? How is remission achieved?

This is just a general question, not referring to my own cat or anything. I've been looking around at lots of peoples' spreadsheets and often see really, really good numbers and wonder why they aren't lowering their doses. I couldn't find a sticky on the subject but if I overlooked it let me know!

If a person is trying to get a cat into remission, are they waiting until nadir is hitting non-diabetic levels consistently for x amount of time and then decreasing the dose, then waiting for the pancreas to heal enough for that lower dose to hit those same low levels, and repeating until the pancreas no longer needs insulin support?

I imagine it's more complicated than that but I'm curious to know how it's done.

 

Normally, doses are decreased very gradually (down to as low as just a drop in many cases) based on when a dose starts to take a cat too low. Ultimately, you want them in normal numbers all the time, not just at nadir. When insulin is stopped, if the cat stays in normal range for 14 days, it is considered remission.

Unfortunately, remission is not going to happen for every cat. Some cats just continue to need a small dose of insulin to keep them in/very near the normal range. Mia is a good example. She has been on as low as a .10 (which is really not much more than the 0 mark) or even a drop for long periods of time with really good numbers. There were even a couple of occasions when I decided to try no shot for awhile to see if she continued to hold her own, but each time, after a couple of days, her numbers began to trend upward some, so I restarted her small dose. We are nearly two years into this, so I have pretty much accepted that she may always need insulin (I always keep a tiny sliver of hope, but have to be realistic too). Insulin needs can always change, too. There are periods when Mia needs .25 for awhile rather than .10 or a drop, then it drops back down. (Right now, she is up to .50, but this is not 'normal', she is dealing with an issue with her eye and possibly teeth, so I have had to up the dose to counteract her higher glucose until we get through this.)

I am not aware of a sticky that is just about remission. I know you use ProZinc, but on the Lantus forum, there is a sticky that describes the two dosing methods used for Lantus, and it talks about dose reductions and has a paragraph about remission. http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

 

Thank you for the link to Lantus about reductions, this is exactly everything I was interested in reading about! I take it the information listed applies to all insulins?

Wow, Mia has got some beautiful numbers. You two are so close! I really hope that one day she's about to go without assistance (never say never). Again thank you, Mia's SS is definitely a good example of what I was wondering about. <3

 

Well, parts of it do, yes. The concept of gradually reducing the dose and what is considered remission do; however, keep in mind that Lantus and Levemir work differently than ProZinc, so it is not all going to be the same. Lantus and Levemir are 'depot' insulins whereas ProZinc is an 'in-and-out' insulin. Lantus and Levemir usually have a later onset and are longer lasting. So, there are differences in things like how low of a pre-shot you can safely give insulin on and how many cycles it takes to see the full impact of a dose.

There is a sticky about ProZinc that you may want to review, if you haven't already: http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.165103/ You can always post on the ProZinc forum for assistance with dosing decisions.