Insulin/Glucose Panel


shabbonawoman
 

I realize everyone's been quite busy which has been the reason for a
little delay regarding my question on blood draws and the case
history update. I had one of those lucky moments today with an
unplanned conversation with a new vet. To sum it up I asked if she
felt that IR and Cushings were different or the same and brought up
my Insulin/Glucose test confusion. She was a graduate of University
of MO and said they made sure to drum all this into her head. She
picked the lab that follows the correct parameters. She draws the
blood and takes it right back to the office where her staff have
specific instructions on how to handle the tubes for Insulin Panel
and/or ACTH. I explained to this vet what was tested in each vial,
grey and red, as I posted it here and she just said "huh?"

I mentioned that Luke doesn't fit the profile and test done 3-years
ago was for a baseline. She remarked that it's not that unusual and
what she recommends is to get both the Insulin Panel and ACTH to
check for early Cushings when the owner feels something is not quite
right and you don't see the signs.

This certainly clears up confusion caused when I first posted the
case history on Luke. The clinic I have been using, uses the Insulin
test as their basis for diagnosing Cushings. IR, Cushings are one in
the same. Their thought is that in some Cushing horses, they see a
insulin rise in the winter. Now that I've dug into this from behind
the scenes, I'm using the wrong outfit!

I did get the fax today and
T3 35 range 40-80 ng/dl

WBC 5.9 range 6.1 –11.8 x10?
RBC 5.9 range 8.5-11.8 x10?
Hgb 10.4 range 11.0-16 g/dl
Hct 30.1 range 32-46%

One of my original questions was regarding the correlation of anemia
and iron overload. Now that I look at this, it seems he may have
something else going on. Which brings me back to one of my original
questions. The way this bloodwork was handled for these tests, what
part if any, is any good? Seeing that the Insulin/Glucose will have
to be redone by the other vet, should I do the ACTH at this time of
the year or should I just wait until summer and get both?

Thanks for your patience in my confusion,

Cheryl
Looks like a vet will get a call in the morning questioning the Hgb
and Hct.


Eleanor Kellon, VMD
 

--- In EquineCushings@..., "shabbonawoman"
<shabbonawoman@...> wrote:

I did get the fax today and
T3 35 range 40-80 ng/dl
This is a relatively small decrease, within the lower range for some
labs. Could be mild "euthyroid sick syndrome".

WBC 5.9 range 6.1 –11.8 x10?
Some suppression in white cell count is common with Cushing's. May
also see high neutrophil percentage, low lymphocytes (normal is in
the range of 50:50)

RBC 5.9 range 8.5-11.8 x10?
Is that a typo by any chance? What were the MCV and MCHC? This
number doesn't fit with the hemoglobin and hematocrit.

Hgb 10.4 range 11.0-16 g/dl
Hct 30.1 range 32-46%
Mild depressions again common with Cushing's, but also common in
older horses in general. I wouldn't worry about those levels.

Which brings me back to one of my original
questions. The way this bloodwork was handled for these tests, what
part if any, is any good?
How was it handled?

Seeing that the Insulin/Glucose will have
to be redone by the other vet, should I do the ACTH at this time of
the year or should I just wait until summer and get both?
You can do them now, although if your weather is still cold might
want to wait until it warms up to over 40.

Eleanor


shabbonawoman
 

--- In EquineCushings@..., "Eleanor Kellon, VMD"
<drkellon@...> wrote:

--- In EquineCushings@..., "shabbonawoman"
<shabbonawoman@> wrote:
T3 35 range 40-80 ng/dl
This is a relatively small decrease, within the lower range for
some labs. Could be mild "euthyroid sick syndrome".

What is "euthyroid sick syndrome?" In 1/07 it was 49.
> RBC 5.9 range 8.5-11.8 x10?

Is that a typo by any chance? What were the MCV and MCHC? This
number doesn't fit with the hemoglobin and hematocrit.
Yes.
CHEMISTRY 2/08 *10/6 **6/06 2/05 6/01 Range
WBC 5.3 7.2 7.2 5.7 5.3 x10 to the 3rd
RBC 5.9 7.9 9.86 6.28 5.83 x10 to the 6th
Hgb 10.4 13.9 18.3 11.3 9.8 11.0-16g/dl
Hct 30.1 41.8 52.3 32.5 29.7 32-46%
MCV 51.1 52.9 53 51.7 50.9 38-52
MCHC 34.5 17.6 35 34.8 33. 30-33g/dl

* Severe skin infection on one hind leg and sheath. Reoccured in Dec.
on other side.
**CK was 2281 IU/L. I think is a indicator of tying-up? Luke was
never worked.
When I charted those numbers, it looked like he was all over the
place unless blood wasn't handled correctly. Sorry, it maybe more
info than you need.

How was it handled?
All samples are iced. Purple tube contains blood for complete blood
count and is spun when vet gets back to office that night. Thyroid,
Insulin and blood chemistry is in other tube and not spun but
chilled.

We probably won't see 40's until April and I'll wait.

Thanks so much,
Cheryl


Eleanor Kellon, VMD
 

--- In EquineCushings@..., "shabbonawoman"
<shabbonawoman@...> wrote:


What is "euthyroid sick syndrome?" In 1/07 it was 49.
Euthyroid sick syndrome is when thyroid hormone levels are suppressed
in the face of a chronic illness, sudden serious illness, malignancy,
injury, etc. Think of it this way. The thyroid hormones "permit" and
assist the body cells in burning fuels, storing fat, etc. When the
body is in crisis mode or another illness is interfering with
metabolism, thyroid hormone levels drop to assist in conserving body
fuels. Others feel it is not actually beneficial in any way but is a
secondary disease state. Either way, it's reversible when the primary
problem is controlled.

http://www.emedicine.com/med/topic753.htm

Thyroid. 1997 Feb;7(1):125-32.Links
Euthyroid sick syndrome: an overview.McIver B, Gorman CA.
Division of Endocrinology and Metabolism, Mayo Clinic, Rochester,
Minnesota 55905, USA.

Abnormalities of thyroid hormone concentrations are seen commonly in
a wide variety of nonthyroidal illnesses, resulting in low
triiodothyronine, total thyroxine, and thyroid stimulating hormone
concentrations. These thyroid hormone changes may be mediated in part
by cytokines or other inflammatory mediators, acting at the level of
the hypothalamus and pituitary, the thyroid gland, and the hepatic
deiodinase system, as well as on binding of thyroxine to thyroid
binding globulin. The degree of thyroid function disturbance
correlates with disease severity and low levels of thyroid hormones
predict a poor prognosis in several illnesses. It remains unresolved
whether the hormone responses in the euthyroid sick syndrome
represent part of an adaptive response, which lowers tissue energy
requirements in the face of systemic illness, or a maladaptive
response, which induces damaging tissue hypothyroidism. Consequently,
the use of thyroid hormone therapy in the euthyroid sick syndrome is
controversial. The small number of controlled trials performed to
date have shown conflicting results on the cardiovascular effects of
triiodothyronine, and none has had the statistical power to address
the question of altered mortality. Future trials of therapy should
concentrate on patients with severe nonthyroidal illness and a high
mortality rate. Meanwhile, better understanding is needed of the
impact of the altered thyroid hormone status on tissue function.



CHEMISTRY 2/08 *10/6 **6/06 2/05 6/01 Range
WBC 5.3 7.2 7.2 5.7 5.3 x10 to the 3rd
RBC 5.9 7.9 9.86 6.28 5.83 x10 to the 6th
Hgb 10.4 13.9 18.3 11.3 9.8 11.0-16g/dl
Hct 30.1 41.8 52.3 32.5 29.7 32-46%
MCV 51.1 52.9 53 51.7 50.9 38-52
MCHC 34.5 17.6 35 34.8 33. 30-33g/dl
On 10/06 and 6/06 you have some dehydration, pretty significant on
the 6/06 sample.

It's physically impossible to have an elevated MCHC (that 10/06
figure is calculated wrong. MCHC = Hgb divided by Hct x 100 = 33.2).
The reason it's impossible is that you can only fit so much
hemoglobin into a certain space. The most usual cause of elevated
MCHC is rupture of red blood cells, either during sample collection,
sample storage or because they are fragile or being destroyed in the
body. Several different conditions and drugs (including bute) can do
this. There's no way to tell from the numbers themselves what the
cause is but you really don't have a progressive anemia here (by
hemoglobin and hematocrit) so best thing to do would be to repeat it
making sure a large bore needle is used and by all means use a
different lab/machine. Also helps to make a fresh blood smear slide
right there at the barn so that the lab can get an accurate idea of
what the red cells look like. The longer they sit in the tube before
the smear is made, the more artifacts there are.


**CK was 2281 IU/L. I think is a indicator of tying-up? Luke was
never worked.
We occasionally see CK that high in Cushing's horses. A more common
cause is a horse that is spending a lot of time down. An unwitnessed
fall or kick can also do it. With tying up it's much higher than that.

Eleanor


shabbonawoman
 

--- In EquineCushings@..., "Eleanor Kellon, VMD"
<drkellon@...> wrote:

by all means use a different lab/machine.
Thank you Dr. Kellon for all the information. I realize that some of
the chemistry numbers don't mean too much when looking at the big
picture, but either way, one shouldn't be paying for numbers based on
sloppy handling. Your response put a face to why I wasn't comfortable
with a number of conversations I've had with the clinic.

I've learned so much from following the posts and discussions on the
group and hope with a new vet and new blood draws in April, I can be on
the pathway to posting correct information, getting advice from the
group, and then be able to post another success story.

Thanks for the treasure chest of information,
Cheryl