Dr. Kellon and/or other IR experts--please advise


Maggie
 

Back in March of 2011 I submitted Chancey for the EMS study being done at UMN. He was denied because he was on pergolide, but has since been weaned off the pergolide (last dose March 25th) and now they are willing to take him, and Spiral (nonIR/PPID) as the control horse. Following is the email I received from them and with what I know (or think I know) from this ECIR group, I am wondering if I should participate. At best, it may be a waste of time and money, since the horses would be basically fasting, and at worst, Chancey could be harmed by the oral glucose tolerance test (but this is optional), since he is on a low s/s hay only diet. I thought that fasting prior to blood testing was only appropriate for humans, not horses, since they are grazers and meant to have food basically 24/7. It would be nice to have all of that "hay/pasture/feed samples and blood samples" testing paid for, but I already have had my hay analysed and wouldn't blood tests related to IR be inaccurate if the horses are fasted? I would appreciate your advise on this--both if I should participate, and if I do, should I opt out of the OGTT? Have other group members been involved in this study?
Thanks so much!
Maggie, Chancey and Spi
March 2011
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/



Dear Maggie,

Your horses Chancey and Spiral have been selected to participate in the final phase of the equine metabolic syndrome study being conducted by the University of Minnesota in collaboration with Drs. Ray Geor (Michigan State) and Nicholas Frank (University of Minnesota).

Please let us know if you would like to continue participation in the study and we will then send you a sample collection kit. The sample collection process includes submission of hay/pasture/feed samples and blood samples. The horses will need to be held off pasture the night prior to the scheduled morning sample collection. It is OK for the horses to receive their normal evening meals, however at 10PM do not leave more than 1 flake of grass hay with each horse. Do allow free access to water.

The morning your veterinarian is scheduled to collect the blood samples do not feed the horses until the blood sample collection process is completed. The appropriate blood tubes will be included in the sample collection kit. You are responsible for costs associated with collection of the blood samples by your veterinarian. We will cover costs associated with shipping and analysis of all samples.

We also invite you to participate in an optional simple oral glucose tolerance test (OGTT). Performing an OGTT provides a better indication of insulin resistance than simply evaluating a fasted blood sample. The OGTT involves administering Karo syrup by mouth after the baseline blood samples have been collected then waiting 75 minutes and collecting a second blood sample. The simple oral glucose tolerance test bears minimal risk. The amount of sugar administered is similar to a small grain meal. It is not mandatory to perform the glucose tolerance test to participate in the study. You also have the option of only performing the glucose tolerance test in the "control" horse.


Please let us know if you plan to continue participation in the study and which horses will be taking part in the optional glucose tolerance test. This will allow us to ship the appropriate materials in the sample collection kit. Also, please let us know if the horses receive the same or different types of hay, grain, or pasture. Please provide a current shipping address for the collection kit to be sent to.

Please let us know if you have any questions regarding participation in the study. We greatly appreciate the time and effort you put towards helping us learn more about the genetic and environmental risk factors for EMS and laminitis in hopes of being able to better understand, diagnose, treat, and prevent the disease. The bloodwork and hay/pasture/feed analysis results will be sent to you when available. We hope you will also find this information beneficial for your management program.

Sincerely,
Nichol Schultz DVM
Molly McCue DVM MS PhD Dipl. ACVIM


Eleanor Kellon, VMD
 

If one goal of the study is to determine if an oral Karo challenge is more sensitive at picking up IR than a fasting insulin and glucose there's not much doubt as to how that will turn out.

Many researchers jumped on the fasting idea because it eliminates potentially high levels from the sugar/starch composition of the diet. This is true, but if the protocol of the Va Polytechnic pony study is followed, feeding is not an issue. In that study, normal ponies had insulin no higher than 12 uIU/mL even when maintained nonfasting on pastures that caused laminitis in IR ponies. No problem with false positives.

On the other hand, there is little, if any, evidence that IR horses overproduce glucose when fasted like humans do. If you look at the prefeeding (assumed fasting) insulin levels in the first link I posted this morning, it looks like the highest was around 20, others lower.

You're not going to learn anything new in terms of whether or not your horse is IR, except whether or not he tests positive when fasted, but Dr. McCue's portion is to look for a genetic component. You could contribute to that.

I don't know how risky the Karo challenge is, but the risk is not zero.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Maggie
 

You're not going to learn anything new in terms of whether or not your horse is IR, except whether or not he tests positive when fasted, but Dr. McCue's portion is to look for a genetic component. You could contribute to that.
I don't know how risky the Karo challenge is, but the risk is not zero.



Thanks for the info, Dr. Kellon.  I ema iled them a few questions this morning and am waiting on a reply.  I am not too keen on the idea of fasting my horses overnight.  They are never locked up in a stall and that's the only way I could keep them NPO overnight.  I would like to contribute, but not if it involves stressing my horses out--even it is only overnight.  If I do participate, I will opt out of the OGTT.  T hanks again


Maggie and Chancey in VA
March 2011
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/






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Vanessa Register
 

Maggie,
My two horses participated in the study and I opted out of the karo syrup part.
When I researched some of the other studies using the Karo syrup, It scared me to give them that much sugar,
I dont even give a carrot slice.
they make you sign a lot of documents saying you understand the risk and they will not be responsible if you horse gets laminates.
I also researched the DR's involved in the study, one of them did one where the horses were put in to laminates and then had to be euthanized.
I'm all for science and knowing more to help, but not with my babies,
Vanessa
Yucaipa, CA
Jan 2009
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Maggie
 

I dont even give a carrot slice


Thanks Vanessa,

My horses only get ODTB's for treats now--like yours, never even a piece of a carrot or apple.  Honestly, they don't seem to know the difference.  My "control" horse does graze, and HATES to be locked up, so not sure if it's worth the risk of locking him in the stall overnight so he cannot graze.  If I do, I will definitely opt out of the OGTT.  It wasn't clear if that was optional for the control horse, or not.  Waiting to hear back from them. 

Maggie and Chancey in VA
March 2011
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/



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