Asking for input on test results (ACTH, Insulin) for Bella & Destiny
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lynnc66
Test results from Cornell for 1/21/21 show lower ACTH for both Bella and Destiny. And higher insulin for Bella. I've updated their Case Histories.
They are both on 0.5 mg of Prascend, and I'm considering continuing Bella's Prascend as per Dr. Kellon's input: "As I said before, the big unanswered question is whether these early cases benefit from pergolide year round. I don't know the answer but would probably be inclined to keep Bella on it because of her laminitis history."
And I'm not sure what's best for Destiny - to keep her on Prascend year round or not.
Brief summary:
Bella:
In Feb, Bella was diagnosed by vet with laminitis. Her feet are still sore, but much improved with boots. She stands square, with no founder stance. She walks around the dry lot and keeps up with the other horses.
Insulin >200 in July, 135.85 in Oct, >200 Jan 21, 2021
ACTH was 29.2 in Feb, 139 in Oct, 39.7 Jan 21, 2021
Destiny:
The vet called Destiny obese in February. I've been exercising her at the trot, about 25 minutes 3x/week, she has lost 75 lbs, and is at her ideal weight now. She is sound, no issues with laminitis.
Insulin > 200 in July, 31.67 in Oct, 39.4 Jan 21, 2021.
ACTH was 19.2 in Feb, 318 in Oct, 17.2 Jan 21, 2021
Asking for your input and advice please, especially on the following:
1) Dosage of Prascend for Bella
2) Keeping Destiny on Prascend year round?
3) Starting Bella on Metformin or Invokana
4) When to retest ACTH
Thank you,
Lynn Cox Kern County, CA May, 2007 Bella Case History https://ecir.groups.io/g/CaseHistory/files/Lynn%20and%20Bella |
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Bella needs a higher dose to get her ACTH well within normal. Repeat ACTH in 4 weeks. Try metformin first but if repeat insulin after a week is not dramatically better I'd go to Invokana.
Same fence-sitting on keeping Destiny on pergolide. Considering her age I'd probably take her off and repeat ACTH and insulin in 4 weeks. Put her back on early to mid August. -- Eleanor in PA www.drkellon.com |
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lynnc66
Thank you Dr. Kellon.
What would be the dosage of Metformin for Bella? She is currently 304 lbs. -- Lynn Cox |
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30 mg/kg - 4145 mg twice a day. Closest you get to that is eight of the 850 mg twice a day.
-- Eleanor in PA www.drkellon.com |
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lynnc66
Thank you Dr. Kellon. I have several bottles of 1,000 mg tablets left over from a horse now deceased. The bottle says discard after 6/30/23. Would it be okay to use those, or better to get new ones of 850 mg?
-- Lynn Cox |
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lynnc66
Thank you Dr. Kellon,
For the 1,000 mg tablets, shall I give 4 tablets, 2x/day -- or 4.5 tablets, 2x/day? And with the repeat insulin test, is it best to do with Cornell as previously, or can it be done with Antech? Much appreciated, -- Lynn Cox |
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Regarding switching labs: it's not ideal if you are comparing to previous data as the assay can sometimes differ and therefore numbers cannot be directly compared. We generally advise sticking with the same lab.
For Antech vs Cornell, specifically: https://ecir.groups.io/g/main/message/259507 Please note that the double-shipping of ACTH to Cornell via Antech increases the risk of reducing the result artificially if it degrades at all during the second shipping. You have no way of knowing if it did or not. At least if it is sent with glucose to Cornell directly from your vet, the glucose number will provide an indication of whether or not the sample was degraded during shipping. -- Kirsten and Shaku (IR) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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lynnc66
Thank you Kirsten, this is very helpful.
-- Lynn Cox |
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