I'd proceed with the Nov 29 blood pull for ACTH, insulin, and glucose.  If ACTH is good now, which you want to check sooner rather than later, it will only go lower outside the rise as long as Rico stays on the same dose of pergolide.  It cannot go too low.

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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
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Hi all -

Question for you on the timing of Rico's blood draw - it is scheduled for next Monday, November 29th.....but based on recent messages posted here, I wanted to ask if it would be both better for my budget as well as more "true" information in the results if I rescheduled the appointment for end of December/early January?

Rico was started on 1/2 Prascend during the rise - on October 19th.  He is an 11 1/2 yo gelding (Paso Fino/Rocky Mountain cross) and his ACTH came back at 137 in late September and he was exhibiting hoof tenderness that came on in late July.  We did a trial of Metformin starting 9/18 and the blood test at the end of September was to check and see how it was working - his insulin came back at 48uIU/mL.  I stopped the Metformin on 10/26 because it was getting increasingly difficult to get the drug into him and my thoughts were that removing it would give me clear answers on the next bloodwork results as to how much the Prascend and lowering his ACTH effects his insulin numbers.  And he was/is no longer hoof tender.

Previous bloodwork on 8/4/2022:
Insulin 56.03
ACTH  34.8
Glucose 98

Should I reschedule his bloodwork for late December/early January?  Or even further into 2023? 
His ACTH on all bloodwork draws up to late September, 2022 did not trigger the early PPID diagnosis.
Here's the data on ACTH values:
July 2021 - 22.4
October 2021 - 63.6
March 2022 - 15.2
August 2022 - 34.8
September 2022 - 137

thanks so much,
Jenny

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Jenny Heishman and Rico  
Bainbridge Island, WA   June 2018
https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico
https://ecir.groups.io/g/CaseHistory/album?id=60437