How to assess the chances of remission?

Alisia Evans

Alisia Evans

Member Since 2025
The first month and a half of Asik's therapy was not very successful until we switched to Levemir. And I am worried about the question of whether we could have lost precious time while receiving ineffective treatment for him.
Is there any literature that helps me understand if we are on the right track? I understand that some families have been doing this for years, and we have only been doing it for 4 months, but sometimes I give up. If I hadn't insisted on switching to long-acting insulin, we would still be on caninsulin. In my place, the level of veterinary endocrinology is very low. I feel confused and constantly feel ashamed of my cat and guilty for letting him down. I look into those sad eyes and my heart just breaks. Daily measurements, injections, it is really very tiring.

measurement table

Previous: Should I increase the dosage of Levemir? Is it advisable to switch to Lantus?
 
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Hello Alisia & Asik!

There aren't very many Ukrainian-speakers here, so I'm going to reply in English.

I completely understand your sadness and frustration about having possibly lost time, and not having had good advice. This has been the case for so many of us who have found our way here, myself included.

But being here, and starting to follow a proven protocol gives Asik the best chance for going into remission. Part of it is diet, the other part is insulin and following the proven protocol for it, and the other is managing any other underlying health issues Asik has.

Please start reading the stickies, which are the "must-read" articles in this forum, for Feline Health, and the Lantus/Levemir/Biosimilars forums. It can feel like there's a lot to learn, but we will help you get acquainted with this helpful information, and give you as much help as you need with getting Asik regulated, which will give him his best chance for healing and going into remission.

It's important to know two things: every cat is different (ECID), which means that what works for one cat might be different for yours. Cats have their own agendas! 😸

The other is that this is a marathon, not a sprint. Healing takes a while, and you have to put on your "patience pants" as one of the valued members often reminded me. We want to see progress right away, but the kitty is in control. My beloved cat never went into remission, but had a very long and healthy life, of more than 17 years.

However, by being here, following the right protocol for your insulin, which would be Tight Regulation or Start Low Go Slow, you give your cat his best chances.

Wishing you a very happy and healthy new year in advance!
 
Lara & Luciole (Lu) said:
Hello Alisia & Asik!

There aren't very many Ukrainian-speakers here, so I'm going to reply in English.

I completely understand your sadness and frustration about having possibly lost time, and not having had good advice. This has been the case for so many of us who have found our way here, myself included.

But being here, and starting to follow a proven protocol gives Asik the best chance for going into remission. Part of it is diet, the other part is insulin and following the proven protocol for it, and the other is managing any other underlying health issues Asik has.

Please start reading the stickies, which are the "must-read" articles in this forum, for Feline Health, and the Lantus/Levemir/Biosimilars forums. It can feel like there's a lot to learn, but we will help you get acquainted with this helpful information, and give you as much help as you need with getting Asik regulated, which will give him his best chance for healing and going into remission.

It's important to know two things: every cat is different (ECID), which means that what works for one cat might be different for yours. Cats have their own agendas! 😸

The other is that this is a marathon, not a sprint. Healing takes a while, and you have to put on your "patience pants" as one of the valued members often reminded me. We want to see progress right away, but the kitty is in control. My beloved cat never went into remission, but had a very long and healthy life, of more than 17 years.

However, by being here, following the right protocol for your insulin, which would be Tight Regulation or Start Low Go Slow, you give your cat his best chances.

Wishing you a very happy and healthy new year in advance!
Click to expand...
I wish you a happy new year too. Your story about a 17 year old cat is really inspiring. How old was he when he was diagnosed with feline diabetes?

I have reread the article Tight Regulation or Start Low Go Slow several times, but I can’t understand the difference between them and I can’t clearly determine which option we have. With Levemir we started with a dosage of 1.5 and gradually reduced it by 0.25. But then there was a setback from wonderful results, but the doctor said to continue to keep the dose at 0.25. And then she just stopped responding to my messages. A personal visit is not possible, unfortunately.
 
Hello Alisia! My first diabetic cat was diagnosed when he was 13. He lived to be over 17 years old. His brother lived to be 21&1/2 years.
Here they are at age 15.

9287270626_0ddae34320_c.jpg


I have always used Tight Regulation because I work from home, so I can do testing whenever needed. With SLGS, my impression is that it's a good choice for people who are not home as much, although there are still people who do TR who aren't home a great deal of the time, and make it work.

I'm giving a very shallow, incomplete overview of the two methods, and there are people here who can give more intelligent and comprehensive explanations.


For Asik, first of all you're doing remarkably. You have a spreadsheet set up, and your signature. 💐 to you!
It looks like you just switched him to Lantus, is that correct?

You want to keep him on the current dosage, to give him a chance to adjust to it, and then get advice on how the dosage should change, based on how Asik's doing.

If you don't mind, I would suggest, starting tomorrow, post a new thread with a blue ? prefix in front, and call it something like, "New to Lantus, asking for dosing advice" Ask for advice about what to do in the next few days, and also help understand the protocols. There are very smart, caring, and experienced people here who can help.

Regarding your vet, quite frankly you're better off here. Many vets don't undertand diabetes deeply. Here, there are people who do, and have many years dealing with it in their own cats, and helping others. I had terrible advice from my vet before I came here, as did many here.

Wishing you two all the best & і перемога, і мир для України
 
OK, wonderful! I'm looking forward to good things for you, not only here, but for the new year.
And regarding Asik's weakness in the hind legs, that's a sign of diabetes among other things. Are you giving him Vitamin B12, either orally or injections?
Another thing to ask about in your future posts, but this is the typical treatment.
 
Welcome to FDMB!

Could you take a look at your spreadsheet and make a chance to the access permissions? In order for us to see the spreadsheet, you need to set the permissions to "anyone with the link."

I'll do my best to summarize the differences between SLGS and TR.
  • TR was developed using clinical research and was published in a leading veterinary journal. One of the authors is a vet from University of Queensland and did wonderful research on using Lantus (and Levemir) with diabetic cats. One of her research partners is a university professor in Germany who founded the Lantus forum there.
    • SLGS is not based on formal research. It was developed here and pre-dated TR. It is a generic method whereas TR was initially developed specifically for the longer acting insulins (Lantus and Levemir).
    • Both methods have gotten cats into remission although the process has been studied more rigorously with TR since there are researchers who developed the protocol.
  • With TR, after the initial week, you evaluate the dose every 3 days/6 cycles. With SLGS, the dose is evaluated weekly.
  • Dose reductions: With TR, for cats within the first year of diagnosis, the dose is reduced when the blood glucose numbers drop below 50. With SLGS, the dose is reduced if numbers drop below 90. (These are numbers based on a human meter for both methods.)
  • Generally speaking, TR is more aggressive. The dose increases/evaluations are more frequent with the idea being that the sooner that you are able to get your cat into closer to normal numbers, the better the chances for remission.
  • With TR, the cat must be eating a low carbohydrate canned food or raw diet. While low carb is recommended for SLGS, a low carb dry food is permissible.
I don't necessarily agree that it's "easier" to follow SLGS if you work outside of the home. When I first came to FDMB, the TR Protocol was just becoming popular. I worked full time outside of the house throughout my cat's life. With both methods, the minimum number of tests per day is four -- you always want to test at pre-shot times (AMPS and PMPS) to be sure that it's safe to give insulin. You also want to get at least one additional test during both the AM and PM cycles. I tended to test a lot because I liked having data.

The leg weakness is likely diabetic neuropathy. You need to supplement a specific form of vitamin B12. You want to get methylcobalamin (methyl B12). The other forms of B12 are not as effective.
 
Lara & Luciole (Lu) said:
OK, wonderful! I'm looking forward to good things for you, not only here, but for the new year.
And regarding Asik's weakness in the hind legs, that's a sign of diabetes among other things. Are you giving him Vitamin B12, either orally or injections?
Another thing to ask about in your future posts, but this is the typical treatment.
Click to expand...
I'm very ashamed of this, but no, I haven't given him B12. I first read about it yesterday in one of the discussions here. Is there an article somewhere about how to give it and the correct dosage?
 
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Sienne and Gabby (GA) said:
Welcome to FDMB!

Could you take a look at your spreadsheet and make a chance to the access permissions? In order for us to see the spreadsheet, you need to set the permissions to "anyone with the link."

I'll do my best to summarize the differences between SLGS and TR.
  • TR was developed using clinical research and was published in a leading veterinary journal. One of the authors is a vet from University of Queensland and did wonderful research on using Lantus (and Levemir) with diabetic cats. One of her research partners is a university professor in Germany who founded the Lantus forum there.
    • SLGS is not based on formal research. It was developed here and pre-dated TR. It is a generic method whereas TR was initially developed specifically for the longer acting insulins (Lantus and Levemir).
    • Both methods have gotten cats into remission although the process has been studied more rigorously with TR since there are researchers who developed the protocol.
  • With TR, after the initial week, you evaluate the dose every 3 days/6 cycles. With SLGS, the dose is evaluated weekly.
  • Dose reductions: With TR, for cats within the first year of diagnosis, the dose is reduced when the blood glucose numbers drop below 50. With SLGS, the dose is reduced if numbers drop below 90. (These are numbers based on a human meter for both methods.)
  • Generally speaking, TR is more aggressive. The dose increases/evaluations are more frequent with the idea being that the sooner that you are able to get your cat into closer to normal numbers, the better the chances for remission.
  • With TR, the cat must be eating a low carbohydrate canned food or raw diet. While low carb is recommended for SLGS, a low carb dry food is permissible.
I don't necessarily agree that it's "easier" to follow SLGS if you work outside of the home. When I first came to FDMB, the TR Protocol was just becoming popular. I worked full time outside of the house throughout my cat's life. With both methods, the minimum number of tests per day is four -- you always want to test at pre-shot times (AMPS and PMPS) to be sure that it's safe to give insulin. You also want to get at least one additional test during both the AM and PM cycles. I tended to test a lot because I liked having data.

The leg weakness is likely diabetic neuropathy. You need to supplement a specific form of vitamin B12. You want to get methylcobalamin (methyl B12). The other forms of B12 are not as effective.
Click to expand...
Yes, I just checked the accesses, now everything should be displayed correctly.

Regarding the method - I can quite control insulin often, and I did it, but our doctors say that there is no need to rush, although it is obvious that this is not the case. Last month I asked about increasing the dose and was refused. I already heard from the new doctor that Lantus is better and decided to switch to it and start adjusting the dosage.
 
Put this in your post tomorrow with the ? prefix, along with your other questions.
Hopefully some Europeans will reply with what B12 is available for you.

I'm in Canada and have injectable B12, and a tablet with iron & B12. It helps a lot, so will be good for your boy.
 
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