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High insulin again- metformin, mare cycles


 

Here we go again, only during the seasonal rise. I’d appreciate a review of the steps I’m taking to address Cayuse’s latest high insulin. Updated CH link.

 

On 9/11/20 I received the second very high insulin test for Cayuse in 6 months, this time 106.29 ulu/ml. I immediately started trying to syringe 13.5g of metformin twice a day, gave a ½ mg increase in pergolide and started soaking her hay longer. Soaked hay tests before I increased soaking times showed ESC of 5.9% 6.7% (two tests, same hay, soak time) and 4.9%

 

The results of a follow-up draw 17 days after these management changes: insulin dropped to 60.29 ulu/ml. ACTH is unchanged. 

 

Metformin dosing wasn’t spot-on during the 17 days until I found reusable syringes (silicone O-ring is the key) that I can operate smoothly with one hand. I know that Cayuse is now getting the full metformin dose. That didn’t happen until three days before the follow-up blood draw. We had a glitch the day before the blood draw when we missed the AM dose.

 

My plan has been to continue metformin, with another ½ mg increase in pergolide, and check insulin and ACTH again in the second week of November. That will be two months since we started metformin. I don’t see any way to know metformin’s role in reducing insulin, so for now I don’t plan to stop it. OTOH I’m not prepared to give metformin all credit for the insulin drop because Cayuse had a similar insulin drop in late spring without metformin. 

 

A new factor is that this year, for the first time, her mare cycles were noticeable and seemingly endless. When I checked hormones a few years ago, only progesterone was high. Is there any sense in rechecking hormones at this time of year? Could these high insulin tests be capturing the pattern of her estrus cycle?

 

Her insulin values are fluctuating in a bad way with a clear upward trend. Right now, interestingly, she looks good: body condition trim, crest smaller, bucking and playing. 

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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Kirsten Rasmussen
 

Cass, I hope Dr Kellon has some advice for you.  You certainly now have mastered the dosing via syringe of Metformin!  I think you should share that with the group when you have time... 

The only suggestions I have are can you get her ACTH into the mid-teens (as others have found to be beneficial), and can you increase exercise (right now I think your CH indicates she is sedentary?).  Thank goodness she is not in pain, if you can increase exercise it might be a good time to start?  (I'm not sure what the smoke situation is there right now though)

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
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Thanks, Kirsten.
I can post what solved the syringing puzzle for me, if that's what you mean. I will start a new subject heading. As for exercise, yes, I plan to, as soon as temperatures drop to a point where I can tolerate being out in the sun.  Still in the 90's here much of the day, expected to continue into next week. If I get the bib clip done, that will be a start.  
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos