Tommy Boy, my little macho tabby cat, was born in the palms of my hands to a stray mother cat, Maryann, whom I had taken off the street.  Four litters of Maryann’s kittens had grown up feral in the street, and come to a variety of awful fates.  A nice lady down the block was feeding them, but she was elderly and unable to TNR.  The day I saw Mary pregnant for the fourth time in three years, I said, “OK lady, that’s enough.  You’re coming with me.”  I grabbed her, took her in over her great protests, and she had her babies, 7 of them, in my home with my husband and myself as midwives.  Breaking the cycle, Tommy Boy and his siblings began life in safety and love, in a home instead of the street. 

Tommy Boy wasn’t a runt but he was the last born.  I could always distinguish him from his brothers and sisters, who were all identical tabbies, by the white tip on the end of his tail. 

As Tommy Boy grew up, I also recognized him by his vanguard personality.  He was the first to do everything; the first to open his eyes, the first to walk, the first to climb out of his baby bed at only two weeks old.  He was the first to seek out human company, and the first to try to climb the virtual Everest (to him at 4” long) of our bed.  At approximately three weeks old, Tommy Boy started coming clear across the apartment to sit on my foot as I worked.  That pretty much cemented his status as a member of our family, and when all the other kittens got adopted to new families, Tommy Boy stayed.

 Tommy Boy had a long, mostly happy life.  But the point of my article is not to write Tommy Boy’s life story, only the end of it, which broke my heart and was entirely unnecessary, so that other guardians of diabetic pets can learn from my mistake.

Tommy Boy was 9 years old when he was diagnosed with diabetes.  Along with the detailed and daunting instructions I received about insulin dosing, one of the first things I was taught was that chronically high sugar levels leave diabetics open to opportunistic infections.  After instruction #1, which was that he must have insulin or he will die, this was absolutely basic, must-know knowledge, item #2 in Diabetes 101. 

When he was diagnosed, the vet started Tommy Boy off with very low doses of insulin, fractions of units in a distilled water dilution (1/10 ratio), and increased gradually over several weeks time until we had an optimum dose.  That turned out to be about 6 full units twice a day.  “Optimum” was determined by observing his overall condition, appetite, thirst, and a measurement of ½% or less sugar in the urine, tested with a dipstick.  The dosage of 6 units twice a day remained more or less the same for many years.

Starting at about age 13-14, however, approximately every 6-8 months, Tommy Boy would have a low blood sugar episode.  This is a dramatic and unpleasant event, but unless you can read tea leaves, it’s virtually unavoidable with diabetic animals, and sometimes even with people. 

Blood sugar levels change every hour depending upon countless factors including food intake, exertion, stress, and sleep.  The only way to know the exact sugar level is to monitor it with a blood glucose meter.  This is where you prick the finger with a needle, and hold the blood drop to a strip that is inserted into a small machine that measures the sugar level. 

People can do this easily enough.  Theoretically, you can do the same with cats.  But unless you have an absolute angel of a cat who will let you do anything to him, it’s impossible for an owner to get blood out of them; doubly impossible to get it in the 12 seconds allowed to get that droplet onto the strip. 

The only practical tool for monitoring sugar in pets is Ketostix or KetoDiastix.  These are colored strips that change color when they detect sugar in the urine.  You hold a strip under the urine stream (if and when you can catch them in the act), then wait 30 seconds comparing the strip to the color chart.  The patch changes from pale blue to dark brown over 30 seconds depending upon the concentration of sugar in the urine.  KetoStix measure only sugar.  KetoDiastix also alert you to keytones, a toxic substance that accompanies very high sugar in the bloodstream, a very dangerous condition.

It’s hard to know what causes the blood sugar level to change so much as to cause a low blood sugar episode in an animal that eats pretty much the same thing every day, rests the same, has little stress, and takes virtually the same insulin dosage very day.  For whatever reason, the sugar is low to begin with, and you give a dose of insulin that, though it’s the identical dosage he gets every day, is too much for his system at that moment, and drives the blood sugar down too low. 

I was forewarned that this could happen suddenly, how to recognize it, and that it could be quickly cleared up with a tablespoon of Karo syrup, and withholding the next two or three insulin shots. 

The first few times this happened, being armed with these instructions, I did exactly that, and let the vet know by phone afterward.  The vet made a note to his chart, and Tommy Boy jumped right back into his regular routine after a few days.  This worked fine in about 3 episodes over about 2 years.  And here I’m going to go out on a limb and say that after six years managing a diabetic cat, 14 years as Tommy Boy's guardian, and 40 years developing my judgement and intuition, as long as I was managing his insulin regimen, Tommy Boy was a stable diabetic.  The day I let myself be talked out of my own better judgement was the beginning of the end of Tommy Boy’s life.

Tommy Boy went in for a yearly check up just before his 14th birthday.  I discussed with his vet this handful of low blood sugar episodes.  His advice during this check-up changed.  He told me the next time it happened, I needed to get Tommy Boy right in to the clinic. 

So, the next time Tommy Boy had an episode, I brought him in.  Instead of prescribing that Tommy Boy miss a few doses and get back into his normal routine, the vet dropped Tommy Boy’s insulin to 1 unit ONCE a day, and instructed me to start him all over again from scratch with the gradual build up.  This sounded crazy to me, and I questioned him at length.  Why would we do that?  How could that be good for him when he was used to 12 units a day?  Wasn’t that way too dramatic a drop from so high?  Wouldn’t the system suffer?  Wasn’t something more moderate the right way to go?  Why was this advice so different from what I had originally been instructed to do?  Which had been working fine so far in these low blood sugar events? I really gave him the third degree, but he was adamant about his advice, had an answer for everything, and I’m not a doctor, so how could I argue?  I did what he told me.

It took Tommy Boy 3 months to get back to his optimum dose after this low blood sugar episode.  When we finally reached it, he was his old self.  In the meantime, he was lethargic, irritable, and sick.  He vomited regularly.  He had frequent diarrhea.  He wouldn’t play, wouldn’t interact with the other cats, and didn’t want to be snuggled or touched.  At the worst of it, he could take a maximum of ten steps at a time before he would drop down winded.  Obviously this draconian approach to the low blood sugar episode had been ill advised.  But I’m not a doctor, and I let myself be convinced that while I know my cat better than anyone, and the evidence of my eyes told me this was wrong for him, surely the vet’s scientific instruments give more accurate numbers than my intuition.  He had to know what he was doing.  Right?

At the time of the next blood sugar attack about 8 months later, I took him in, and the advice was the same.  Again, against my better judgement, they made me start all over again with this: dropping him down to nothing and working back up over a laboriously long time.  This time, however, halfway into the process I decided it was ridiculous.  The toll on the cat far outweighed any benefit there might be in this insane insulin deprivation, and against the doctor’s advice, I accelerated the process until we reached Tommy Boy’s his last known optimum dose in about half the time.  Tommy Boy went from lethargic, sickly, miserable and cranky to his old self in half the time.

I was now at the end of my patience with this vet who had disappointed me in other ways as well.  He had misdiagnosed in at least two instances that I could recall, with rudimentary but serious illnesses that should have been patently obvious.  He had a very nasty associate, and some true birdbrains on his staff who constantly made me late to refill Tommy Boy’s prescriptions.  The last straw was when he couldn’t wait for my cab to arrive to close the office one night, insisted on driving us home, and then dumped me and Tommy Boy out in the street in a rain storm halfway home because it would have taken him an extra five minutes out of his way.

I began using a phone-a-vet that makes house calls instead.  Little did I know that in the next low blood sugar episode about 6 months after the last, the clinic he would take Tommy Boy back to for tests was the previous doctor’s office, and that the advice would be the same all over again.  However, this vet had an all new language to convince me why I needed to follow this regimen.  And again, contrary to my own intuition and better sense, I was frightened into this crazy scheme, and dropped Tommy Boy to 0 insulin for the third time.

We were about a month into the gradual increasing, and at about 3 units twice a day (half Tommy Boy's proven optimum dose) when on a Christmas Eve, I noticed his eyes didn’t look right.  They were dark, and puffy and pained.  He was rubbing them.  He looked so strange that I asked my neighbor to look in on him at some point during the 2-3 hours I would be out with family for dinner.  On Christmas Day, the eyes were worse.  Very dark looking, swollen.  The day after Christmas I took Tommy Boy to a brand new local vet.  She diagnosed him with conjunctivitis and sent him home with some ointment to administer for 7 days.  He also had an ear infection which needed drops.

Of course!  This is what I had been warned about in Diabetes 101.  Chronically high sugar will start to cause infections.  I was not doing this crazy insulin deprivation scheme a third time. 

But it was too late for that decision.  Two days later, I was awakened at 7AM to the sound of Tommy Boy’s hysterical crying and screaming.  I rushed out to the living room to find him stuck behind the television cabinet unable to extricate himself from the corner.  I lifted him out and when I turned him to face me, I saw the cause of his wailing.  He was blind.  The entire visible surface of both his eyes was covered over with a thick orange-white coating.  The eyes were swollen to about 125% of their normal size.  I was horrified.  And so was Tommy Boy.  His cries were heartrending and pitiful.  In my robe and slippers I ran from the house into the snow and took him to a large Manhattan emergency clinic, the only one open for miles during the holiday weekend.

I’m going to fast-forward here, and cut a very long story very short.  We fought for two months to save Tommy Boy’s eyes.  He got his some limited sight back temporarily with antibiotics and steroids, but the infection was too advanced to eradicate it completely.  Ultimately he lost both his eyes.  The cause:  Bartonella bacterial infection allowed to flourish in the high sugar environment of his system without insulin.  That’s if you listen to ME.  If you listen to one vet, the cause was “complications of diabetes,” or the other one, “no causative factor identified.”

My heart was broken.  My one true phobia is blindness.  If it were me losing my sight, I would jump from the nearest rooftop without a second thought.  To think of my poor Tommy Boy being blind was more than I could stand, and my friends will tell you I had a near breakdown over it.  If it were as simple as a prospect of losing both eyes in one fell swoop, I would have put Tommy Boy out of his misery before it came to that, and called it a blessing.  But he didn’t lose his sight all at once.  In the second month after the hysterical holiday ER dash, one eye deteriorated so much that it had to be removed.  But he still had another eye with limited vision.  By the time it was ascertained that he had completely lost the sight in that eye as well, he had been living blind for a couple of weeks.  The dilemma then was whether to put down a cat who was blind, but coping.  I couldn’t do it. 

So Tommy Boy lived three more years as a blind cat.  I never would have dreamed he could do it as well as he did, but he adjusted.  In true Tommy Boy form, he did everything on his own.  I didn’t have to help him with anything.  He found his way to his food, his water, his litter box, and his bed, and took care of all his business without a stitch of help from me.  He took head to toe baths, and even managed to jump up on the sofa and the bed without help.  He amazed me every day.

Tommy Boy had a few more low blood sugar episodes during the last three years of his life.  However, having paid the dear price of his sight, which I felt responsible for having three times implemented this insane insulin deprivation regimen that I knew was wrong, I ignored all such advice, and I winged it on my own.  For almost the rest of Tommy Boy’s life, I did what I knew was right.  I kept his insulin at or near 6 units twice a day, and monitored him the best I could.  And for three years, though blind, Tommy Boy was a healthy cat. 

At a certain point, the vet refused to continue prescribing Tommy Boy’s insulin syringes without seeing him.  So I was cornered.  I had to take him in. 

They tested his blood sugar, and reported that while his glucose levels were within normal range, his “fructosamine” levels evidenced a sustained period of low blood sugar.  This, they explained, could be from something called “honeymooning” where, for reasons unknown, a cat will suddenly stop needing insulin.  The vet seemed very convinced of what she was saying.  And rather than patronizing me with lay terms, she expressed her diagnosis in real words.  The prescription: drop Tommy Boy’s insulin back to 1 unit 2x a day and……

Wait a minute.  This is what I had done four times already!  This is what blinded him! 

She pulled out the papers.  Showed me the numbers.  Explained in exhaustive detail why what she was saying was absolute fact, and why, if I didn’t follow her prescription, I would be putting Tommy Boy’s health in serious jeopardy.  We had a half hour conversation/argument about this, at the end of which, having heard the science, I was compelled to believe her.  Again, I was frightened into following advice I knew in the bottom of my heart was absolutely wrong, but how could I argue?  She had the numbers.  She had the papers.  Numbers don’t lie!

So I did it.  I did it to him again.  I dropped his insulin to 1 unit twice a day.  Over two weeks, I watched Tommy Boy go from a blind, but reasonably healthy older gentleman cat, to a wasted, skinny, bone that could hardly lift himself off the floor. 

On the 14th day, when he had absolutely collapsed, I called the vet’s office.  “This can’t be right,” I said. 

“It can’t be wrong,” she said. “The numbers don’t lie.  He’s honeymooning. I know it’s never been explained to you adequately before, but it is accurate.  What you’re seeing is probably the result of too MUCH insulin.  Drop him back to one unit ONCE a day.” 

God help me, I did it.  She had frightened me to death with her numbers and her certainty, and so I did it again. 

In two more days, condition worsening, I called again.  “Doctor,” I said, “ this absolutely CANNOT be right.” 

“What do you want to do?” she asked me impatiently. 

“I want to give him his normal insulin!” I said. 

“You’ll kill him,” she said.  “He’s honeymooning.  I promise you.  Just keep up the program.  You’ll see, he’ll start getting better.”

Later that night, he urinated on the floor because he couldn’t make it to the box.  I took a dipstick to the urine.  The sugar was at the top, dark brown, and now, the second stripe, always clear before, indicated the presence of keytones.  Keytones means dangerously high sugar levels with toxic side effects. 

It was 10PM at night, and I called the vet’s emergency number.  In a few minutes, an associate called me back.  I said, “Look, this prescription absolutely cannot be right.  The cat is lying prostrate on the floor.  He can’t eat.  He can’t make it to the litter box on his own.  The sugar is at the top of the dipstick, and now it’s showing keytones.”

This doctor said, and I quote, “well, it’s just not possible for a cat to go from the fructosamine numbers he had to high blood sugar in two weeks.  It doesn’t happen.  Are you sure you’re reading the dipstick right?“

If she had been in the room with me I would have kicked her.  “Yes, I’m reading it right.  I’ve been reading these sticks for 6 years, I think I know how to do it.  Of course,” I added with some sarcasm, “this is the first time I’ve ever seen it show KEYTONES!”

Her ultimate answer was, “While I wouldn’t say anything’s impossible, it’s highly, highly unlikely that he went from the numbers he had two weeks ago to blood sugar that’s off the charts. But if you believe you have high blood sugar and keytones, go to an ER.”

I hung up absolutely disgusted with her.  With them.  With the whole system.  I didn’t know what to do.  The only ERs around here were lousy.  I hated to go to any of them.  And with the whole damned bunch of them agreeing that his sugar was low while I was looking at sugar levels off the chart, who was to say the ER vet wouldn’t take insulin away from him altogether?!

I had a blood glucose monitor here that I had never been able to make work, though I had tried many times, he just would not sit still for it.  But now he was absolutely prostrate on the floor.  I’d have bet he was in a near coma if asked to lay money.  He wouldn’t be able to fight me. 

With shaking hands, I pricked a vein in his ear, and took a reading.  The meter said, “HI”. 

What?  Had it just come on?  Was it saying, “hello?”  Or was it giving me a reading?  I found “HI” in the manual.  It said that “HI” represented a number so high, it couldn’t be measured by this meter.  “See your doctor immediately.” 

I blinked.  I must not have done that right.  I did it again.  It read “HI” again.  Oh My God. 

I immediately got the syringe and insulin and gave Tommy Boy 3 units.  It was against all advice.  And much too much if I listened to a veterinarian.  But their advice had made this mess.  “F--- them,” I said, pardon my language.  I was past listening to that nonsense, and shaking from fear, and rage.  Had any of those veterinarians been present in the room, I could have done them serious bodily injury.

I waited half an hour, and took another droplet of blood from Tommy Boy’s ear.  This time the blood read 584.  The 3 units of insulin had brought his sugar down from an unreadable number to something the machine could at least read.  But this was an outrageous number!  Normal blood sugar is 70-120.  If there were any question in my mind that those veterinarians had made a grievous mistake, it was erased entirely by the sight of this number on the meter.

While I stared in disbelief at the meter, my mouth gaping open, Tommy Boy began to try to stand up.  He was shaky on his feet, and not altogether coherent.  But as he came to, he became aware of his discomfort and began to cry.  He tried to pace, and fell down.  He tried again, but listed to one side, and turned round in a circle. 

I knew what was happening to him.  The sugar, elevated to this insane level over two weeks time (and the compound effect of all the other times he had been insulin starved before this) had created nerve damage, a.k.a. diabetic neuropathy, and probably brain damage.  Diabetic neuropathy can be intensely painful.  It causes extreme sensitivity to touch, shooting pains in the extremities or any affected nerve group, tingling, burning, cramps, as well as gastric trouble of all kinds, and loss of motor coordination.  I knew I could not manage this crisis at home, and I HAD to go to an ER whether there was a decent one or not.  Perhaps, an ER could give him fluids, stabilize him for a couple hours while I waited, and I’d take him to – lord knows where, we’ll figure it out- in the morning. 

I took Tommy Boy to the local veterinary ER.  The on-call vet took one look at him, heard a few words of my story, and said, “This is clearly not low blood sugar.” 

I asked the vet to put him on an IV drip, stabilize him, do what they could for him, and I would find a new vet in the morning (this place was just an all night ER.  They close at 7AM; all animals have to be on their way to hospitals or their home vets by 6:30.)

He said, “This cat is in desperate condition.  He needs at least a week of intensive care to pull through this.  IF he makes it through the night.  He can’t go home tonight.”

I asked him, with my heart in my throat, “Are you saying he’s dying?” 

“Yes.”

“Can’t you do something to stabilize him?  At least give him an IV?  Some hydration?  He’s obviously dehydrated…..”

“This is way beyond that,” the ER vet said, his message implicit.

At that moment, Tommy Boy stood up and began to vomit.  Nothing came out.  He had no strength to stand, and fell down on the slippery stainless steel table.  I wrapped him in a towel and held him to me.  He lay in my arms and panted.  He was just a bone.  And I knew it was time.  I had promised him after the surgery that removed his second ruined eye, when he was hysterical with pain and fear, that I would not put him through any treatments or procedures that required him to be away from home.  A week in intensive care, in this atrocious condition, without the ability to even see where he was or who was doing what to him, was more than I could dream of subjecting him to after all the rest.  This was it.  It was over.

I spent five minutes alone with Tommy Boy cradling him, crying my eyes out, and apologizing to him for the egregious lapses in my judgement that brought him to this point.  I begged him to forgive me.  Then I allowed the ER vet to euthanize Tommy Boy.  My little 3” pioneer.  The little tabby fur person that was the first to do everything.  The best and bravest and smartest animal I ever knew.

I will never forget Tommy Boy or the lesson I learned from his life and his death.  I will never, ever, EVER in all my days, ever again doubt my own instinct.  I have known for a very long time that the only absolute and infallible protection a person has is their intuition.  That small voice inside that tells you without the aid of research or education or parental advice what is right and what is wrong for you and your own.  If you listen to it, you will never come to harm.  If it speaks and you ignore it, you go wrong every time.

I tell this story not to break hearts and make people cry, but to warn guardians of diabetic pets to BEWARE the stories of HONEYMOONING.  It may be true of some cat somewhere.  That cat may be your cat.  But it was not my cat.  And it was not my cat on all four occasions that I was assured it was.  BEWARE also the PROOF of honeymooning.  I saw it with my own eyes, the papers, the reports, the numbers.  All were wrong.  They “couldn’t be”, but they were.  LEARN FROM MY STUPIDITY.  I did the draconian prescriptions these veterinarians recommended because I WAS FRIGHTENED INTO IT by the assurances.  The absolute certainty they evinced that they were right convinced me to set aside my own better judgement, my “mother’s intuition”, which had never failed Tommy Boy before, in favor of advice I knew was wrong.  It looked good on the paper.  But how stupid does it all sound now?  It was my first lesson in diabetes: “If he doesn’t get his insulin he will die.”

The hard truth is that I killed my cat.  I killed him with the stupid refusal to put my own instinct before the almighty word of a veterinarian even when I KNEW I was right.  When I had PROOF, and FOUR SEPARATE AND DISTINCT EXPERIENCES TO PROVE that I was right.  But I did it anyway.  I killed Tommy Boy. 

It took me 10 months to be able to tell that truth.  I thank Judy Dick for asking me to write Tommy Boy’s story when I had contacted her only for the name of a feline diabetes charity to donate to in Tommy Boy’s name… for seeing the value to others in this story and prompting me to write it.  Had she not asked, I would not have done it.  It was hard to relive, and to face that truth in black and white, but writing it has helped me get some closure on his death, and if it helps one person avoid making the mistakes I did, it’s worth every painful word.