Dr. Kellon - request for clarification of diabetes and pancreatic dysfunction in lab results

Cindy M

Mary Ann,
As an aside, you could probably improve Rosie's acceptance of needles by working on it with Positive Reinforcement training. It's worked well for me with several horses. If you email me privately, I may be able to put you in touch with someone in Nova Scotia who uses that approach. maddogranch@...
Cindy Martin
Nov 2009
Lincoln, AR
Scout Case History

Mary Ann

Thank you for the information. I will review this and discuss it with my vet. 

Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020

Eleanor Kellon, VMD

Nancy has answered the majority of your questions. I want to first focus on the sedation. It is well known that this drug causes a rise in glucose and insulin suppression and after two hours or so that reverses. Either way, you cannot get accurate results in the sedated horse. This is the most recent study: https://www.sciencedirect.com/science/article/pii/S1090023321000058?via%3Dihub .

As for excitement causing an ACTH increase, it doesn't. Taking blood does not cause a rise in ACTH regardless of excitement level https://pubmed.ncbi.nlm.nih.gov/26246396/ .  Response to stressors like a twitch or an injection of epinephrine only lasts 5 to 10 minutes. https://www.sciencedirect.com/science/article/pii/S0737080618307366

As for diabetes in horses, you may not need that information after all but if your vet does a basic PubMed search she will find several papers. I just posted two recently where they were also hypertriglyceridemic.

Pergolide dose is highly individual. The animal should get the dose that controls the ACTH.
Eleanor in PA

EC Owner 2001

Kirsten Rasmussen

This us a summary of known effects of sedatives on insulin, glucose and ACTH.

I wonder if the use of the dorm is affecting Rosie's insulin and glucose results?  Could you ask your vet to try sedating with Valium before her appointment?  It is the least likely to affect insulin, glucose and ACTH.

I too tested my soaked hay.  I dried it in the oven on the lowest setting ("warming") I have before mailing it.  It should be dry for the lab.

While in Canada the recommended upper dose for Prascend is 2mg, in the US, the package insert says Prascend can be increased to 3mg, and in the UK it say it can be increased to 5 mg.  It is a regulatory issue, not a safety issue.

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

Nancy C

Hi Mary Ann

Not Dr Kellon, but I had a diabetic gelding.  I can offer some info for you.

PubMed quite a few studies on diabetes in horses. https://www.google.com/search?client=firefox-b-1-d&q=equine+diabetes+pubmed

While not the majority of horses, there are many that have been reported here.  Searching on diabetes in the case history sub group brings up a number of case histories that mention diabetes.  https://ecir.groups.io/g/CaseHistory/filessearch?p=name%2C%2C%2C100%2C1%2C0%2C0&q=diabetes

Your horse is IR as well as PPID. The ingredients in the senior feeds can make the IR worse, specifically fat, inverted omega 3 and 6, iron and manganese. The use of ground wheat as the starch would give me pause. As far as I can tell they do not list the starch guarantee. Here are a couple of links to explain other aspects of your questions.

Soaking hay originated here in 2002 or so. Retesting a hay crop what will be soaked long term is the recommendation. You would need to resample the soaked/dried hay and send to the lab. In 2012, I found major reduction in ESC, potassium and iron.  All good news which allowed me to more correctly and tightly balance my rations.

We have many horses on pergolide at doses higher than the label. My gelding got as high as 14 mg. Here is a link to some of the ECIR historical data. https://ecir.groups.io/g/main/wiki/1484

Dr Kellon will be reviewing current and potential medications in two of her presentations at the NO Laminitis! Conference. in two weeks. AAVSB RACE approved veterinary credits are available.  www.nolaminitis.org

I can't speak to pancreatic exhaustion specifically but I suspect the goal would still be to make the insulin sensitivity as good as possible, with diet as a core element.

Hope this helps.
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room

Mary Ann

Dr. Kellon,
I had a one hour consult with my vet today and she would like to get some clarification on some of the topics we discussed about Rosie's high ACTH, insulin and glucose numbers. Are there other blood tests in addition to the endogenous ACTH test you would recommend I have done, and why? Can you elaborate on Rosie's latest lab results and the comment that her bloodwork "is consistent with advanced, untreated PPID with pancreatic exhaustion and diabetes"? Can you recommend recent literature that I can provide to my vet that indicates diabetes is found in horses and also recommendations for treating diabetes and pancreatic exhaustion? Can you explain why certain ingredients in senior pelleted feeds (such as Purina Superfibra Integri-T) are not suitable for a horse with advanced/uncontrolled PPID and why? Can you give some details as to why a specific amount and/or type of fat in the diet of an aged PPID horse may not be beneficial?

Due to my mare's aversion to needles, she has been consistently sedated 45 minutes prior to the vet's arrival with Dorm gel (1 mg dose). This allows the vet to perform oral and eye exams and administer vaccines and/or draw blood samples with great ease. She can become extremely agitated as soon as the vet arrives and they begin working on her. This heightened state of anxiety alone can cause a significant rise in cortisol release which, in addition to the sedation, can lead to much higher ACTH levels (according to my vet). She wants to do the next bloodwork in September as that is the month is was performed in the previous year. She is still not comfortable increasing Rosie's dose of Prascend higher than 2 mg based on her weight. She would like to know more information on this. Can you provide me with links to studies or scientific data that talk about giving higher doses of Prascend than what is on the manufacturer's label? Ultimately, she is agreeable to leave it to me as the owner and caregiver to either maintain her at 2mg or raise it to 3mg without first sampling the ACTH level again and with no new symptoms other than a small change in topline condition and the continued frequent urination and thirst. We plan to take another full set of x-rays in September to compare them with last year (for my own peace of mind). We discussed tapering her dose of Flunixin in September once the bloodwork results are in and then weaning her off the Flunixin during the winter months when her uveitis seems less likely to reoccur. She also brought up a valid point regarding hay analysis and mineral balancing. If this year's crop tests above the 10% NSC range and soaking is recommended, will the lab that performed the analysis (based on dry matter) retest a soaked hay sample to see how much of a change has occurred in the level of nutrients that were sampled? She recommended I contact the lab who will be doing the analysis to find the answer to this question.
Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020