Date
1 - 6 of 6
How long of DDE before starting meds?
|
Diana RL
Hi,
Cody was recently diagnosed IR/PPID (I still have to start a file on him...). How long do I try to correct with DDE before moving to meds? Insulin is above 1000 and acth is 50.7. -- Diana and Scooter and Cody Jan 2019 PA https://ecir.groups.io/g/CaseHistory/files/Scooter%20-%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=283361 |
|
|
|
Hi Diana,
A PPID diagnosis mandates pergolide medication. Prascend or compounded pergolide should be started immediately. Dietary changes are also almost always required, too. Start the Emergency Diet, if you haven't already. If Cody also has EMS, then you should know that the VAST majority of horses high insulin from EMS will come down to safe levels if you follow the Emergency Diet 100%. If you don't see changes within a few days of diet, we advise starting with Metformin first as it is cheap and safe, although it can be a pain to give it. https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin Some hays, even soaked, are going to be unsuitable for these horses so if the ER Diet doesn't help, we recommend looking for different hay. Keep in mind insulin can come down but pain can persist due to trim mechanics, abscesses or cold weather. So, after changing the diet we recommend retesting insulin, glucose and ACTH, so you know what you're dealing with if pain continues. For ACTH, it's best to retest 3 weeks after Cody has been taking his prescribed dose in full once a day to make sure he's getting the right amount of medication. -- 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 |
|
|
|
Diana RL
Thanks for the response, Kristen! I realized I left out some important info to inform this group's guidance. 1. Cody was diagnosed about 7 weeks ago. Since then, I have changed his diet to be in line with recommendations, started him on Prascend and put him back into "work" about 4 days a week. 2. He is not lame. 3. We just redid bloodwork. Long story short, I believe the results for my 2 horses were switched so we are redoing the bloodwork. But...assuming my belief is correct, 1mg of Prascend (which I started him on) did absolutely nothing and this is the first time we have the actual insulin number 1010 (last time it was just >200). 4. With this extra info, I am wondering if I should start Metformin now (Metformin did nothing for my other guy who is now on Invokana) or continue to try to get the insulin down for a month or so with continue diet and exercise. 5. Also, since the acth is still 50.7 how much should I increase Prascend by? He is about 1250 lbs. I will update both horses' files as soon as the retested results come in. Thanks. On Tue, Jan 31, 2023, 11:23 PM Kirsten Rasmussen <kirstenrasmussen3@...> wrote: Hi Diana, |
|
|
|
Hi Diana,
Ideally you would get ACTH down to the mid teens or low 20s. If he's at 50 on 1 Prascend, I would try 2 Prascend and retest in 3 weeks to check. That should help reduce Cody's insulin a bit, too. His insulin number is terrifyingly high. I can't believe he's not laying on his back holding his feet up in the air! I'm not sure how long a horse can have high insulin like that and not succumb to laminitis but pulling out all the stops to bring it down would my priority. Soaked low sugar hay, strict diet of only proven safe supplements and carrier. Exercise since he's sound. If he's not lame then Metformin isn't as urgent, so its up to you, but be prepared to start it if you see any signs of laminitis. I would not go to Invokana until you see the high insulin is intractable AND he develops laminitis. You could ask your vet to submit a duplicate blood pull to BET labs, as Dr Kellon has suggested in the past when Cornell insulin comes back really high but the horse isn't showing signs of high insulin. -- 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 |
|
|
|
Sherry Morse
Hi Diana, What were the weather conditions when the insulin testing was done? How long after feeding was the bloodwork done? What was the meal? Was anything else done prior to testing? I would plan on doubling the pergolide dosage if the ACTH has not changed. If you're following the emergency diet with him once you have accurate test results you can evaluate starting meds vs. just concentrating on diet and ACTH regulation.
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 |
|
|
|
Diana RL
Hi Sherry, Nothing out of the norm. Mild for January. He is essentially on only free choice hay and some supplements. Blood drawn around 11am. Thanks to you and Kristen who both said to double the Prascend. I will titrate up starting tomorrow.
|
|
|