Date
1 - 11 of 11
Dr. Kellon Questions: Insulin Test and Timing of Metformin Dosing
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Lab results in with Insulin at 184 and ACTH at 37. I have a few questions:
(1) Vet is thinking to retest insulin closer to Metformin dosing thinking it would indicate if Metformin is working or not. Is that true? Or can I conclude that because his insulin is high that it in fact is not working? (2) If I am to conclude insulin is no longer controlled with Metformin, what do I do? (3) With ACTH at 37, do I keep his pergolide dosage at current amount or do I increase? He has such an awful, lengthy laminitic eposide last fall/winter and I want to do anything possible to prevent reoccurrence. Help please. Thank you in advance. -- Robin Aiken, SC 2022 https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan |
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Sherry Morse
Hi Robin, If this were my horse I would increase his pergolide dosage now as his ACTH is not where we want to see it for a horse on pergolide. I'd put him on 1mg a day starting now with a plan on retesting in 3 weeks to see if his ACTH is down to the upper teens/low 20s where it should be this time of year. You do not have a metformin dosage included in your CH but it should be 3,402mg 2x a day if Hogan is still 250lbs. If that's what he's getting the test results show that it is not working for him at this point. Testing him closer to when the medication is administered isn't going to change that. Is the beet pulp being rinsed/soaked/rinsed now or just soaked and rinsed? Is he getting anything that's not listed on his CH? What was the temperature outside when this most recent test was done? How long after eating?
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Thank you Sherry!
He is getting .5 mg pergolide. I'll increase him slowly to 1 mg and then retest 3 wks after. Thank you! Metformin, yes, that is the dosage he's on. Do I discontinue and retest insulin to make sure it doesn't go even higher? Or keep him on it? It did help get him out of his painful laminitic eposide when I started it. Beet pulp is now being rinsed, soaked, rinsed as of a few weeks ago. I changed his vitamin e from MVP to a different brand that I purchased through a vet. She swore it had no sugar in it. Maybe I should send to a lab to test. His insuling and ACTH test was done 12/14 at 11am. He gets feed his timothy cubes, bp and supps at about 7:30am, but is a slow eater. Temp was about 43 degrees. Thank you for your guidance. -- Robin Aiken, SC 2022 https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan |
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Robin,
The metformin is not controlling his insulin but I wouldn't stop it. It could be controlling his pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538784/ . Assuming he stays comfortable the rest of the winter, after temps warm up this spring you can retest his insulin and see how he does off metformin. If needed you could try him on ertugliflozin or canagliflozin. -- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
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Sherry Morse
Hi Robin, Dr. Kellon already answered the metformin portion of your question but as far as the Vitamin E - you can get it for probably much less than the vet is charging by purchasing human grade capsules and using those. That way you don't need to worry about sugar or any other ingredients that may or may not be in it. I would definitely bump his pergolide up and keep his legs wrapped and hooves in boots if it gets below 40.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Thank you Dr. Kellon. I can't thank you and your volunteers enough for helping us keep our horses safe from pain and being put down. Your guidance is filling a great void that exists in this area with most of our veterinarians.
-- Robin Aiken, SC 2022 https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan |
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Thank you Sherry! Great idea to proactively get his hoof boots on him! Why is it that you recommend wrapping his legs?
The vitamin E I purchased is by Equine Daily Nutrition. It is called VIT E 5000. Ingredients are d-alpha tocopheryl (natural source of vitami E), extruded soybeans and calcium carbonate. Are these ingredients all safe for him? -- Robin Aiken, SC 2022 https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan |
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Sherry Morse
Hi Robin, Hoof boots and leg wrapping can help stop/lessen winter laminitis events and with insulin already elevated you want to do anything you can to avoid that. As far as the Vitamin E, the listed ingredients are fine, but you probably still need to use oil with it as it sounds like it's a dry powder.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Hi Sherry,
The Vitamin E is a moist consistency. Not a dry powder, but not liquid either. Why are you recommending an oil with it? -- Regards, Robin -- Robin Aiken, SC 2022 https://ecir.groups.io/g/CaseHistory/files/Robin%20and%20Hogan |
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Hi Robin,
Equine Daily Nutrition is not the manufacturer. Who makes this product? I am curious about the consistency and have been trying to find it. Thanks. -- Lorna in Eastern Ontario 2002 |
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Sherry Morse
Hi Robin, Vitamin E needs to be in contact with oil to be effective. main@ECIR.groups.io | Vitamin E product in oil is a recent discussion of Vitamin E.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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