Butterscotch I:G ratio #file-notice


naomi.dechaine@...
 

Hi! I updated Butterscotch's CH the other day, and wondering about her I:G ratio. The vet said the levels were normal but I don't think did I:G ratio. So I put her out on grass. But as I was doing the CH and did I:G ratio myself with the calculator, then looked up normal ranges I was more worried. It looks from the ratio she is in compensated IR? Could that be part of PPID, or is she mildly IR?


Sherry Morse
 

Hi Naomi,

In June I would have rated her about a 5 for BCS is about where you want her but you now say she's overweight and has a crest.  If that's the case she should NOT be out on grass unless she's wearing a sealed muzzle and it's for exercise, not for eating.  You've done a great job getting her to being compensated IR which means the diet changes are working but this is a complete lifestyle change and needs to be maintained for Butterscotch to avoid a laminitic event.

I'd also be concerned about her ACTH level as while it's in the 'normal' range it's still on the higher end of that range and we try to keep these horses in the middle to lower end of the range.  This can have a knock on effect on insulin levels in some horses so I would speak with the vet about bumping up her dose of Prascend, at least for the next few months of the rise.




Kirsten Rasmussen
 

Hi Naomi, 

I would not be worried about Butterscotch's latest insulin as long as that is a non-fasting result.  She is only a smidge above normal.  I would continue the management you had in place when her blood was pulled.  Her glucose number is a bit lower than we'd expect, which could be due to some sample degradation on the way to the lab, so the G:I ratio might look a bit low.  And her insulin could be slightly elevated from the PPID, but it's still nice and low.   Your July ACTH is still a bit high.  The goal with these horses is to keep ACTH in the middle of the lab range through the rise, and Butterscotch was at the upper end already at the very start of the seasonal rise.  I agree with Sherry that a dose increase is warranted.  If you can keep her ACTH tightly controlled I don't see why she couldn't be turned out on pasture.  But right now it is not tightly controlled.  As a rule I definitely recommend always testing insulin (and ideally glucose) with ACTH since that will give you a better idea of how strict her diet needs to be.

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


naomi.dechaine@...
 

Thank you so much Sherry and Kirsten for your replies. 

In terms of weight she has always had a bit of a crest ("always" being since I got her end of January), but a bit ribby so I put her at 5+ before to average her out. Now on pasture she has a bit better rib coverage but I didn't think to actually measure her neck before putting her out, so I can't be sure but her crest looks about the same to me. So I put her at a 6? I am new to actually using body score so I will try to post a picture to see if that makes sense compared to the last one I posted. I also still need to get actual measurements for weight... my brain is like a sieve most days...

And this was the first I heard that the ACTH is supposed to be in middle of normal range, love the knowledge offered here in this group thank you. I will be in touch with my Vet today about raising the pergolide. From my experience so far they have very limited knowledge, are there any suggestions for how much would be a reasonable amount to bump up the pergolide to? We are at 1mg now, I am imagining going up to 1 1/2 or 2mg? 

Thanks!!
--
Naomi D, AB Canada, 2021
https://ecir.groups.io/g/CaseHistory/files/Naomi%20and%20Butterscotch
https://ecir.groups.io/g/CaseHistory/album?id=264934


Kirsten Rasmussen
 

"Middle of normal range" is based on our observations here that once a horse is diagnosed with PPID, they do better if ACTH is not allowed to increase with the seasonal rise.  That is not something your vet would be aware of, and they may disagree strongly because ACTH in healthy horses does go well above that with no negative effects.  Our collective knowledge based on managing 1000s of PPID horses is that they need stricter control for optimal results.  Your vet should already know that ACTH is not the only hormone driving this disease and that it may actually be low while the other hormones are higher, so signs of PPID may still manifest even if ACTH is still at a level through the seasonal rise that would be fine in a normal horse.  However, pergolide treats the cause of the hormonal abnormalities, not just for ACTH but also for the other related hormones.  So tighter control of ACTH via pergolide also helps tightly control the other hormones, which may or may not be more active, depending on the horse.  That is probably why we see a benefit to keeping ACTH low through the seasonal rise, or in other words, at a level that would be more typical of a healthy horse in the spring when ACTH is lowest ("middle of normal range").

For BCS I would not include the crest since it is a sign of PPID that can vary with no actual change in weight.  If she was a bit ribby then she would be <5 in my opinion.  If she has any other unusual fat pads that are characteristic of PPID (or EMS) try not to include them in your BCS assessment.  I'm new to estimating BCS, too, but if you post before and after photos someone here will provide a more experienced opinion.  :)

How much pergolide to give is a bit of an art.  Since this is her first year with you, you don't have any knowledge yet of how high her ACTH goes in the fall or how sensitive she is to pergolide.  If she had a history of fall laminitis that might make slightly over-medicating justifiable compared to slightly under-medicating.  Whatever you do chose for the dose increase (either of those options would be reasonable), if you have her retested near the peak of the rise (fall equinox) you'll get a sense of whether or not you should have increased it further and you can keep that information tucked away for next year.  My tendency is to go with the higher dose for at least the seasonal rise if she tolerates the medication well (you can always lower it in December), but others might prefer to keep it as low as possible.

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


Sherry Morse
 

Hi Naomi,


Also, you can use this link to help you do a weight calculation based on measurements: https://ecir.groups.io/g/main/files/Case%20History%20Tools/Tools%20and%20How-To%20Help/Horse%20Weight%20Calculator.xlsx

Just as a quick observation which I didn't mention the other day - you have her estimated current weight at 900lbs.  That's more than my 15h Arabs weigh so she would be extremely obese at that weight, which is not what I see in the pictures you posted. She should be closer to 750lbs or less would be my rough guess for an ideal weight.

Do you still have her on alfalfa mix cubes at this time?  If yes, I would stop those and see if there's any effect on her crest?