Re: Dewi - latest blood test results - high resting insulin - what to do next?


Kirsten Rasmussen
 

Jenny, I was reading the 2020 EEG guidelines last night (in preparation for a conversation with my own vet) and noticed that they specifically state that Invokana ("canagliflozin") can be useful in "horses with laminitis and severe ID that do not respond to recommended management changes. Smaller equids may be treated at a more reasonable cost because of their size"...this group is very well respected and your vet will almost certainly take their advice as the current gold standard of treatment for EMS.  The guidelines are updated every 2 years, or more frequently when new information becomes available.

Here is the link to the download site:
https://sites.tufts.edu/equineendogroup/
Maybe you could send your vet the pdf in case he/she has not seen the new recommendations, and ask him/her about that treatment option?  You already know Metformin is not likely to be helpful, which is the only other recommended pharmaceutical for lowering insulin, so that leaves trying the "Sodium-glucose co-transporter 2 (SGLT2) inhibitors", which includes canigliflozin (aka Invokana).

They also do up a guideline on PPID (same link), which I highly recommend you download and read given that Dewi's ACTH is abnormal.

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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
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