What Are Your Observations Regarding Remission

[Lana & Yoyo]

Most of what I read says that the longer a cat is on insulin, the less likely it is that the cat will go into remission. I have looked at many spreadsheets of people here on FDMB and I see many, many examples of cats on insulin well over a year who go into remission, especially in this Levemir group. What are your thoughts?

Also, many of you have cats like mine who had diabetes previously and went into remission but are now out of remission and back on insulin. I am assuming that we have all continued our cats on low-carb diets, so why did this happen? There must be other factors besides food that drive this. Do cats that are diabetic a second time have a chance of going into remission a second time?

Probably a good question for the Health Forum... but I would like to ask the opinions of this forum because I am so familiar with many of your experiences and spreadsheets.

Lana

 

[Vicky & Gandalf (GA) & Murrlin]

Sheila's Beau is a Levemir success story because he was on Vetsulin for 2 years and went into remission after only 3 months on Levemir. Partly that was due to Sheila's diligence in seeing that he needed such small doses.

I think it's pretty well accepted that even if a cat goes in to remission, they should still be considered diabetic, just diet controlled. The pancreas has been damaged and it may continue working fine or the remaining beta cells get tired and they need insulin again. Tired is a layperson's term :smile:

Yes, remission could come and go. Or be temporary. The original Levemir cat, Jock, had a 1 month remission then got very ill with liver issues I think it was and became diabetic again.

The best way to look at remission is not as the goal, but a possibility. Good control of the diabetes can result in remission, but not always. I think many owners beat themselves up because they blind themselves to only that goal. Focus on achieving good control and the possibility of going in to remission is much greater, even probable.

 

[Sheila & Beau GA & Jeddie GA]

There are probably "best practices" to achieve remission, if it is possible to achieve, but I think a lot depends on the individual cat and caregiver (and diet, environment, etc.).

Beau was not supposed to go into remission. He was a 2+ year diabetic on a fast-acting insulin. He had a history of pancreatitis and steroid use. He had other health issues (cardiomyopathy and hyper-T). So how did he end up in remission? I do not have an answer for that. My vet calls him the Miracle Kitty for surviving cardiomyopathy long term (over 9 years) AND going into diabetic remission.

Yes, I was very diligent (thank you , Vicky!), yes I recognized rebound and decreased his dose when everyone else said "increase". He did not follow the "rules" of the protocol either. I had a high do not shoot number (130) on an ultra-micro dose of .05u - otherwise he dropped into the 30s. Heck, I can shoot Jeddie when he is in the 90s on a full dose of .7u and he doesn't drop like that.

And speaking of Jeddie, he was OTJ after I adopted him and shot ONE dose of insulin (vetsulin that he came to me on). And he stayed OTJ only a few months and has been back on insulin over a year now. Initially, I changed his diet, but, yes, it has stayed changed so why loose BG control?

The similarities with both of them are that I did not shoot low numbers (at first with Jeddie) and I gave them a few trial runs. With Beau that was because I was out of town for a week and he was unpredictable so I raised the do not shot number to 180 for the sitter - he went the whole week without insulin, but could not quite stay down on his own. With Jeddie, I was not able to test him at every shot time (without getting bitten) and he was on a fast acting insulin. Plus, the few tests I got in he was under 200, so I was cautious.

The differences: while they both lost a lot of weight, Beau has never gained it back and remains underweight. Jeddie did gain most of it back. Beau has hyper-T which has to effect BG control somehow. Jeddie has a bit of anxiety and is on prozac (and doing very well, BTW).

I just don't think that remission is predictable. It happens or it doesn't. It lasts or it doesn't. Yes, the goal should be regulation in the best control you can manage and the best diet you can manage. Remission is a gift of unknown duration.

 

[Ilkka and Tom]

Most of what I read says that the longer a cat is on insulin, the less likely it is that the cat will go into remission. I have looked at many spreadsheets of people here on FDMB and I see many, many examples of cats on insulin well over a year who go into remission, especially in this Levemir group. What are your thoughts?

Also, many of you have cats like mine who had diabetes previously and went into remission but are now out of remission and back on insulin. I am assuming that we have all continued our cats on low-carb diets, so why did this happen? There must be other factors besides food that drive this. Do cats that are diabetic a second time have a chance of going into remission a second time?

Probably a good question for the Health Forum... but I would like to ask the opinions of this forum because I am so familiar with many of your experiences and spreadsheets.

Lana

The longer a cat is on insulin, the lower the chances of remission, is not exactly correct... I mean, we have to ask, measured from when? on Day 1 of insulin therapy, zero of a thousand cats have gone into remission, so their chances of remission actually increase each day until.. some point -- after which the chances decrease gradually. What is the window for maximum success?

There is some data on this, and not all of it agrees... What percentage of diabetic cats go into remission to begin with? How quickly do cats go into remission and after how many years can they still go into remission? As you said, many go into remission a year or longer after insulin starts. I just read an article that says 70% go into remission overall, but that seems very high to me. Maybe someone else here has some better data. I read it used to be that most cats that were going into remission, did so within two years of starting insulin. Now with improved insulin and general understanding of the disease, this fat part of the bell curve is occurring earlier. Just mathematically, the fact of not having gone into remission after the window where most cats do, means that the percentage chance is decreasing each day. Luckily, our cats are more than mathematics. And yes, some cats do go into remission a second time. Let's hope.

Tom took less than three months to remission, which I consider a bit of a miracle. His relapse after 17 months could be due to several factors -- one, his diet was not as controlled as I would have liked; two, stress -- he is a "cat of the house" who has had to adjust to the presence of too many other animals, rescues, and it has been tough on him. We're taking care of a neighborhood colony of cats, originally fifteen, now down to six through adoptions and attrition, all of whom we have gotten spayed, neutered, shots, vet care, most even microchipped (and these are "feral" cats), and while I try to minimize Tom's contact with these guys, I can't control it entirely. Which brings up the point that while food is a major control factor for treatment of diabetes, esp after dx, it does not mean that food is the cause or main cause of diabetes -- in talking about pancreatic dysfunction, there has to be a genetic predisposition component, and emotional precursors, since a cat's emotions are directly imprinted in blood chemistry. Biggest example, adrenalin, which is an glucose "agonist" (hence a stress on insulin); and stress is huge in upsetting and testing insulin production; and finally there is the whole question of endocrine system disorders, and their various and mysterious origins.