Hi all,
I finally got follow up insulin results for Captain Drifter. Its still >200. He started Metformin March 4. He slowly responded to it, and on April 18 got the Ultimate shoes removed and got into boots. He relapsed May 1. My excellent trimmer comes every 2 weeks. My vet drew blood April 1 to check insulin/glucose but the sample was lost and weeks went by with my vet saying no results yet. Blood was redrawn with results arriving May 24 showing insulin >200. No mention of glucose. He’s on custom mineral blend and is eating the recommended amount along with Vitamin E gel caps with 4 TC balance cubes soaked for dinner.  The custom mineral blend is in a flax base and I was told no need to add flax. He gets Uckele J-herb 30 minutes before hay in am and 30 min before dinner. His gums are nice and pink. He gets 10 lbs weighed hay with ESC + starch well below 10%. He won’t eat it soaked. He’s in a dry lot of 8 stalls joined with 1-2lb hay bags spaced around. I asked my vet today for Invokana and he said there wasn’t much else we could try. But he’ll do some research. I have photos my trimmer took - I’ll try to get them uploaded. I’m having trouble getting the blood work updated- can’t figure how to edit. I added the pony’s TRH Stim test but put it in the wrong place. He doesn’t have Cushings. Thank you all!
Laura Harvey in Tx 2022
case history: https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Captain%20Drifter
https://ecir.groups.io/g/CaseHistory/album?id=273113

Hi, Laura. 

To update your case history, you need to edit the original Pages.app word processing document that you should have saved on a computer hard drive or in the Cloud. Editing the PDF that you uploaded to Groups.io requires special software. 

To edit Captain Drifter Case History.pages, open it up using Pages.app. Be sure to change the date of the update on Page 1 and then add the blood work and any comments. You have plenty of room to add new labs without editing the tables. Then change the document name to Captain Drifter Case History 2022-05-28.pages or something similar to show the current date. Save it on your hard drive or in the Cloud. Export a PDF of the updated CH and upload it to your CH folder linked in your automatic signature. Give a shout if you run into problems.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Hi Laura,
One thing I would mention is that your vet can ask for the insulin test to show more accurate results above 200.  Those results might offer better guidance at this point.   Most tests fall below 200 so the extra attention isn’t needed but, for those tests which typically are higher, they are willing to adjust their techniques/calculations.

Edited to add that if you’ve been giving the correct dose of metformin (30mg/kg, twice daily) since March and the insulin is still >200, the metformin is not working and your vet needs to be introduced to invokana, which Dr. Kellon can help with.
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Laura,

I have a background file I can send to your vet if you e-mail me his e-mail address.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001