Is metformin supposed to cause weight loss. Joker started metformin about 6 weeks ago. At that time he was a body score of 6 and had a very cresty neck. Within 2 weeks his neck was not cresty and his insulin was significantly decreased on the meds. He is on 12 pills twice a day. He has lost a lot of weight fast and has not been in work. His body score is a 4 now and I want to make sure that he does not lose more weight going into winter and wanting to start him back to work soon. 

Mostly I want to know if the metformin is likely the only cause for the weight loss or if it might be any of my other program factors. He is usually on the fatter side unless he is in a lot of work even on the laminitic diet. 

I have just added timothy pellets and increased his stabul 1. Sorry my case history is not updated yet with his changes since starting metformin. 
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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Following this because my gelding Salsa is about 5 weeks into 11 metformin twice a day and he too has lost quite a bit of weight.  He went from 830 on a weight tape (and vet visually looking at him saying about 850) - to 730 on weight tape.
Now I know why people call metformin 'exercise in a bottle'.

I need to update his pics on my photo link.  I think now he probably is a 5 on body condition - I can feel ribs and he looks better overall. **EDITED TO ADD - I did just post two new side body shots of Salsa and his September 9 lateral xrays are on my photos too.  Since the xrays my farrier backed his toes WAY up.  He is wearing glue-on shoes and I'm excited that he's growing sole.

Not sure if we are supposed to adjust the dose of metformin down.  It did get his insulin down from 67 or so to 30 in two weeks.  Need to update my case history with all this.

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Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827

Should I expect his weight loss to level out?
Should I be reducing the number of pills he is on? 

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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

At this point, I am worried about Joker losing too much weight especially at the rate that he has lost so much over these past 6 weeks. He can not losing anymore at this time. 

Is there a possibility that his dose is too high especially now that he has lost weight. I am giving him 12 pills twice a day with an assumption of a 900 lb horse. He is not 900 lbs any more. He is now closer to 800.

I am wondering if others have found that they need to decrease their dose or if a decrease in the dose would still be effective in lowering his insulin while maintaining his weight instead of him continuing to lose weight. 

Sherry, 
Is there a way that my case history can be a google doc? So when I change things on it, it will automatically change what you all can see instead of me having to create a new PDF every time? I think you would get more updates from all users this way. 

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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Hi Anna,

Yes, you should adjust the Metformin dose for his new weight.

I don't know why he would have lost weight so dramatically from the Metformin, unless lowering insulin also supresses the appetite.  A hard crest can soften overnight once insulin comes down.  Can you increase his hay?  How many lbs is he eating now?  Can you feed it loose or in a large-hole net instead of a slow feed net (if you're using one) so it's easier to eat?  If you're feeding soaked hay, experiment with adding a little unsoaked hay to temp him to eat more.

I would expect his weight loss to level out eventually, but of course you don't want him too thin either.  Aim for a BCS of 4.5 and see if he will eat more hay.  You want to be able to just barely see his ribs.

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

Snickers' Case History
Snickers' Photo Album

Re: Metformin and weight loss. First thing to check is if he is still eating the same amount of food.

Yes, you should adjust dose down to his current weight.
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Eleanor in PA

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

Would changing from 12 pills to 10 pills sound appropriate? 

Joker has also been switched to a 1 inch size hole net that holds an entire bale instead of a 1 1/2 or 2 inch size net. He still has hay available at all times. His hay is not soaked. 
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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

So I would say his hay consumption has been slightly decreased, but also that he was getting more than he needed before which is why I switched to a smaller hole. I could easily go back to the larger hole though. 
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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Hi Anna, the dose for Metformin is 30mg / kg BW.  So, 800 lbs ÷ 2.2 lb/kg = 364 kg x 30 mg/kg = 10,909 mg (11,000).  If you're feeding 1000 mg pills, that's 11 pills, twice a day.

Give him a bigger holed hay net to help him eat more easily for now.

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

Snickers' Case History
Snickers' Photo Album

Kirsten, 
Thank you! I was also wondering if I only gave him 10 pills, would the dose be ineffective and a waste or would it just not have as strong of an effect? 

I have been told his weight loss will level out. How long should this take? 

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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29

Giving less than the correct dose, 11 pills, is likely to be ineffective. Increase his hay intake with a larger hole net, start Stabul 1.
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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 the help on adjusting Joker's metformin dose. He has now been on 11 pills since Oct 17 at the same time I increased his Stabul 1 from 10oz to 16oz, added 4 cups of timothy pellets, and gave him a haynet with 1 1/2 inch holes again instead of 1 inch. His weight is appropriately improving.

I am still concerned that Joker's entire demeaner has changed. He is lethargic, depressed and uninterested in anything. He used to be very playful, even playful when his feet were sore. Today, I only walked him around the indoor 2 times and then got off because he was moving so slow and choosing to stop. He did this before when his feet were sore, but I dont think his feet are sore now. He is just so distant and a shell of the silly playful pony he used to be. I don't know how I am supposed to get him back into an exercise program when he seems like he barely has energy to move. He also eats his hay so slowly now. 

I am looking for advice on if this is a normal side effect of Metformin and what I should do to help him. I was feeling so positive when the metformin originally helped reduce his cresty neck and helped with weight loss and lowered his insulin from over 100 to 40, but now he is just so lethargic that I am worried about him. 
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Anna Warzecha, MI, 2022

Joker (IR), Coco (PPID, IR)
https://ecir.groups.io/g/CaseHistory/files/Anna%20Warzecha:%20Joker%20%28IR%29,%20Coco%20%28PPID%29