About -Flozin Drugs and Triglycerides


Eleanor Kellon, VMD
 

The -flozin drugs work by causing loss of glucose in the urine, which decreases the demand on insulin. However, too much loss versus dietary supply of glucose/starch and alternative energy sources of free fatty acids from fermentation will cause mobilization of triglycerides to fill the calorie gap.  Too much triglyceride mobilization can cause fatty liver, which we don't want.

The mobilization of triglycerides during energy shortage is a normal process. It occurs during starvation, fasting and exercise.

The challenge with horses/ponies/donks etc. on -flozin drugs is to limit triglyceride mobilization to a level that does not threaten the tissues. We don't have a foolproof method for doing this, and I'm sure it's complicated by individual factors, but the first step is free choice hay and don't soak the hay.  Beet pulp is an excellent source of acetate on fermentation which can readily substitute for glucose in the cells.

Exercise when on these drugs may take additional measures, potentially stopping the drug on days of exercise and/or adding oats or Karo as we have already suggested for IR horses that have returned to work - or both. We're still learning. Your input is priceless.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Hi Dr Kellon, I know you have mentioned limited exercise for horses with TG over 200, and Vinnie has constantly been over that number, but to aid with insulin what amount of exercise is ok under these circumstances?

I feel like I am a little caught between a rock and a hard place with Vinnie in finding the balance.

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Nan,

The problem here is that exercise in a negative energy balance state will cause triglycerides to rise further. The Invokana is mimicing exercise to some extent by drawing off glucose supplies although I'm not sure it has the same metabolic benefits inside the muscle cells. If you are going to exercise him on Invokana and elevated TG I would follow the recommendations for feeding recovered laminitics. If you don't, TG will continue to rise.

How is he doing clinically? Have you had insulin tested at another lab?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

We haven't done another insulin, plan to in 2 weeks. At about day 12 of the 225mg dose he  became super forward and really wanting to boogie durong turnout.  He was offering trot and canter to play and his turns improved dramatically.  I immediately pulled him out becisse inwas worried he would do too much and we walked a little around the ranch and he has continued to thrive. He wasn't Dore the next day etc.  I can tell the insulin over the last few weeks may have caused a bit of a laminar wedge because that hoof wall distortion shows pretty immediately because of the damage medially. So we will need to address that.

Based on how he is doing we decided to hold at 225mg til next labs in two weeks, with the only change being the prebiotic for hind gut fermentation.  

He is about as sound as he as ever been considering the p3 bone loss and ringbone. In really soft sand at the trot he looks sound but on harder surfaces he does take off steps, but not bad considering where we have been.

I would share video of him in turn out but I am ashamed of being a bad mom for letting him get a little bonkers until I caught him lol...

For now, I guess we limit exercise to just keeping his old bones moving? :)

Thanks again:)
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Nancy & Vinnie & Summer
 

Note, just realized you said another lab.. We could try another lab for sure. What would be your recommendation?

The other thing I have been wondering is even with horses on invokana do they have insulin highs and lows thru the day and what is acceptable under those circumstances.  I know we do alot of labs on Vinnie, maybe more than others so I was wondering if that is a symptom of what we are seeing in the data?  How consistent should the labs be on a managed horse that is on a -flozin if the labs are pulled at the same time of day etc etc.? 

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Exactly how much exercise is he getting? Not being sore the day after (or day of!) is the best indicator he didn't do too much.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

He has had a significant laminar wedge for quite a long time. You are just seeing it growing out.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

I try to turn him out for about an hour every day for self exercise and have been walking 20 to 30 mins around the ranch.  I was going to start ponying him off my other horse to start building some strength.

My goals are to eventually walking him under tack and  introducing him to the driving cart I bought for him in 2019 :)
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

You could use BET or Idexx. It's always best to pull insulins at the same time of day, no exercise, at least 4 hours after the  morning meal if the horse did not have food available overnight.

Some horses have normalized, or very close to it, on Invokana. At the opposite end of the spectrum are one or two whose insulin did not change one bit but their hoof pain disappeared. I'll settle for that.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Sounds good - and driving is especially good for relieving strain on the front.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Could a glucose monitor reading before and after exercise show low glucose? 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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Eleanor Kellon, VMD
 

Yes, a glucometer could be used for that -  just to be sure to read all instructions and calibrate properly. Exercise will exacerbate glucose/glycogen shortage and TG mobilization.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Hi,

I was contemplating getting a glucometer this weekend to see if part of my issue is blood glucose levels dropping during exercise and perhaps that being part of Vinnie's tryglicerides challenge.

Plan would be to take glucose before exercise and then afterwards.

On his labs his glucose has always been above 95 sometimes higher than the high end of the range, so I am curious of there is a dramatic drop during put walking routine.

I read up on the recovered laminitic protocol and since he is getting copious amts of beet pulp already would I just add oats?

Could alfalfa be an option if he tolerates it?

Thx Nan

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Nancy,

Exercise definitely adds to the triglyceride issue. To start, test his glucose before exercise and immediately after then 10 minutes after.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001