Reposting in hopes Dr. Kellon had input on Flame’s labs (he’s on Invokana). 

Original post: I know I got meds titrated and labs done late this year, but life happened. Here are Cornell results for both horses.

Diana (EMS): glucose 88 mg/dl, insulin 25.26 uiu/ml, ACTH 43 pg/ml & leptin 9.06 ng/ml. 
Diana gets Timothy 3 times a day (less at lunchtime), a cup of Timothy pellets, a cup of TC Timothy balanced cubes, a cup of Stabul 1, 1/4 cup ground flax, scoop of smartpak spirulina (allergies), 1 tsp AAKG, 1/4 tab (of 227mg) Previcox & 5mg of Pergolide (fall dose). She is ridden or lunged lightly three times a week, hand walk three times a week and hangs out in her pen once a week. 

Flame (EMS & IR)- glucose 100 mg/dl, insulin 138.49 uiu/ml, ACTH 15.4 pg/ml & leptin 5.41 ng/ml.         Flame gets 4 pounds of unsoaked Bermuda twice a day, 2 1/2 pounds of TC Timothy balance cubes twice a day, 2 cups Stabul 1, he gets a lunch & night snack of 1 pound of Bermuda, 4 pounds RSR beet pulp. In the beet pulp is 2 ounces of flaxseed oil, 1 teaspoon of liquid vitamin E, 3 teaspoons of Jherb, 1 1/2 teaspoons of AAKG, 2 1/4 teaspoons of carnitine, 2oz salt, Vit A gelcaps, 5mg Pergolide (fall dose) & Invokana 225mg. As a reminder, my head tested too high in nitrates so we are trying to dilute out the hay by giving 1/2 hay, 1/2 TC cubes & increased BP to 4 pounds. Flame is lightly ridden or lunged three days a week, hand walk three days a week and hangs out in his stall/run one day a week.

Questions- I know I’m kind of behind the eight ball, but should I increase Diana’s pergolide? If so, to what dose? 5mg did control her ACTH last year. Anything else I can do to try and drop Flame’s insulin? It’s never been under control even on Invokana. I did not draw triglycerides this time since they had been drawn so many times already this year. I will draw them with spring labs next year. I’m trying to update both horses case history but I’m still fighting with a very old and finicky laptop.

NV Oct 2013

Flame Case History

Flame Pictures

Diana Case History: https://ecir.groups.io/g/CaseHistory/files/Beth%20and%20Diana