Dixie updated case history


Have just uploaded updated case history and would appreciate any thoughts on the last few items in the comments section please.  

After being on Metformin for a month Dixies insulin was down to 15 so we stopped the Metformin and tested again after 2 weeks and insulin was back up to 59.  Rather than go back onto Metformin, my vet preferred to start Ertugliflozin which brought the insulin back down to 18, however Dixie is now quite lethargic, not wanting to leave her stable, and laying down a lot.  She has 24/7 access from her stable to a small dirt yard.  I have tried letting her out into a very small paddock in a closed muzzle for a short time, with 2 shetlands for company and she has no interest in their company either, just wants to return to her stable.    Her diet is very tightly controlled, she eats all of her food, she is not losing weight, manure and urine appear normal, she is drinking normally.  While on the Metformin she was really perky, whinnying when anyone came into sight, out in her yard watching what was going on, since Ertugliflozin she is just flat.   Should I put her back onto the Metformin, is it wise to chop and change?  It seemed a reasonable idea to go to the Ertugliflozin as I believe that the Metformin would stop working eventually, and obviously the diet was not controlling the insulin without the medications, now I don't know which way to go for the best as Dixie was much happier when on the Metformin.

Also my trimmer noticed bruising on all 4 hooves 3 weeks ago and asked me to stop the Jiaogulan.  Dixie was most uncooperative at that trim so I also put her back on 4 tbsp of Devils Claw.  Dixie also had slight bleeding from one hoof while being rasped, which my trimmer had never experienced before.  At the latest trim earlier this week the bruising had reduced, however there was slight bleeding from all 4 hooves this time.  It is not profuse and stops within seconds, however my trimmer advises that there should not be any blood vessels anywhere near where she is working, and this had also happened on a couple of non PPID/IR horses being trimmed for seedy toe and hoof crack issues within the last couple of weeks.  Could this be a result of the very hot and humid conditions we have had for the past few weeks as the other horses have nothing in common with Dixie, or is it just a coincidence?

Many thanks
Terrie H in Australia 2021
Case history: https://ecir.groups.io/g/CaseHistory/files/Terrie%20and%20Dixie

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