New blood work and Gracie's insulin is way to high


@AngelaBelzner
 

Dear Members,

Please help because I don't know what to do next.

I received the new blood work today and Gracie's insulin level from the Cornell test is 102.63 ulU/mL.  Her ACTH is 21,5 pg/mL  She has been on 1 mg of Prascend pergolide since the end of February.  I have had her hay tested and balanced since March.   She gets 18 pounds of Bermuda and 1 pound of Stabul 1 with balanced minerals each day.  Vet told me today to keep exercising her but that's obviously not enough. I take her for a 25 minute walk every morning plus 4 to 5 times a week 1 work with her in the arena for 25 minutes.  I have been so good about her diet and exercise so I don't know what to do for her.  Two weeks ago I put Gracie back in the Soft ride boots because i could tell she wasn't moving as well as before.  With the boots she does much better so she's still getting her exercise.

I would like to up date Gracie's case history but I am not technical at all.  I can't even figure out how to update it.   At first I couldn't even find her file but finally I did when i hit new topic and it was under my signature.  There must be an easy way to find it.  Also when i click on it it won't let me add anything.  I can't find my welcome email which probably had that information but I don't know if it did.

Please help me on how to update Gracie's file.  And if you know what i can do for her insulin level.

Thanks in advance for all your help!
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


 

You’re doing great, Angela.  Don’t panic.  You found your case history in your signature and that’s the best way to find it, the reason we ask people to add the link to their signature.  Here’s a link to your Welcome letter.  I found it by looking for all your posts, which is here.  

In order to edit and amend your case history, you need to look on your device.  Depending on which device you use, you should find a Word doc. or a Pages document, the original word processing document you created before you converted it to a pdf for posting.  Your pdf was posted toward the end of January ‘22 so I would think you should be looking for a document created in mid January.  If you didn’t save it for some reason, you will need to create a new CH document from scratch.  In either case, the newly amended or created document should be exported as a pdf file for posting.  Be sure to keep the word processing file someplace safe, such as in a folder you label ECIR.

--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


Sherry Morse
 

Hi Angela,

Martha's already addressed how to update your Case History folder.  With Gracie's PPID being well controlled but her insulin still being elevated you want to look at using Metformin to bring it down as well as looking where her diet can be tightened up.  The dose for that is 30mg/kg twice a day and I would start her on that ASAP as her insulin is high enough to be causing laminitis.

Has she lost weight since you first did her case history?  Has her trim been corrected since you posted pictures?  





@AngelaBelzner
 


--Thank you Martha for your help!!! I will try to get Gracie's file updated in the next day.

I appreciate you so much! 

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


@AngelaBelzner
 

Martha,

I will ask my vet about Metformin.   Yes she has lost 100 pounds since last December.  She is now 985 with the weight tape I always use.  She was 1100 in December.  She looks great. In her boots she moves well but if I take them off I can tell she's sore and doesn't move as well. 

She gets trimmed every four weeks by Aliki who told me about this group so i think her trim is good.

Thanks for your help!
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Kirsten Rasmussen
 

You could also start soaking her hay.

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


Kirsten Rasmussen
 

It's ok for her to be in boots uf that's what makes her comfortable.  Many horses need them permanently.  Her Jan 2021 xrays do show thin soles.  Its nice to see the bottom of her hoof is minimally touched by your trimmer, but we would say that Gracie's feet in February needed the toes to be brought back.  There are very few trimmers out there that do this to our satisfaction.  Long toes do pull/stretch the sole forward and can contribute to thinning it.

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


@AngelaBelzner
 

Kirsten,

I have started soaking Gracie's hay again and I'm keeping her boots on at all times.  I can take new pictures of her feet. Would I take them now or after her next trim on September 5th? I am waiting to hear from the vet about the Metformin.

I am almost finished updating her case history but i don't know where I add the hay analysis because i think I am suppose to put it in there. Also do  just put the last hay analysis?.  I have had 3 done since i started in March.

Thanks for all your help!!
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


 
Edited

Hi Angela,
If the hay analyses are in pdf format or you can convert them to pdf, make a new folder inside your case history folder and label it Hay Analyses.  Open the link to the folder in your signature and click on the blue button which says “+New/Upload” and then “Add Folder”.  You can leave them all there but best to label them with dates.  If you have photos and can’t export them to pdf, you can add them to your photo album.

If you do the photos now, you should have time to receive advice before your next trim.  If you wait until after the trim, we can comment on it and offer advice but putting it into action won’t happen until the following trim.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


@AngelaBelzner
 


--Hi Martha,

Thanks for your help!!    I have up dated Gracie’s case history.  I will work on getting my hay analysis loaded.  I will also go take pictures of her feet and add to my album.  

 Soaking her hay and should hear back from vet tomorrow about Metformin.  The vet wants me to put her back on Insulin wise.  I had taken her off it in May.


Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Lesley Bludworth
 

Angela,
Thank you for mentioning this product.
The study listed along with the product at its website looks promising but it was only with 4 horses.
Was your horses insulin well-maintained while on it? How long on it?


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of abelzner3@... <abelzner3@...>
Sent: Sunday, August 21, 2022 11:33:37 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] New blood work and Gracie's insulin is way to high
 

--Hi Martha,

Thanks for your help!!    I have up dated Gracie’s case history.  I will work on getting my hay analysis loaded.  I will also go take pictures of her feet and add to my album.  

 Soaking her hay and should hear back from vet tomorrow about Metformin.  The vet wants me to put her back on Insulin wise.  I had taken her off it in May.


Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749


Sherry Morse
 

Hi Angela,

As a rule our members have not found Insulin Wise to work. At least they offer a money back guarantee, but we would advise against using it as there are better options for insulin control.
--

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/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


@AngelaBelzner
 

Hi Lesley,

Gracie was on Insulin wise from December 21, 2021 to May 6th so about 4 and a half months.  December her insulin was over 200.  In February it went down to 50 but I was also soaking her hay. I stopped soaking hay in March because i had my hay tested. At the end of April Gracie's insulin was up to 75.  She was still on Insulinwise.  I took her off it at that time and now her insulin is 102. I don't know if it helped or not. 
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Lesley Bludworth
 

Angela, 
I'm sorry to hear that.
I am just starting this insulin management with my mare, she was excessively high recently.
Where do you get your hay?
I usually get Bermuda from western ranchman or Scottsdale live stock.



From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of abelzner3@... <abelzner3@...>
Sent: Sunday, August 21, 2022 8:20:15 PM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] New blood work and Gracie's insulin is way to high
 
Hi Lesley,

Gracie was on Insulin wise from December 21, 2021 to May 6th so about 4 and a half months.  December her insulin was over 200.  In February it went down to 50 but I was also soaking her hay. I stopped soaking hay in March because i had my hay tested. At the end of April Gracie's insulin was up to 75.  She was still on Insulinwise.  I took her off it at that time and now her insulin is 102. I don't know if it helped or not. 
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749


@AngelaBelzner
 

Hi Sherry,
Gracie was on Insulinwise for 4 and a half months.  At first her insulin went down from greater than 200 to 50 but i was also soaking her hay.  Then i stopped soaking hay because i had the hay tested and insulin went up to 75 even though she was still on Insulinwise.  I took her off of it and insulin has gone to 102 so maybe it helped a little. I don't know.  Someone told me about Metaborol and also Ezium metabolic.  Have you heard of them? Are those options? Or what options do you recommend?  

I have Gracie's case history updated and i also took new photos of  her feet today.  I downloaded them into the photo album.  I also put the hay analysis in the photo album.

Thanks for all your help!!


--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Sherry Morse
 

Hi Angela,

In order to tell if Insulinwise was the sole reason for insulin reduction you'd have to change nothing else in management while using it.  Looking at your case history you started limiting hay as well as soaking it in December. You also stopped the timothy pellets and Crypto Aero and took her off the Dynamite vitamins at the same time so lots of changes beyond just the Insulin Wise. 

At this point if you wanted to satisfy your vet you could stop soaking the hay and put her back on Insulinwise and test her in a week to see if the insulin level has come down.  I'd ask the vet to foot the bill for the Insulinwise and the bloodwork for that personally.  We've seen much better results overall with Metformin for refractory insulin.

If you haven't already read Dr. Kellon's overview of the study please see https://ecir.groups.io/g/main/files/Insulinwise/Review%20of%20InsulinWise%20Study.pdf.  




@AngelaBelzner
 

Hi Lesley,

I but my Bermuda at Black Mountain feed in Cave Creek.  It's usually pretty good hay.
Good luck with your mare.  This is not easy getting the insulin down but I will never give up.
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Lesley Bludworth
 

Angela,
Thank you, yes I'm sure there is a way. I took her swimming last week and hope to get her some good cardio swimming to make her insulin sensitivity better until she feels good enough for land based exercise!
I just bought some Bermuda and have not tested it yet.
I don't know if its worth going in together cost wise to test hay in the future, but I'm open to that if you are. 



From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of abelzner3@... <abelzner3@...>
Sent: Monday, August 22, 2022 3:50:35 PM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] New blood work and Gracie's insulin is way to high
 
Hi Lesley,

I but my Bermuda at Black Mountain feed in Cave Creek.  It's usually pretty good hay.
Good luck with your mare.  This is not easy getting the insulin down but I will never give up.
--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History
https://ecir.groups.io/g/CaseHistory/album?id=277749


@AngelaBelzner
 

Hi Sherry,

Thank you for the information.  It makes sense.  I did change a lot all at the same time to get the insulin down. My vet called me back today and he ordered the Metformin for me so I will be starting Gracie on that soon. I am also soaking her hay again.  Looking at Gracie's case history is there anything else that you see that I should be doing or changing for her?

Also I uploaded new photos of Gracie's feet and  I am wondering if someone can give in put before her next trim.  She had her last trim August 6th and will have her next one September 5th.

Thank you all your input!  I sure appreciate everyones help!!

--

Angela B
Cave Creek Arizona 20222

https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 

https://ecir.groups.io/g/CaseHistory/album?id=273132


Kirsten Rasmussen
 

Hi Angela,

I looked at your trim photos.  It appears to me that there's little difference in the fronts and RH since the Feb photos, so the trim is maintaining the long toes and not actually improving them by shortening them horizontally.  Either the time between trims needs to be shortened, or more should come off at each trim.

There is a major event line growing out about 2/3 down the hoof capsule, but unfortunately the new growth above it is not coming in as tight as we'd like to see.  Gracie's ongoing high insulin has affected the integrity of the new growth and the leveraging forces from the long toes and walls are contributing to pulling the new hoof wall away from the inner structures.  The chips in her hoof wall are also indicating that they are being left too long and are too disconnected to support her weight.

Have you had hoof markups done before?  If you'd like to get on the list you can start a "New Topic" titled "Request for hoof markups" and let us know when your next trim date is.  It would be helpful if you could add lateral and dorsal photos of the hooves including the cannon bones, with Gracie standing square. 

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