Hi Gayel,

You're right - glucose is the missing value. Unfortunately, it's still missing. In order to change anything in your case history you need to upload a new case history form with any added/changed info then delete the old form. Best way to do this is to keep the latest version stored on your computer, update that then upload as needed.

No grain. Just feed hay until test time. What you don't want is to have Spirit go more than 6 hours without hay. If he does then for the 4 hours after his first meal after that 6 hours of "faasting" he will have an insulin/glucose spike that won't reflect his real status.

His ACTH was very high and will keep rising unless he is on pergolide to control the PPID. Uncontrolled PPID will also push his insulin/glucose numbers up as well. Laminitis is the most obviously dangerous consequence of this cascade but there are other issues as well. The immune system becomes compromised so he tends to pick up more infections and not be able to clear them. Over-reactions to vaccinations and bug bites become more common, muscling - esp along the topline -  decreases. Have a read on our website for more in-depth info on the consequences of leaving PPID untreated:

http://www.ecirhorse.org/index.php/cushing-s-disease

What he was experiencing is called the "Pergolide Veil". This is a transient side effect of starting the medication and can be mitigated/eliminated by tapering slowly onto the drug. An adaptogen called APF is also extremely helpful during the adjustment period. Because of his concurrent IR status his diet should also be managed to lower his insulin/glucose numbers to guard against laminitis rearing it's ugly head. Starting him on 1/4mg initially is a great idea. compounded pergolide would make this infinitely easier (and cheaper) for you as the Prascend caplets should not be quartered. If you will be using the Prascend, cut the caplet in half, dissolve in a few cc's of water in a syringe and give half of the syringe contents on day one, refrigerate the remainder, then give that on the second day. Repeat for 3 pills (6 days) then go to 1/2mg daily (1.2 caplet) for 6 days, then do 3/4, then a full pill. Will need to retest after 2-3 weeks at the full dose to see if the dose is high enough. This likely won't be enough as by then you will be in the seasonal rise period and his ACTH will continue to climb so you end up "chasing the numbers". Difficult but doable.

Ideally, testing now would be good so you know exactly where you stand and how far from normal he is. It is likely his numbers have risen since the last test and will continue to do until at least late October. If he were mine, and finances permitted it, I would test now, start the pergolide immediately after the testing (without waiting for the results) then plan to raise the dosage even more to try to compensate for the rise effect. Then retest in Sept to see where I stood.

He is IR as well as PPID. His insulin is solidly elevated and his leptin is right on the edge of high normal. These are additional red flags that Spirit is  a lamintis time bomb waiting to go off.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team