G.T.F Chromium/ fasting blood work


Kirsten Rasmussen
 

Hi Kimberly,

You'll probably have to be the squeaky wheel with your vet about pushing for Canagliflozin/Invokana if you want to try it.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
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Kimberly
 

thanks Kirsten and yes i understand this which is why I will not drop their food amounts.  Mouse does not need to lose weight but Ryn does so he is getting plenty of daily exercise along with his rations of 1.5% of current weight.  Dr. Kellon sent my vet info on Canagliflozin weeks ago.  It went no where.  I will research more as you suggest.  Dr. Kellon, yes I have a pretty clear understanding of how this would effect my horses so have no intention of feeding less than 1.5% and incorporating exercise for Ryn most days.  He gets pretty vigorous exercise for 20-30 minutes w/t/c and is losing the weight he needs to lose.  And also a yes, that they are pure Spanish blood, albeit wild horses.  Very few Kigers I see are at a safe weight and looming problems are on the horizon.  Thanks for the input.  
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Eleanor Kellon, VMD
 

Kimberly,

Insulin is a moving target. It responds to the glucose (and protein) load presented to it. Fasting insulin with no glucose or amino acids being absorbed should be less than 8 uIU/mL.

Severely restricting calories puts the body in alarm mode. It will preserve precious glucose intake for heart and brain. To do this, the horse's body goes into insulin resistance (those tissues don't require insulin for glucose uptake). Obviously this on top of already existing insulin resistance is not a good thing!

I would not go below 1.5% of current body weight, or 2% of ideal body weight. True Mustangs of Spanish origin are definitely insulin resistant because of their heritage. The best thing you can do for them is plenty of exercise - ideally 20 miles/day.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

No, starving will only cause a bigger insulin spike with meals because then every meal occurs after a fast, which is worse.  Some vets recommend down to 1% of body weight but if they don't need to lose weight it is pointless at best, and possibly harmful to cut calories so extremely.  I don't think Mouse needs to loose weight from your photos. 

I've list track if why you're not using Metformin but I assume it wasn't working?  If not, I think you should look into putting them on Canagliflozin/Invocana then.  Ask your vet to email drkellon at gmail dot com to get the bloodwork and management protocols.  You can do a Message search for Canagliflozin or Invokana and Ertugliflozin or Stelgatro, or search "flozin" to learn more about what is involved.

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


Kimberly
 

Hi Kirsten, we did a "fasting" test to see if they would be closer to an optimum normal range.  That is why I had the question about Chromium.  I am not sure how to get it down lower, except by controlling calories and exercise.  They are both on safe hay that I soak anyway, both are getting 1.5% of their body weight per day with everything being weighed.  My vet wants me to feed about 3 flakes of hay only a day which is like 6 pounds.  My understanding from many sources is that much lower than 1.5% of body weight can lead to hyperinsulimia and organ damage.  My vet says that is hogwash.  In my mind they are already compromised due to high insulin and to starve them will only exacerbate my problems.  
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Kimberly joined 7.17.2018 Virginia
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Kirsten Rasmussen
 

Hi Kimberly, 

Its not clear to me now whether the results posted in the first message were fasting or non-fasting.  If they were fasting then they are waaaaay too high, as you know now.   If they were non-fasting then they are high but not alarmingly so.

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


Eleanor Kellon, VMD
 

The only truly accurate way to establish a reference range for insulin resistance is to compare the results from presumably "normal" horses to what is found using a well established intravenous test like FSIGTT, which is what the first paper I gave you did. I can guarantee they didn't do that. The diet of the horses should also be standardized, testing time identical, and at least 120 animals sampled, with extreme outliers thrown out of the calculations.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kimberly
 

Thanks Dr. Kellon, I am downloading all of these and am waiting for a call from her now to discuss.  She is only looking at Cornell's reference range and drawing a conclusion from there that they are normal.  I am trying to get someone from Cornell to explain that to me so I can explain to her.  Ryn is in work, and if we can get Mouse's lameness in order he will be back in full work, but we are a bit stumped as to why he is still lame after several trim cycles and great hoof growth.  
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Kimberly
 

and Kirsten, thank you for your encouraging words.  I am feeling a bit like I will never get this resolved but with Mustangs, it is an ongoing and often uphill battle.  I know well as I have 7 of them.  Ryn is getting at least 30 minutes of exercise 5-6 days a week, weather and footing permitting and he is gradually losing weight.  He has dropped about 30 lbs over the last few weeks and weigh in is on Tuesdays.  Mouse is still lame on RF which we are attributing to a thin sole.  He only has a DP in that foot and on the medial side.  He will get trimmed again in a week or so, as will Ryn.  Mouse is normally in full work, but being lame, he only has his paddock to move about in for exercise.  Every few days I walk him into the arena as the footing is soft but we do not do too much.  If we can ever get him sound he will be in work.  I am perplexed as to why this is ongoing as he has been thru 3 trim cycles and still lame.  
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Eleanor Kellon, VMD
 

This might help too https://wp.me/p2WBdh-1hR . If you do any research on insulin levels in normal horses you will find they are always less than 10 when fasting and only in the 20s after a grain meal.

As others have already said, your levels are well below the acute laminitis range so you are doing a good job. You may not be able to get them lower without regular vigorous exercise.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kimberly
 


Eleanor Kellon, VMD
 

Here is the original study on normal insulin (nonfasting) https://ecir.groups.io/g/main/files/Blood%20Testing%20for%20IR%20and%20PPID/IR%20PROXIES%20ORIGINAL.pdf , then this field study of ponies on grass so that should definitely be the upper limit of normal! https://ecir.groups.io/g/main/files/Blood%20Testing%20for%20IR%20and%20PPID/IR%20PONY%20FIELD%20STUDY.pdf . As for fasting insulin, see: https://pubmed.ncbi.nlm.nih.gov/31554591/ .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kimberly
 

Kirsten can you point me to that research? Vet says they are all normal, with Ryn o  the high end.
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Kirsten Rasmussen
 

Hi Kimberly,

Those insulin numbers aren't terrible and your work is paying off.  I don't think Metformin is necessary since they are not in danger of laminitis.  Obviously it would be good to see insulin lower, below 25 or 20, if possible,  but there are many horses here who are doing well with insulin around 40.  That might be where exercise comes in to play if they are sound enough to work.  Not sure what is possible but if you could get a good 30 min workout in for each of them daily/most days, that should help. 

Testing fasting insulin and adding chromium are not likely to do any harm, except to your pocketbook, but make sure your vet understands there is new research shoeing that non-IR fasting insulin is between 5-8 uIU/mL.

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


Kimberly
 

Sorry, Ryn was Glucose 107, Insulin 40.48 Leptin 25.30 and Mouse was Glucose 99 Insulin 28.58 and Leptin 13.00.  The vet read what the label on the container from Uckele says and thinks it will help.  I am doubtful.  They are both on low starch/sugar hay that I am even soaking.  They are on s/r/s beet pulp and about 4ounces a day of Stabul 1 as a carrier.  They are on the least amount of hay that i should safely feed them.  Getting Metformin in them proved to be unsuccessful and was causing both of them much stress in attempting to get it into them.  I will keep monitoring blood work, have more hay tested to see if I can get a lower ESC number and keep trying.  
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Kimberly joined 7.17.2018 Virginia
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Eleanor Kellon, VMD
 

None of those results are normal assuming they were on a low sugar and starch diet. Insulin normals depend on the diet. Chromium is part of the normal insulin response to glucose but there is no evidence of chromium deficiency outside of areas in the west where soil is very alkaline. You could try it without any harm but I wouldn't expect it to have a positive effect for a horse already on a low sugar/starch diet.

BTW, those fasting values are WAY too high. By published research, fasting insulin should be no higher than 8 uIU/M./.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Hi Kimberly,  I’m glad you were able to help your vet understand our protocols for testing and interpretation.  We want to know what the insulin level is on a normal day, not during a fast.  After fasting, it should be lower and these insulin results are not alarmingly high but are definitely elevated.
Many years ago, our Morgan gelding developed laminitis.  The vet did not suggest chromium but my husband, a physician and nutrition buff (at the time) wanted to try it.  We did and the vet was pleased with our results and went on to recommend it to others, crediting hubby’s input.  Much later, I found my way here while caring for my PPID horse and I learned that we don’t recommend chromium.  I searched the files (which you can also do) and brought more returns than I had time to deal with but I could not find the reason we don’t recommend it.  My recollection is that the horse is not in short supply and more won’t help.  Having said that, I am sure that the person with the “real” answer will step in to correct me.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sherry Morse
 

Could you please clarify which horse had which results? For fasting blood work when all other pieces are in place your next option is going back to Metformin.

Chromium beyond what is needed to balance minerals will not effect those numbers.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


Kimberly
 

My vet wanted to perform fasting blood work on Mouse and Ryn.   Mouse was Glucose 107 and Insulin 40.48 and Leptin 25.30.  Mouse was Glucose 99, Insulin 28.58, Leptin 13.00.  My vet says these are within normal range and I have explained why they are not within the normal range.  We are struggling to get insulin down on safe/soaked hay.  She has asked if G.T.F Chromium is something we should try?  Please advise.  I have updated photo album for Mouse as well.  Thanks for any input!  
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