Metformin Added/Not Eating Food


Jamie Miller
 

Hello. 

I started Walker on Metformin on Wednesday the 11th.  Knowing how picky he is, I started him on 8 pills, then up to 10, then 12, and 13. The increases were 8 in the a.m., 10 for p.m. dose, then 12 for the next a.m., then 13 in p.m. Full dose given on Friday a.m. /p.m. and Saturday a.m./p.m.  He is not eating his food now that the metformin is added.  Had no problem before.  He gets 18 lbs of soaked Timothy cubes per day, but now won't even eat 1/4 of that per day.  This morning I fed him without giving him Metformin.  His tummy was growling so loudly I couldn't bear it.  I was crushing pills and mixing with his ground flax, salt, vitamin E and Herbal mune thinking that since he ate those supplements before, he might still eat it with the metformin added, but no.  He's not eating his food topped with crushed metformin.  I even tried really mixing it up into the food rather than simply top it.  He always ate his soaked cubes with the plain supplements sprinkled on top. Now I don't know what to do. 

Any idea on alternative ways to entice him to eat his food or get him to take his pills?

Thanks in advance for any help or guidance. 
--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


 

There's a file explaining how to syringe metformin using a carrier of milk of magnesia. I did it for a while. It required a fair  amount of MOM to dissolve the metformin and make is non caustic. When I had the right amount of MOM, I had no skin reaction to the suspension. Metformin makes my face burn. I recommend both wiping off the lips and rinsing the mouth after syringing.

My experience:
https://ecir.groups.io/g/main/message/274028 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Jamie Miller
 

Thank you. I did read that as an option and will consider that.  He's not wanting to touch any of his soaked timothy balance cubes, even when there isn't anything added, just plain.  So, for now, I've added a little handful of molasses-free chopped beet pulp shreds to at least make it appealing again (hope that was okay - figured he has to eat or I'll have a different major issue on my hands), then I'll try adding the metformin again.  The vet was coming this Friday to draw blood because it would have marked his 10th day on Metformin, but clearly, now that will change. 

The barn owner is a physician and when I mentioned Walker was taking metformin now (and it was my hunch that was the cause of Walker not eating the morning food he put out) he asked why he was on metformin and not something else, given that it was the insulin that was high, not his sugar/glucose levels (which in December were 104 and the target range was 71-122. Granted, he may not have all the information and is a physician for people, but I thought it was a logical question.  So how does metformin impact insulin levels when glucose levels appear to normal?

Thank you in advance for entertaining my curious mind. 
--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


Maxine McArthur
 

Jamie, you could refer your BO to the study in our Files (UK study, 2008) on the efficacy of metformin in reducing insulin levels in horses. EVJ 07-146 Durham (groups.io)

The reason Walker's blood glucose is not elevated is that most horses do not have elevated glucose even when their insulin is very high. If glucose levels are elevated, it is likely the horse has developed diabetes, which is not common. 
Horses' glucose metabolism has some differences to that of humans. If you search some of Dr Kellon's comments on the subject, you'll find much more detailed information, well above my pay grade. There is also quite a detailed explanation of insulin resistance/EMS on our website: Physiology of Equine Metabolic Syndrome (EMS) | ECIR Group, Inc. (ecirhorse.org)

Enjoy the reading! 

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Jamie Miller
 

Thank you, Maxine. 

I will share the information in the links you provided. It is interesting that of the two studies mentioned, one showed positive results for the use of metformin and one, though much smaller, did not.  Where research is concerned that is to be expected, I imagine.  I have increased Walker's Prascend dosage to 3 pills per day and have not had bloodwork drawn to see its effect on his levels.  That is coming soon.  Was hoping to have it drawn when we checked insulin again after using metformin for a week. His ACTH and insulin levels were the lowest when I administered his dosage twice per day rather than once per day.  I gave 1 in the morning and then 1 1/2 in the evening.  When we checked levels, things were moving in the right direction.  When I returned to the once per day administration, per the recommendation here, his levels went back up.  Dr. Kellon suggested trying the twice per day again with 3 pills per day, 1 1/2 in a.m. and 1 1/2 in p.m. and then see if that does the trick.  My guy is 34, and I know that as they get older issues will arise.  Just trying to do what is best for him right now.  Hoping the addition of the molasses free beet pulp will get him eating his food again, at least. Diet-wise, there's not much more I can do .. he doesn't get any hay nor pasture. Just TC Timothy Balance Cubes and supplements. 

I did a quick search for diabetes in horses, but that since it is not very common and often included with PPID, EMS, and IR, I gained only a little bit of info.  Seems that diabetic horses will always have high glucose (?).  In Walker's case, his glucose, in December at last check, was in the normal range at 104 (70-122) and ACTH and inulin were high.  https://ker.com/equinews/dietary-management-diabetic-horses/ 


--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


 

Jamie, did Walker's change in eating happen when you raised his Prascend dose?
 

--
Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History 


Jamie Miller
 

Thank you, Ellen. That's a good question, but no, it changed when I added the Metformin last week. 2 weeks prior to that, I increased the Prascend from 2 1/2 daily to 3 pills daily and he was eating the soaked cubes and supplements just fine. 
--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


Sherry Morse
 

Jamie,

Are you rinsing Walker's mouth after administering the metformin?  As it is very caustic he could be experiencing issues related to that which are making him unwilling to eat.




Jamie Miller
 

Thank you, Sherry. Since I was crushing the pills up and mixing it in with his supplements and food, I didn't really think I had to rinse his mouth with that method of administration. It was my understanding that I might need to do that if I gave metformin to him by syringe.  Do I rinse his mouth after he eats?  He meanders between buckets and it could take him several hours before all his mash is gone. He was eating better tonight - soaked Timothy cubes and molasses free beet pulp with ground flaxseed.  I may try the gradual increase in metformin once he's not afraid of eating from his feedbuckets again. 

BTW - I bathed him this past weekend, and of course, he goes out and rolls immediately afterwards. Video
And a video of him tonight stopping for a scratch before continuing on in search of his feedbuckets that are spread throughout his paddock area. 
--
Jamie Miller
Louisville, Kentucky, USA
July 2019
Horse: Hiram Walker
Walker Case History: https://ecir.groups.io/g/CaseHistory/files/Jamie%20and%20Walker
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=93084
Link to Profile for Hiram Walker


Sherry Morse
 

Hi Jamie,

I think you have your answer - the metformin being given in his food is obviously not going to work for him.  I would recommend syringing with the milk of magnesia and then making sure you rinse his mouth and wipe off his lips as Cass recommended.  Given that he's a picky eater and he now thinks you poisoned him it may take him a bit to get back to eating his bucket feed on a regular basis, but he still should be getting the metformin regardless.




Eleanor Kellon, VMD
 

Don't wait any longer than a week after starting to syringe it in to recheck insulin.  There are some horses where it does not work, no  matter how you give it. Recheck in 3 to 4 weeks too.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001