Flame & Diana fall labs
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I know I got meds titrated and labs done late this year, but life happened. Here are Cornell results for both horses. Flame (EMS & IR)- glucose 100 mg/dl, insulin 138.49 uiu/ml, ACTH 15.4 pg/ml & leptin 5.41 ng/ml. Flame gets 4 pounds of unsoaked Bermuda twice a day, 2 1/2 pounds of TC Timothy balance cubes twice a day, 2 cups Stabul 1, he gets a lunch & night snack of 1 pound of Bermuda, 4 pounds RSR beet pulp. In the beet pulp is 2 ounces of flaxseed oil, 1 teaspoon of liquid vitamin E, 3 teaspoons of Jherb, 1 1/2 teaspoons of AAKG, 2 1/4 teaspoons of carnitine, 2oz salt, Vit A gelcaps, 5mg Pergolide (fall dose) & Invokana 225mg. As a reminder, my head tested too high in nitrates so we are trying to dilute out the hay by giving 1/2 hay, 1/2 TC cubes & increased BP to 4 pounds. Flame is lightly ridden or lunged three days a week, hand walk three days a week and hangs out in his stall/run one day a week. Questions- I know I’m kind of behind the eight ball, but should I increase Diana’s pergolide? If so, to what dose? 5mg did control her ACTH last year. Anything else I can do to try and drop Flame’s insulin? It’s never been under control even on Invokana. I did not draw triglycerides this time since they had been drawn so many times already this year. I will draw them with spring labs next year. I’m trying to update both horses case history but I’m fighting with a very old and finicky laptop. -- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Lesley Bludworth
Diana,
Soaking the hay, even if it is"safe hay", reducing the amount of TC balance timothy cubes and eliminating the stabu would be the first thing I would do to lower insulin. I have to soak "safe hay" for my mare and reduced the cubes.. TC balance cubes are higher in starch/ESC than even the non soaked hay in my case so I had to cut back to just enough to get supplements in and I feed that after she has had access to 1 hr of soaked hay in the am to try to avoid spiked insulin. Flames insulin seems dangerously high -- Lesley Bludworth Phoenix, AZ 7/2022 Sophie TWH mare https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Thanks for your reply Lesley. Diana’s insulin is ok- it’s her ACTH I was concerned & asking about. Flame’s insulin has been not controlled before or after starting Invokana, although it is lower on Invokana. Any suggestions on either of those?
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Lesley Bludworth
Ha! Sorry, thought you were Diana ;) ooops!
Beth, Flame's insulin levels are what I referred to. Since Diet and exercise are you primary tools for EMS/IR horse, especially since meds are not cutting it. Based on what you wrote, Flames diet seems like it could be made safer for him/her. You wrote the hay is unsoaked, soaking the hay can make a difference even if it is considered safe. The TC cubes are higher in energy than some hays and can be reduced, and some horses do not tolerate the stabul. And of course some kinds of exercise are better than others for insulin management. -- Lesley Bludworth Phoenix, AZ 7/2022 Sophie TWH mare https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Sherry Morse
Elizabeth, When were these tests run? I would be very concerned about Flame's insulin but since he's on Invokana I'll let Dr. Kellon address that. As far as Diana, she might be fine on the 5mg pergolide dosage the rest of the year now but need a bump up for the rise next year. The only way to confirm that would be retest in the spring on the 5mg and see where she is at.
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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Sherry- I drew their blood 10/10 & my vet spun it & sent next day to Cornell. Ok, I’ll leave Diana on 5mg for the spring & then bump up for next fall. I do spring labs so we’ll be able to see how the 5mg does. Lesley- Flame is on the TC cubes & Stabul 1 per Dr. Kellon’s suggestion from our spring labs & starting Invokana. My hay was too high in nitrates so we are using the cubes to replace 1/2 the amount of hay he was eating. I’m down to the last few bales & on Saturday will be coring samples & testing the new hay I just bought. NV Oct 2013 Flame Pictures |
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Hi, Lesley. While I don’t doubt your good intentions, your message to Beth overlooks the critical fact that Flame is on Invokana, an experimental treatment for hyperinsulemia. Dr Kellon offers specific guidance to members whose horses are treated with SGLT2 inhibitors because of their unique dietary and management needs. Elevated triglycerides are one potential side effect of SGLT2 Inhibitors that is managed through special diet and supplements. You can read about it when you have a block of time to search Messages for Invokana + posterid:58231 It’s a fascinating and sometimes confounding treatment that requires special feeding. -- |
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Lesley Bludworth
Hi Cass,
Oh! Okay, thank you. Yes, didn't know that. That will be good to read as I am considering Invokana for my horse if the diet changes are not enough.
From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Cass in NorCal <cbernstein@...>
Sent: Friday, October 28, 2022 10:47:54 PM To: main@ECIR.groups.io <main@ECIR.groups.io> Subject: Re: [ECIR] Flame & Diana fall labs Hi, Lesley. While I don’t doubt your good intentions, your message to Beth overlooks the critical fact that Flame is on Invokana, an experimental treatment for hyperinsulemia. Dr Kellon offers specific guidance to members whose horses are treated with SGLT2 inhibitors because of their unique dietary and management needs. Elevated triglycerides are one potential side effect of SGLT2 Inhibitors that is managed through special diet and supplements. You can read about it when you have a block of time to search Messages for Invokana + posterid:58231 It’s a fascinating and sometimes confounding treatment that requires special feeding. -- -- Lesley Bludworth Phoenix, AZ 7/2022 Sophie TWH mare https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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This is why we don't recommend Invokana unless there are no other options. The feeding regime is complicated and a big change from what we do normally to control insulin. We're still learning how to do this. Dr Kellon has the final word on diet for Invokana horses. Hopefully you don't have to go that route for Sophie, Lesley! It's ok to offer advice as member input is valuable, but in some situations like this one you might get corrected. :)
-- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Lesley Bludworth
Thank you Kirsten,
Learning from mistakes is a powerful way to learn ;) I hope not too regarding the Invokana for Sophie. Flames high insulin made me anxious, like Sophie's does, and I felt compelled. :( I will follow the thread for more learning. Much gratitude. -- Lesley Bludworth Phoenix, AZ 7/2022 Sophie TWH mare https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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I forgot to ask, should I give fall vaccine (flu/rhino) with Diana’s ACTH high & Flame’s insulin high? Flame did not get spring vaccine because of his high insulin, but realistically his insulin has always been high & I’ve given him vaccines in the past. Spring was the first one I held off on. Neither horse travel to shows anymore, but I do trailer off property for occasional trail rides. Other horses at the property do travel to shows.
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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I wouldn't be overly concerned with vaccinating Diana as her insulin is fairly low. The safest time of year might be outside the seasonal rise, but she seems to be doing well despite high than ideal ACTH. Flame would be one you'd want to discuss with your vet since his insulin is high enough to cause acute laminitis already. A vaccine could potentially be the last straw. Not saying that it WILL, just that it COULD. Talk to your vet about the risks of not vaccinating if the horses around him are vaccinated.
-- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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