Hi Wally,
It potentially could be type 1 - I think the stat I've read says that 85-90% of the time it is type 2, but some cats
must make up that 10-15%.
Either way, just about every cat diagnosed needs insulin, whether short term or long term or forever in some cases.
There's all sorts of links about it, a couple of which would be these:
http://felinediabetes.com/dummies.htm
http://www.vet.cornell.edu/fhc/brochures/diabetes.html
http://en.wikipedia.org/wiki/Diabetes_in_cats
http://catinfo.org/?link=felinediabetes (this is Dr. Lisa's info)
Sometimes the pancreas functions incorrectly, and it can be due to damage from infection for instance. Sometimes it quits working (at least as far as insulin production) at all. In many cases, that damage can be partially or mostly repaired, at least to the point where a cat can be regulated or controlled and have BG just over normal with tiny doses on insulin every day for the rest of his life. Some cats go into remission, but that can be short term or long term. Even in cats, there is no such thing as being "cured" of diabetes. Bob is a diet controlled diabetic. Hopefully he'll stay that way forever, but there's no guarantee of that. He'll always be one bag of dry food away from a relapse.
This is something I've read that I think is good:
Regulating your cat ideally requires an understanding of how insulin works, and the relationship between insulin and food. It requires patience, and a certain scientific detachment to overcome the instinct to make several changes simultaneously in a desperate attempt to stumble on something that works. Even if you get lucky and find that the glucose is under control, you won't know why, and when something changes (and it will) you have no knowledge to help you decide on how to deal with the sudden loss of regulation.
One simplistic approach is to increase insulin slowly until you think the cat feels pretty good. For me that is just the starting point. I believe that blood testing is the sole reliable measure of regulation -- the brain grabs it's share of the available glucose, if necessary short-changing the body cells ... the cat may be perkier and more responsive, but some organs are left in a permanent state of minor overload, and the rest of the tissues slowly deteriorate.
It hits all the main points we advise here - insulin and food interacting, going slow, and home testing, all combined to manage the disease effectively.
Another one which stresses that remission is possible in type 2 diabetes cases:
It is in most cases, it is possible to induce remission (a temporary or permanent freedom from insulin-dependence) in type-2 diabetic cats. This appears to be unique to cats. There is growing agreement among experts[10][29] that a combination of low carbohydrate healthy diet, long-lasting insulin, and well-chosen dosage plans can in many cases partially heal a damaged pancreas and allow the cat's blood sugar to be controlled entirely by diet thereafter. (A low carbohydrate diet is usually required for the remainder of the cat's life.)
Remission is a realistic goal for treatment of type-2 diabetic cats (that is, 80-95% of all diabetic cats) who are properly regulated quickly.[34] Chances of success are highest in the first few months after initial diagnosis, due to ongoing damage from glucose toxicity caused by hyperglycemia. This limited time window is a good reason to start with low carbohydrate diet and very slow-acting insulins, the most successful known combination, right away.
In both types, the ability of the pancreas to produce insulin is effected. Type 1, the pancreas' beta cells can't produce enough insulin. With type 2, there's decreased production, plus there is insulin resistance going on within kitty's cells:
There are two types of diabetes. Type 1 and Type 2. Type 2 is the more common form in both humans and cats.
Type 1 occurs when the beta cells of the pancreas are not able to produce enough insulin.
Type 2 is characterized by two problems. The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin. The second issue is one of insulin resistance. In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose (hyperglycemia) and cellular 'starvation'. The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin. The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.
Bottom line, Wally. Odds are that Costello most likely has type 2, simply because the overwhelming majority do. Most cats on the board are type 2s. Costello's numbers and results so far a pretty much "normal" for cats we see in FDMB. And the way that you describe the treatment and the improvements in BG? I don't follow the logic that for type 1's it would be initially any different. In both types,the pancreas isn't functioning well. In both types we see liver action releasing glucagon. In type 2, you still have to increase the dose until you find one that works before there's an improvement and the dose can start to come down. Consider the insulin resistance mentioned by Dr. Lisa in type 2 cases. Some type 2s never get to the "healed" stage, where the insulin dose is eventually removed. I guess what I'm saying is that no matter which type, a cat can require insulin permanently. It's more likely that a type 2 will go into remission, I suppose, but not a "given".
A cat with 400-500 bg levels is putting out little to no pancreatic insulin. Once a kitty starts to live in the pink/yellow/blue zones, we sometimes see what we call a "sputtering pancreas", where the pancreas will work some, which we always see as an extremely positive sign that healing is taking place. I think that a cat with usually high numbers is just about totally dependent on outside insulin, at least until the numbers are controlled to a good degree.
wow. now THAT's "wordy"....
Carl
