Diabetes - new approaches

[solomonar]

Years ago I expressed my doubts about the reality of diabetes in cats
At that time I was wrong by stating that while diabetes in humans is irreversible, so-called diabetes in cats cant be real since it can enter into remission. This assertion proved not true, by my personal experience: human diabetes can enter into remission as well.

About two years ago my Hb1c was found 6.2- which is a pre-diabetic value.

Long story short, after removing carbohydrates from the diet and increasing the amount of fat and after intermittent fasting and exercise, all is back on track, without any medication. Surprisingly, one century ago, before insulin being used, the doctors treated diabetes with a low-carb diet!

I am writing these rows to encourage forum mates with cats having diabetes. The key to understanding what is this about is looking into insulin resistance. I am not giving any medical advice, of any sort. I am only saying that it is worth looking deeper into recent scientific findings.

 

[IndyJones]

I don't know enough about it in animals except that they tell you to give the animal a shot of insulin daily.

Now in people, they tell you to test your blood and adjust your diet as needed and only use insulin when you need it.

Insulin is expensive so I don't understand why people don't just test their pets blood with a glucometer like they do people. Wouldn't it be a better option than giving insulin when it may not be needed?

 

[LTS3]

I don't know enough about it in animals except that they tell you to give the animal a shot of insulin daily.

Most diabetic pets need two shots of insulin daily.

Now in people, they tell you to test your blood and adjust your diet as needed and only use insulin when you need it.

Insulin is expensive so I don't understand why people don't just test their pets blood with a glucometer like they do people. Wouldn't it be a better option than giving insulin when it may not be needed?

Diabetic pets can have their blood glucose levels taken daily. Many people use regular Human diabetic blood glucose meters as those are more widely available than pet specific blood glucose meters. It's highly recommended to test the blood glucose levels before giving insulin so you know if the level is at a safe enough for any insulin to be given. The general cut off level for insulin is 150 mg/dl for newbies to prevent hypoglycemia. More experienced diabetic cat owners can give insulin at 100 mg/dl or so but they have data from their cat's many blood glucose curves and and daily testing to back up giving insulin at normal levels.

FelineDiabetes.com is a great place to get up to date info on managing diabetes. The forum has lots of good info on all the different insulins that can be used in cats as well as info on insulin resistance and how to break through that.

 

[mrsgreenjeens]

Many people DO check their cats glucose levels by doing a prick (i believe on their ears) to test their blood, and a lot of people put their diabetic cats on a very low carb diet to put the diabetes into remission. I'm guessing that the cause of the diabetes may determine whether or not it can go into remission.

 

[LTS3]

Some cats never go into remission and that's ok You can do everything "right" but the cat's body just doesn't want to cooperate for whatever reason. I had a "lemon" diabetic cat years ago who never went into remission and that was fine with me. My cat was happy and healthy otherwise and that was all that really mattered

 

[kittenmittens84]

Yes, some people’s type 2 diabetes can go into remission. Generally diabetes reversal is achieved through sustained weight loss, since excess weight (excess fat, really) can increase insulin resistance and thus losing weight can reverse some of that resistance.

Not everyone with diabetes can achieve remission though, even if they do everything “right”. Sometimes the cells that actually make insulin are damaged and they can’t be fixed, which means you’ll need to take insulin forever.

 

[bear]

Shoot. It's time again.
Attach the fresh needle. Dial the pen up. Track the line of red dots from the last few days and create a nice fold of skin. Push the needle in, knowing that going slow is just fine.. Back out the needle and hope the solution doesn't spray back out the hole as it does once in a while. Safety cap on and unload the needle. Put it all safely away.

Look for Forte who will be watching from a distance and know that now it is time for me to hide her kibble for tonight's "Great Kitty Hunter" kibble hunt. Forte will wait until I am half way up the stairs before starting her hunt. As a "Touch Me Not" cat, she will see no need to risk any attempt from me to pet her.
Yep. Together we have our routines before bedtime.

When you have an overly sensitive cat, who you know would hide for days if medicated, you control their weight to avoid those situations. Each time she walks away, it is another opportunity to look for even the smallest hint of chunky monkey butt. Adjust her intake as needed. Her nightly hunts require stretching, jumping, climbing, which all help keep her healthy and in good physical condition.

 

[solomonar]

If the pancreas cells are heavily damaged or if the life regime does not change sufficiently, then it is no chance of remission.
But, for humans, I found that far too easy people go for metformin and reject a lifestyle change to cure insulin resistance, change which can literally save their life or shield them from dementia - which is in fact the worst thing that could happen to them.

The reason for these remarks is that cats may follow the same pattern- namely an abnormal regime that causes diabetes.

 

[bear]

X2
On the automotive restoration and performance boards, X2 means I wish to agree with and reinforce the post above me.
I wish I had the knowledge solomonar just shared when I started the medicine path 18 years ago. Our push to so called heart healthy low fat, higher carb percentage diets led many of us down a wrong path.

As I slowly obtained that knowledge through the years, my feline friends have benefitted from discussions with our Vet and targeting and changing as needed, their diets to keep them at a weight that leaves a small amount of reserve over their optimal size. That very small additional size is there to help carry them through an illness. Although my personal reserve is definitely more than adequate, I too have benefited from getting closer to an optimal size. How I wish I had made those changes earlier and avoided the side effects that comes along with certain meds.

 

[kittenmittens84]

If the pancreas cells are heavily damaged or if the life regime does not change sufficiently, then it is no chance of remission.
But, for humans, I found that far too easy people go for metformin and reject a lifestyle change to cure insulin resistance, change which can literally save their life or shield them from dementia - which is in fact the worst thing that could happen to them.

The reason for these remarks is that cats may follow the same pattern- namely an abnormal regime that causes diabetes.

Keep in mind metformin can also help people lose weight.

 

[fionasmom]

Neither of my diabetic cats reversed their condition. Not saying that others might not be able to do that though.

Metformin....interesting. I am not diabetic and do not use it but it is prescribed by some oncologists to cancer patients who are not diabetic because of the fact that insulin cans stimulate cell growth which may lead to cancer. Some researchers have now called cancer a metabolic disease in some cases.

 

[solomonar]

The same level of blood glucose can be maintained by either low or high insulin. High insulin levels to maintain "normal" glucose level is the first stage of insulin resistance. The sad point here is that if somebody - human, but I suspect cats as well, but please correct me if I am wrong- if somebody checks the glycemia alone, it may be very well of acceptable values, although the insulin resistance may be already present.

First sign of insulin resistance is a Hb1C above 5.7. But to be noted that the jump to much higher values occurs very rapidly.

Another sad point in diabetes medication is that it offers the illusion of control. The insulin resistance keeps growing in the background.

===

I am not advising to give up medication, I am only saying that it offers no cure. The only cure is a low-carb diet. Again, this is true for humans, but I suspect is may be true for cats as well.

Or even more relevant for cats, since they are not "designed" to feed carbohydrates anyway.

===

The mechanism of getting insulin resistance by excess carbohydrates and to frequent meals is worth reading, in my humble opinion. Although it has a complex (and complicated) biochemical explanation, there are plenty of "vulgarisation" texts and videos that are easy to understand with no biochemistry background.

Far to many persons - and perhaps cats- follow an wrong diet, with an unnecessary high proportion of carbohydrates and not justified low proportion of fat. In place of a maximum 3 meals a day, many people go for 5 and a number of snacks, triggering insulin release each time. This diet causes diabetes and dementias, among other conditions.

I am not sure about cats meals,number, however. Should it be "at will" - mimicking the natural way? Or should it me 3-4 meals a day? I don't know, and giving the personal bad experience with approach to diabetes, I am very cautious in drawing a conclusion from not scientifically grounded rationales I've read on the internet.

===
Just a side note: there is no proven diet to lose weight.

 

[LTS3]

There is no cure for diabetes. Diabetes can only be managed with insulin and / or diet. Just like people, diabetic pets can go into remission and come out of it for some reason (stress, medication for another health issue, etc).

Several small meals daily works for many diabetic cats to keep blood glucose levels stable. A low carb diet is best but even such a diet plus insulin may not work for all cats. My diabetic cat was on a low carb diet and a good insulin and I tested his blood glucose levels daily but he never got close to remission. Some cats cab go into remission from a simple change to a low carb diet. Other cats will always need diet and insulin to keep blood glucose levels in check.

FelineDiabetes.com is a great resource to get into the more scientific background of diabetes. The various stickies on the message board has the most up to date info.

 

[solomonar]

The correct name of the condition should be "insulin resistance".
Diabetes mellitus is just a stage of insulin resistance. Therefore, a distinct condition called "diabetes" does not exist. Unless one prefers to call the total death of the pancreas like that. But this is the very final stage of insulin resistance.

Insulin resistance means that the cell receptors for insulin need more and more insulin to open up for the glucose to pass the membrane. As a result, the glucose in the blood increases, while glucose into the cell decreases.

The pancreas is therefore forced to produce more and more insulin, to keep the balance and to prevent blood glucose rise to the point L-cells are exhausted (or dead) and stop producing insulin.

The process of insulin resistance growing lasts for decades before it skyrockets in a few months so it is very difficult to catch it.

The receptors can get their sensitivity back if the proportion of carbs on the diet is drastically reduced and the frequency of meals is a maximum of 3/day. Again, this is for humans, but I think a similar rationale work for cats.


===
For humans, once the insulin resistance reaches a certain level, then physicians prescribe drugs and at the end synthetic insulin.

It should be noted that this treatment does not result in getting back insulin sensitivity. But the opposite- the treatment keeps the insulin cell receptors blocked. This is why people usually think that there is no cure for diabetes: the treatment does not aim at reversing the process but is designed to build an artificial metabolic path. Which is not successful and masks the inflammation which keeps occurring in the body, damaging small blood vessels.

===

Why is this biochemistry aspect important for cats?

Insulin role is:
a) to transfer glucose from the bloodstream to the cells
b) to store excess carbs - as body fat (there is also a small amount stored as glycogen in the liver)

If the glucose is more than it is needed, insulin pushed it to be stored as body fat. When one has frequent meals - each including high quantities of carbs-then the insulin drops trigger the hungry feeling, and the person must eat again. This vicious circle leads to fat accumulation and to insulin resistance. So it is not the obesity generating insulin resistance, but it is exactly the opposite: carbs excess leads to obesity ( the fatty matter in the food is much less relevant!) and insulin resistance.

In the case of cats, I suspect that the small amount of carbs in their diet triggers a similar mechanism. And removing the carbs from the diet shall reverse the insulin resistance process. Again, if it is not so advanced then the L-cells in the pancreas are irreversibly damaged.

What does it mean ""excess carbs?"" For humans, some consider 50 g/day as a maximum. Which means 3-4 bread leaves/day. For cats, since they are not designed to eat carbs and since they are 20 times smaller than an average person, it may be 50/20 =2.5 g, assuming that they can process carbs in a limited manner. Otherwise, the quantity shall be divided by 10-20, resulting in around 0.2 g/day. How many carbs contain regular cat food?

 

[solomonar]

I do not know about cats, but for humans:
- HbA1C is the leading test for insulin resistance evolution
- HOMA-IR
- Echography shall reveal fatty pancreas and fatty liver

I also had a look at the feline diabetes site. It misses some important points.
It does not explain that insulin resistance is reversible and the dynamics of this process.
The body can work very well on ketones, not only on glucose. This is why the body needs fat and not carbs. There is a process called gluconeogenesis which transforms other matter into glucose to feed the brain (mainly), if needed.

===

I wish to stress the most important side of the monitoring of insulin resistance: glycemia within normal limits does not mean the absence of insulin resistance.

Up to a certain moment in time, the pancreas can keep glucose under control by increasing the amount of released insulin - so building insulin resistance little by little, while we sleep quietly thinking everything is OK.

So, the question is not "Is my glycemia values within normal values?" but "How much insulin releases my pancreas to keep glucose within acceptable limits?".

This approach is true no matter the animal species.

Insulin resistance starts with normal values of glycemia and keeps increasing for many years, without any noticeable sign. Let aside diabetes type 1, insulin resistance is caused by excess carbs. Not by fat, not by obesity, not by "too much sugar" (every now and then). Obesity itself is caused by excess carbs.

===

Another important point here: cortisol. Cortisol is the stress hormone, it turns the available matter into glucose, pushing up the insulin and increasing the insulin resistance if stress is prolonged. So even in the low-carb diet situation, stress can cause insulin resistance.

This is valid for humans, but since the cats can be stressed, I suspect it is valid for them as well.