Fasting glucose test


Ditte
 

  I have an appointment with the vet for Monday morning to get both my horses tested for PPID and the gelding also for Lyme as I found a tick on him in June. A couple of weeks later he had an allergic reaction with swollen lips, eyes and lumps all over on his neck and shoulders. It went away quickly without treatment and I didn't think more of it even though it was more difficult to keep the pulses away than usual. Now (on/off since late November) he's not doing so well with pulses and warm hooves. I've never had issues with him (or the mare) this time of year. Previously it has been in May/June and has gone away as soon as grass intake was reduced and he hasn't needed the muzzle after august until this year. The mare which is usually the one with problems is doing fine on the same feed. Haylage is not tested, but from 2019 and 2020, so I've used it before without problems. So something is definitely "wrong" with the gelding. The vet wants to do a fasting glucose test. I have linked to the ECIR guidelines trying to convince him to do it non-fasting without succes. Is there any point in doing the fasting test, when given their long history of trouble tolerating grass,  I'm pretty convinced they've been IR since they were 2 years old in 2007/2008?                                                 

     Ditte
   Denmark
   June 2019


Sherry Morse
 

Hi Ditte,

As you already know we don't recommend fasting for testing as it will possibly create a falsely low insulin which makes many vets think that the horse is not IR when they really are. You have the option of not fasting and not mentioning that to the vet and then interpreting the tests with that in mind or know that for a horse to truly NOT be IR when fasting the insulin number should be below 6 NOT in what is the 'normal' range of 10 - 40.

Issues at this time of year are usually seen in IR horses who are experiencing winter laminitis due to the cold.  Do you have him in hoof and leg boots at this time?



Ditte
 

  I can't follow the guidelines for a non-fasting test either, when the time of the test is in the morning as they don't have acces to haylage all night. No I don't have him in boots or "legwarmers". It's not really that cold here, so I don't think that's the issue. He's shod and it's very wet and muddy now, so that would be a mess. they're stalled evenings and nights. 
--
   Ditte
   Denmark
   June 2019


Trisha DePietro
 

Hi Ditte. Just wanted to share my experience with a vet who insisted on fasting prior to testing....I explained that what I was needing was a baseline of how well my horses body was functioning  when it was ingesting food....because my horse is never without some type of food getting processed. So, to have a test done on a fasting horse just doesn't make any sense. You can't really determine how the cells are functioning, if they aren't being stimulated by the process of digestion and absorption.  Just like a lameness exam....you don't have the horse just stand there to evaluate for lameness, right? They get the horse to walk, trot, etc to see the anatomy function or lack of function...and then make a decision from there. Hope this helps in speaking with your vet. 
--
Trisha DePietro
Aug 2018
NH
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Primary Responder


Eleanor Kellon, VMD
 

Ditte,

In that case you should do a fasting insulin because if you can't wait the 4 hours after feeding you will have an artificially high insulin.

Fasting insulin should be no higher than 5 to 8 uIU.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Ditte
 

  Thank you. If the vet had agreed to a non-fasting test I would have gotten a time later in the day at least 4 hours after the first feeding also in the hope that the mare would be easier to draw blood from after a few hours of turnout. She does not like vets and needles. A nightmare to get her sedated in June 2019 when she got her teeth done. Got three doses, the first in a muscle because she was so worked up,  the next 2 in the blood. Also got a vaccine and the farrier was here just before the vet and all that combined triggered her laminitis ( I found this group after searching for a link between vaccine and laminitis). They probably should get a tetanus (and flu-shot) now, and teeth checked, but I'm not sure I dare.
  As said I sent him your guidelines, but was told that they follow never guidelines/recommendations from the lab and a large group of vets.
  I fed them for the night an hour ago and his hooves are a lot less hot and only a very "weak" pulse even though the leg was angled back. The last couple of days it has been "strong" in the evening and morning even on a vertical or slightly angled forward leg. But no heat or pulse in the afternoon after turnout. I started soaking his haylage 32 hours ago, maybe that's was has helped.
  So a fasting test where I'm giving them glucose 60-90 minutes before blood is drawn is better than no test?
--
   Ditte
   Denmark
   June 2019


Eleanor Kellon, VMD
 

Yes, certainly better than no test.

Soaking may have helped but what you are seeing after turnout is the benefit of movement on circulation.  Pulses are prominent because circulation is being impaired.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Michele Cameron
 

My vet also wanted me to fast my horse before testing.... So, in order to not alienate him,I fed my horse as usual, then right before the vet was due, I swept up the tell-tale signs that he had been fed his morning hay.
I would never give my horse glucose even if he wasn't IR.... You can just let the vet do what he needs to and say whatever he says. There is no point in arguing or trying to educate a vet beyond texting them the link to the ECIR site....
I  suggest that you use the Riski (sp?) chart
and advice from the group.   Unfortunately, most vets are light years behind Dr. K. and this group's understanding of IR and Cushings... It may be scary to
step away from your vet's advice, but that is what I would do.... I did not do the baseline tests until my horse's IR was well under control, therefore, my vet said, "He
is not IR, he is just the type of horse that might eventually develop it", then he suggested that I feed him 1st cut hay and a good vitamin.... Fortunately, I have a great
relationship with my vet, and as the years have passed, Elijah has thrived on NO GRASS, tested hay, balanced minerals, exercise, and frequent, proper trims. I am grateful to
this group and to my good fortune in finding it.     
Michele Cameron & Elijah Mustang
Everson, Washington USA 01/2015


Ditte
 

  I did try to give the gelding the glucose, even though it felt completely wrong to put all that sugar in him. But quickly gave up as the holes in my syringes are way too small or my fingers to weak to get that thick sticky stuff through. So no glucose test today. 
--
   Ditte
   Denmark
   June 2019


 

Ditte, a solution to that problem is to cut off the tip of the syringe and fill it from the cut end.  And then hold it carefully so it doesn’t spill it’s contents.
My vet used to ask for a fasting test which I generally ignored but then once I asked what was meant by fasting.  To that vet it meant the pony’s regular hay but no grain.  So, I elected to use that definition of ‘fasting’ with other vets going forward.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

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Ditte
 

       Strange definition of fasting yes. If you know or suspect your horse has EMS/IR you're probably not giving it grain anyway.
As predicted the mare was not cooperative. Had to put the tool (don't know the English name?) that squeezes the upper lip real hard on her to get the blood. So now waiting for results of the PPID tests. 
--
   Ditte
   Denmark
   June 2019


 

Hi Ditte,
Depending on how excited she got while you were attempting the blood draw, the results may be artificially elevated.  We call the tool you refer to a “twitch”.  I’m not sure how using a twitch would affect the results but the stress leading up to its use would be expected to increase ACTH.  I had a needle averse mare.  As long as she didn’t see the needle, she was fine.  We would toss something light over her head.  Sometimes, I would get someone who didn’t know her well to hold her as I’m sure she picked up on my anxiety.  Eventually we learned that you could do most anything to her after floating her teeth.  She loved that!
--
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


 
 


Kirsten Rasmussen
 

Hi Ditte, 

I believe you are talking about a "twitch".

I had always thought them cruel, until I read this article:
https://horse-canada.com/magazine/equine-ownership/10-facts-about-twitches/amp/
I see Dr Kellon recommends them over sedation for simple procedures:
https://www.equisearch.com/HorseJournal/sedating-your-horse
What I don't know is how they might affect the results of the bloodwork.

It sounds like you will have fasted insulin results with no glucose challenge.  That will be fine.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
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Ditte
 

   We didn't do the glucose test at all. Once I gave up on feeding them the glucose I fed them their beetpulp and haylage, because I didn't think/know the fasting test could be done without the glucose.   Yes I suspected the stress could affect the results, but we did put the twitch on fairly early, before struggling with her for too long, so hopefully they wont be too affected. It started as a needle phobia, but now I think it's vets in general needle or not. She didn't seem agitated while we drew blood from the gelding in the next stall though. Didn't start until it was her turn.  
--
   Ditte
   Denmark
   June 2019


Kirsten Rasmussen
 

If you gave them food before the blood pull AND they were fasted overnight, the insulin results will be artificially high.  There is always an elevation with the first meal after a fast.  We recommend feeding at least 4 hours before the blood pull to avoid this effect of the first meal of the day.

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