I hope you manage to get some cans of the DM to allow you to transition him at a pace that will not upset his tummy.
Thankfully the other vet clinic still has quite some stock! Bought 24 cans, should buy me enough time for the next food plan.
I think what your are remembering reading is reductions for a long term diabetic cat/ or a cat that has shown he doesn't hold reductions.
Exactly, that's it! Thanks. And that's why I couldn't find it, I'd left out the "cat who can't hold reductions" bit.
Quintus is at 122 right now. So, it's a little high. But if I look at his numbers overall for the last 24 hours, he hasn't been higher 125 -- not something I'd achieved on the previous days with insulin. He's really pretty flat. Now, would it be better to have him as flat, and lower, and could I work at that with micro-doses of insulin? I'm sure it's possible.
But I went back and looked at Quintus's labs since I've had him. I have quite a few, because I follow my cats quite closely. As I mentioned in my opening post, I put the numbers in a dedicated sheet for convenience. They were not all fasting glucose -- but I'm not measuring fasting glucose here. Over the years, he's varied between 93 and 157. So, maybe he's just a "slighly sweet" cat in his normal, "healthy mode" numbers? If he hadn't soared sky-high, and I'd bought a glucometer to test him, and got those numbers, they'd look "normal". Now, I agree that "after FD requiring insulin" and "before" are not exactly the same situation. But I'm trying to put these numbers into perspective. If he was taking insulin right now and getting wonderfully flat and stable numbers like this, I think overall it would be considered a good situation. It's not as low as what TR aims for, but it's still pretty good. (I'm assuming it is not a prerequisite for participating in discussions here to be aiming for "tight regulation".)
Which brings me to
Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission, an interesting study that was pointed out to me yesterday (thanks,
@Wendy&Neko).
Here are my take-aways from the study, run on 21 diabetic cats in remission (against a control group of 28 healthy cats). It shows that higher fasting glucose levels and impaired glucose tolerance (measured a few hours after administering glucose) are associated with relapse. 30% of the post-diabetic cats relapsed in under 9 months. Compared to the control group, the fasting glucose levels and glucose tolerance of the post-diabetic group is worse. This indeed tells us that a cat in remission with high fasting glucose (or impaired glucose tolerance) is at higher risk for relapse.
Now, what I'm more interested in is what is not in the study (or if I've missed it, I think you in advance for pointing it out):
Of the healthy control cats, did any develop diabetes within the 9 months after the study?
[ETA not very likely with a sample of 28, given a prevalence of FD that might be around 1%] and if so, was there a link between their fasting glucose levels, glucose tolerance, and the onset of diabetes? this would be interesting as it would tell us if it is just those levels
per se which are a problem, or if they are just a problem in post-diabetic cats. This is what I would have liked to find, as it seems given his lab history that Quintus, had he been included in the study pre-diabetes, would probably have a higher-than-most fasting glucose.
So, is it that if you have high fasting glucose you are pre-diabetic anyway and at higher risk of developing FD? -- whether you've had it before or not?
Another interesting thing to know would be what the fasting glucose of the post-diabetic cats was
before they developed diabetes. Was it high? Does looking at a bunch of post-diabetic cats mean we are looking at cats who already had high fasting glucose before the onset of FD? This would be consistent with the findings of the study, ie that high fasting glucose puts the cat at higher risk of relapse.
Which brings me to something else, that I thought about this morning, regarding TR, and the idea of "strong remission". Where I would definitely see a benefit on insisting on low numbers before tapering off insulin is if those low numbers "stick".
Say Quintus has been a 120 kitty pretty much all his life rather than 80. If we keep him on Lantus until we get nice flat readings between 60 and 80, say,
are we resetting his "normal, healthy" BG in a way? If that is the case, then I would say that argument makes a strong case for insisting on the "strong remission" with low numbers. But if it's not, then it just means that a "120 kitty" will just fail and fail to stay with those lower numbers, and either never go off the juice, or go back up to his "normal" when we stop it.
So this is really something I'd be interested in knowing.
If we have a cat who lives happily all his life at 100 or 120 rather than 60 or 80, and we put him on Lantus and bring his numbers down, and keep them there, and taper off, will those numbers stay down? What if we try that on a non-diabetic (well, maybe pre-diabetic) cat? If it worked, it could be worth it -- extrapolating (this would need checking of course) from the above study that being pre-diabetic puts you at increased risk of becoming diabetic (d'oh).
I hadn't thought of it, we probably have many people here who have pre-FD GLU values for their kitties. It would be interesting to have a preliminary look at them if people are willing to contribute (or if I go spreadsheet-hunting for lab values after I've cleaned the disaster that is my kitchen).
. It also seems to contraindicate its use in animals using NSAIDS and some other drugs , I can't see that mentioned on the US insert.
) His position was that this was definitely not something to worry about in the coming weeks given the numbers, but that we would keep an eye on it on the occasion of the next blood panel.