Insulin Resistant #Vitex_CHB_Chasteberry


Andrea
 

Hi there,

I have just joined this group because of a recommendation from a new acquaintance that has a track system at her barn for horses.  If you are on here, I do appreciate your telling me about this group.

I’m not into social media, so I don’t know about hashtags, but I am looking for advice on how to feed my 23 year old Paint gelding just diagnosed insulin resistance.  

I’m still learning what all the numbers mean, but here are his numbers from bloodwork pulled on 5.10.22.

ACTH 14.7
Insulin 68.95
Leptin 10.75

He is retired, does have a cresty neck, but not to bad over weight.  

Thanks so much,

Andrea


Bobbie Day
 

Hello Andrea and welcome to the group!
Since you're a new member, and this is your first post I will be sending along your welcome message. It is quite lengthy, but I promise you it will be well worth the read and please keep it handy to refer back to, the blue links will also take you even deeper into the subject.
But first, yes it does appear that your boy's insulin is quite high, and you're on the right track (ha-ha) the best thing for keeping that insulin down is exercise, and many of our members have track systems to help with movement. 
Would you please fill out a case history for us so we can better advise you? Pictures, any test results, x-rays etc. Everything helps us to help you. 
The cornerstone of the ECIR philosophy is based on DDT/E, which is Diagnosis, Diet, Trim and Exercise. Are you taking any steps to lower his insulin besides movement?
We suggest the emergency diet (outlined below), which includes low starch and sugar grass hay (tested below 10%), if he is footsore you will need to soak as well. Have you tested your hay? Do you have results? All that really matters here, high insulin can cause laminitis among other things so it's very important that his diet is very tight as well as his trim. Weight is also important but more below! 
Diagnosing Insulin Resistance 2016 (groups.io)


Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

 

 


--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


LJ Friedman
 

 Why are you labeling his insulin “”quite high? “With 10 to 40 normal and his current number I would say it’s high. It’s nothing like 100s and 
over 200
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Nancy C
 

LJ

10 - 40 is not normal, but is the lab reference range. Here's a link that explains what that means
https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php

I agree with Bobbie there is concern here. Assuming the labs were draw correctly, at nearly 70 for insulin, this paint is closer to a tipping point to laminitis than I would like to see.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Andrea
 

Thank you, Bobbie, for all the wonderful information.  I’ll do my best to work on the case history as soon as I can.

I’m getting ready to implement the diet you recommend, but it is not at a barn with a track system; however, he is turned out in a dry lot and I am trying to exercise him more.  


He is not foot sore at the present time.  I have not yet had a chance to have the hay tested.  The barn owner thinks her hay supplier may have results he can share with me.  He weights approx. 1050 lbs. and stands at 14 2.  

Andrea in Kennesaw, GA joined May 2022


Andrea
 

I should clarify the blood for this test was not drawn after fasting.  I had the vet out for teeth, Coggins and shots and asked him about his weight and wether he might have some metabolic issues.  The vet said he thought he looked good, but given his age (23) and sometimes his lack of a spark, I forced the issue of a blood test for metabolic issues.  

Andrea in Kennesaw, GA joined May 23, 2022


Kirsten Rasmussen
 
Edited

Hi Andrea,

Just want to let you know that sedation can affect your metabolic bloodwork, in case he was sedated for his dental.  Depending on the type of sedative it can increase or decrease these numbers.  So can the timing of the blood draw after the first meal of the day, which is why we recommend waiting at least 4 hours after they start their breakfast so the insulin spoke has time to normalize.  It's not clear if these were factors in your results.

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


Andrea
 

Thanks, Kristen for making this point.  

He was not sedated, as it was determined he did not need his teeth floated?

There should have been substantial time after his breakfast, but he had access to rye grass hay up to the point of the blood draw.  ☹️

Andrea in Kennesaw, GA joined May 23, 2022


Eleanor Kellon, VMD
 

It should be pointed out here that ryegrass hay is definitely not appropriate for a horse with metabolic syndrome. Too much sugar and starch. Not enough to get those numbers on a normal horse but enough to get high insulin with a metabolic syndrome horse.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Andrea
 

Thank you, Dr. Kellon,

I’m now aware of this.  I’m trying to see if fescue or orchard grass can be given to him.  

Andrea in Kennesaw, GA for Tobias—joined May 23, 2022


Eleanor Kellon, VMD
 

Fescue isn't a good choice either because the endophyte that can infect it causes hoof problems.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Andrea
 

Oh boy.  Okay.

Which is best?

Andrea in Kennesaw, GA for Tobias—joined May 23, 2022


Eleanor Kellon, VMD
 

Any other grass hay.  The Orchard would be fine but you'll need to test it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Andrea
 

May I ask if a powdered form of Vitamin E with added Selenium is okay to use for the ‘emergency diet?’  I’m trying to make it easier for the barn help where he is boarded; I would like to put the powdered form into a zipper bag with his other supplements.  

https://uckele.com/e-se-pellet-2lb.html

I’m so appreciative of your help.

Andrea in Kennesaw, GA for Tobias—joined May 23, 2022


Eleanor Kellon, VMD
 

You could, but the powdered E isn't as well absorbed. If you use the human soft gel caps of E in oil (not glycerin) you can just toss those in the baggie.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

The powdered form should be mixed with a bit of oil to make a paste or liquid.

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


Andrea
 

Thank your for all this great information.  Do you know of a soft gel that does not have glycerin?  I’m having a hard time finding one.

Andrea in Kennesaw, GA for Tobias—joined May 23, 2022


Lavinia Fiscaletti
 
Edited

Hi Andrea,

Glycerin is used to male the soft gel so is an ingredient in virtually of all of them. It's not a problem. Just need to use ones that include some type of oil inside the gelcap (soy is the most common).

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Andrea
 

Thanks so much!

Andrea in Kennesaw, GA for Tobias—joined May 23, 2022