Lifestyle
 

Remission

From Diabetes in Pets

It is in many cases possible to induce remission (a temporary or permanent freedom from insulin-dependence) in diabetic cats. (This appears to be unique to cats, unfortunately for dogs and humans. Dogs may experience remissions if their diabetes has a transient or secondary cause.) There is growing agreement among experts[1][2] that a combination of low-carb healthy diet, well-chosen insulin, and well-chosen dosage plans can in many cases bring glucose levels and insulin requirements down to what the damaged pancreas can handle, and allow the cat's blood sugar to be controlled entirely by diet thereafter. (A low-carb diet is usually required for the remainder of the cat's life.)

Remission has been claimed (by Dr. Rand and Dr. Hodgkins) to be a realistic goal for all cats who can be properly regulated quickly. Chances of success are highest in the first few months after initial diagnosis. This limited time window is probably caused by amyloidosis and glucose toxicity, and is a good reason to start with low-carb diet and very slow-acting insulins, the most successful known combination, right away. Dr. Elizabeth Hodgkins[3] and Dr. Jacquie Rand[4] both recommend regimes of Tight regulation to achieve remission.

In cats whose diabetes has been recently caused by steroids or some other transient cause, remission seems particularly likely if regulation can be achieved early.

An explanation can be pieced together from recent studies[5] in which diabetes in cats is perpetuated, if not always caused, by a combination of glucose toxicity and amyloidosis , such that the insulin-producing islets of the pancreas become clogged with amyloid deposits. In cats with type-2 diabetes, hyperglycemia left untreated will damage the pancreas over time until it can no longer produce insulin, making remission impossible.

Note that Glipizide and similar oral diabetic medicines have been shown to increase amyloid production, and amyloidosis when blood sugar is high, damaging the pancreas and therefore making remission less likely.[6]

Contents

[edit] Insulin therapy for cats with "sputtering" pancreases

When a diabetic cat's pancreas begins again to produce insulin, that insulin production is seldom predictable or sufficient to immediately put the cat's blood glucose levels in a non-diabetic range. That is, a cat's recovering pancreas usually does not have a "full on" or "full off" switch. Achieving remission may take several weeks or months of careful monitoring and administration of insulin that is reduced in both timing and amount.

If a cat's pancreas is "sputtering," making the decision to administer exogenous insulin at all can be complicated. Some have referred to it as a game of "chicken." It is not unusual for a diabetic cat nearing remission to have a blood glucose level in the high 100s and for that level to fall, without exogenous insulin, to the low 100s or lower within a couple ofhours. Adding exogenous insulin to the mix when that is happening could lead to hypoglycemic levels. In fact, unexpected falls of blood glucose levels to or near hypoglycemic levels on insulin dosages formerly known to be "safe" are a strong indicator of either more efficient use of insulin (healing glucose toxicity), or a sputtering, recovering pancreas.

In the first stage, insulin dosage may be gradually reduced to keep glucose levels in a safe range. This works until the cat begins producing enough endogenous insulin to be able to skip shots, even at the lowest possible doses. Then the next stage of attempted remission begins.

With a cat attempting remission, some caretakers choose a blood glucose level (be it 120 or 150 or 180) at or above which to administer exogenous insulin. The decision of whether to administer insulin in those situations should be affected by knowledge of when the cat last ate and whether the elevated level could be the result of food. Another consideration is the type of insulin being used, that is, whether it is a long-acting or fast-acting insulin. In these situations, even thorough knowledge of the cat's past reaction to various dosages of insulin may not provide sufficient information to make an appropriate dosing decision. You should carefully monitor a cat in this situation after an insulin injection to make sure it does not become hypoglycemic.

[edit] Research on cures

New research on possible cures for diabetes is starting to get promising, though the studies are currently in mice. Promising research includes:

  • Induced diabetic remission in mice by injecting donated spleen cells into the pancreas[7]
  • Induced diabetic remission in mice by deadening pain nerves in the pancreas[8]

[edit] Case studies

See Category:Remission cases for stories of cats brought into remission.

[edit] Further Reading

[edit] References

  1. ↑ Medical News Today-Study Shows 'Catkins" Diet Helps Cats Beat Diabetes
  2. ↑ Protocol for Success in Managing/Curing Feline Diabetes--Dr. Elisabeth Hodgkins
  3. ↑ Dr. Hodgkins' protocol for inducing remission in diabetic cats
  4. ↑ Dr. Rand on how to induce remission in diabetic cats
  5. ↑ JBC Online 2004: Chronic Oxidative Stress as Central Mechanism for Glucose Toxicity in Pancreatic Beta Cells in Diabetes
  6. ↑ American Journal of Pathology 2000-A Feline Model of Experimentally Induced Islet Amyloidosis
  7. ↑ NIH Scientists cure diabetes in mice using donated spleen cells
  8. ↑ Toronto scientists cure diabetes in mice using capsaicin
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