I am currently going thru another bout of laminitis with Flyte.  To recap, his January labs showed a triglyceride level of 5.4 mmol.   In October it was 2.6.   His  liver enzymes in Jan. were GGT 208 u/l, AST 545 u/l.   Clinically at that time he was doing fine, so my vet wanted him off the Invokana.  He was on 200 mgs.  Despite tight diet, hay tested 6.3 s/s 25 lbs. , balanced - he has become lame.  Left front is the worst.

We have had strange weather really cold nights, warm days, he is in at night. He had his feet trimmed on tueday and he became worse.  I have put him back on Invokana, 200mgs as of today.   My question is how worried do I need to be about the triglyerides,  how high is too high, and what is lesser of two evils.  In my discussion with my pharmacist, he has suggested to add niacin to counter act the high triglycerides.  Do we know if that will have any effect on horses?   
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Lecia Flyte and Flame
Alberta, Canada

Niacin worsens insulin resistance. They don't care as much in people because their focus is on glucose levels but insulin is what causes laminitis. What is his diet?

Hypertriglyceridemia can persist for years with the only change being elevated liver enzymes https://pubmed.ncbi.nlm.nih.gov/23663085/ . Nevertheless, I prefer to keep liver enzymes normal by dietary manipulations whenever possible.

Remember you should not use bute, Banamine or EquiOx with Invokana.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Thank you for your reply. Good to know about the niacin.  As of Friday, he is eating 28 lbs of grass hay,  6.3 per cent s/s.  with  2lbs of TBC split between am and pm as a carrier for supplements.  I started the invokana again on Friday,  and moved him into my indoor sand arena.  He has been there 24/7.  He is in cloud boots. He wont eat beet pulp anymore.  What can I give him to lower his liver enzymes?   He gets 15 grams Alcar along with the usual supplements.   I know he should have free choice but that is a little difficult at the moment.  During the day I am giving hay at 7 11 and 3.  3lbs at a time and the balance (17) at 7pm.   At present he is still lying down alot.  As always, I appreciate your time and advice.   And yes, I did remember about the anti inflammatory drugs.  My vet wanted him on banamine but I am giving him devils claw instead.    Thanks.
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Lecia Flyte and Flame
Alberta, Canada

It seems to be the older horses that have the most trouble with this. Something is off in their ability to handle the TG and/or to produce glucose to replace what is lost.

Flyte could have hay with s/s higher than 6.3. Up to 10 seems to be handled. If that 28 lbs is all he will eat free choice that's fine. Otherwise, give him as much as he will eat. If you can get wheat bran, add  1/2 lb to his TBC am and pm. Also give him 25 g L-glycine AM and PM https://www.nationalnutrition.ca/aor-glycine-powder-100-500g.html and start Mad Barn's B Pak https://madbarn.ca/product/b-vitamin-pak/ .
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Dr. K  I have put  Flyte back on free choice as of this afternoon.  I also ordered the supplements you recommended.   Here's hoping he rebounds quickly.  It was tough to see him have this setback.   Once again heartfelt thanks for all your guidance.
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Lecia Flyte and Flame
Alberta, Canada