Transient Diabetes?

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Michele1980

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Has anyone had this experience??
My cat was diagnosed with diabetes about a month ago. He was getting 2 units once a day for about a week...I took him back to the vet where his BG level was 433 or something to that affect. He was upped to 2 units of insulin twice a day. I brought him back today to the vet (about 2 weeks later) and his BH was 49!!!!!! I was told to stop giving him insulin. I have to bring him back in 2 more weeks for another reading. Has anyone experienced this??? I am ery optimistic that his diabetes was transient and is hopefully gone forever! Thoughts??
 
It may not be so much that he is in remission as it is that his dose was too high. But there is no way of knowing without testing him at home, there are certainly cases where a cat was a steroid induced diabetic and once the steroids were removed went into remission. But once a diabetic always a diabetic, there really isn't a cure for it, and it can return at anytime.

My Maxwell is a diet controlled diabetic and has been off insulin now for going on almost 2 years, but he is still a diabetic, he will never go back to eating high carb food, and I will always have to be careful if he should ever need steroids, or even if he gets an infection from a bad tooth, they can all throw him right back into being an insulin dependent diabetic again.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
I hear you about the dosage...but he was on a low dose and that didn't work so it had to be upped. From my research online it does appear that diabetes CAN go away and stay away
 
Feeding the right food is part of the equation in remission --- no more dry food -- go for low carbohydrate canned foods (avoid gravy made with wheat/rice etc)

read more at www.catinfo.org for excellent Feline Nutrition information written by a veterinarian, Dr. Lisa Pierson
 
Also - if the high blood sugar were caused by a steroid shot or by an infection / bad dental health --- heal the infection and the high blood sugar goes away.
 
Actually, he has been eating Hills Prescription W/D canned food (which many people have advised against) and these are the results I'm getting. Not sure what to make of it all. And he wasn't on steroids...but he did have pancreatitis
 
No...he has been eating canned food for years. First Friskies and then I switched him to Innova senior canned food (he is 17 years old!)
 
Neither 2 units once a day (which is an incorrect way to dose insulin in a cat) nor 2 units twice a day is a low dose...yes 2 units in a day would have been a low dose if it had been given as 1u in the morning and 1u 12 hours later. By going to 2u twice a day the dose was too high which is where the 49 probably came from. Dosing shouldn't be raised by full units at a time. Normally we raise and lower doses by no more than .25u to .5 units at a time. Again no way of knowing without testing him at home, but I'm almost willing to bet that when you take him back again in two weeks, (if you don't test at home between now and then) you will find yourself right back on insulin again because his numbers will again be high. Hopefully not, but I can't think of a single cat that I have seen in the last 2 years that I have been a member of this board that has gone into remission and held it going from 2u twice a day to zero..Hopefully Mister is an exception to the rule.

In the research that you did on transist diabetic cats, did those cats that remained in remission stay on the diet that got them into remission? Or did they go back to eating high carb dry food? If they remained on the diet that got them into remission then they are diet controlled diabetics, not non-diabetics.

My Maxwell will celebrate 2 years of being off insulin on Nov 1st 2012, but he is still a diabetic, he is just diet controlled. If I go back to feeding him dry cat food or canned that is over 10% carbs he will be right back on insulin, because he is still a diabetic, just not an insulin dependent diabetic at this time because of his diet.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
From what I gather, diabetes most certainly can go away. It is called transient diabetes...an underlying infection causes the diabetic symptoms and once that is cleared up the diabetes can go away forever.
 
Well, if you read it closely, it doesn't really go away:

In this population of cats, if you lower the blood sugar by giving insulin and correct or control concurrent disorders, beta cell function may be restored, and they begin to release insulin again, and the cat returns to their subclinical state, i.e. they’re go back to being “on the brink” again. Most likely, Mooch’s pancreas was experiencing glucose-induced desensitization at the time his diabetes was diagnosed, and initiating insulin therapy and controlling his weight caused the desensitization to resolve allowing the pancreas to start releasing insulin again. Unfortunately for Mooch, his own insulin, combined with the insulin he was receiving by injection, was a bit too much, and he became hypoglycemic.

Mooch is currently off all insulin, and his pancreas seems to be able to secrete enough insulin to keep things under control.

End of story?

In a study, published in 1999, of ten cats with transient diabetes, seven cats did not experience a recurrence of their diabetes. Three of the cats, however, had a recurrence of their diabetes, one six months later, one 14 months later, and one 3.4 years later. In the study, it was not possible to predict which of the transient diabetics were at higher risk of a relapse. Certainly, cats whose diabetes seems to have resolved should be considered to be susceptible to a recurrence of their clinical diabetes, and it would be important to avoid the circumstances that could promote a return to the diabetic state. That would include avoiding any medications known to antagonize the effectiveness of insulin, such as glucocorticoids and progestins, maintaining ideal body weight, and minimizing concurrent illnesses.
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So, they'd be "pre-diabetic" or forever predisposed to the symptoms returning.
I think we would all add to that last list of possible causes for the diabetes to return with "feeding a non-diabetic appropriate diet" like high carbage food? Cats have no nutritional/dietary requirement for carbohydrates, so by re-introducing them to a carb-laden diet, you'd be playing Russion Roulette and just asking for a return of the disease. That is why we refer to all diabetic cats no longer on insulin as "diet controlled diabetics". There is no "cure" for diabetes.

Carl
 
I second what Bob says. Even if your cat is able to go off injections, you will have to be vigilant for any changes in behavior, etc. My Missy went OTJ within a month of diagnosis. She was in remission for 4 months. I did periodic testing and BG was always good. Then I noticed her asking for more food. I checked her and BG was high. That was in August and we are still fighting to figure out why.....nothing external changed. Same food, same routine. She is now seeing an internal medicine specialist because she has been impossible to regulate this time around. Just be vigilant for any changes in behavior and do periodic home testing, because relapses DO happen, unfortunately.
 
IMO, you need to be testing at home daily. Who knows if the 49 was a fluke? Or the result of getting too much insulin? When you take numbers on a daily basis then you'll know for sure if your cat has gone into remission.
 
Awesome! I'd just keep ckecking his bg at random times and keep smiling!

Carl
 
Please reconsider home testing his blood sugar. He may seem ok now, but you have no idea if he's really in remission if you're not testing. He won't be symptomatic unless he has extended high blood sugar for a long period of time, which means you don't know that he's diabetic from symptoms alone until things are so bad they are dangerous for him. Also, it could ruin what chances you have of getting him into remission permanently. Testing seems hard at first, but after about a week it becomes super easy. The quicker you can head off high blood sugar with proper dose adjustments, the more likely are your chances of remission. The only way to detect this is through home testing.

Also, once you cat is in remission you need to test once or twice a month to make sure everything is still ok. A diabetic cat off insulin is still a diabetic cat--meaning he can go back to diabetic numbers if he eats high carb food, or has dental issues, or gets an infection. If that's the case, you need to get him insulin as soon as possible so that you stand a better chance of getting him back off it again. If you wait for symptoms, things are going to be much worse.

It is very doubtful that your cat is actually in remission while you're still feeding high carb food and with the drastic, sudden reduction in insulin. If he is in remission on the W/D, that's awesome--home test every couple days for a couple weeks to confirm it. If he's not, it's dangerous to let his blood sugar get out of control again, and will make it hard for you to get him into actual remission.

Again, you cannot tell what his blood sugar is by symptoms unless the high blood sugar is severe--Bandit needed insulin for a year and he did not show any diabetic symptoms because we caught the diabetes and treated it before it was really bad off. There was no noticeable excess urination, drinking, or weight loss before diagnosis or after. Vet testing creates artificially high, inaccurate results. The only way to know what is going on is to home test. If you can tell us what issues are preventing you from doing it, we have a ton of help and advice here to get you started.
 
Like I keep saying, I am following my vet's instructions. He is going in again next week for another Bg reading to determine if he really is in remission. At that point I will be discussing my options with my vet.
I have no problem doing the home testing...I just haven't had a need to do it yet. When/if I do, I will need a lot of advice as I have no clue where to even begin.
My cat had pancreatitis. He only had high BG levels for less than 2 weeks. I have read several articles that indicate pancreatitis can cause the high BG levels...once the pancreatitis is cleared up, the high BG issue is too
 
It is possible--but the only way to know for sure that the diabetes has gone into remission is to test at home. Like I said, numbers at the vet's office are inaccurate because stress raises blood glucose levels. However, those types of instant remissions that occur when a condition has cleared are also dependent on the change to a low carb diet. Regardless of whether the diabetes is transient, a diabetic cat still needs a low carb diet to maintain remission. Right now, there is no evidence that your cat has actually reached remission--only that he dropped too low on 2u of insulin, which is a high dose and not surprising. Most cats on a low carb diet never need much more than 1u of insulin, and even that can be too high a dose.

If you start home testing, you will be able to tell if he's in remission or not easily. All you need is any human home glucose meter. The Relion Confirm or Micro from Walmart are very popular among diabetic pet owners because they are a good meter and have inexpensive test strips. Here are tips and links to get you started: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287. I would also pick up a box of 26-28g lancets--these make testing in the beginning a lot easier than trying to use the 31-33g lancets that come with the meter. If you have any questions or problems post back here and there will always be someone to help you out!

I understand that you are doing what your vet is telling you, but what diabetic cat owners all find out eventually is that their vets are usually not current with the recommended treatment guidelines. This is because a lot of research about feline diabetes has only been released in the past 3 years or so, and most vets aren't aware of the new treatment recommendations. Vets have to know the basics about many different diseases for many different animals, so when it comes to feline diabetes, it's incredibly rare that a vet makes all the proper recommendations.

Please print this document out and give it to your vet: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. It's the current diabetes treatment guidelines from the American Animal Hospital Association. Note page 218 (4) where Home testing is "ideal" and "strongly encouraged". Also note where it states to feed a canned diet with the lowest number of carbs the cat will eat (217-218).

I had a fantastic vet who had Bandit on a low carb, commercial diet from the start, told me I had to home test in order to give insulin safely and accurately, and started him on Lantus (glargine), a highly recommended insulin for cats. However, her dosing advice was all wrong, and I discovered this once I did my own research on the subject. So I no longer trusted dosing advice from her, and made those decisions myself with the help of the extremely knowledgeable people on these boards. Eventually, I learned the dosing protocol myself and made my own decisions with dosing. It's very important that you self-educate for any disease that your cats may have--because vets usually see more dogs than cats, things like diabetes that are treated differently in the two animals often get mistreated.
 
Thank you for all of the advice. I understand that home testing is a good idea. My vet (who is also a friend of mine from high school) graduated from vet school within the last 2 years so I would think he would be up-to-date on this information. I also trust his opinion/advice very much. In any case...I guess my point just was that it IS possible for the diabetes (or high BG levels as the case may be) to normalize and not return to the high levels. It seems like everyone jumps right to the fact that this will never or could never happen, but that is just not true. After I get the BG results next week (and possibly a fructosamine test), I will consider my next options.

I am sure that you are all probably just being realistic while I am trying to be more optimistic.

My cat has been on low carb canned food for years. He is on the Hill's Rx food now, which I will definitely be discussing with my vet. He is not overweight and never has been. I don't think diet played a role in any of this.

Also, you said that the cat can be stressed at the vet, causing high BG levels. However, the opposite is what happened, he had a super low BG level.
 
The problem is, the curriculum of most vet schools have still not been updated. I live in the same town as Cornell, which has the top vet school in the country, and they did not begin to update their curriculum in regards to feline diabetes until last year. Their web site is still out of date, including with diet recommendations. The Cornell animal hospital only started changing their treatment (Lantus, home testing, low carb canned diet) for feline diabetics two years ago, and hospital changes there always precede curriculum changes.

That he had a super low BG level despite being at the vet (and stressed), means that he likely dropped way too low because of the higher insulin dose. I understand you want to be optimistic, but keeping your cat in extended hyperglycemia can impede getting him into actual remission, if he's not there yet (and I am skeptical he's in remission because of the diet and dosing and lack of testing). We see hundreds of cats here with all sorts of diabetes, including transient, but the diet is always key in keeping them in remission. I've also seen many transient diabetics end up right back here because once they got off insulin, their owners started being lax with the diet.

I'm not trying criticize you or your vet--I just want to help you actually get your cat into remission. Bandit's been off insulin for nearly two years now, and remission is the healthiest and safest condition a diabetic can be in. However, there is a window on remission. The sooner you get BG and carbs under control (with frequent data collected at home), the better your chances. The longer a cat stays in a hyperglycemic state, the more difficult it is to get them off insulin.

I've attached one more paper for you to share with your vet, regarding dose adjustments via home testing with Lantus. I understand this is a different insulin then he's prescribing, but it has been more closely studied than Prozinc and illustrates how remission is achieved with diabetic cats using home monitoring.
 

Attachments

A fructosamine gives an average blood glucose level for the previous few weeks. It's not very useful except for diagnosis. If you're home testing, there is no need to pay for fructosamines, or any vet testing. And it's cheaper and more accurate.

Daily numbers are far more revealing, as blood glucose levels can fluctuate day to day, or even hour to hour. A human diabetic would never dose or adjust insulin without daily numbers, and it's no different for cats.
 
Apart from the bloodwork and urinalysis from Bandit's initial vet visit where he was diagnosed, I've never had any blood testing or fructosamines done at the vet. My new vet said she would like to do a frustosamine when Bandit started seeing her, but when I asked her how that would be any different from averaging his last few weeks of daily home numbers, she said that it wouldn't, but she hadn't considered that since most her current diabetic patients weren't testing daily.

Averages are not nearly as important as treating diabetes as patterns.
 
Michele1980 said:
I am still in the diagnostic phase which is why my vet and I discussed doing that test.
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Was your cat ever confirmed diabetic with a fructosamine or urinalysis (testing for glucose in the urine) before you started insulin? Or was insulin prescribed only off of blood tests?
 
Is there any reason why you are resistant to home testing? As you stated you are in the diagnostic stage and home testing is a great way to collect data?

Think about it this way. If we were talking about a human (say yourself, spouse, or child) would you be resistant to home testing, knowing that that information is crucial in managing diabetes, transient or otherwise?

It's honestly no different, just because the patient is a cat and not a human.

Many of us on this board have had to disagree with our vets on this and take matters into our own hands and the ones that have home tested and realized it's not as difficult as it seems and the cat isn't freaked out over it, have empowered ourselves with knowledge and the ability to better treat our loved ones.

What do you say, are you willing to home test? If for no other reason than to prove us all wrong......
 
You know, I think this is just a case of the wrong words being used.

If your cat had BG that was hyperglycemic for 2 weeks, then maybe that's all it was - high blood glucose readings. It doesn't mean it was "diabetes". If that is the case, then your cats higher bg numbers could very well have gone back down to normal levels. Especially if the diabetes diagnosis was NOT verified by using a fruct test or urinalysis.
But no matter what your vet says, or what you choose to believe, if a cat is correctly diagnosed with "feline diabetes" then he's that way for the rest of his life, period. Diabetes doesn't just "go away". If you read the information I quoted above, it says that very plainly. If he had diabetes, then he will remain that way. Saying over and over again that "it's just not true" doesn't make it "not true".

Certainly, cats whose diabetes seems to have resolved should be considered to be susceptible to a recurrence of their clinical diabetes, and it would be important to avoid the circumstances that could promote a return to the diabetic state. That would include avoiding any medications known to antagonize the effectiveness of insulin, such as glucocorticoids and progestins, maintaining ideal body weight, and minimizing concurrent illnesses.
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And Julia is 100% correct. If you wait until you see physical signs of diabetes, when you could have discovered the disease was present much sooner by doing a simple blood test, then that's just pointless and not good for your cat, and it does damage to his body. The earlier you catch diabetes, the better the chances that a cat will go into remission. Unless and until your kitty has BG levels in "normal range" for 2 weeks, he isn't "in remission". We didn't make that up. It's according to published studies.
I understand that your vet is your friend from high school, and that you trust his opinion very much. If you can't trust your vet's opinion and advice, then there's no point in doing business with them because it's just flushing your money down the toilet. We have provided multiple links to actual studies and data. If your vet has published data and studies that says the opposite of what we are saying, then please share them with us. Maybe we can all learn something together.

My cat has been on low carb canned food for years. He is on the Hill's Rx food now, which I will definitely be discussing with my vet. He is not overweight and never has been. I don't think diet played a role in any of this.
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You might be right, and it wasn't diet that played any role. But Hill's Rx food is junk, and the fact that most vets don't know that or won't admit that is criminal. And Hill's doesn't make a "low carb" food.

Also, a cat doesn't have to have been, or be, overweight to get diabetes. Every cat I have ever been blessed with, prior to Bob getting diabetes, ate the same food. Mostly dry, and rarely low carb canned. I've had fat cats, skinny cats, a couple of obese ones. They've died from just about everything from getting hit be a car, to cancer, to just plain old age. Yet Bob is the only one whoever got diabetes. It just happens, there aren't any guarantees that it will or it won't. But now that I know what is the best diet for any cat, I will never subject any cat I own in the future to high carbs or dry food, because it's the wrong thing to do.

The pancreatitis could be what's behind the high readings, and now that the pancreatitis has been treated, the numbers are back to normal. But if the pancreas has been damaged, or future flare ups of pancreatitis happen, then his ability to produce insulin may be adversely affected, in which case the high numbers will return, and might stick around next time.

What people are trying to do is convince you to be proactive. We all know how much is sucks to have to deal with treating a diabetic cat. I only had to do it for 10 weeks but I sure don't want to have to do it again. Some of us have been dealing with FD for years so we understand how much goes into it, and most importantly we understand how horrible it is for the cat to be an uncontrolled or undiagnosed diabetic. We're trying to help you avoid that, for you, and for kitty.

Carl
 
Without testing your cat's blood sugar at home, you have no idea at all if it's a good number or not. Sure, your cat could be acting just fine but that means next to nothing. Cats are taken to the vet for all sorts of issues or even for their annual checkup, and blood work comes back saying diabetic. The cats were acting fine, but blood work shows different.

Fructosamine test is OK to give you the average over the past two weeks. It is merely an average and could well come back higher than expected.

Testing at the vet office is useless if you are looking for a true reading. Stress can cause animals to test high and some test low. My two cats were one of each. Shadoe ALWAYS tested higher at the vet office, but within 30min of being home again, her numbers came down. My Oliver was the opposite. I had to take HC food with me because he would drop low at the vet office and then come up to his normal numbers once we were home.

Sure, transient diabetes exists, but I would not base it on a couple numbers at a vet office. Only by testing at home will you know for sure.
 
I really do appreciate all of your advice. Thank you all. My cat was diagnosed all based on blood and urine tests. Is that incorrect in any way?
 
As for the home testing, I am just hesitant I think because I don't want to hurt him and put him through that on top of the insulin shots :( But I do understand that if it's necessary I will just have to suck it up and do it. I love him sooooo much and I don't want to do anything that will put him at risk. I will be discussig all of this next week at the vet after BG test
 
The ear pokes for home testing doesn't bother them at all...and it certainly doesn't hurt them...if it did not one of my 3 diabetics would have a single thing to do with me, since we had no past history together when I first started testing them. You see I adopted all three of mine as diabetics from DCIN (Diabetic Cats in Need)...Maxwell sleeps on my pillow everynight, Musette also sleeps with me and Autumn whom I have had less then 2 weeks, has been laying on my lap and purring most of the day today.


Mel, Maxwell, Musette, Autumn and the Fur Gang.
 
Yes, we understand the fear of hurting our cats. The fact is, it's a little pin prick in the edge of the ear. And I won't lie, there were occasions when Maui felt it more than others and maybe I hit a more sensitive area. However, she never once ran away, got angry or resented anything I did. In fact, she always got a special treat after testing (which was a good brushing) and if I would try to walk away without brushing her, she would not budge and wait for me to smarten up and brush her.

The fact is, if you are giving insulin, the only safe way to do it, is to test! Otherwise, how do you know if it is safe or not? And since you are still diagnosing the situation, the only way to truly know if you have a diabetic is to test at home.

If you need help to test, tell us where you are located, there may be a member close by who can come over and show you. Of course, we have all kinds of tips/tricks and videos to help as well.
 
A blood test and a urinalysis is enough for a diagnosis. So you are out of the diagnostic phase at this point.

Testing does not hurt the cat because cats have very few nerve endings in the tips of their ears. What upsets them is that you are doing something new and startling to them and most of the time people are nervous and the cat senses it. Bandit fought me testing the first week...I had to use a blanket to restrain him. Once he realized he was getting a (low carb) treat after every test he was fine with it.In fact, when he hears the meter Heep on he comes running, jumps in his testing basket and starts purring. If you had told me the first week that would be his response I would have said you were nuts. :smile:
 
2 weeks with no insulin and still no symptoms. Going to vet tomorrow for BG test and will post results. I am pretty confident that he had a case of transient diabetes
 
I just wanted to add my cat Gem's story, with the understanding that every cat is different, but just another POV.

Last summer, she started peeing outside the litter box. No other symptoms. Vet Dx'd her with diabetes after doing blood work and urinalysis. After about 2 -3 weeks on insulin, and a change from dry to wet food, Gem stopped eating, so we stopped the insulin. Took her to the vet, who did a curve and confirmed her BG numbers were now "normal". Rechecked a few weeks later, still normal. Vet declared her transient. I kept her on the wet food, but was seriously confused as to how she could be transient so quickly. This was before I found this site, with all it's great info.

Fast forward 6 months, still peeing outside the box, and re-diagnosed with diabetes, along with a bunch of other problems. I can't help but look back and wonder. Knowing what I know now, I figure she initially became diet-controlled, but that didn't stick. There weren't really any other clinical signs, besides the peeing. I feel by the time I had her re-diagnosed, more damage had been done. I wish I would have been more on top of it.

Anyway, what's done is done. Hopefully, your kitty will be free & clear. Just a vote for keeping an eye on her BG.

Good luck!
 
Just got back from vet. His blood sugar was 91. The vet said she has not seen a cat reverse diabetes in over 10 years but it does happen. I am still hopeful it is gone forever :)
 
Michele1980 said:
The vet said she has not seen a cat reverse diabetes in over 10 years but it does happen.
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Honestly, this is red flag to me with your vet. The large majority of cats go into remission with a low carb diet and the right insulin therapy, so if your vet hasn't seen a cat go into remission in over ten years, she is not well versed in the correct treatment guidelines for feline diabetes. Bandit's vet sees about two thirds of her diabetic cats go into remission. Studies show that with the right insulin therapy and diet, 86% of newly diagnosed cats go into remission. About 25% of newly diagnosed cats go into remission from the diet change alone.

Keep in mind that a diabetic cat without insulin is still diabetic, so you have to pay attention to diet and other factors that can cause a relapse. Make sure he's eating a low carb, canned diet with no dry food or treats (low carb freeze dried meat treats are good to use instead). Also, please learn to home test and test his BG levels once or twice a month. Illness or infection can cause a relapse, and the sooner you catch it, the easier it is to get him back into remission. If you wait until you see symptoms, the cat's body is already being damaged from extended hyperglycemia. Being vigilant will help prevent harm. Bandit is in remission, and I test him about twice a month. He actually had to go back on insulin last year for about a month because of a health issue, and if I hadn't have caught his high blood sugar with my testing then I might not have been able to get him back into remission so quickly, or even at all.
 
Michele1980 said:
Just got back from vet. His blood sugar was 91. The vet said she has not seen a cat reverse diabetes in over 10 years but it does happen. I am still hopeful it is gone forever :)
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This is really great news, and hopefully it sticks.

Again, I want to caution you based on my experience with Gem. We had a similar situation, and the vet was unable to explain how she was transient so quickly. Unfortunately, she was wrong in not advising me to monitor her BG and we are now dealing with multiple health issues. Of course I don't know if things would have been any different, she might still have gotten sick. But the earlier you can catch things, the easier to treat and the better your chance for remission.

So celebrate the good numbers, but try and home test your kitty when you can, just to keep an eye on things.

Best of luck to you.
 
They do think they know why it happened so quickly. He had a case of pancreatitis and once that was resolved, his levels went back to normal. I have read about that happening. As for the vet, I think she was referring to the fact that his diabetes has been reversed. He only had high BG levels for about 2 weeks. This was caused by the pancreatitis. I understand what you are all saying. He has eaten low carb canned food for years. It IS possible for diabetes to reverse itself. I am not even sure that he could have been considered as diabetic in the first place.
 
I am not even sure that he could have been considered as diabetic in the first place
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I think this is the point many people have been trying to make. Just having elevated BG does not automatically mean diabetes. If it was elevated due to other circumstances, then sure, once those resolve, you'd expect the BGs to go back to normal. Not the same as diabetes "reversing itself". Maybe it's semantics, but I think it's an important distinction.
 
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