Hyperglycemia - just PPID or diabetes?


A 23 year old Andalusian gelding had laminitis in December, initial x-rays not bad, follow up x-rays early this month showed serious rotation with imminent risk of coffin bones coming through the sole on both hinds (posted on BRR0210 - Cervantes) and ECHoof:

5th Feb blood tested at Liphook for insulin 15.0 uIU/ml (<20) and ACTH 41.2 pg/ml (<29) (glucose not tested) and horse prescribed 1 mg Pergolide which was started 9 days ago.

The owner isn't sure the blood was handled correctly - apparently it was "found" frozen at the vets' 2 days after being collected and then sent on to the lab, and I don't think it was collected into EDTA (but may have been transferred into EDTA afterwards) - so no idea if it was spun and separated properly.

Blood tested last Thursday (11th Feb) showed glucose 10.7 mmol/L (2.8 - 4.9) which is 192.6 mg/dl!

WBCs 15.4 (5.0-12.0)
Neutrophils 13.86 (2.5-7.5) being 90%
Lymphocytes 0.92 (1.5-4.0) being 6%
Monocytes 0.62 (< 0.5) being 4%
Eosinophils 0 (0 -.5)

RBCs I think are ok (RBCs 7.36, hemoglobin 14.7, Hct 41.7%, MCV 56.7, MCH 20.0, MCHC 35.3) but moderate rouleaux formation reported in RBCs which (in humans) can apparently be a sign of diabetes.

Vet has diagnosed an infection (I think this is just based on WBCs) and has prescribed antibiotics (I'm waiting for name). To me this looks like a Cushing's WBC profile, but are figures this far outside normal usual with a Cushing's profile? TP is 78.3 g/L, albumin 39.6 & globulin 38.7, which I think indicates that an infection is less likely (as globulin would normally be raised with an infection?) - I'm just rerunning UBW but we're not quite at the stage where I can ask about biochemistry!

The horse is currently in a barefoot trimmer's rehab clinic (the Imprints have been removed, toe shortened, heel lowered, pads on feet, abscesses mobilising), the owner is an hour away from the horse, and I'm in a different country advising by email!

The glucose result has scared me - are we looking at uncontrolled PPID, or perhaps an infection (bacterial most likely?) plus PPID, or is it possible this horse has got diabetes?

The horse is still in a lot of pain - should the owner have insulin, glucose & ACTH tested again now? What about testing the urine for glucose?

I'll add more details tomorrow and see if I can provide a full history. I just wanted any suggestions about the glucose and WBCs as quickly as possible.

Many thanks!

France/UK Jan 2010

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