Re: Ertuglifozin v. Metformin
Assuming he doesn't have PPID and just has EMS, there's a very good chance you can manage Max through diet and exercise alone. It might mean you have to make more dietary changes, such as sourcing a lower sugar hay or even soaking it, and get him into regular workouts once he's recovered from this episode. If that insulin result is for blood pulled while he is on the Emergency Diet then you will definitely need to look for a different hay if you want yo avoid drugs. My horse first tested with a similarly high insulin at around 80 uIU/mL on a soaked hay full of clover (11% ESC + starch). I put him an unsoaked lower sugar grass hay (7% ESC + starch) and insulin came down to the low 40's. I started soaking the low sugar hay and got him trotting 3x a week for 20 min, and that brought insulin down into the teens. Through this 2-year process he also lost about 200 lbs, which undoubtedly helped.
I wouldn't leap to Ertugliflozin unless Max had intractable high insulin, meaning diet and exercise and Metformin didn't work. It seems like a miracle drug but it is very new in horses and there is the potential for serious side effects. I don't know about Australia but in Canada it is also very expensive. As Max ages you might find his EMS gets harder to manage, at which time the meds may be needed.
Agree that you need to investigate the possibility of PPID because that really does require medication (pergolide or Prascend).
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
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