Regulation vs. remission

[Molly and Sammy]

I'm new but have been around long enough that I have questions beyond testing and shooting. My Sammy was diagnosed in September, with BG at the vet of 720. I changed diet and started testing immediately, then added insulin. I have a cool vet, who pointed me to this forum and loves the spreadsheets I send her periodically. Sammy is 11, and I am afraid he'd had diabetes for several months before I took him in- I thought he was just getting old with excessive drinking and peeing, back leg limping, weight loss, lethargy. Because of this the vet said we were probably aiming at regulation rather than remission. Her approach is conservative - don't shoot under 250 (AT), for example, treatment goal is numbers under 300, average 250.
We're on Lantus and beginning to flirt with some low numbers at last. I've been inconsistent with dosing strategies (and am no longer consulting vet for change approvals) but am closest to SLGS. Is there a different strategy for regulation, perhaps less aggressive like my vet's, or do I stick with SLGS and hope for remission? Since food change and starting insulin Sammy has gained about 2 pounds, no more excessive drinking and peeing, loves his new l/c diet, and other than some neuropathy (recently started Zobaline) is really symptom-free. Vet says treat the cat, not just the numbers. Thoughts?

 

[Elizabeth and Bertie]

If your cat is happy and in good health, that's great!
But don't necessarily give up on the chance of remission. While many cats who go into remission seem to do so within the first months of treatment, some do go into remission many months later, or even years later. ...My cat went into remission 10 years after diagnosis! ...And 11 isn't 'old' at all. Bertie is now 20....

Eliz

 

[Darwin H.]

Im a lot like you and hoping for the best but Simba's numbers never got up past 450 and HE DID PEE a lot besides lose weight and weakness in his legs. Trying to get him consistently below 200 with regulating 100 - 300 according to my vet. I have not seen any change in his numbers this first 2 weeks (see SS) but I am hopeful as he is 95 % off kibble. Ugh. Have to give him his first Curve tomorrow...

 

[FurBabiesMama]

I find it odd that the vet's goal is 'under 300, average 250'. The renal threshold is supposed to be about 250.

I would say aim for remission, why cheat Sammy out of a chance (and yourself), but even if you are aiming for only regulation, try for a little better regulation than 250/300! At the very least, I would say try to stay UNDER 250 with AlphaTrak.

 

[Darwin H.]

I find it odd that the vet's goal is 'under 300, average 250'. The renal threshold is supposed to be about 250.

I would say aim for remission, why cheat Sammy out of a chance (and yourself), but even if you are aiming for only regulation, try for a little better regulation than 250/300! At the very least, I would say try to stay UNDER 250 with AlphaTrak.

Maybe I was not clear. Yes. we are shooting for remission and under 200.

 

[Veronica & Babu-chiri]

If you ask me I would try and get him regulated on normal glucose values (step by step of course ) not under 300 that would give him the best chance of remission, remission may or man not happen but even if he does not go into remission he will be much better living in normal numbers.

I don't know how long had Babu had the diabetes, he was very hungry and peeing a lot by the time he was diagnosed and it was because of a very bad case of UTI but he was 14 years old and with HCM and he did got into remission , my vet like yours did not thought it possible.

 

[Molly and Sammy]

If your cat is happy and in good health, that's great!
But don't necessarily give up on the chance of remission. While many cats who go into remission seem to do so within the first months of treatment, some do go into remission many months later, or even years later. ...My cat went into remission 10 years after diagnosis! ...And 11 isn't 'old' at all. Bertie is now 20....

Eliz

Sammy isn't even regulated yet, but we're on our way. I know his numbers have to come down a lot and stay there, but am curious about the best way to get there. So glad that your Bertie is doing well!

 

[Molly and Sammy]

Im a lot like you and hoping for the best but Simba's numbers never got up past 450 and HE DID PEE a lot besides lose weight and weakness in his legs. Trying to get him consistently below 200 with regulating 100 - 300 according to my vet. I have not seen any change in his numbers this first 2 weeks (see SS) but I am hopeful as he is 95 % off kibble. Ugh. Have to give him his first Curve tomorrow...

I can promise you that the testing and the curves get easier! Hope some of the replies to my question help you, too.

 

[Molly and Sammy]

I find it odd that the vet's goal is 'under 300, average 250'. The renal threshold is supposed to be about 250.

I would say aim for remission, why cheat Sammy out of a chance (and yourself), but even if you are aiming for only regulation, try for a little better regulation than 250/300! At the very least, I would say try to stay UNDER 250 with AlphaTrak.

Thank you! This helps a lot.

 

[FurBabiesMama]

Maybe I was not clear. Yes. we are shooting for remission and under 200.

I was responding to Molly, the person who started the thread.

 

[Molly and Sammy]

If you ask me I would try and get him regulated on normal glucose values (step by step of course ) not under 300 that would give him the best chance of remission, remission may or man not happen but even if he does not go into remission he will be much better living in normal numbers.

I don't know how long had Babu had the diabetes, he was very hungry and peeing a lot by the time he was diagnosed and it was because of a very bad case of UTI but he was 14 years old and with HCM and he did got into remission , my vet like yours did not thought it possible.

Thank you, I agree and will try for tgat!

 

[Veronica & Babu-chiri]

Sammy isn't even regulated yet, but we're on our way. I know his numbers have to come down a lot and stay there, but am curious about the best way to get there. So glad that your Bertie is doing well!

To be considered in remission a cat needs to be with in normal blood glucose values (under 120) without getting insulin, I think that statistically the tight regulation has had more success but a lot of cats have gone into remission on SLGS too, Babu being one of them.

On either case what you need is to slowly get his numbers down until you are in normal values WITH insulin , from there it will depend on his body if his pancreas starts working on his own or not but being on normal values allows his pancreas to rest and recover and gives them the best chance of remission

 

[Molly and Sammy]

To be considered in remission a cat needs to be with in normal blood glucose values (under 120) without getting insulin, I think that statistically the tight regulation has had more success but a lot of cats have gone into remission on SLGS too, Babu being one of them.

On either case what you need is to slowly get his numbers down until you are in normal values WITH insulin , from there it will depend on his body if his pancreas starts working on his own or not but being on normal values allows his pancreas to rest and recover and gives them the best chance of remission

Thanks, Veronica, that helps too. I think I was overthinking this, as usual for me. I read the forum messages obsessively, and my head gets too full to stay on course. The goal, after all, is to get our furkids healthy!

 

[MrWorfMen's Mom]

Bertie definitely wins the long journey to remission prize but my girl and I had a journey of 3 yrs, 7 months and 12 days so no matter what the vet tells you, don't give up hope that remission is possible. I was also battling a high dose condition with my girl but I now know remission should never be considered off the table.

 

[Molly and Sammy]

Bertie definitely wins the long journey to remission prize but my girl and I had a journey of 3 yrs, 7 months and 12 days so no matter what the vet tells you, don't give up hope that remission is possible. I was also battling a high dose condition with my girl but I now know remission should never be considered off the table.

Thank you for the advice and support. Reading these posts has made me realize that aiming for remission just makes sense, and for me that's following the SLGS protocol and trusting my instincts. Sammy is amazing and has accepted a complete diet change, constant tests, and his injections as if he knows they will keep him alive. I just need to learn patience!

 

[Chris & China (GA)]

I'm going to disagree here, but it's with the best of intentions.

We shouldn't aim for remission....we should aim for regulation. That's what keeps our kitties alive as long as possible. Getting their blood glucose below renal threshold is the #1 thing....then keeping them in "normal" numbers as much as possible.

If they happen to make it to remission, that's icing on the cake, but it shouldn't be the goal.

 

[PussCatPrince - GA]

I'm going to disagree here, but it's with the best of intentions.

We shouldn't aim for remission....we should aim for regulation. That's what keeps our kitties alive as long as possible. Getting their blood glucose below renal threshold is the #1 thing....then keeping them in "normal" numbers as much as possible.

If they happen to make it to remission, that's icing on the cake, but it shouldn't be the goal.

I concur. Regulation is the focus first and foremost.

Remission is the long long game.

 

[Molly and Sammy]

I concur. Regulation is the focus first and foremost.

Remission is the long long game.

Understood, and the way we get to either one is pretty much the same road, isn't it? Or once you achieve regulation, do you alter your dosing strategies if you want to push for remission? I really feel I'm missing a chapter in the manual somehow. Thank for all the responses, I'm eager to learn all I can.

 

[Chris & China (GA)]

do you alter your dosing strategies if you want to push for remission?

No …..there's no special dosing method for remission. It's totally up to the cat (well, their pancreas) if they go into remission or not.

It's just not something you should have as your main goal. If it happens, that's wonderful and we're all happy for them, but the vast majority never make it so you shouldn't concentrate on it.

That being said, your best chance at achieving remission is Tight Regulation …..the sooner you can get their BG into normal numbers, the better chance they have of healing the pancreas enough to resume working.

Yes, we have had some cats on SLGS go OTJ, but TR gives the better results because you don't hold onto a dose that's not working as long.

 

[Elizabeth and Bertie]

Understood, and the way we get to either one is pretty much the same road, isn't it?

Sure. There are things that increase the chance of remission, but these are the same things that also make good regulation more likely anyway.

Incidentally, the Royal Veterinary College in London did research into feline remission, and concluded that around a third of diabetic cats "in the general population" have the potential to go into remission; and they noted that the chance can increase a lot with the factors that we already know to be beneficial; low carb diet and long-lasting insulin. They also found hometesting was helpful (as we know all too well!).

Interestingly, they trialled Lantus and Prozinc, and got similar remission rates from both. They were keen to test this since Lantus is often talked about as if having almost magical properties in terms of achieving remission, and they wanted to see if this was really the case.
Good overall glycemic control seems to be significant in achieving remission (whichever insulin is used), but this is also good for insulin-dependent cats as they will likely have improved clinical signs.
Low carb diets contribute to good glycemic control, and Dr Mark Peterson (feline endocrinologist) has also found that diets not exceeding 4 - 6% calories from carbs seem optimal, and increase rates of remission.

But, at the end of the day, it's ultimately up to the cat's pancreas as to whether remission does or doesn't happen...

Eliz

 

[FurBabiesMama]

To me, 'aiming for remission' is a somewhat different mindset than 'aiming for regulation'. We know that the guidance given here is very different than the guidance given by many vets. Sometimes, that difference is because most vets are happy with just regulation. You can have a cat whose pre-shots are consistently 200ish and whose nadirs are consistently 100ish on an AlphaTrak. That cat is very well regulated, and if regulation is the end-game goal, you have achieved it and can keep treading water. IF, on the other hand, you want to push toward the greatest chance of remission, you are probably not going to be fully satisfied with that, so you are going to approach your dosing a little differently.

We cannot control whether they go into remission or not, but we can choose to push the numbers down and control things more tightly in order to give the best possible chance of it happening rather than stopping at 'very well regulated'.

 

[Molly and Sammy]

Thanks, everyone. I got a much better understanding of the difference between the two, and the role the choice of protocol plays. Exactly what I was looking for!