Karen,

There's nothing about metformin that would make him have a systemic "veil" type reaction but oral ulcerations could certainly make him feel bad.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Dr. Kellon,
I will check into soy hull pellets. I thought about sprinkling Metformin on moistened hay and will try that after vet does exam this Wednesday.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817

Hi Cass,
Vet scheduled to check Apollo's mouth and float teeth if needed this Wednesday.  Haven't seen any yawning or chewing jaw movements since Saturday morning and then wasn't much but shortly after giving Jiaogulan.  I originally suspected mouth pain related to Metformin because within 24 hours of stopping it, he was eating well (including his mash) and had a much brighter look in his eyes, even started nickering for feed again.  It may be unusual or never reported before but Metformin seemed to make him feel bad.  What I saw was similar to what he was like when I increased his Prascend from 1.0 mg/day to 1.5 mg/day (this happened even though he'd been on Prascend for 9+ months).  I did wonder if Jiaogulan might be a contributing factor since also given 2x/day but didn't stop Jiaogulan because no consistent pattern with yawning/jaw movements when I gave it and he's more comfortable when on Jiaogulan.  Dr. Kellon recommended it for morning stiffness/foot soreness that improved with activity and no morning stiffness/soreness since,  Will need to hold Jiaogulan 24 hours before vet comes as anticipating needing sedation for mouth exam.  Three past vets who've worked on Apollo said draft breeds are more sensitive to IV sedation than regular size horses and need a smaller dose.  Interestingly, light draft breeds have higher normal levels of leptin than regular horses according to info on Cornell lab report. Is it possible draft breeds metabolize Metformin differently and that could account for Apollo's unusual reaction to it?  
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817

Try soy hull pellets. Just need to be dampened. No rinsing.

--
Lorna in Eastern Ontario
2002

Karen,

If you can locate a feed COOP or a mill that mixes their own feed someone may be able to order you soy hull pellets. You could try a mash of those and most horses really like them. Could also try sprinkling the metformin onto moistened hay but before doing that I'd get his mouth examined for ulceration and let that heal.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Not sure what other kind of mash I could use given Apollo's severe IR.  He does not eat RSR beet pulp by itself or in timothy cube mash. Stabul 1 has 5% starch content which can cause problems for some IR horses.  Yes, I have experimented with different amounts of water for making mash and he prefers his on dry side.  Given a choice between hay and mash, he will always eat his hay first and then eat his mash when there is nothing else.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817

What other mashes have you tried? Have you experimented with amount of water used?
--
Lorna in Eastern Ontario
2002

I wish I could get him to take it in food but I can barely get him to eat his supplements in timothy cube mash.  
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817

-- assume you need to syringe the metformin?  what have you tried to use as a mix without syringing?  
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 

Bloodwork done 09-14-2022.  Not sure why whole panel done but maybe less expensive than individual tests through Cornell. Blood sample obtained 5 hours after nighttime fast ended.  Fed dry grass hay until blood draw.  Received morning Metformin dose by syringe.

Glucose 93 mg/dL (reference range 71-122); same as 8/15/22

Insulin 47.35 uIU/mL (reference range 10-40); decreased from 62.60 on 8/15/22

ACTH 20.1 pg/mL (reference range 2-30); increased from 10.3 on 8/15/2

Leptin 8.35 ng/mL (reference range 1-10); decreased from 13.06 on 6/3/22

T4 2.58 ug/dL (reference range 1-3); increased from 1.50 on 4/19/22.  Last dose of Thyrol-L was 1/2 tsp on 9/11/22.


Metformin:  needed 2 syringes to give 20 tablets/20,000 mg dose. Put 10 finely ground pills in 25 ml of wild cherry Milk of Magnesia in feeding syringe with angled metal tip. Rinsed mouth with water after dispensing medication from each syringe and then fed hay. Apollo took medication well but unfortunately, it depressed his appetite and made him sluggish, almost like Pergolide veil.  First noticed eating less of timothy balance cube mash with supplements. Tried manipulating type and amounts of supplements and added various flavorings but eventually wouldn't even eat plain timothy balance cube mash. Would eat all of his hay, but much slower than normal.  On 9/17, noticed him yawning a lot when just standing out in paddock during day.  Then on 9/18, after giving evening Metformin dose, he kept his mouth open, moving his lower jaw/making faces (not chewing and yawning motions).  Did same thing with his mouth again next morning when given Jiaogulan by syringe but this time was acting like something was stuck in his mouth. I couldn't get a good look inside when I tried so did not give Metformin and decided best to put on hold.  Also noticed he hadn't eaten any of plain timothy balance cube mash given night before which was unusual.  Apollo started eating some plain mash again on 9/20 and more eagerly eating hay so I started reintroducing supplements.  On 9/23, had couple of yawns/mouth chewing motion after giving morning Jiaogulan but was eating normally.  Did not appear foot sore on any of these days.  Today when farrier was here to trim other horse, I noticed Apollo doing a lot of yawning in his stall. Couple of days ago, I started a new bag of Jiaogulan (from Horsetech) which he doesn't like it as much, it's brown and smells like tea whereas previous Jiaogulan (from MadBad) was dark green and smelled more like grass. Now he sometimes does chewing/mouth opening when he gets new Jiaogulan. Think getting his teeth checked would be a good idea.

Doesn't seem to be having hoof pain. No shifting from foot to foot at rest. In Cloud boots with pads 24/7. Walked about 500 feet on blacktop road last night. Moved freely, at good pace, heel first contact most of time but sometimes more foot flat but not toe first. Currently keeping him outside 24/7 when has dry place to lay/sleep so he can move more. Hasn't been running in paddock as has in past but may be because he's weightbearing on his soles more now. No drastic changes in trimming/rasping, Have been gradually (every 3-4 days) working on hoof flares and taking toes back on fronts. Also working on back hooves. Hoof trimmer found through ECIR gave some suggestions but thought we were doing well. Will be taking new hoof photos this weekend.

Since Apollo's current hay was tested by hay grower, I had Equi-Analytical retest Apollo's this hay for ESC+starch. Hay grower's results done by Holmes Laboratory:  ESC 3.88 + starch 1.92 = 5.88%; my retest results (based on sample from 20 bales): ESC 4.9 + starch 1.2 = 6.1% which is difference of 0.3% and average of two tests is 5.99%.  Seems low enough to not have to soak.  I've decreased Apollo's intake from 28 lbs/day to 26 lbs/day.  Cresty neck still significant but feels much softer and nuchal ligament easily palpated.  Fat pad by tail also seems smaller and softer.  I've added new body pictures to his photo album.  Kathleen is doing hay mineral balancing.

Apollo is definitely doing better now than a year ago but still has a long way to go so it's hard not to feel discouraged at times.  Hoping we can start hand walking soon to help with insulin.  Don't know about trying Metformin again given "pergolide veil" effect it had on him and concern about mouth ulcers.  The expense and potential side effects of Invokana are quite concerning.  A big thank you to all who suggested increasing Apollo's pergolide dose in June as his ACTH went from 10.3 on 8/15 to 20.1 on 9/14. Very pleased to see his T4 at 2.58 without Thryol-L.


  





--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817