Recent Bloodwork results- where should I go next?


Kelly Gilmartin
 

Dr K et al,
my initial metabolic panel is in from Cornell- still
awaiting TRH stim results- he always had a normal ACTH but was abnormal on stim. The same appears here. 

baseline ACTH 22.3 of/mL range 9-35
insulin 99.75 uiU/mL range 10-40
glucose 100 range (71-122)

what should I do next? Metformin? Invokana? Do horses get hypoglycemic on metformin? Welcome suggestions for getting insulin down as he is still not comfortable moving long term. 

Thanks
--
Kelly Gilmartin/Buddy
Western Massachusetts 
member since 2019
https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Apostrophe%20GCH/BuddyCaseHistoryAug2020.pdf

https://ecir.groups.io/g/CaseHistory/album?id=251736


Kelly Gilmartin
 


Kirsten Rasmussen
 

Hi Kelly,

Before jumping to meds for IR, you will want to make sure the basics are in place.  It's not clear to me from your Case History if Buddy is still on pasture, it says 0 hours in one place and 4 hrs in another.  If he is getting any grass or weeds, that needs to stop ASAP.   You can also soak his hay, at least until you can have it tested and confirmed to be low sugar.  His most recent high insulin is worrying and although I'm not sure if it was done before Aug 1, or after Aug 1 when his pasture was reduced/stopped, it is likely why he is laminitic.  Until these 2 basics are in place, we usually don't recommend meds.

The Insulin Wise may help a little, but if you look at the study used to promote it, it seems to me it has little effect (and possibly not at all for many of our members), but I don't think it's harmful (just $$$).  The vitamin C supplement (how many mg is 2 scoops?) will increase his iron absorption, which will worsen insulin so unless it's absolutely necessary for his joints I would not give it to an IR horse long term.  There are other supplements that can be given for joints.

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


Kirsten Rasmussen
 
Edited

As for the low T4, getting the IR under control should cause it to normalize. 

https://ecir.groups.io/g/main/files/1%20Start%20Here/1.%20New%20Member%20Primer.pdf

Specifically:

Hypothyroidism – Secondary to IR or Cushingʼs (PPID)
Primary hypothyroidism in horses is rare.  Low levels are most often secondary to primary IR or Cushingʼs. Symptoms are VERY nonspecific and many overlap considerably with those of insulin resistance and or Cushingʼs:
• slow shedding/longer than normal coat
• poor energy levels and exercise tolerance
• horse may be irritable and sensitive to touch.
Hypothyroidism cannot be diagnosed with any certainty by symptoms alone – blood tests are required. Measurement of both T3 and T4 is recommended. 
Treatment Options
Provision of adequate correctly balanced minerals in the diet to support thyroid function. Treatment of IR and/or PPID together with correct nutrition will usually result in normalization of hormone levels.  Provision of a thyroid supplement such as Thyro-L (levothyroxine sodium) at levels sufficient to restore normal readings, at least initially.  Despite the fact that the weight of the evidence points to hypothyroidism as being secondary to IR/ PPID rather than related to any primary pathology of the thyroid gland, the use of Thyro-L remains popular among practitioners, often because of favorable clinical responses in terms of energy level and attitude. If thyroid supplementation is used, it should be done only with frequent monitoring to avoid over supplementation, keeping T4 and T3 within normal limits and with the realization that endogenous production of thyroid hormone may well normalize as the metabolic syndrome comes under control.  Because supplementation suppresses the horse's own production of thyroid hormones, a very slow tapering of
supplementation is advisable as clinical status and insulin results improve.

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


 

To pinpoint Kirsten's excellent information:

Measurement of both T3 and T4 is recommended.  
Treatment Options
...adequate, correctly-balanced, minerals in the diet to support thyroid function...

When my underfed Paint first came here ribby and hippy, 150 lbs underweight, her T4 was 0.164. The last thing she needed was Thyrol-L.

It is critical to get Buddy's diet balanced. I see no evidence in Buddy's case history that he is getting essential trace elements in his diet, including  iodine -- important to thyroid function. Here is the list of trained diet balancers. Optimum nutrition -- not more nutrition -- makes a huge difference to our horses.
https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING.pdf 

As for his body condition score, would you add a set of clear body shots in your photo album? Instructions and angles are at the bottom of this link: https://ecir.groups.io/g/main/wiki/1472 

P.S. It is so much easier for ECIR volunteers to answer your questions if you update your signature to include your case history folder. Here is the link. Copy it and replace the one in your automatic signature. Don't forget to SAVE the change. 
https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Apostrophe%20GCH

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 


Kelly Gilmartin
 

Hi Kristen-
he is no longer on pasture at all. He is in his large dry run out. I have a hay test at Equianalytical and will be workigg by with Kathleen Gustafson to balance. His iron levels are really high so although I am trying to get things in order I am very overwhelmed.  He gains weight on nothing and I know I need to get weight off him but can’t move him yet. Iron, insulin and weight needs to come down and I don’t know how to do this at the moment.
--
Kelly Gilmartin/Buddy
Western Massachusetts 
member since 2019
https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Apostrophe%20GCH/BuddyCaseHistoryAug2020.pdf

https://ecir.groups.io/g/CaseHistory/album?id=251736


Sherry Morse
 

Hi Kelly,

Are you soaking the hay while waiting for the test results to come back?  Weighing the hay? For these IR horses it's really important that they be getting exactly the right amount of food - which for Buddy would be 18lbs a day TOTAL including the hay and the Speedibeet.  So if he's getting 2/3 of a pound of Speedibeet, you need to make sure his hay is limited to no more than 19.3 pounds a day.

I'd also think he might be a candidate for Metformin but you need to give the diet changes a chance to work and if you've just instituted a reduction in hay it's going to take a bit of time to see results from that.




 
Edited

Hi Kelly,
I’m not sure what happened to the link to your case history.  It took me to the general files listing.
I located your case history where it should be and this is the link you should use.  It’s actually for the folder, which is a good place to link to as you can add additional files to this folder and we’ll still be able to find them.

https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Apostrophe%20GCH

Edited to add:  The one is this folder is maybe not the most recent one.  I found another one loose in the general files folder.  The loose one should be moved to your folder.  One of us can help with that if you don’t know how.  Once in your folder, you will want to delete the older file.

Thanks!

--

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