Good news on insulin level but now what?? #file-notice


Alice
 

I had Peanut's insulin level rechecked last week. It was last done in May. Her level is now down to 46 from 66. She has lost some of her cresty neck and I would give her a BCS of 5 now.   I am thrilled that my management changes are having the desired effect!

I do have a couple questions.....is it reasonable to expect her insulin levels to drop any further?? Or is this likely her baseline insulin level??  When would it be reasonable to check bloodwork again?? 
I have updated both her case history and her photos.  Are there any other management changes that I should implement??

Thanks so much for all or your past advice!!
--
Alice A
March 2021, Custer, SD 
Case history: 
https://ecir.groups.io/g/CaseHistory/files/Alice%20and%20Peanut   .
Peanut's photo album: 
https://ecir.groups.io/g/CaseHistory/album?id=262374  .


Eleanor Kellon, VMD
 

Alice,

You are doing a good job but insulin levels are hard to predict because so many factors go into them. He's young enough that it  looks like the seasonal rise isn't a problem - but winter cold weather will be. All EMS horses need hoof protection from cold and sometimes supplements to support nitric oxide for circulation in the feet.  Otherwise, exercise is by far the most important factor. As soon as he is sound enough, as much exercise as possible is your friend.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Alice
 

Dr. Kellon,  my girl is perfectly sound, is currently shod, and get several hours of riding or driving every week. She has never had laminitis....I'm simply trying to prevent that from happening. I don't understand what seasonal rise you are referring to for EMS.. Is there a reference you can point me to? 

Thank you
--
Alice A
March 2021, Custer, SD 
Case history: 
https://ecir.groups.io/g/CaseHistory/files/Alice%20and%20Peanut   .
Peanut's photo album: 
https://ecir.groups.io/g/CaseHistory/album?id=262374  .


Sherry Morse
 

Hi Alice,

Some horses who are PPID and IR will see an elevation in insulin during the seasonal rise when their ACTH levels go up.  Since Peanut is only IR and not PPID that isn't a concern at this point.  Keeping her trim on point and her insulin as low as possible (via diet and exercise) is going to be the key to keeping her happy and healthy going forward.

Personally, my gelding has never tested below 45 for insulin even though he's in regular work (5 - 6 days a week of dressage training and/or trail riding) and doesn't have a crest or obvious fat pockets.  I keep his trim and diet as tight as I can but I do worry about him, particularly as he is getting older (19 now).




 

Alice, you can read about the seasonal rise here: https://www.ecirhorse.org/seasonal-rise.php All horses experience it.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Kirsten Rasmussen
 

Hi Alice,

Like Sherry's Scutch, who does not look like an EMS horse (there's a photo of him on our website, second horse down: https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php), baseline insulin in some horses can still be abnormal even though the horse is sound and in full work.  Other horses can get to lower insulin levels and benefit from doing so.  Both my horse and Lynn's Relevante ( https://ecir.groups.io/g/main/topic/84716664#267804 ) show signs of problems when insulin is in the "40's".  When we soaked our hay to get the insulin lower, the physical signs improve, and in my horse's case the insulin dropped to just a few points above normal. 

So it really depends on your horse.  If Peanut has no outward signs of IR/EMS and is 100% sound then that is probably a reasonable baseline for her.  But if you still see physical signs, like a hard crest or fatty pockets above her eyes, then I personally would aim for lower.

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


Alice
 

Thanks so much Sherry, Cass and Kirsten.....those  are all very helpful insights. Peanut and I will both benefit from your past experiences.  Thank you for being here and being willing to share!!

We will keep on the same path and watch for any changes. 

--
Alice A
March 2021, Custer, SD 
Case history: 
https://ecir.groups.io/g/CaseHistory/files/Alice%20and%20Peanut   .
Peanut's photo album: 
https://ecir.groups.io/g/CaseHistory/album?id=262374  .