Remission question...

[Dr Schrodinger]

Hey y'all.

With the fortunate kitties who go into remission, does anybody know if this is due to increased pancreatic function (i.e. secreting insulin again) or decreased insulin resistance?


Any pointers or references will be gratefully received!

Thanks

Juliet

 

[MommaOfMuse]

At least with Maxwell it was his pancreas taking over again and producing his own insulin again. But even though he is in remission he is still a diabetic and will always need to eat a low carb high protein diet.

Mel, Maxwell, Autumn & The Fur Gang

 

[Elizabeth and Bertie]

Hi Juliet,

I read an article recently (will try to find the link) that said type 2 diabetes in cats is characterised by impaired insulin output coupled with insulin resistance, so it's a bit of a 'double whammy'... If that article was correct then would both those things need to resolve somewhat to bring about remission...?
confused_cat

And is insulin resistance the same as 'glucose toxicity' (or is it caused by glucose toxicity...?)....

I've been reading too (slightly off topic I know) about brewers yeast and the theory that it can help diabetic cats by improving insulin uptake. So that - if correct - would seem to refer to insulin resistance... The subject really interests me because - if it is true, then brewers yeast could perhaps - theoretically - help cats into remission, or help keep them there. (However, I also came across info that contradicts the view that brewers yeast can help at all!) I've contacted other feline diabetic groups to see if they have experience of using this, but found very little. It was suggested to me that I experiment on Bertie, so that's what I'm doing at the moment. Nothing conclusive either way yet though!

Intially it was assumed that chromium was the useful agent in brewers yeast I think, but now it seems that there is another element in the yeast too, and perhaps these work together?

Anyway, I digress. Sorry.....

 

[Elizabeth and Bertie]

Me again,

This isn't the article I was thinking of but is actually much more pertinent to your question, Juliet:
http://webcache.googleusercontent.c....com/wiki/Remission+&cd=9&hl=en&ct=clnk&gl=uk

 

[Dr Schrodinger]

Aha!

i just found the article I was looking for.

This here: http://www.uq.edu.au/ccah/index.html?page=43391&pid=0 was written by that nice Prof Rand in Queensland:

"The hallmarks of type 2 diabetes are, firstly, an absolute or relative deficiency of insulin, and secondly, insulin resistance or impaired insulin sensitivity."

"...Glucose toxicity contributes to loss of β-cell secretion. Initially this toxicity is functional and reversible, but later it leads to permanent loss of β-cells. Glucose toxicity is defined as impaired insulin secretion from chronic hyperglycaemia..."

"β-cell failure results from a number of factors, the major one being chronic β-cell hyperfunction. The chronic hyperfunction is the result if increased insulin secretion, secondary to insulin resistance. The chronic hyperfunction results in β-cell damage, which triggers apoptosis (cell death). Importantly, insulin resistance is on both sides of the pathogenesis equation. It simultaneously increases the requirement for higher concentrations of insulin, and at the same time contributes to β-cell failure and the inability to secret sufficient insulin....."

So, in order to reverse, this, the cat needs to become less resistant to insulin, and also regain the function of its β-cells. So yes, you're right Eliz, it is a double whammy... :shock:

Presumably, therefore, diabetic cats in remission still have a resistance to insulin & maybe reduced β-cell function, but limiting the amount of glucose that enters their blood stream, can ameliorate these two impairments. laptop_smiley

*pootles off to research yeast & chromium*

J
xx

 

[Blue]

Hey y'all.

With the fortunate kitties who go into remission, does anybody know if this is due to increased pancreatic function (i.e. secreting insulin again) or decreased insulin resistance?


Any pointers or references will be gratefully received!

Thanks

Juliet

A cat could go off insulin for many reasons. If just a normal DM cat whose pancreas needs a bit of help, your giving insulin give the pancreas time to 'heal' until it can function 100%. If your cat has pancreas issues that just may not heal, you're here for the long haul.
There have been many cats who are on insulin for a short time, and the odd one for a longer time, then they go OTJ. Many who return sometimes have more trouble going OTJ again, and the majority never do.
There are other cats whose issues are insulin resistance conditions, and they can be resolved in a variety of ways.....
IAA takes guts for you to really fight back against the antibodies but it can be beat.
Acromegaly has nothing to do with the pancreas but rather to do with a tumor which can be treated with SRT, and many of the treated cats go OTJ because the tumor's stopped output of GH. Other cats with acromegaly just stop needing insulin without treatment, the reason is not know other than to suspect the tumor changed and maybe no GH output stopped.
My Oliver was very sick Dec/2011 and he went off insulin in 10days. I still test him because he is acromegalic and if the tumor starts output of GH again, he will need insulin again.

I don't think anyone is tracking why cats go OTJ or which ones return to needing insulin. I don't know if there is a way to know for sure the reason why, but to me, I don't care if my cat is healthy according to a vet with bloodwork to confirm.

If your cat goes off insulin, I guess you can continue to test here and there to be sure the BG stays in non-diabetic range and definitely stick with the low carb diet - too many cats have needed insulin again because the owners thought it was OK to give dry food or 'just a bit of high carb' foods. I think some cats may need to get more help with insulin later in life as maybe their pancreas is just not up to performing all duties.

 

[Dr Schrodinger]

I think some cats may need to get more help with insulin later in life as maybe their pancreas is just not up to performing all duties.

Hmm. Yes, I think so. I was just speaking with a colleague who works on human diabetes & knows a lot more about it than I. Apparently in humans, you can track the drop of pancreatic function during the lifetime. It's not just our dietary habits, obesity & inactivity that predispose us to type 2 DM. As we are now living so long, the pancreas begins to wear out, which is another contributor to the incidence of DM in humans.

But, we know, our little birdie-crunching four-legged friends are very different. There is no remission in humans, it has only been observed in cats (in standard DM anyway). Maybe with our long-lived feline companions this age-related issue is also true?

 

[Elizabeth and Bertie]

...too many cats have needed insulin again because the owners thought it was OK to give dry food or 'just a bit of high carb' foods.

SOOO true. I've lost count of the times that people have posted about a cat coming out of remission; and it later transpired they'd been feeding some dry food... It shocks me actually, because I feel that maybe there's a message here that we simply haven't got across to people. There is, I suspect, still a feeling abroad that 'remission' means 'cure', instead of remission meaning 'finding a balance between food and insulin that the diabetic pancreas can cope with'. That is to say, the diabetic pancreas may be able to produce enough insulin to cope with a low carb wet diet. It cannot produce enough insulin to cope with more than that. A diet higher in carbs than the the diabetic pancreas can cope with will require exogenous/injected insulin.

 

[Lisa dvm]

This here: http://www.uq.edu.au/ccah/index.html?page=43391&pid=0 was written by that nice Prof Rand in Queensland:
"...Glucose toxicity contributes to loss of β-cell secretion. Initially this toxicity is functional and reversible, but later it leads to permanent loss of β-cells. Glucose toxicity is defined as impaired insulin secretion from chronic hyperglycaemia..."

This is not a good way to define "glucose toxicity" since GT affects every cell of the body - not just the pancreas. Think renal failure....microvascular damage....etc.

Yes, GT damages the pancreas but that is not the only part of the body it damages. Therefore, the way that Dr. Rand worded it (at least in the excerpt above) is misleading and not all-encompassing.

 

[Carl & Polly & Bob (GA)]

This link might help. It is chock full of info about glucose toxicity
http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=62960

Carl

 

[Dr Schrodinger]

Yes, GT damages the pancreas but that is not the only part of the body it damages. Therefore, the way that Dr. Rand worded it (at least in the excerpt above) is misleading and not all-encompassing.

I agree, but that quote is lifted completely out of context from a paragraph concerning itself with the activity of β-cella, and not systemic pathology.