Alternate drug to Metformin


Kandace Krause
 

Hello all,
I stopped Metformin after approx. 2.5 - 3 months last late winter as getting horse to injest it was an impossible task and I (mis)understood that it should be used to get Insulin down, and then discontinued as it eventually becomes in effective.  
Today I have read in a post that it is "for life".
Was I mistaken in the reduced effectiveness of this difficult drug?
Also, I was speaking to a friend, pharmasist and horse owner, and he asked about using "Ozempic" a weekly injectable, instead of a daily 54 pill thing.
Has any research been done or started on this?  I have emailed him back to see if this drug is same class as Metformin but haven't heard back yet.
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


 

Hi Kandace,
I don’t know whether or not you were mistaken but metformin has been shown to have decreased effectiveness with time.  I’m sure this will vary from horse to horse.  We recommend doing everything possible with diet to bring insulin down and saving metformin for truly obstinate cases.  Once the metformin option is no longer working, the next step is invokana.  The drug your pharmacist friend recommended is for diabetic people.  It acts to bring blood sugar down.  What we’re looking to control is horses is insulin levels.  The blood sugar is generally in range.
--
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


 
 


ferne fedeli
 

My horse has been on Metformin for 4 or 5 months now & I grind it up in an old Braun coffee grinder & mix it in his supps in soaked ODTB Cubes & some Stabul1 w/some Cavalor FibreForce on top & he licks his plate clean!!!  So interesting how horses have such different tastes, just like humans...

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Ferne Fedeli  Magic & Jack   2007

No. California
Case History

 

 


 

Ferne, I never had any issues either feeding that way to a pony for years.  That was before I learned how lucky I was and how unlikely it was to be doing any good at that point.
--
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


 
 


ferne fedeli
 

Well, so far the Metformin seemed to be lowering his insulin fairly well.  I am going to wait & retest in January & hope it is down to a fairly normal range & then will decide whether to keep him on it.

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Ferne Fedeli  Magic & Jack   2007

No. California
Case History

 

 


Kandace Krause
 

Okay, that was my original understanding and when I stopped giving it, Metformin had performed a lot and until this fall we seemed to be winning. 

As the Seasonal Rise is over, and my only opportunity to test was September showing higher insulin and okay ACTH, what do I do now?  Dr Kellon had suggested upping pergolide, that scared me.  Now I see that it may be needed to increase again and again over lifetime and no adverse effects from that increase is likely.
Also, I could have hauled to get insulin test but thought it was  going to show a false higher level.  How do you balance that since I am struggling to get timely vet appointments now?  Is ACTH also so easily impacted by feeding, temperature, travel etc. as Insulin or is that the super sensitive one?
IMO, my horse travels well, she has hauled with out issue or accident for 11 years of my owning her, competing, conditioning etc.  We had about a month in her third year of riding when she started to object to getting on trailer, but we worked through that and she walks in easily now and up until 2020 Covid life halting events, she travelled apprx. once a week all summer long.  Am I being foolish to worry about this travel to vet in Insulin results?
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Sherry Morse
 

Somewhere in the archives I believe somebody said that if you can be at the vet at least 4 hours before testing any effect on ACTH is fairly well mitigated.  Insulin is more sensitive and will take longer to normalize.  It doesn't matter how used to hauling your horse is, there's an increase in these hormones which will show up in test results.  That's one of the reasons we suggest having somebody local draw blood if your only option is to haul to a vet.




Kirsten Rasmussen
 

Hi Kandace, 

Once we have diagnosed pergolide, we have found its best to keep ACTH at or below the middle of the normal range, even through the seasonal rise.  PPID horses seem to do better with this really tight control on ACTH.  Your bloodwork shows a value of 27 pg/ml in mid-August, which is already above that middle-of-the-range max we recommend.  Guaranteed it went higher still into the seasonal rise, unless you increased the pergolide at that time.  Insulin was already high then, and it likely climbed higher as well.  Did you test in September, too?  Your Case History only goes to Aug 29.

You might want to talk to your vet about switching to compounded pergolide.  You can justify it because it will be easier to give 1 pill a day (and there are huge cost savings).  Island Pharmacy on Vancouver Island is fantastic and highly recommended here.  Keep some Prascend on hand for dose increases, if/when it needs to be adjusted.

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