Metformin-When do you figure out if enough is enough.


Kandace Krause
 

Thanks in advance for help,
While metformin is relatively inexpensive, it is most definately a pain to administer and hard on my horse.  If it causes mouth ulcers what is it doing to her stomach.  I do not own a barn coat not covered with spit out.

My question is about how long to keep up administering it.  On Dec 10, insulin was 46.22 and then horse seemed to have another laminitis session.  In clinic started on Metformin in Clinic and is now at end of week three.  She was tested at end of week two, just prior to release back to me and results back up to about 65 (waiting for papers).  Since she was just into the Nanric ultimates and still obviously sore and uncomfortable, I would think that this number is scewed too high.  Vet recommends keeping her on it, but I see a very unhappy horse.  Much of what I find on topic is a few weeks improvement should be seen then discontinue it.
She will not eat BP with the new minerals tho she is very happy with her hay, so it isn't an inappetence.   As life for her is quite miserable as it is, it would be great to be able to take away one more discomfort for her.

--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


 

Kandace, 
You're right: factors other than uncontrolled EMS could be elevating your horse's insulin:  cold weather and pain. Pain can also make a horse fussy about eating supplements. That is a kind on inappetence. We have no way of knowing which factors are at work here. The only way I know to check the effect of metformin is an insulin blood test done with all the details described toward the bottom of this web page on Equine Metabolic Syndrome: https://www.ecirhorse.org/DDT+E-diagnosis.php

I do agree that syringing metformin is no fun. Please you ask your vet the dose of metformin that was prescribed. There is no point to going through the aggravation of syringing unpleasant tasting medication twice daily if the dose isn't sufficient. Here is the information file on metformin, including dose. https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf If you choose to continue metformin, consider syringing metformin using wild cherry-flavored milk of magnesia as a carrier. My horse had no mouth ulcers at all after I used milk of magnesia. Details in this post: https://ecir.groups.io/g/main/message/256392  
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


 

Kandace, another factor which could elevate insulin is uncontrolled PPID.  Your last testing for ACTH was Dec ‘20 (you may want to check the date as you have ‘21 entered) was mostly out of the rise but still well above normal.
--
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


 
 


TERRI JENNINGS
 

Hi Kandace,
I still have stains on multiple barn shirts from cocosoya oil I used as a carrier for Finn and Elliott. I even had a huge flare up of carpal tunnel from grinding so many pills. I was kind of happy when it stopped working but I did know that it was likely that my vet would get on board with prescribing Invokana.  Teeny was happy to eat her metformin in her hay soup and it did continue to work for her right up to her end but I know that is not what typically happens. Is your vet willing to try invokana if the metformin stops working?  I remember scheduling bloodwork to prove to my vet that it wasn’t working.  I was kind of  hoping it had stopped so we could be done with metformin.  After a few months on invokana my metformin days seem so long ago.  

--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Jennifer Murphy
 

My little mule has gone up and down over the course of the last 3 years.  In 2020, we drew blood 6 times.  4 of those times showed insulin over 200, two of the tests showed insulin well over 100.  All that time he was on a strict diet and Metformin.  He would pick at his food, but he'd eat at least 80-90% of it, so he was definitely getting some quantity of the Metformin into him, and for the last six months he only had 2 days that he didn't get any at all.  The numbers just proved it wasn't working in any capacity, and it was time to go a different route.
--
Jennifer in NH
2020

CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea

Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0


Kandace Krause
 

Thx Martha
We have upped pergolide again.  Now at 1.5 tablets one day and 2 tablets the next, repeat.
Kandace
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kandace Krause
 

Thx Terry,
Invokana has not been discussed.  I have seen it mentioned here but know nothing about it.  I did say no to Metformin at first and now months later I am doing it.  Is it possible it is not available in Canada?  I will check this out after finishing reviews.
I have and the cost seems very prohibitive.  
Kandace
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kandace Krause
 

Thx Cass,
I will use the Milk of Magnesia, does this change needs of adding Magnesium to food?
I am sending Metformin info to my vet, as well as the human drug use sheet I got when I bought medication at human pharmacy.
I am using 500mg tablets at 27 per dose.
How can I tell about impact of cold?  Honestly I don't think this is part of problem, but we are cold now and expecting two more months of temps below 5 and 20 degrees below zero F for the next few months so I want to know what I am seeing.  She appears to be more mobile now that both boots are back on and protected from pull off with bell boots.
Kandace
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


 

On Mon, Jan 25, 2021 at 08:01 PM, Kandace Krause wrote:
>will use the Milk of Magnesia, does this change needs of adding Magnesium to food?

The short answer is...I don't know for sure, but I seriously doubt it. There's a nice chart in this article reporting 167 mg magnesium in 5 ml oral suspension of milk of magnesia. https://www.aafp.org/afp/2009/0715/p157.html  I used between 20 and 30 ml for each dose, for a total of between 40 to 60 ml/day The range of added magnesium --- not accounting for bioavailability --- is only 1.3 - 2 grams of magnesium. The amount of magnesium needed to balance the diet requires a look at everything in the diet, which is beyond my scope as a volunteer moderator. All three of the hays in your folder have very low magnesium, and I seriously doubt milk of magnesia would add nearly enough magnesium to make up the deficiency or affect any diet balancing you've done.

>How can I tell about impact of cold?
I can think of three ways. One is to see if insulin blood tests show higher insulin during cold weather seasons. I live in a mild climate, and even I get higher insulin labs during our colder weather in December and January. The others are to watch for symptoms of high insulin and/or cold induced laminitis. Start here for a list of symptoms. https://www.ecirhorse.org/Equine-Metabolic-Syndrome-overview.php It's not always easy to see them in winter conditions. What I usually observe is delayed: hoof wall separation that only becomes visible in a few months when it's grown out to ground level. Cold-induced laminitis should be obvious. Sounds like you're already taking proactive steps to avoid it.
 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Kandace Krause
 

Cass, sorry so much going on I can't keep up..
M of M is seeming to reverse violent rejection of syringing.  Two of the three hays have actual mineral ass.so I will trust that mag. is low.  I am sort of making progress on getting minerals added back to her feed (she has been rejecting BP but seems slightly more interested now.)  So I will add magnesium oxide next to her BP.

I give up on cold.  it is cold, period.  she doen't appear to need socks, laminitis is for sure endocronic induced with a neglected long toe as catalyst.

--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Lorna Cane
 

On Wed, Jan 27, 2021 at 03:27 PM, Kandace Krause wrote:
I give up on cold.  it is cold, period.  she doen't appear to need socks, laminitis is for sure endocronic induced with a neglected long toe as catalyst.
Just don't ignore the idea altogether,ok?
It could be something more to try when you're at your wit's end, looking for better results with comfort level.
Many people have found keeping the legs/feet warm works wonders. Not something that is conventionally thought of, but then this isn't necessarily a conventional group. We just stick with  what works.
 
--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Nancy C
 

On Wed, Jan 27, 2021 at 03:27 PM, Kandace Krause wrote:
I give up on cold.  it is cold, period.  she doen't appear to need socks, laminitis is for sure endocronic induced with a neglected long toe as catalyst.

Sorry, Kandace. I may have missed something.  You've tried recommendations for cold - eg., Socks -- and they have not worked?

Let me know if you'd like links as to why this works.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2021 NO Laminitis! Conference, August 12-15, Harrisburg, PA


Kandace Krause
 

Lorna and Nancy C.
I must not be making myself clear.  I haven't tried the sock thing, I am wondering how I would know if horse wants/needs them.  She has these giant things on the bottom of her legs (NANRIC boots)  I cannot remove them.  I could try something, lined shipping boots, leg wraps, or something, but what I am trying to find out is there a sign that tells me this would help?  She doesn't appear cold, the NANRIC's are of a material that would offer insulation to soles and hovves themselves, plus there is a felt pad in between hoof and boot.
I guess I want to know if you are seeing a sign that it is better for your horses?  If I do something, how will I know if it is helping?   How can you tell they are more comfortable?
I am not dealing with winter laminitis, it is rotation of p3.  Does this make sense?
Kandace
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Lorna Cane
 

Hi Kandace,

Sorry for confusion.
Can you tell us any signs of discomfort that you see?
Any part of body,or whole body,anything?
Or anything that you think isn't quite right?

Point form would work,I think.
Let's try to nail this down.

Quick answer about warmth in feet/legs....it is well known here that keeping the feet/legs warm can add siginicantly to the horse's comfort.Might mean horse walks better.Might mean she stands more comfortably,for example. Or other.

Lots of people don't think of this area needing to be warmed. But in our compromised horses it's a frequent choice.

I guess,if it were me,and there were anything I thought I could make better in this regard,but didn't know what,I would use boots/wool socks and wraps(shipping boots) and watch to see if I noticed anything different because of the warmth.

You can't add boots because of the appliances on her hooves,but if she were mine,I would add fleece-lined shipping boots.
Can't hurt, might help, based on what we have found here.


--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Cindy Giovanetti
 

How do you know if your horse needs socks or boots for warmth?  I think the idea is that if they come down with laminitis in the winter and there’s no other change in their care, you assume it’s because of poor circulation to the extremities caused by the cold, which you can alleviate by keeping their extremities warm.  It’s something to try anytime you have winter laminitis.

 

Cindy


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Kandace Krause
 

Hi Lorna,
Well crap just keeps happening as "K" has pulled off one of the heavy NANRIC boots overnight.  This is not new, she has done this off and on sh=ince getting them, seems as she stands her self up, she muct step onto the back and pull it right off.  A lot of stress in that because they are wrapped up hoof in casting material, plater of paris stuff.  And glue.  All has to be removed to reinstall the boot.  As they currently have a rocker base built on to them for angles, they are very heavy and high so point form of discomfort is

- as front end is now three inches higher than rear, she steps funny.
- as she is on total stall rest how bad it really is is not know
- the boots are also very heavy so she tends to drag them a bit
- as only one hoof shows signs of seperation and rotation, turning in that direction is harder 
None of these lead me to think she needs warmth.
Today, sans one boot
- She will now be lopsided as my Cloud boot is still 2 inches different height and many pounds lighter
- She was shifting her weight a lot this a.m. but on her back feet, resting one and then seconds later resting the other.

Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kandace Krause
 

Thanks Cindy,
As you explain, This was my initial take away and since I didn't qualify on any points I did not cover, but I kept reading more and more and getting less and less sure of my decision.
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Lorna Cane
 

Hi Kandace,

We need Lavinia here.
But I'll just offer that for me this would be a good time to remove the remaining device as well .
Make lemonade.🤗
From what you have said about this happening frequently,my thoughts are that there needs to be a Plan B.

Take pictures of her feet, if you do remove the other appliance,  according to guidelines here,and post them (sorry,I need to go to her album to see most recent pics),for input from hoof people.

My guess is that she's shifting weight behind because she's trying to get weight off  the discomfort in front.

I'm not understanding why you think this, ahem, event has anything to do with her need for warmth in her lower legs/ feet, so I'll defer to others on this.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Kandace Krause
 

Hi Lorna,
CH updated as best as possible.
Re NANRICS and removal, I did question that on the last pulled off replacement date and my vet said , well we are started down this route so...
I felt then it was best and am guessing that with the boots on, in casting the hoof is being contained and there fore new growth is held in place without opportunity to be changed due to trauma's big or small with minor protections IE Cloud or soft ride boots.
Does that make sense?
I am waiting to hear back from my farrier to see if he is willing to come here and replace this boot.  As opposed to vet who also drives as far but charges farm visit etc etc etc...  Both vet and I think that farrier is less expensive option.  Vet clinic has a Dr. Ric Redden trained vet podiatrist and I believe their farrier who originally put these boots on and did trimming has learned from Dr. Redden also.
--
Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Lorna Cane
 

Hi Kandace,

Just a quickie.
No, your thoughts about the advantages of the devices she has on her feet don't make sense to me. I know it is a common belief,and I'm not there on the ground,so.....
For me,having compromised feet bare,using boots/pads for protection is the way to go. The advantages are that the entire hoof can be seen, and it is possible to judge what trimming corrections....rehab....can be made. Frequent trimming is often needed in rehab situations. Also,the hoof is unencumbered wrt growth.
Five of my then-9 horses sloughed all of their hooves, one winter years ago. I did have casts (nothing more) applied to the fronts of one of the boys.They made an impressive improvement in his comfort level.
For a while.
My mistake was that we left them on for too long at a time,between trims. His trim needed to be adjusted frequently....oh,and the other  mistake was that his trim wasn't where it should have been before casts were even applied.
Maybe my errors can help someone else.

Thanks for heads up about your updated case history.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php