Info Insulin Resistance - LONG - Really.

Discussion in 'Prozinc / PZI' started by Carl & Polly & Bob (GA), Apr 1, 2012.

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  1. OK, so I've been doing a lot of reading lately, just trying to really understand this disease, so that I might be better equipped to "deal with" trying to help you all make sense out of your day to day struggles. Lot of that going on lately....

    So, partly due to my level of frustration at not being able to put a precise timeline on digestion, blood glucose levels, and insulin cycles, I took another route.
    I googled "how does insulin work in cats". What a wealth of info I found. (I have 7 tabs open right now in my browser).

    My motivation is some questions I've seen posted lately that I haven't had a clue how to answer, mostly having to do with "why doesn't a dose work anymore", "why did I get a few good cycles and a bunch of flat ones", things like that. And the often bumped "Glucose Toxicity" thread caught my eye again.

    One thing that made a light bulb go off in my head is how we routinely think that Insulin and BG are opposing sides in a fight, but in reality, they aren't. Actually, they are best friends. Without insulin, blood glucose is 100% useless to a living being. We seem to look at it like this: BG is poison, and insulin is the antidote for the poison. Not true at all.

    Insulin's purpose is to allow glucose to leave the bloodstream, and enter every cell of a cat's body. The reason that diabetic cats are diabetic (hyperglycemic) is because their cells can't absorb the glucose out of the blood. The reason that they can't absorb the glucose is because there isn't enough insulin in the body, because the pancreas can't produce enough of it (or any of it), so we have to add it.

    In a non-diabetic, all this stuff happens automatically, and apparently very quickly. When a cat eats, and turns the food into glucose, the pancreas puts out just the right amount of insulin in order to trigger the cells to absorb the glucose. The glucose is then used by the cells as "energy" or fuel to keep the cell functioning normally.
    In a diabetic, the pancreas tries and fails to produce that insulin, and the glucose has no place to go, so it stays in the bloodstream until it eventually is detected by your handy-dandy meter as "BG" in excess of normal levels. So we add insulin twice a day to try to control that excess glucose, to enable the cells to absorb it and use it like nature intended. Unfortunately, we're always playing "catch up". We can't put it into the cat with anything close to the degree of "natural" pancreatic insulin production with regard to amount or timing. Our goal is to at least get the amount right, but that's really all we have any control over. We'll never be able to act like "an artificial pancreas" with the degree of success, say, an artificial heart might have. When we are successful, it's sort of like "in the ballpark" and it still manages to work in some cases. In one of Dr. Peirson's posts here, she said it something like "we need a monitoring system that checks BG continuously 24 hours a day, coupled with an insulin drip that responds to the changes 24 hours a day". Maybe our grandkids might get that, but it ain't happening for us.

    This brings me to the subject line of the thread - insulin resistance. I've seen it mentioned here and elsewhere, and it's usually mentioned in extreme cases, where a cat is on a really high dose and still not responding. But after reading about it, that isn't right. Diabetes is insulin resistance. ... stance.pdf
    This is from Dr. P's site, specific to type 2 diabetes, which we believe is what the overwhelming majority of our cats have:

    Carbohydrates, Obesity and Diabetes

    This is from that first link again:
    I "bolded" those two things for a reason, because they are seen fairly often here.
    Here's a site that puts things in really simple terms:

    Note, that site is trying to market some supplements that are supposed to help manage nutrition, but the info is there and easy to understand.

    Another thing that I have repeatedly read here is about "liver panic" and how when the BG goes to low, the liver will dump "glucagon" into the blood to raise the BG. Well,the liver does dump stuff, but not Glucagon. It turns out that glucagon is actually produced naturally by a part of the pancreas called " the islets of Langerhans" (which to me sounds like a wonderful destination for a cruise or vacation, doesn't it?).

    Here's a good explanation of what takes place in the blood, pancreas, and afterwards the liver when BG rises or falls:

    So what does the glucagon do?
    It makes the liver dump glycogen, coverted into glucose, into the blood so that it can show up in your next PS reading!
    And what happens when there is too much insulin? It does exactly what we don't want it to do:
    In balance, that's a good thing, and in a non-diabetic, it would do so in amounts that made sense in the body. But if insulin is excessive, and it cause the liver to store more glycogen, then when the BG goes too low, and the pancreas puts out glucagon, and it makes the liver dump the glucose from the glycogen, then the pancreas (and the insulin) is sort of working against itself, isn't it?

    So, what does this all mean? It means Carl is trying to learn junk. Look, y'all, I don't have a sugarkitty on insulin at the moment. I'm here because I want you all to be able to say that too. Diabetes is just a freaking disease, and it doesn't need to kick our collective butts. No, some kitties will never "get there". But that doesn't mean they don't have a chance at it. What the hell is so special about Bob, or Kitten, or Scout, Cello, Harry, Curt, Stinkyboy, Sev's Kitty, or any other furry that has gone OTJ? Nothing. It just happened. Not by itself of course, don't get me wrong. The beans had something to do with it, this Forum had a tremendous bit to do with it, but it can happen to any of us or any of our kitties.
    I just want to learn all I can about it, which is why I'm doing all this "research". It's why I'm still around.
    Well, that, and to show off my pics when I get a good one!

    Too tired to continue tonight.


    P.S. I haven't read the whole thread, but a discussion on this topic took place on the old board too. It was on page two I think, of my google search. But so cool that FDMB discussions get hits on Google! ... 616,675616
    Lynn & Rupert likes this.
  2. Catannc

    Catannc Member

    Feb 28, 2012
    This was part of another response I just wrote, but then I thought it makes more sense over here:

    Carl's new research: the pancreas actually produces the hormone that signals the liver to dump glucose. So bounces are part of the pancreas figuring out again how to self regulate....if you're getting a very low nadir and a bounce because of too much injected insulin not good, but if you've injected an amount that normally does not send the cat too low and this cycle BAM, cat goes to 50, I call that the P taking over. It might make too much insulin and try to correct BG and you get a bounce, but it's learning how to function again. I think some of OUR crisis situations are less of a worry to the cat, I have seen some charts where kitty goes low on a dose that shouldn't do that and throughout the 15 min testing the cat is eating a TON of food, and BG still stays down. This could only be because you are fighting a overdose of injected insulin or kitty is making it themselves, and when you know you shot a safe dose what else can it be but Mr. P trying to keep BG in absolutely normal non-diabetic numbers that scare the crap out of us because we've been told over and over that they are not safe?
  3. owlgal

    owlgal Well-Known Member

    Nov 15, 2011
    Wow! Awesome Carl. Felt like i was sitting in my anatomy and physiology class again in college. Wish you could educate some of the vets with this knowledge and info!

    Thank you for hanging around with us sugar kitties. I love the science behind everything and FD drives me crazy trying to figure it out scientifically. This helps in understanding it a little better. THANKS!!! Keep reading!

  4. Sheila & Beau GA & Jeddie GA

    Sheila & Beau GA & Jeddie GA Well-Known Member

    Dec 28, 2009
    Great stuff, Carl. thanks for doing the work and compiling it - and posting it!

    I do think that "liver panic" had it's origins in the right "science" but it just became easier to say the "liver" panicked and dumped stored glucose than try and explain the pancreas/glucagon initiation of the process. Then it gets repeated by well-meaning people who don't know the science and misunderstanding ensues. Maybe we can come up with a better short hand for the process - can't think of anything right now though.

    Let us know when you come across cruises to the Islets of Langerhans - we can all go as a group! And bring our sugar kitties (but they have to stay in the staterooms or no one will get out alive).
  5. Grayson & Lu

    Grayson & Lu Well-Known Member

    Jan 9, 2012
    I'd like to reserve a place on that cruise! ;-) ... and just think of the kitty buffet on board!!! :lol:
  6. Lydia & Sid & Jake(GA)

    Lydia & Sid & Jake(GA) Well-Known Member

    Feb 16, 2010
    This is very interesting Carl. Thanks for posting the information. I for one am really glad you are here offering help.

    I'm trying to read this info and think about what it means for Sid's situation. I think Sid's intestinal disease plays a big part and then he keeps developing infections that throw everything off. I think his pancreas is firing off all kinds of miscues! I know his fspecl test for pancreatitis came back normal but on an ultrasound his pancreas was a black spot and very diffuse (I think). So something not so good is going on in addition to the lymphoma and IBD...

    Anyway, thanks for all your work you do for us :D
  7. lauramarie

    lauramarie Member

    Jan 10, 2012
    WOW!!!! Thank you Carl. For all of your time and care for all of us :YMHUG:
  8. Pip & Rupert

    Pip & Rupert Well-Known Member

    Feb 10, 2012
    excellently compiled articles! All information is great, just helps us beans try and figure out what's going on. AND.. if i think I'm reading it correctly, the bounces (whilst hideously annoying!) actually suggest that there IS life left in that there old pancreas and it's trying very hard to reboot itself and get going. So.. whilst it's very depressing to see those bouncy numbers (and i seem to have the king of bouncers at the moment!).. i THINK it actually means that there is hope, and things are on the right track.. and that the pancreas isn't completely destroyed already. Correct me if I'm wrong?!

    it might also explain why kitties (at least mine anyway!) seem to be looking/feeling totally icky when they are up in the red and black numbers when we first start this journey and then when they start the bouncing, and therefore the high numbers are SELF induced.. they don't seem to be nearly as sad feeling at all. I know that Rupert can have hideous numbers and look quite quite fine and dandy when he's bouncing.

    all very interesting!
  9. I think that it does indicate that the pancreas, at least in part, is working, yes.

  10. bookw0rm

    bookw0rm Well-Known Member

    Aug 11, 2011
    hmm... So that means having a tigger isn't really a bad thing? Cool. Cass still has a chance.
  11. Well, it's still something we hope will go away or at least not happen all the time, but from what I read, it sounds like bounces mean that part of the pancreas is doing what it supposed to do.

    Of course Cass still has a chance!

  12. hmjohnston

    hmjohnston Well-Known Member

    Dec 30, 2011
    This is amazing! Bookmarking this for repeated perusal!

    Great going Carl.
  13. Barn Cats R Us

    Barn Cats R Us Member

    Nov 10, 2011
    I've had my hands full with numerous “crashing kitties” lately. Without having time to read the massive amount of info in this post...this is the one topic that caught my eye...I don't know if this is helpful, but since Marilyn has been such a difficult kitty, the following is a "note to self" that I added to the top of her Excel SS a couple months ago (along with a few others):

    The pancreas releases glucagon when blood sugar (glucose) levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is then released into the bloodstream.

    Once I discovered that little tidbit, I just assumed the term "liver bounce", used all over the boards, is a shortcut phrase for the entire process. The way I see it, the "liver bounce" is basically the end result of a process that's started by the pancreas. So if this is the case, the term "panicky liver" is FDMB speak, for panicky pancreas...triggering the liver to set things keep the body out of (what the pancreas perceives to be) harm's way.

    What bugged me about this realization was....if Marilyn's pancreas is supposed to be "resting", in order to heal, so she can possibly go OTJ...then how in the world is all of this "bouncing", and newfound "flatness", resting the pancreas? It didn't seem "right" to me. So after 4-months of dives, bounces, and most recently, high flatness...I started to "panic", and decided it was time to take control of her situation. My theory was...if I could stop the rebound process...her pancreas might truly rest, and in turn, heal. It turns out that "stopping the rebound process" is not for the faint of heart...or those who have to leave the it's not practical...but it is possible.

    I might post about it, eventually, when I have more time. I've actually been holding back on posting, since I've been making some bold strategic moves, that may not have a place on these forums. All I know was her best day we're working on it. She went 39-hours without R, 23-hours without ProZinc, and 14-hours without N, and handed me a BG reading of 82. Although it's a work in progress, I'm hoping for a happy end to this "dive, bounce, flat-fest", that I could no longer imagine was, in any way, "resting her pancreas".

    Good topic to bring up, Carl. I actually wanted to start a Think Tank topic a good while ago...but the Barn Cats, would never allow me the time needed to get my thoughts together. Nice job!
  14. Deb,
    Do not despair! The Islets are not an all or nothing thing.

    It is the alpha cells that produce glucagon and direct the liver to dump. The beta cells are the the ones that produce the insulin. And here's another new word for me to explore.....what the heck does somatostatin do?
    Not quite sure where that takes us, but it sounds like somatostatin is the key, since it seems to be what allows or doesn't allow the alpha and beta cells to do their thing?

    Please do post about it eventually.... have you considered that no matter what it is that you are trying, there might be another cat/bean or three that might benefit from it? Had I not "slipped" and told people that I shot Bob with IM shots the whole time, maybe Lydia and Sid would be worse off, because when someone saw it, they PM'd me and asked me to chime in... even though my "slip" was pretty much met with a less than positive response. This place is all about learning from each other, not about following the status quo like a bunch of lemmings. Some of the first lemmings off the cliff might not feel that way, of course... The very first person who said "hey, you can test BG with a human glucometer" was probably not well received...

  15. Skylin

    Skylin Member

    Apr 26, 2011
    Wow, great read, Thank you! :smile:
  16. I had reason to look for this today and thought I'd bump it. It's got some useful information in it.

  17. terriy

    terriy Member

    Dec 29, 2011
    Thank you for your research Carl.
    This also gives me insight on how the Liver goes hand in hand with diabetes.
    Thank you for caring so much!
  18. nckitties3

    nckitties3 Well-Known Member

    Jan 12, 2013
    WOW! Just WOW! :eek: @-) :shock:

    How did I miss this post for so long? Maybe because we were in Lantus land at the time. who knows? Thank you for the research you did, it is greatly appreciated, not just by me, but by everyone, I'm sure.

    Good to see ya Carl. :YMHUG:
  19. WenDawg

    WenDawg Member

    Aug 30, 2014
    Thanks for posting. Great info!
  20. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Dec 2, 2014
    @Carl & Polly & Bob (GA) Wonderful post. I would suggest the information part of this post be put as a sticky in the health links and should be one of the first reads for new members. It is a much more detailed description of the whole involvement of multiple processes within the body without being so "scientific" that it would be too hard to follow for people new to feline (or any) diabetes. Understanding the processes and the variables is such an important part of learning to deal with the sugar dance and its ups and downs.
  21. Mister's Owner

    Mister's Owner Member

    Mar 15, 2015
    So I have a question....
    I haven't had money to do a blood panel in a long time,
    but years ago when I adopted my kitty and he had F.L.U.Ts we ended up in the ER 6 days after adoption and his blood panel showed liver damage.
    Everytime I give a food high in phosphorus his bg sky rockets and he lays in the litter box.
    so im assuming he has kidney damage from prolonged diabetes.
    Is it possible its actually still his Liver?
    when I change doses on insulin he does great for a few days and than nothing.
    3.0 seems to high and 2.5 insulin gives good numbers but still kinda high.
    These articles have me thinking.
    Thank you!
  22. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Dec 28, 2009
    Mister's Owner, I answered this on your other thread.
  23. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
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