Date
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Blood work results and confused!
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Jewel is doing fantastic! Riding over 100 miles a month her weight and demeanor amazing and the morgan crest soft and minimal. Her diet has NOT changed per case history, although a new supply of tested hay she is now eating and will be retested, just in case.She remains dry lotted. I am struggling to update my case history so please bear with me.
I just received blood work and although I am pleased with the ACTH but I am really surprised with her insulin levels rising. The BIG caveat here is that the lab values and lab has changed and so have the measures of her previous insulin levels which was 36.4 uIU/ml range 4.5-20.0 at IDEXX LAB in March 2019 ACTH 8.2pmol/L Aug to Oct range 4.62-11.66pmol/L Nov to July range 2.42-10.22 pmol/L TRUE NORTH LAB INSULIN 1422 pmol/L range 28-330 pmol/L TRUE NORTH LAB I cannot measure her trends with the different labs and values, can someone help decipher this? IF her hay test reconfirms low sugar which I anticipate it will as it is a reputable dealer <8 ESC +starch. What else should I be doing? I'm very worried or should I be.? -- Cheryl and Jewel Oct 2018 https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel https://ecir.groups.io/g/CaseHistory/album?id=81063 |
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Lavinia Fiscaletti
Hi Cheryl,
Insulin: To convert the pmol/L results to uIU/mL: divide by 7.1. So 1422 pmol divded by 7.1 = 200.28uIU/mL ACTH: To convert pmol/L to pg/ml: divide by .22. So 8.2pmol divided by .22 = 37.27pg/ml Because Jewel is a confirmed PPID horse, we have found that keeping the ACTH solidly within the low-to-middle of the range at all times works best over the long haul . As her ACTH is already above the normal range, and still climbing due to the seasonal rise influence, that indicates the pergolide dose needs to be adjusted upward to compensate. Insulin seems to have shot up considerably but doesn't seem to jive with Jewel's appearance. However, the previous insulins were done fasting, correct? That would give you falsely low results. Were these results also done fasting? There are no glucose values listed in the case history - has Jewel's glucose ever been tested? Would you please add your general location to your signature as that helps us to be more specific in answering your questions. Thanks for your help with this bit of administrative housekeeping. -- Lavinia and George Too Nappi, George and Dante Over the Bridge Jan 05, RI ECIR Support Team |
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Sorry i thought my case history had baseline glucose from last year.
Initial insulin 16.3uIU/ml range 4.5 to20 Glucose 4.7. Mmol/L range 4.2-6.4mmol/L These were fasting last Sept My posted result today was NOTfasting Pergolide dose is at 1.0 mg.What would you recommend as increase. My vet doesnt think so but your site I find is much more on board Cheryl and Jewel Port Alberni BC Canada -- Cheryl and Jewel Oct 2018 https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel https://ecir.groups.io/g/CaseHistory/album?id=81063 |
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Hi Cheryl,
Regardless of what any of us might think, you need to get your vet on board. It's basically impossible to compare your insulins because of different labs, different assays, different potential for cross-reactions. ACTH units aren't always directly interconvertable either for the same reasons. My main concern would be a repeat performance of last year but you would make a stronger case for an increase if you are seeing any changes in your horse like more drinking and urination, topline wasting, belly enlarged, crest increasing. Otherwise, talk to your vet about a prophylactic increase with the possibility of weaning back down to her current dose in late winter. -- Eleanor in PA www.drkellon.com |
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P.S. Another consideration here is whether you will be able to keep up the same level of exercise throughout the seasonal rise. Exercise (the more, the better) is the best tool for controlling insulin. If that drops, the effects of uncontrolled ACTH will magnify.
-- Eleanor in PA www.drkellon.com |
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Thank you sooo much again for all the feedback. I do not see any changes in Jewel ie excessive thirst etc so it’s hard to present the argument! I may just arbitrarily increase her dose by 0.5 mg thruout the rise anyhow if I can not get buy in from my vet. I did go back to my case history and my previous blood work IS there so I’m not sure why Lavinia said there was no glucose etc. I am so thankful for this group! -- -- Cheryl and Jewel Oct 2018 https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel https://ecir.groups.io/g/CaseHistory/album?id=81063 |
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Lavinia Fiscaletti
Hi Cheryl,
Sorry, you're right - somehow I just missed the last glucose result in the case history. -- Lavinia and George Too Nappi, George and Dante Over the Bridge Jan 05, RI ECIR Support Team |
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So IF I can get my vet on board with a prophylactic increase of pergolide during the seasonal rise, what seems to be the practice in the past for dosage increases given even tough Jewels acth remains within normal limits although it has doubled from 4 to 8 since her March value.As I spoke to her today, she’s thinking on it but admits not much experience with this process. I only want to prevent last years scenario and am worried -- Cheryl and Jewel Oct 2018 Port Alberni BC Canada https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel https://ecir.groups.io/g/CaseHistory/album?id=81063 |
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Given the history, I think a 1 mg increase is reasonable.
-- Eleanor in PA www.drkellon.com |
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Thank you. I will work on my vet. I have just uploaded an up to date case history but cant seem to delete to old one from March. Apologies
-- Cheryl and Jewel Oct 2018 Port Alberni BC Canada https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel https://ecir.groups.io/g/CaseHistory/album?id=81063 |
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Sherry Morse
Hi Cheryl, You couldn't delete the old case history because Tanna loaded it for you so I've done that. I also put the new case history in your folder - https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel%20Port%20Alberni%20BC%20Canada I'm not sure why but the link in your signature goes to the main CH folders listing so can you check that the above link is correct and if so put that one into your signature. Even though I moved it you're still the author on the current CH so when you go to update it next time you should be able to delete that file with no issues. Thanks, PA 2014 |
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Another example of why we need members to learn how to do this for themselves.
-- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President/Treasurer 2019-2020 Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA |
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