Topics

Logan Insulin increase


Nancy C
 

It could explain why some horses are not as sick as we might expect them to be but it's not a reason to not treat because that high ACTH is a marker of the disease and how well, or not, it is controlled.
This is a fundamental reason why ECIR Group needs the details of a Case History. Just one of many fundamental reasons why.

The devil is in the details.


--
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


Eleanor Kellon, VMD
 

LJ,

There are only 2 studies on this. The first from 1982 and a second in 2011 which hasn't actually been formally published. https://www.tapatalk.com/groups/thelaminitissite/acth-bioactive-v-immunoreactive-t19.html

They show that there are ACTH forms or ACTH-like substances in the pituitary of PPID horses that do not have the same hormonal activity but will cross-react on antibody based test assays.

This does NOT mean you can ignore the number. For one thing, the high number means that the pituitary intermediate lobe has uncontrolled output. It may not be all active ACTH but some certainly is and there are other active hormones being overproduced as well. It could explain why some horses are not as sick as we might expect them to be but it's not a reason to not treat because that high ACTH is a marker of the disease and how well, or not, it is controlled.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


LJ Friedman
 

RE: inactive acth.
  I see this phrase being used only just recently... Is this new data that says we cant solely look at an acth number to see if we need to raise our ppid meds?  for ex...  there are no signs of colic, hair growth etc,,, and acth is high... Must the inactive be taken into account when deciding if an increase is needed??
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Kirsten Rasmussen
 

Hi Irene, 

-high insulin
-colicky episodes
-hamstring issues
-classic signs of PPID (loss of topline, long coat, etc)

Based on what I've read in this group, these signs all suggest to me that an increase in pergolide is warranted.  You might not be able to use ACTH as a marker for how well Logan's PPID is controlled (ie, if some or all of that ACTH value is from an inactive form of the hormone), and instead you need to look for improvement in the above signs to know whether his dosage is correct.  If he has high insulin (yes he does; share the above explanations for the Cornell insulin range with your vet), hamstring issues, and colicking problems these are things your vet should take seriously.  A trial increase in pergolide needs to be considered.  That's assuming that what you are already giving him is being stored properly and that he is getting the full dose...review his medication storage and dosing with the barn staff.

If your vet is not supportive, you might want to share with him/her the ECIR database on high pergolide dosages.  See this recent topic for more info:
https://ecir.groups.io/g/main/topic/69667617

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Eleanor Kellon, VMD
 

Good explanation, Amy.  The insulin of 80 (give or take) is an estimate for triggering an acute episode but there is smoldering damage going on with high insulins even if the horse does not show an acute episode.

The 4 hour wait after first  meal of the day is not needed if the horse had access to hay or pasture overnight.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001


LJ Friedman
 

might u consider a switch of 8 or 9 mg of cp?
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Amy Veatch
 

The 10 - 40 uIU/mL on the Cornell lab report got me too. Ive been doing a lot of reading in the files and here is what ive gathered so far: turns out tge Cornell range (reference interval) is a reference range not a normal range (although it looks like one the way it's used in the report). You can search "VA Tech pony proxies" in the files and you will get info on what a normal range should look like, i.e.  less than 10-12 uIU/mL. From what i have read in the files, the lab reference range or interval Cornell cites includes all sorts of testing conditions that can increase insulin , such as: recent exercise before blood draw, recent high sugar and/ or starch meal, sudden cold temps, stress, etc. I'm sure there are lots of other factors more knowledgeable peeps can fill you in on.  The VA Tech pony study established a safe insulin range for both previously laminitic and non-laminitic ponies to keep them from slipping into endocrinopathic laminitis triggered by high insulin (i think i read somehere where Dr. K said that 80 uIU/mL was the tipping point there, but we'll see if someone else can give us confirmation on that. The  thing about the Cornell lab reference range is that it doesnt use any proxies to determine normal.  Their numbers are not adjusted to compensate for various feed/exercise etc. scenarios at the time of testing (and im not sure how one could normalize that kind of uncontrolled data anyway since there arent any standard calculations to adjust insulin results from all the various feeding and exercise states of the horses they tested. The pony proxies, on the other hand, provide a normal range when testing occurs in a fairly controlled and repeatable way--blood draw 4 to 6 hours after 1st meal of the day and horse steadily eating hay the whole time right up to blood draw.

I hope that helps and that someone will jump in if I've misstated anything.
--
Amy & Princess (12 year old KY Mtn Saddle mare) & Max (6 year old mini gelding) - both PPID/IR
Southeast TN, Joined 2019

Max:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=134444&p=Name,,,20,1,0,0

Princess:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Pincess

https://ecir.groups.io/g/CaseHistory/album?id=96097

 



Lorna Cane
 

Irene, I only see 5mg of compounded pergolide reported in Logan's CH . Do you have current data to add, there and in other areas of the Case History?
Just wondering about the 2mg Prascend you mention in your message.

--

Lorna  in Eastern  Ontario
2002


 


Lorna Cane
 

Hi Irene,

Check out Dr. Kellon's explanation of 'nornal insulin'.
https://ecir.groups.io/g/main/message/245673?p=,,,100,0,0,0::Created,,normal+insulin,100,2,0,69649901

--

Lorna  in Eastern  Ontario
2002


 


Irene Collins-Fotino
 

Hi Sherry,

Logan is on 2 mg Prascend and 5 mg Pergolide from Pet Health Pharmacy.
The vet is reluctant to increase his dosage. 
I doubt that the barn staff will r/s/r the beet pulp. I have asked before, but it
was not a welcomed suggestion. 

Best,

- Irene
--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan


Irene Collins-Fotino
 

Hi All,

Please disregard that prevous email, it got away from me:

Hi Amy,

I'm not sure I understand your first sentence especially the part about that 10-11 is the target max.
The only thing I would add (besides I'm kind of surprised his insulin has been as close as it has to normal (keeping in mind that 10-11 is the target max) in the past with his ACTH numbers--wow!  those are really high)
The target range for insulin is 10-40. No he is not eating bananas or any treats as far as I know. 
Everyone at the barn knows he is a "no treat" horse. Of course we do get visitors from time to time
so that is an unknown. He does occasionally pull me and others to grass, but that is a momentary
issue. 

You're right  - his ACTH numbers are crazy high. I'm still trying to understand Dr. Kellon's remark
that there are horses with high ACTH that are "biologically inactive". I asked my vet about this
also and she said that he IS showing biological signs i.e., longer hair, insulin increase, dropped 
back (although his topline has increased substanially with the TriAmino acids). So if anyone
can explain this further, I would so appreciate it!

He seems to be doing well. I'm back to riding him - he has an issue with right-rear hamstrings,
so we are trying to be careful to work those. He has lots of energy.
I'm looking for some suggestions to replace the InsulinWise. 

Thank you all so much!
--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan


Irene Collins-Fotino
 

Hi Amy,

I'm not sure I understand your first sentence especially the part about that 10-11 is the target max.
The only thing I would add (besides I'm kind of surprised his insulin has been as close as it has to normal (keeping in mind that 10-11 is the target max) in the past with his ACTH numbers--wow!  those are really high)
The target range for insulin is 10-40. No he is not eating bananas or any treats as far as I know. 
Everyone at the barn knows he is a "no treat" horse. Of course we do get visitors from time to time
so that is an unknown. He does occasionally pull me and others to grass, but that is a momentary
issue. 

You're right  - his ACTH numbers are crazy high. I'm still trying to understand Dr. Kellon's remark
that there are horses with high ACTH that are "biologically inactive". I asked my vet 
He seems to be doing well. I'm back to riding him - he has an issue with right-rear hamstrings,
so we are trying to be careful to work those. He has lots of energy.
I'm looking for some suggestions to replace the InsulinWise. 
 
--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan


Sherry Morse
 

Hi Irene,

Is Logan on pergolide or Prascend at this point in time?  If not he needs to be as that could be making his IR worse no matter what his diet is.  The beet pulp could be R/S/R even without molasses in it, but I would look to get that ACTH number under control as soon as possible.




Amy Veatch
 

Hi Irene,
The only thing I would add (besides I'm kind of surprised his insulin has been as close as it has to normal (keeping in mind that 10-11 is the target max) in the past with his ACTH numbers--wow!  those are really high) is that I noticed he stopped receiving yummy bananas in June 2018 (apparently after an insulin result in the 80's) and that in the months afterward his insulin dropped significantly.  Is there any chance a good-intentioned but poorly-informed someone at your barn is slipping him treats without your knowledge? Just looking at those numbers and comparing his feed history, it looks like he might have snuck back on the banana train. :-)

--
Amy & Princess (12 year old KY Mtn Saddle mare) & Max (6 year old mini gelding) - both PPID/IR
Southeast TN, Joined 2019

Max:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Max
https://ecir.groups.io/g/CaseHistory/album?id=134444&p=Name,,,20,1,0,0

Princess:

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Pincess

https://ecir.groups.io/g/CaseHistory/album?id=96097

 



Irene Collins-Fotino
 

Hi Sherry and Martha,

I will put all of this into Logan's CH but for now here is what I have:

most recent blood work was sampled on 11/12/19 and finalized on 11/20 at Cornell:

glucose    103   range 71-122
lipemia     5   normal <30
hemolysis    6   normal <20
icterus    1   

ACTH  >1250
Insulin   55.47   range  10-40

Previous bloodwork is in his CH. 

His feed now - recommended by Dr. Kellon in October is:

6 pounds of ODTB cubes. These are soaked in hot water. He likes them warm
   and wet, but not sloppy wet
4 pounds of Stabul 1
4 pounds of beet pulp      These do not contain molasses. They are soaked in not water, but
   not R,S,R

The vet is usually at our barn in the morning, but he probably had his morning meal of
beet pulp, Stabul 1 and cubes piror to the blood draw.

Thank you so much,
--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan


 

Irene, I wasn’t able to pick this up from Logan’s case history but is there a reason you and your vet haven’t increased his pergolide any further?  My horse, Logo, would have colicky episodes before putting him on pergolide which my vet attributed to ulcers.  I could give him a small amount of cimetidine when he was having those spells and in 20 minutes he was fine.  
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sherry Morse
 

Hi Irene,

You can do a search in the messages for Insulinwise but off the top of my head most people haven't had any luck with using it.  It would be very helpful to us if you could update your case history with what Logan is currently eating as well as the test results because in looking it over I see a few things that could be tightened up in his diet but I don't know if that data is accurate or not.  One thing it would be helpful to know is when was his most recent bloodwork done (not only the date but time of day and when was it in relation to being fed a grain meal).



Irene Collins-Fotino
 

HI all,

Logan's recent blood work shows an inrease in insulin to 55.74 from 17.81. ACTH is still
off the charts. Other blood work is within normal limits. I will post an updatated CH soon. 
I started him on InsulinWise per our vet and he has been on that for about a month.
Has anyone had experience with this product from Kentucky Performance and is there another
product that you prefer? 

He had another colicky episode this past weekend. Perhaps it's my imagination and not sure
what your thoughts are, but when he presents with colicky signs, I give him an acupressure
treatment which seems to help. This last time, he bounced back within a very short period of
time - before the vet arrived. I told her what I had done and asked what she thought and 
surprisingly she responded positively and said that he looked much better than she was
expecting.  He received a very brief rectal bowel clear and two hours of fluids and was himself. 

Thanks in advance for any thoughts, suggestions etc.

--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan