Re: Zahr Update: Insulin and glucose results

Mikaela Tapuska

Hello again!

Zahr's ACTH results came in today, and we are in the high range again at 21.1 pmol/L. Or at least, high for him. He seems to be pretty sensitive to increases in ACTH - when he had his initial (and to date, worst) laminitis episode, he had ACTH levels of 24.7 pmol/L. So this is one more piece of the puzzle that helps explain his elevated insulin levels even with the dietary changes.
Lab results:,%202022.pdf

I am not panicking yet because his diet is under control, but I would like to get his ACTH lowered ASAP so that he doesn't have another flare up. When he had an episode last summer, his ACTH was incrementally higher than the IDEXX lab reference range at 10.1 pmol/L and my vet recommended we double his dose of prascend from 1 mg to 2 mg. He has been on this dosage since June 2021. I've yet to talk to my vet yet about this one (I got the results tonight while I was at work), but given Zahr's history would it be overkill to jump straight up to 3 mg daily to nip this in the bud or would 2.5 mg be more reasonable?

On that note, I think if I have to increase Zahr's dosage again I need to look into getting compounded pergolide for him instead of prascend. Although the latter works it is going to be too expensive to keep up at this dosage. So I need to find a compounding pharmacy that gets fresh pergolide in, if I remember correctly from other messages? 

At least this should mean that Metformin is off the table for now (hopefully) if his IR is mainly being aggravated by high ACTH levels right now and not getting out of hand on its own, so small silver lining there!

As always, any input is very much appreciated. Thank you!

Mikaela Tapuska in Calgary AB, 2021

Case History:

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