I’ve been changing Dutch’s diet over the last couple of weeks. He now gets 11 lbs. a day in 4 feedings. It’s made up of half TBS’s and half LMF Low Carb Complete. I intend to keep lowering the Low Carb and increasing the TBC’s but since he hasn’t had much besides pelleted feed for a long time I’m moving cautiously.  I’m using small amounts of Low Carb for treats and have cut out any other feeds. He is now getting Thyro L 2 scoops a day and has lost some weight but as usual the cresty neck and fat pads on his rump appear unchanged. The vet commented that his crest looks larger but I think that’s because the overall weight loss makes it stand out more.

I had a trim done and repeated his x-rays. The angles look better but I am still having trouble with farriers not doing what I ask (GROWL) as in no shoes. They insist on putting shoes on with a pad. He does appear much more comfortable after the newer trim and shoes. I have an appointment in 4 weeks with a new farrier who works directly with my vet to reevaluate his trim and discuss the shoes. I’m letting him out of his stall into a very small enclosure for a couple of hours a day. It’s helping to keep him from going stir crazy. I’m hand walking him for 10 to 15 minutes in a sandy arena. There’s no evidence of unsoundness at the walk and he’s turning fine on a small circle.

I repeated his glucose and insulin 2 days ago. We drew the sample 5 hours after his last meal. I will update my case history with the new information but the results show glucose is 53 mg/dL and insulin is 108 uU/ml.  I’m wondering what I should do next.  The glucose seems low and I’d like to see the insulin closer to the normal range. What should I do next? 

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Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

Hi Rebecca,

Agree that with the glucose number being that low it is suspicious for mishandling. It looks like the insulin is responding to the increase in ODTB cubes and lessening of the LMF Carb Complete but that there is still too much of the grain for his metabolism to deal with it. Keep increasing the amount of hay cubes while removing the grain. Thyro-L doesn't usually help lessen crests and the regional adiposity of EMS, although it can help jump start overall weight loss when simply feeding appropriate amounts doesn't do the trick. If his weight is correct, then increasing/keeping him on the Thyro-L probably isn't warranted - something to discuss with your vet. Temporarily adding Metformin to address the high insulin while you are continuing to make the diet switch might be something else to discuss with your vet.

So frustrating when the farrier isn't listening. As you are the person paying the bill, it can be very effective if when you say No Shoes and shoes get applied, you don't pay for the shoes. Are the latest radiographs (dated 4/23) in Dutch's photo album? Were the feet trimmed before or after the rads were done? Are the 4/23 photos from before or after the trim? One concerning thing I see in the photos is obvious rasp marks across the soles in the front half of the foot - an area which is already too thin. Given that he has thin soles, I would expect him to be more comfortable with the pads and shoes as they are padding his soles from ground contact and lifting the entire bottom of the foot higher off the ground - but at the cost of suspending him entirely from his walls and laminar connections, which are already weakened from the laminitis. As you know, you can accomplish the same thing, but in an overall healthier manor, by using padded boots.

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Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

I'm a bit confused about the Low Carb Complete as its listed as a safe feed in the list. It's supposed to be grain free and sugar at 2% and starch at 6%. I know we don't trust these to be consistent across batches but does the ECIR not trust this feed at all? I'm moving toward all TBCs but with his history I'm going to move slowly. 
Scheduled a farrier that works with my vet to come out at the same time as my vet. I'll make sure to show them your comments. We're starting Metformin today and will repeat blood work when the farrier comes.
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Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

i've eliminated the Stable Mix entirely. I'm only feeding the TBCs and LMF Low Carb Complete. I've transitioned to a little more than half TBSCs and Low Carb Complete for the rest. That's all he is eating now. No treats or grass.
Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

LMF has several feeds with similar names, but they aren't all safe. Maybe that's what's causing confusion.

The LMF feeds on the Safe Bagged Feeds List  https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/Safe%20Bagged%20Feeds.pdf are:
LMF Low NSC Stage 1
LMF Low NSC Complete

There is another LMF feed call LMF  Senior Low Carb that is NOT on the safe feeds list.   "LMF Low Carb Complete" is a combination of names that doesn't exist. That may be causing confusion.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

No, I'm not confusing them. Only TBCs and Low Carb Complete in his food now By my analysis I'm a little confused about iron. There's none in the TBCs and none added to the Low Carb Complete. I'm sure there's some in the Low Carb but none listed. This throws my ratios off at least the iron, copper, zinc and manganese. Is this a problem?
Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .

I'm feeding the Low NSC Complete. Not the Senior.
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Rebecca
July 2009, Sacramento, California
Case History, https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Dutch%20-%20Snuggles/Dutch  .
Dutch Photos, https://ecir.groups.io/g/CaseHistory/album?id=857  .