Proposed Mechanism for Feline Diabetic Remission
Steve and Jock propose the following mechanism for remission in diabetic felines. This hypothesis relies on three premises:
1. Damaged feline pancreas can regenerate in 8-12 weeks, as livers are generally already accepted to do.
2. Hyperglycemia temporarily suppresses most insulin production in cats (as per Hodgkins and later also Rand[citation needed]).
3. Glucose toxicity plus amyloidosis permanently damage pancreatic beta cells[8]
If these three are all proven, then a mechanism suggests itself:
Beta cells are originally suppressed by some transient condition (such as high steroid dose, insulin resistance or overly high carbohydrate diet).
Consequent insulin shortage causes hyperglycemia, which by premise 2 suppresses beta cells and stops insulin production, keeping condition diabetic.
Glucose toxicity, by premise 3, damages pancreas, including newly regenerated cells, and prevents recovery.
Insulin therapy + low-carb diet keeps blood euglycemic for 24 hours out of 24 over a few days allowing insulin production to resume, though insulin resistance from damaged tissue remains.
Continuing euglycemia from insulin therapy and low-carb diet allows oxide-injured tissue to heal, reducing insulin resistance, leading to reduction in insulin dose.
Long-term euglycemia from Insulin therapy + low-carb diet over 8-12 weeks stops toxic oxidization of regenerating pancreatic cells, allowing more undamaged beta cells to produce insulin.
Required basal insulin supplementation drops to zero when newly-regenerated pancreas gradually reaches about 50% capacity, though bolus supplementation may still be needed in high-carb diet -- so no such diet should be attempted.
Pancreas, if unstressed by further blood sugar spikes, may continue to recover lost capacity as new cells regenerate.
Proving this mechanism might require studies to prove premise 1 and reinforce premise 2. Premise 3 is adequately shown, and the conclusion, that a low-carb diet plus careful slow-acting basal insulin supplementation, slowly decreased over 8-12 weeks, produces remission in more than half of newly-diagnosed cats, is shown by Rand & Marshall.
Note: According to Dr. Danielle Gunn-Moore and (she says) Dr. Jacquie Rand, these points "clearly describe the currently accepted hypothesis for DM remission in cats".
