Zahr Update: Insulin and glucose results
Zahr's insulin and glucose labs are now uploaded into his file, and his case history is updated as well. When we did his blood test he didn't get his beet pulp w/ supplements at night check the night before or the morning of, only hay up until his bloodwork for the 24 hours prior (I was foolish and gave him 2 small crunchies out of habit when I brought him in - no molasses, just the little Hoffmann's cubes - but the vet said that little bit wouldn't have any effect). He was inside away from his hay for about 40 min prior to his blood draw.
His numbers came back as follows: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr/Tapuska_Zahr%20-%20IDEXX%20NSGLU%20results-%20May%209,%202022.pdf
Insulin: 37.2 uIU/mL
Glucose: 5.1 mmol/L
And from the ECIR calculator results:
G:I Ratio: 2.47
So I suppose this makes a lot more sense as to why he keeps having these episodes, even though I thought everything was controlled with the pergolide. I chatted with the vet yesterday morning, and she said since his insulin is pretty high even with the dietary changes we'd made prior to the test (cut out Nutrena feed, switched to RSR only beet pulp) we'll need to get him on something more to control it. She recommended either thyroid powder or Metformin for a couple of months to see if we can get that number down.
I was thinking to start with the thyroid powder first and work our way up to Metformin if that doesn't help, but now that I've had a chance to do some reading in the forum it doesn't sound like the thyroid powder would actually help to lower his insulin levels? There is some conflicting information online saying that it boosts metabolism and can encourage the body to use the insulin more effectively.
So would Metformin be the better choice for him? I haven't picked up the thyroid powder from the vet yet, and still have time to call and get his prescription changed. The main thing that worries me with that one is the mouth ulceration from it being caustic. He currently gets everything he needs in his feed - mineral balancer, DC & PEA for pain relief, etc. - so if he stopped eating it because of a sore mouth that would be a really big problem. I could see about having it syringed, that's how he gets his pergolide and he is a super good boy for that, but rinsing his mouth out after he gets it may be a bit much to ask of the barn owner if this is a long term thing. I can certainly discuss it with her though.
We are also on a transition hay for the time being, he is off the 1st cut brome mix now and is on an orchardgrass/fescue/timothy mix and should be getting a new hay by the end of June. I don't have an analysis on the current one, in the past this mix has been one that's been safe with all the sugar-sensitive horses at the barn, but now that I have these numbers I am pretty concerned about Zahr and I will get that tested asap. Hopefully we don't have to go to soaking his hay, but if we have to we'll make it work somehow.
Zahr has an appointment next week to have his ACTH levels rechecked, too, so I'll have that shortly to add to his case history.
As always, any suggestions would be much appreciated.
Mikaela Tapuska in Calgary AB, 2021
Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr
Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255