she said she was worried about Butterfly’s very low sugar numbers midday. She wanted us to lower the insulin dose and redo the curve in two weeks.

I liked the compliments – I really love compliments, and I especially like when my organizational skills are noticed and appreciated – but I was hoping for a different response. Anything but “do it again.” The second glucose curve, two weeks later, was closer to normal, and the vet told us to keep everything the same, and redo the test in a few months.

By December, Butterfly’s twice daily blood sugar readings were getting wild again, so I ordered extra test strips and lancets and chicken treats and woke up at 5:45 AM on December 30th and started testing her blood every hour or two, administering an enormous amount of chicken treats to get her, and Cricket, through the ordeal. We stayed up until 2 AM, or I stayed up, Butterfly took a few naps.

Nap time.

Nap time.

When we finally met Butterfly’s new vet in person, she had a theory she wanted to test: that Butterfly’s blood sugar was bouncing up so high as an over-correction to too much insulin, and if we lowered the insulin dose again, maybe things would even out. Two weeks on this dose, and then another glucose curve. This was becoming normal for us.

Cricket sniffed Butterfly all over when we got home, to make sure no extra treats had been consumed, but also to make sure Butterfly was still Butterfly. We’d tried taking Cricket with us to the clinic, once, and she spent the whole time hiding behind my legs and barking at everyone and everything. But still, staying home alone made her disgruntled and suspicious.

Cricket's suspicious face.

Cricket’s suspicious face.

Unfortunately, the low insulin dose skyrocketed Butterfly’s blood sugar levels into the too-high-for-the-meter-to-count range. She was drinking and peeing constantly, in the house and out, so even without a glucose curve, we raised the insulin back up. And, of course, waited two weeks and went through the whole day of testing again, to Butterfly’s delight. And the numbers were still not right.

I was afraid that the doctor would give up on getting Butterfly’s sugar normalized and tell me to accept that she’s just going to die sooner rather than later, and it’s not worth stressing about. But she’s my baby! And I am stressed about it! I was angry that being a conscientious dog mommy hadn’t added up to better health and better luck for Butterfly, and for my carpeting.

“What’s wrong with peeing on the carpet?”

And then Mom came up with a plan (okayed by the vet) to give Butterfly an extra unit of insulin when her blood sugar levels are high, and the regular dose otherwise. I have no idea if this will work long term, or why the doctors haven’t wanted us to try it before now, but so far it seems to be helping.

I just want Butterfly to feel better, and not need to pee every five minutes, and live forever. Is that so wrong?

IMG_1259

Sugar

I love sugar. Well, not straight sugar. I was never a big fan of Pixie Stix, or rock candy, or sugar cubes. But I love chocolate frosting and Nutella and Twizzlers and marzipan. I like candy in every color and shape and size. When I first watched Willy Wonka and the Chocolate Factory, I was pretty sure it was a vision of heaven. I don’t like bitter or sour very much, savory is good, salty is okay, but sweet is my thing. Sushi was a wonderful discovery, because it looked and tasted like candy but had actual food value.

One winter, Mom and I took a series of cake decorating classes. They were inexpensive, and once a week, at the local Michael’s craft store, and once we finished level one, we went on for levels two and three, and would have done level four if it had been offered. I loved making cakes, and frosting, and doing crumb coats, and lattice work. I learned how to make royal icing flowers, and animal characters out of fondant and marzipan, and experimented with Nutella cream cheese frosting. I made chess pieces and roses out of molded chocolate, and white chocolate molded flour pots with chocolate frosted dirt. I tried to make petit fours and failed miserably.

Chocolate music on a flourless chocolate cake.

Chocolate music on a flourless chocolate cake.

Marzipan fruit is just as good for you as real fruit, right?

Marzipan fruit is just as good for you as real fruit, right?

Chocolate dirt, enough said.

Chocolate dirt, enough said.

The trouble with petit fours is, even after you find the right recipe for the cake, so that it’s moist but not delicate, you need a sure hand for the cutting and placing of layers, and then you need to be willing to waste a lot of icing by pouring it over the cakes on a wire rack so that the excess pools underneath. This is where Cricket came in, waiting for the overflow to overflow.

"You can start pouring, Mommy."

“You can start pouring, Mommy.”

Cricket was an only dog during the cake decorating winter, and she made full use of her prominent place next to the table, standing by the edge as the icing dripped onto her head, or jumping as high as she could to reach the counter to inspect whatever was going on up there. She cried and scratched at Grandma’s leg to get access to the mixer as it rumbled and tumbled and created glossy white frosting. She’s not especially dexterous with her paws, so she couldn’t participate in molding marzipan figurines, but she loved to help with clean up whenever something fell on the floor. We all had a great time that winter.

Cricket, after icing removal.

Cricket, after icing removal.

But, my father developed adult onset diabetes by the time he was the same age as I am now. In fact, his brother and father also developed diabetes, and then diabetic neuropathy and strokes, and a whole host of other problems, so it is definitely in my genes. I focus on moderation, and go to doctors regularly, and eat my vegetables, and take the medications I’m required to take. I use a lot of vegetables in my cooking, because I like my food to be colorful: red and yellow and orange peppers, tomatoes in all shapes and sizes, red onions, and French green beans, and perfect heads of broccoli cut into individual trees. But I worry.

I am always being told to cut sugar out of my diet completely, that it will solve all of my health, mood, intellectual, spiritual and whatever other problems I may have, immediately, and I will have the energy of a cheetah.

This, of course, is never true. I try it, I suffer, I keep trying, and then I stop. And whether I’ve tried the diet for two weeks or two months or two years, someone is always certain that if I just tried a little bit longer it would all work out and I would be perfect. I’ve tried sugar free, and dairy free, gluten free, and wheat free, and it’s all terrible and squeezes my brain until there is not even one drop of serotonin left and life is not worth living. Mom tells me that too much sugar makes her feel sick and tired, but I’ve never felt that way myself. I might refuse to notice such a thing.

My father went on a high protein diet, eventually, to try and manage his diabetes and ate mostly chicken and spinach. This would not work for me at all, but it would be Butterfly’s ideal, without the spinach. Butterfly, my ten year old Lhasa Apso, has diabetes too, but her diabetes is more like type one, or juvenile onset diabetes in humans, and is controlled by twice daily insulin shots. She also has a special diabetic-friendly kibble and eats a lot of chicken, though not as much as she’d like.

"Yummies?!"

“Yummies?!”

She doesn’t look or act sick, unless her sugar gets very low, and then she gets maple syrup on her gums and she bounces back. It’s a relief to know what’s wrong with her and how to fix it. For Butterfly, sugar is directly related to how she feels every day; no matter how much she craves things like pizza crusts and pancakes and bread, which were among her favorite things in the world before her diagnosis last year, she’s better off, and happier, without them.

The same isn’t true for me. There is no diet that will fix what’s wrong with me, at least that I know of. And while, theoretically, I’d be healthier overall without sugar, I would not be happier, or even happy at all, with a diet like that. I tend to think, and I know this is not the prevailing view, that a little bit more sugar in our diets might help us like each other a little bit more. Maybe I should try to make those petit fours again, and pass them out to my neighbors. I just have to make sure that the icing doesn’t drip to Butterfly’s level. She’d be licking the floor for days.

Cricket, licking the bowl.

Cricket, licking the bowl.

Butterfly, staying on her diet.

Butterfly, staying on her diet.

Butterfly and the Hairball

 

Two days after her most recent trip to the groomer, Butterfly started to throw up. Butterfly is a ten year old, diabetic, pure bred dog, with a serious heart murmur. I check her blood sugar for fluctuations every day (still too many ups and downs), and listen to the strange rhythm of her heart, which sounds fine to me, but I’ve always liked syncopation.

I am acutely aware of her health on a daily basis.

"Mommy, I don't feel good."

“Mommy, I don’t feel good.”

The last time Butterfly threw up was when she was first diagnosed with diabetes. She’s on insulin shots twice a day, so seeing her have what seemed like a serious relapse frightened me. Her blood sugar dropped very low, and she was shaking, and she refused to eat. Butterfly ignoring not only kibble, but chicken treats, is probably one of the signs of the apocalypse.

"Mommy, I think I'm gonna throw up."

“Mommy, I think I’m gonna throw up.”

She also had a lump the size of a kumquat on her lower belly, of unknown origin. She’d had the same thing way back in her early days with us, and back then the vet thought it might be constipation or something equally unimpressive, especially when the lump went away overnight. But it was a scary looking thing and I wasn’t sure if it would go away on its own, or where it came from, and meanwhile, Butterfly could barely sit down from the discomfort.

We put maple syrup on her gums, and cocooned her in a pink towel, and massaged her back, and crossed our fingers.

Time seemed to slow down, or even disappear. I couldn’t remember what time of day it was, or how long she’d been sick. Some part of me was shaking along with her, even as I told her, and myself, that everything would be okay.

Cricket was not impressed.

Cricket was not impressed.

At some point, Butterfly asked for some time on her own four feet, and within a few minutes she threw up again: three times in a row, on the rug in the hallway. When I went over to clean it up, there was a strange dark object in one of the puddles. It looked like an elaborate hairball, made of wiry black hair, honeycombed with bile, an inch and a half long, and half an inch in diameter. Huh?

Whatever caused it, once the hair ball was out, Butterfly started to improve. Her sugar went back to normal, she started to eat her kibble again, she was able to poop outdoors, and she was even smiling by bed time. She wasn’t up to running yet; that came the next day, along with the disappearance of her kumquat lump.

"Mommy, I feel so much better!"

“Mommy, I feel so much better!”

"We need treats!"

“We need treats!”

Once the crisis was over, I was calm enough to contemplate the hairball mystery. I’d never heard of a dog getting a hairball before. The hair was dark, like mine, but unless Butterfly had been chewing on my hair each night while I slept, I couldn’t imagine how she’d get her paws on that much hair in one shot.

But, there was a big, sweet, black haired dog at the groomer the day she was there, and as we were leaving, Butterfly did try to lick his head through the bars of his kennel. They also have a black cat on staff there, and I didn’t see him when we picked the girls up. We haven’t had a phone call from the groomer yet, so, fingers crossed that she didn’t eat their cat.

Walking The Bread Gauntlet

 

One of my neighbors, I’m not sure which one, believes that the tiny birds in our communal backyard will enjoy huge crusts of French bread that would suffocate a goose. We live in an apartment complex and share this backyard with a lot of people we rarely see. And Cricket makes sure to bark at anyone who dares to be outside, so I feel bad complaining about anyone else’s foibles. But the scattering of bread felt like a field of landmines to me. The last time the French bread was thrown out into the backyard was over the winter, when we discovered that my other dog, Butterfly, is diabetic.

The bread in the grass.

The bread in the grass.

Putting white bread in front of Butterfly would be like leaving bowls of whiskey in front of an alcoholic dog.

Butterfly loves the food she’s allowed to eat. She loves her chicken treats and kibble and chew sticks. It’s just that, if I am sitting on the couch eating a piece of pizza, she will stretch until she can reach the pizza and try to chew off the side of the crust. She is very short, but white flour gives her magical powers.

Butterfly is finding bread...

Butterfly is finding bread…

Everywhere!

Everywhere!

Cricket was interested in the bread too, but not more than she was interested in the squirrels, and the birds, and the sticks. When I pulled Cricket away from a piece of the bread, she basically shrugged and said, “whatever,” and moved on to try to rip my arm out of the socket as she ran towards a squirrel who was already miles out of her reach.

A conference is required to sniff this bread.

“Look, Cricket, bread is falling from the sky!”

Of course, my first thought when I saw the bread scattered on the lawn was to do a blog post about it. So Mom brought her camera and I brought the girls and we had to pose Butterfly close enough to the bread to show the temptation, but not so close that she could actually eat the bread. Of course, she gobbled a piece down before I could pull her away.

"Mine!"

“Mine!”

I don’t know what to make of my behavior here. I was worried about Butterfly being tempted by the bread and falling into a sugar coma and dying in front of me, and yet, another part of me just kept thinking – blog post!

The bread was gone by the end of that day, and it hasn’t returned. I have no idea who was tossing the bread out there, but it’s possible that they were watching me and Mom and the girls out on the lawn feverishly trying to get pictures, and decided to scoop the bread back up. Or, the maintenance guys saw the bread and grumbled about how they could possibly mow around these stupid obstacles, and picked them all up and threw them in the garbage.

I didn’t even realize how anxious the bread gauntlet had made me feel until it was gone. Not having to grip Butterfly’s leash in a fist made the bread-free walk, even in the heat, almost blissful.

And yet, I almost wish the bread gauntlet, with its connotations of manna from heaven, would return. I don’t want Butterfly to get sick, but the glee on her face when she sees those magical pieces of bread is overwhelming and, selfishly, I want to see that look again. Is there such a thing as low sugar manna from heaven?

 

"More!"

“More!”

Chasing A Butterfly

 

Butterfly is diabetic, and she has created a ritual for her morning blood test. She sees that I am going to the shelf where her testing kit lives, and with great excitement she runs to the hallway. She makes sure that I can see her, and then runs a few feet away, and then she turns back to check on me, to make sure I’m following her. She makes a dance of it, turning back three or four times down the fifteen foot hallway, bouncing on her toes in between twirls.

"Is it time yet?!

“Is it time yet?!

"Aren't you coming to the bus stop, Mommy?"

“Aren’t you coming to the bus stop, Mommy?”

Then she lands at her bus stop in Grandma’s room. And I mean lands. She flattens herself into a down position and waits for me to pick her up. Then I carry her back to the living room, sit her on my lap, and start the testing procedure.

"You can pick me up now!"

“You can pick me up now!”

At first, when it came time to pick up Butterfly for her blood tests, Cricket would escape to her apartment under the couch. She was very concerned that this blood testing idea would spread, like a virus, like a bath-giving, haircutting virus. But over time she started to notice that not only was Butterfly the only target for the needles, there was also a very reliable treat give-away after the test. So Cricket began to sit by my feet as Butterfly’s blood was tested. I even caught her sniffing the testing kit once, as if she could smell the chicken treats by association.

"We want treats! We want treats!"

“We want treats! We want treats!”

We take blood twice a day from Butterfly’s tail. We tried the veins in her ears, and her paw pads, and the callus on her elbow, but none of them worked, and then I saw a YouTube video of a dog getting her blood tested from her small cropped tail. Butterfly’s tail is long and skinny, so I wasn’t sure if it would work the same way, but there’s blood available every time and it doesn’t seem to bother her, much.

Her insulin shot goes into the scruff of her neck and usually doesn’t bother her either, but sometimes I hit the wrong spot, or maybe the cold temperature of the refrigerated insulin bothers her, and she flinches. But it’s over in a second and then she’s ready for treats. She never runs away or growls or tries to bite me. Thank God all of this isn’t going on with Cricket. I’d have no fingers left.

If Butterfly’s blood sugar is low, which it often is in the morning, she gets a special bone treat, made with whole wheat flour to raise her blood sugar just enough. Mom got this Bake-A-Bone toy for Mother’s day or her birthday this year from my brother’s family, along with books of recipes for special foods for dogs. I think Butterfly has been talking to their dog, Lilah, and trying to influence the gift choices over there.

The magical bone making toy.

The magical bone making toy.

Bones in process

Bones in process

Bones!!!!!!!!

Bones!!!!!!!!

But if the blood sugar is normal-ish, or high, the girls share a chicken treat. They know where the bag is. They go straight over to the book case and stare up at it. Cricket has even tried to climb the shelves, unsuccessfully. They pull out all of their circus dog tricks if the treats fail to come as quickly as desired. Even Butterfly has learned how to stand on her back legs with her front paws in prayer pose, though she can’t maintain the pose as long as Cricket can. Then Butterfly takes her share and runs to the hall to eat alone. And Cricket inhales her treat whole, coughs a bit, and then stares at me expectantly as if I never gave her a treat at all.

Cricket is starving!

Cricket is starving!

The other day, in the middle of the afternoon, Butterfly had a partial seizure. Her eyes started twitching, her legs wobbled, she walked in circles and couldn’t see clearly, and her body shook. When I calmed down, I tested her sugar and it was very low, the lowest it had ever been. We gave her maple syrup – applied to her gums the way the doctor told us to do, so she’d have no choice but to take it in – and within thirty seconds, she was herself again.         Her doctor warned us about listlessness and even coma, but he never mentioned partial seizures, so thank god for doctor Google.

And Now Butterfly is back to normal. I can be sitting on the couch, or at the computer, or trying to sleep, and she’ll come over as if something very exciting is about to happen. She’ll dip her head and smile at me, and then she’ll run. If I’m too slow, she waits for me, every step of the way, because she wants me to catch her. She wants to flatten out on the floor and get scooped up like a rag doll. It’s her favorite thing, chicken treats or not.

 

The Broken Butterfly

There’s a special value in rescuing a dog, beyond knowing that you’ve saved someone’s life, or feeling like a good person: a rescue dog is a reminder of the broken things in the world, and of how sacred they are. My rabbi told us that the broken pieces of the first set of tablets of the ten commandments – the ones Moses smashed when he saw his people building the golden calf – were kept in the ark along with the pristine final set of tablets, as a necessary part of the whole.

           Butterfly, with her missing teeth and adorable protruding tongue, her heart murmur and lumps and bumps, is an important part of the whole story. Not all dogs are born to happy families, or adopted by happy families, and taken to the vet each time they have the sniffles. Happiness is only part of the story.

Beautiful Butterfly

Beautiful Butterfly

          Butterfly was recently diagnosed with diabetes. She had a urinary tract infection back in the fall, but with antibiotics it went away. We were curious about why she’d gotten it, but assumed it had something to do with how low to the ground she was when she peed, compared to long-legged Cricket, who practically hovers in the air.

Cricket  hovering, with help.

Cricket hovering, with help.

          As soon as she started to pee in the house again in February, we took her straight to the doctor. The vet on duty did some tests, took an x-ray to rule out kidney stones, and gave us antibiotics for another suspected UTI. We wrapped the pills in chicken and peanut butter and hot dogs and all of her other standbys; we crushed the pills and mixed them with water and then with her food and parmesan cheese. We did everything we could think of just to get the antibiotics into her system, against her will. But not only wasn’t she improving, she looked sicker and sicker every day. She was noticeably lighter when I picked her up, she didn’t do her usual poopie dance, and she stopped waking me up in the morning, waiting instead for me to wake her up and convince her to go outside.

Butterfly, not eating? Cricket is unconcerned.

Butterfly, not eating? Cricket is unconcerned.

          My concern has always been her heart, because she has a prolapsed mitral valve and is at risk for heart failure. I knew this when I adopted her. But it’s a hard thing to remember when she is running and jumping and smiling at me. I was afraid that after a year of watching her flourish, I was going to lose her.

          We collected some of her voluminous pee and brought it to the clinic to be tested, and made an appointment with a different vet. As soon as we met the new doctor he took a blood glucose test, to confirm the results of the urine test, which, he told us, showed very high sugar. In the office that day her sugar was over five hundred. It’s supposed to be under a hundred.

           I was relieved. I’d been so scared that this was heart failure, and she was dying, but diabetes is treatable. The doctor showed me how to give her a shot of insulin in the scruff of her neck. He also gave us a liquid antibiotic to try on her, instead of the dreaded pills, because the UTI was clearly being maintained by the diabetes and needed another round of antibiotics to wipe it out.

          Every morning, and evening, I give her a dose of the antibiotics which she hates, making angry toddler faces and sticking out her tongue, and I give her a shot of insulin, which she doesn’t seem to mind. Some days I do a better job than others. It still feels strange to stick a needle into her skin, and I can be too tentative, but mostly it gets done, and she’s improving.

          The rest of the day, I follow her around with pee test strips to see how the insulin is working.

          The first time I saw her run again after her diagnosis and treatment began, I thought my body would crack open from all of that joy.

Hopefully this is what she'll look like again soon.

Hopefully this is what she’ll look like again soon.

          There is a sort of halo of white light around Butterfly, that could just be the highlights in her hair, but the light could also be coming through her broken pieces. And I want to keep that light going for as long as I can.

Butterfly , spreading the light

Butterfly , spreading the light

Delilah’s Diabetes

When Delilah was about eight years old, and I was fourteen, she developed diabetes. I don’t know how we discovered it, but we were sensitive to certain signs because my father had been diagnosed with type-two diabetes about four years earlier. Delilah was a healthy, if skinny, Doberman Pinscher until she got sick. She wasn’t the most energetic creature, but as soon as the door bell rang, she would start to bark, like the guard dog she was born to be. Except that, as the person entered the house, Delilah would walk backward up the stairs, and continue to bark from a safe distance.

She spent a lot of time out in the backyard. Mom would leave the back door open, with the screen door in place, so if Delilah wanted to go outside she could push the door open with her nose, and if she wanted to come back in she could bark once or twice. But more often than not she’d just rest on the back porch.

I never saw Delilah jump off the porch, I only heard about it, that this mostly quiet dog could get so worked up over the little birds who nested under the roof of the garage that she would stand on the porch with her front feet on the railing and then leap into the air to catch a bird. The drop from the porch railing looked steep to me, but Delilah was an athlete and took it in stride.

And then she got sick. The vet sent Mom home with hypodermic needles, alcohol wipes, and vials of insulin. She had to get the shots daily, with Mom learning how to pinch an inch of skin and plunge in the needle where Delilah was least likely to feel it.

Delilah was on insulin for almost a year before she died. I don’t even remember her showing signs of deterioration by the time summer came.

I had a habit of waking up early on Saturday mornings to clean the kitchen before my parents woke up. I generally woke up anxious, and scrubbing counter tops calmed me down. One Saturday morning in July, I was halfway down the stairs when I saw Delilah on the floor of the dining room. There was a greenish grey aura around her, like a dark version of the chalk outline the police on TV draw around dead bodies. This dog who had been brown and black, now seemed grey. I knew she was dead, and I panicked and ran back upstairs to hide in my room and let someone else find her.

By the time I came back downstairs a few hours later, my parents were there. They’d found her, wrapped her in a blanket, and moved her body to the back porch, because nothing could be done while it was still the Sabbath.

It was summer, so it was past nine o’clock by the time the Sabbath was over. It was dark by then, and raining. Suddenly, my father thought burying her was an immediate necessity. It couldn’t wait until the morning. It couldn’t be handled by the vet. He couldn’t ask friends to come and help. I had to help carry the blanket covered dog down the porch steps, to the back corner of the backyard, dig a hole, put her in, and cover the hole with dirt.

Mom tells me it was more common back then to bury a dog yourself, but by the time I was fifteen, it didn’t feel common at all, it felt illegal and disturbing. I was crying and shaking and my father was yelling at me to hurry up and to shut up.

It wasn’t a good way to say goodbye to someone who had been family to me for more than half of my life. And it was too dramatic for Delilah. She would have preferred something quiet and peaceful, with the TV on in the background and a few gentle pats on the head.