Ertuglifozin v. Metformin


My equine vet has suggested trialling Max on Ertuglifozin. It seems to be recently available here in Australia and there has been some publicity about it.  Max’s insulin came back on 30/7 at 79 (tested 4 hours after feed, but access to hay). Max has his first bout of laminitis, seemingly after I added an unsuitable feed to his diet.  That has now been removed and he is on the emergency diet, confined to rubber lined stable/breezeway, with soaked hay.  He has improved over the last few days, still has some heat in his feet, but moving better, pulses seem softer, and down to 6ml of Bute per day to taper off after another few days hopefully.
Given I’m certain that this first laminitis was caused by the Lupinpak feed I added to his diet a month or so ago, and I’ve always managed him as an at risk horse for 13 years without issue, I’m hoping I can go back to managing Max without meds.
Should I try that first, and then Metformin if required, leaving the Ertuglifozin for the third step for the first two aren’t  effective? Is it likely for me to get Max back to managing with diet and environmental only, or will drugs be required now he’s had a laminitic episode???
I don’t want to medicate him if I don’t have to, but obviously will if needed?
Michelle & Max
Yarra Valley, Victoria, Australia
Thank you
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