Cross-posted from Lantus (re Akane and dose reduction)

[Ilkka and Tom]

Great comments... (Hi, Libby!)

In my opinion, Akane's chart reflects a lot of messing around with the dose, popularly known as "dose hopping" (a practice that has to do with the bean more than the cat) and which has consequences of the sort where the metabolism is effected and therefore the data for long term insulin need is corrupted and misleading. I think Akane's chart is a textbook case -- at least the Lev part. For that reason I am not in the lower-the-dose camp, as some of my Levemir mates are.

High numbers are often blamed on rebound... sure .. but I think there is reason to believe that lows in response to a reduced dose are also a form of rebound. As Mami points out, Akane comes back up, and alarmingly so. If that rebound is then interpreted as still too much insulin (whereas it is a response to too little!!), it's a disaster because we are taking a cat on a relatively low dose and figuring out how to undermine its systems.

I am suggesting that low numbers in response to reduction can be an "inverse rebound": caused by the pancreas responding to a reduction by calling on reserve capability and delivering an amount of insulin to handle the sudden shortfall. The bean cuts the dose in half? to a quarter of what it was? Fine, you may see lower bg but it is a mirage: the cat is diabetic and can't be operating in emergency mode all the time. Pretty soon the dose is reluctantly returned to higher levels. Poor cat.

I would say the idea that reducing the dose is a possible solution, is not goofy. What is goofy, and possibly destructive, is falling into the belief that it works in more than a minority of cats. Of course it works from time to time -- in those cases where there is the exact set of complications, such as metabolism issues, that present diabetic symptoms.

But exactly what percentage of cats is that? The disease is diabetes, and the last time I peeked, the cause of this disease was not a surfeit of insulin.

My tuppence, centimes, eurocents, whatever.

So nice to see the familiar names. Best regards to all..

Ilkka

 

[Sheila & Beau GA & Jeddie GA]

Hi, Ilkka. Great to see you! We miss you around here.

I am not sure where you read that anyone was suggesting reducing the dose right now. Some of us were countering the "raise the dose" suggestions by pointing out the nice lows that Akane has gotten on the current dose. I think he needs settle time where he is.

Also, not sure about the "inverse rebound" concept. I think we can see lows in the first few cycles after a dose is reduced due to the effects of the previous higher doses. But usually the bounce up lessens over time - to me indicating input of less "energy" (insulin) behind the bounce.

The causes of diabetes, or the root causes, are not complicated and I think type II is, in fact, caused by too much insulin. Diet, lack of exercise, etc. cause increased blood glucose levels and increased insulin production and release. Eventually the cells become resistant to the insulin and BG doesn't come down. The pancreas releases MORE insulin and the cells become MORE resistant. My ex-h was dx with type II and went from diet changes to oral meds to insulin , to more insulin, to MORE insulin (lantus) and was told he would die in 10 years because they could no longer control his diabetes. He had lap-band surgery which, like gastric bypass, forces the diet to become very high protein/low carb (sound familiar?) . Almost overnight his diabetes began reversing. Within weeks he was off all insulin/meds and has been off them two years. Of course he also lost weight which is significant in that it helped the diabetes AND the lower insulin levels caused his body to lose weight. Incidentally, he had his insulin levels tested early after his diagnosis and they were 10 times the level of a normal person, yet his BG was still high - insulin resistance to the max. He had the lap-band removed a year after the surgery and is still in remission 3 years later.

I think the mechanism at work here is the same we see with our cats. Insulin resistance causes glucose toxicity and they feed off each other. Introducing exogenous insulin AND changing the diet to high protein, very low carb allows the toxicity to clear up and that helps with the resistance, but once the insulin resistance is broken, you need to slowly reduce the exogenous insulin or you just recreate insulin resistance and the reliance on exogenous insulin - and possibly on higher and higher doses of exogenous insulin.

And that's my two cents...

 

[Vicky & Gandalf (GA) & Murrlin]

I take it you are referring to a cat which has some pancreatic activity with your "inverse rebound?" It makes sense in that case only. In a cat without pancreatic activity not enough insulin would not lower the BG as it does in Akane's case.