Re: Updated Trim Pictures and Case History

Sherry Morse

Hi Jamie,

If Metformin doesn't work then we look at the other medication options but the first 3 ways to reduce insulin are:
  • Diet
  • Exercise (when possible)
  • Reduce ACTH if that is elevated as it may be driving insulin up

If insulin does not respond to those 3 items or there are other indications medication is needed then the next steps are:
  • Metformin
  • Invokana, if Metformin does not work
As you've already addressed diet and exercise for a horse with compromised feet isn't recommended you're at the steps of 'reduce ACTH' and Metformin.  If those don't work then you would look at Invokana as an option, but you're not there yet.

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