Hello,

Cadet's case history is up to date, including Cornell numbers from 12/7/23.

I've been struggling with him not eating his meals, in spite of an excellent appetite for hay, and I'm afraid I've gotten tunnel vision and missed another problem developing that I've only clued into today.  Since having a program to balance his minerals, thanks to Dr. Gustafson, I have been having trouble getting Cadet to eat the extra Cu and Zn in his meals, but around mid November he started to refuse meals containing Ca Trace Plus too.  Over the next couple of months, I deconstructed his meals, tried switching to Vermont Pro Plus, and tried the CTP as a powder instead of pellets, introducing each gradually.  I also tried many of the suggestions on the Picky Eaters checklist, including alfalfa tea, distillers' grains, changing the flavor of Stabul 1, alternative safe feeds, CocoSoya oil, and ground up Stabul treats.  I have yet to be able to get him to eat more than half of the CTP that he needs and have given up on the extra Cu and Zn.  His willingness to eat meals has remained very unpredictable and he always prefers hay to his meals.  On 1/12/23, I started Cadet on omeprazole (1 full tube of Ulcergard QD) to see if this improved his appetite for meals.  On 1/16/23, I ran a CBC and profile, which was WNL except for a barely elevated GGT of 39 U/L (9-37 U/L); triglycerides were 55 mg/dL (10-90 mg/dL).  There was no real change in his willingness to eat meals after 6 days of omeprazole.

I knew he had gained some weight this winter, but was shocked today at his calculated weight of 1150 lbs.  He doesn't have bulges above his eyes or a crest, but fat is evident over his ribs and behind his shoulder.  I also checked his urine today (6.5 hours after receiving Invokana) and it showed glucose of 250-500 mg/dL.  He has always showed 500 mg/dL before.  Combined with an increase in his insulin to 46.88 uIU/mL (10-40 uIU/mL) in mid December, I wonder if the Invokana is losing its effectiveness.  He's been on 300 mg QD since October of 2022.  The medication is kept at room temperature and I give it to him myself by hand.

He has hay available free choice, as indicated for horses on SGLT2i, and I wonder if the problem with his meals is that he is just not hungry enough for something that doesn't taste as good as hay.  I've been tempted to muzzle him for several hours, which would pretty much prevent his eating hay, and then offering the meal.  This might facilitate weight loss too, but I don't want to cause a problem by fasting him on the Invokana.  If this is even safe to do, how long would be reasonable?  Should I consider switching him to Steglatro?  What would his dosage be?

On a more positive note, he has been sound without boots and I am trying to exercise him, including riding him on trails at a walk, as much as the weather allows.  I really hope I haven't caused him harm by not monitoring his weight more closely.  Thank you in advance for any advice!

Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102

Hi Aunna,

I’m hoping Dr. Kellon will address this as I don’t have any experience using Invokana.

Have you tried sprinkling some of the extras he needs onto his hay?  That probably works best if the hay is dampened.  I do that with salt, which I split between the supplement/carrier mix and the hay.  I’ve also done that with Phosphorus supplements as those products can be distasteful.  I’ve never had mine turn up their noses at hay, even with a top dressing.
--

Sorry, I got the date wrong.  He's been on Invokana since October of 2020, ie 2 years.  Duh!
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Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102

I agree with trying to sprinkle it on dampened hay. He doesn't need the extra calories anyway.

It's interesting how differently the horses react to this drug. On the one extreme we have Vinnie and on the other is Cadet!

If you switch to Steglatro, the dose for him would be 26 mg at his current weight.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thank you Dr. Kellon and Martha.  I am curious if you think this trend of higher insulin, weight gain, and less glucosuria is indicating the drug is no longer working for him?  Switching to Steglatro would almost double the cost of his flozin, with the pergolide on top of that.  Is there any experience to suggest that the Steglatro would work better?  If I can't switch, is it possible that weight loss would increase his sensitivity to the Invokana?  I assume that more exercise is always an option to try to control his insulin, as long as he remains sound.  Is fasting him for some time each day too much of a risk?

I realize that these many questions may not have definitive answers.  I would appreciate any guidance as I try to determine the right course for Cadet.

Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102

Do you always test insulin in the urine at the same time of day? It's probably going to be highest later in the day. His weight gain has his dose just a little bit low but not enough to explain the insulin going up. That could be because of less exercise combined with winter. Do you know how much hay he is eating, by weight? DE of the hay?
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thanks Dr. Kellon!

The time of testing varies, but this is probably the longest after his medication that I've checked it.  More often, it's within an hour or two of administration and the glucose has always been 500 mg/dL.  I'll try to get a sample later in the day.

I don't know how much hay he eats because he is with two other horses and fed free choice.  The hay is in 1 inch Hay Chix nets.  The DE of the hay he's been eating since August is 0.96 Mcal/lb.  He was transitioned to hay with DE of 0.85 Mcal/lb about 10 days ago.

Do you think muzzling him for 3-4 hours per day would facilitate weight loss, or is it too risky?

Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102

He just got a 9% reduction in calories so I wouldn't want to fast him. Do you have all the horses on a balanced diet?

Will he eat his bucket meals with no additives? If so, you could try syringing some or all of his supplements immediately before feeding for a few days then start adding increasing amounts to his meals. The taste will be in his mouth already.

I think I would also try him on 325 mg for a while.Get some 100 mg tablets and a pill splitter that does quarters.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Only two of them are mine, the other, Ruger, eats his meals fine and is on a balanced diet (by Dr. G).  I'm going to try the syringing, he will eat meals with some of the additives, but not consistently.  I'm not sure if I can do the dosage increase right now.  Thank you for the ideas!

Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102