What does spontaneous remission look like?

10 year old cat with steroid-induced diabetes (on super high-dose steroids for 3 months for autoimmune condition, diagnosed with diabetes after stopping steroids in mid-November). Switched to 7% carb food (Innova EVO), started on Lantus. Slowly brought up to 3.25 units over ~10 weeks, had hypo episode ~10 days ago, dropped to 3 units, had even more severe hypo episode tonight before I could do a full bg curve @ lower dose (job is extremely time-consuming and cat is too scared at vet to get accurate readings there). Sarah is currently at the e-vet on a dextrose drip, bg back up to 156 at most recent check.

I've been told that some percentage of cats with steroid-induced diabetes go into remission--is this what it looks like?
https://spreadsheets.google.com/ccc?key ... NZmc&hl=en

I'm going to back way off the insulin for now because I won't be able to do another bg curve until Saturday. She seemed stable at 3 units (pre-shot around 190, nadir in mid-100s), but vet wanted her a little lower, so we went up to 3.25. She seemed stable there until the first hypo episode (bg = 60), dropped the dose, and now bg=30? AUGH!

Sarah is exceptionally difficult to manage because she's also on multiple (non-steroidal) medications for her autoimmune condition, and so spends most of her time hiding from me and my various forms of cat torture. Sometimes she eats, sometimes she doesn't, but it's hard to tell because she won't eat when I'm around (in case of needles/pills/wound cleaning) and I have 4 cats. Everything that I used to be able to count on her to eat (tuna, many brands of wet cat food, etc.), she now won't eat because she associates it with some sort of awful medication or treatment. She would actually prefer to starve than eat with me in the house.

ETA: So just doing ANYTHING to Sarah is awful for both of us because treats are meaningless to her. She hates me. She hates food. She hates life.

Can anyone who's had experience with spontaneous remission tell me what it looks like?

ETA #2: Sarah was 17 lbs at peak, seems to be stable at 11.9 lbs now.

 

I am sorry to hear you are having such a difficult time with your kitty. Most times when cats "hate" something or someone it's because they are scared and don't understand what is happening to them. It's quite possible that Sarah feels pysically ill and frightened- hence her attitude. She will probably change, when she starts to feel better physically.

Make sure that you create pleasurable experiences for her- whether it's letting her watch the birds, sleep in the sun, or whatever else she enjoys. If she won't eat "in public" you can let her eat "in hidding" for now- somewhere where feels very safe for her- under the bed for instance.

Be patient, you have a difficult cat, but things may change as she starts to feel safe and well physically.

Know that your efforts are not in vein. You are helping another being and creating a good karma for yourself.

As to spontaneous remssion- hope someone else has info about this.

HANG IN THERE!

 

hi there

as far as spontaneous remission, what do you mean by that?

remission does happen and it happens often like your case. often diabetes is steroid induced, diagnosed, treated, and kitty goes into remission. steroid induced diabetics have a fantastic remission rate actually. mind you, they are and will always be diabetics so even after going into remission you have to keep them on a diabetic diet, etc....or they will have to go back on insulin.

when Sarah comes home, i would advise that you hometest her BG levels and if she's high enough to need insulin again, you need to start over at probably around 1/2 unit twice a day. often after a hypo a cat is sensitive to insulin and sometimes they even don't need it again. it sounds like you are hometesting? if so, that is the best way to keep Sarah safe from another hypo and it is the easiest way to catch a hypo before they have symptoms and need an ER. up your hometesting if you can and be extra careful with the insulin from now on.

 

Remission does not happen all at once. Since you started high at 2 units, then increased quickly, you could be seeing rebound, or your dose could have been too high all along. I suggest you cut back to 1 unit BID, test religiously for ketones and begin gathering more data.

 

I am sorry you guys are having such a tough time! I wish I could help with the other medical issues but I cannot. All I can suggest is that when looking at your spreadsheet, I didn't see enough data to warrant that dose increase...you need preshots throughout the day to show nadir and duration, and there is no evening data either. I think you and your vet were a teensy bit too aggressive, but hopefully you can get her back on track soon. Just be very cautious with that dose ok?

Hugs

Jen

 

Thanks for the replies. Sarah was on IV dextrose all night, and her most recent BG was 89. She's home now, and my vet is recommending that I continue to monitor her bg values over the next few days and not give any insulin unless she gets back into the high 100s.

For those who have had cats go into remission, can you direct me to your BG spreadsheets?

 

I would be very cautious about what number you set for giving insulin, and I'd also be very cautious with dose.

There is no single link to spreadsheets for cats who go into remission, and each cat does it differently. For us, Squeak's preshot numbers kept going lower and so did his nadirs...insulin needs kept tapering and he was already on a low dose. Soon he was on once a day dosing and then none.

Honestly, you don't have enough data yet to know.