Help! Rising ACTH and Insulin


Suzy Berkowitz
 

On February 4 Scout’s ACTH was 29.7 and his insulin was 152.31. He started metformin that day with the recommended 30mg/kg. On February 25 his insulin had come down to 76.51. He seemed very comfortable. The past week or so walking a bit slower, so rechecked ACTH and insulin. March 31 results- ACTH is 33.9 and insulin is back up to 110.44.He has been on metformin all this time.  He has been on 2mg prascend since December after being on 1.5mg for years. He still has fat pads. My questions are should I increase his prascend now or can I safely wait till July before the start of the seasonal rise? Can I try increasing his metformin, have others tried dosing at higher than the 30mg/kg? Thank you.
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Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Sherry Morse
 

Hi Suzy,

Sorry - bunch of questions for you:

1 - how tall is Scout?
2 - how much is he currently being fed (weight of hay and any concentrates)
3 - is he on grass?
4 - when were the x-rays you posted taken?  Has he been trimmed since they were taken?

Metformin does stop working for some horses but we need a clearer picture of his diet as well as what his current trim situation is as pain can drive up insulin, as can increasing ACTH numbers.  Were he mine I would probably want to bump him up another .5mg and see if I could get the ACTH to go more towards the teens now and not wait until summer to try to get it under control.  However, I'd also want to get his diet as tight as possible now and make sure his trim is optimal to help get his insulin back in line as well.



Suzy Berkowitz
 

Hi Sherry,
1- Scout is 44”. About 400 lbs. He will be 30 years old in June.
2- he gets 1.25lbs stabul1 with flax and salt am/pm. 6 lbs triple crown Timothy balance cubes divided into 3 meals.
3- the paddock is about 1.5 acres, that he shares with Ziggy the mule. There is a heavily bedded two stall barn in the middle that they have free choice to go in and out. There is a mix of weeds/ grass. This is south Florida so nothing rich in there.
4- the newest set of x-rays were taken on Feb. 3. His latest trim was on March 18. He wears custom clogs up front.
Thanks


--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos: https://ecir.groups.io/g/CaseHistory/album?id=260915


Suzy Berkowitz
 

Hi Sherry. Typo on #2. The 1.25 lbs of stabul 1 is divided am/pm. 
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Lavinia Fiscaletti
 

Hi Suzy,

Were there any changes made to the trim after those Feb rads were taken?
Was he wearing clogs at the time of those rads or were they added after the rads were done?
Would you please get some hoof pix posted.

Thanks.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Kirsten Rasmussen
 

Hi Suzy,

I'm sure it's been mentioned before but your description of the paddock being a mix of weeds and grasses is a red flag when insulin is so high.  Even if it's not lush and green, stressed grasses and some weeds can have much higher sugar content.  It can take so little to trigger laminitis.  Can you make a smaller area next to the shelter completely grass/weed-free and see if that helps Scout?  I have my pole barn divided in 2 with panels and I keep my insulin resistant horse on the side where I scrupulously kill grass, and my non-IR boarder/companion horse on the other side where I don't fuss about killing grass.  The non-IR horse is also eating a different hay that my IR horse cannot tolerate so I have to keep them separate anyways.  They both come and go as they like in their 2 parallel paddocks, and can mutually groom over the steel panels.

I also agree with Sherry that increasing his pergolide is a good idea because 33.9 is high for March.  But the insulin going back up so high suggests to me that better dietary control might be needed.

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


Suzy Berkowitz
 

Hi Lavinia, the Feb x-rays were taken by the podiatrist who trimmed Scout’s feet and made the clogs for his front feet that day. He has taken over from my regular farrier. I will get some hoof pix. Thanks


--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos: https://ecir.groups.io/g/CaseHistory/album?id=260915


Suzy Berkowitz
 

Hi Kirsten, I will up Scout’s prascend by .5mg and retest in 3 weeks. Thanks


--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20Scout
Scout Photos: https://ecir.groups.io/g/CaseHistory/album?id=260915