New Member Gracie insulin resistant


@AngelaBelzner
 

Hello group members, 

My horse Gracie got laminitis in December and her blood work showed her sugar is very high and that she is insulin resistant. I have been soaking her hay since and my vet has her on Insulinwise and Equioxx.  She was on 24/7 hay with slow feeders for the last six months. She became over weight with a cresty neck so now the vet has me weighing her hay. I hired a nutrition consultant because the vet didn't see anything wrong with what I was feeding her.  I just received the consultant's report and have started her on a little bit of one of the products yesterday a balancer. I haven't bought the other products yet. I also had x rays done of her front feet this week.  Today, I had the trimmer come to trim her and she told me to join this group for help. I really want to help my sweet horse so any help is appreciated.  
--
Angela B Cave Creek Arizona 20222


Sherry Morse
 

Hi Angela,

You'll be getting a full welcome message shortly but for a horse that's insulin resistant and experiencing laminitis using a NSAID like Equioxx will not provide any pain relief so we recommend weaning off them as soon as possible.  Insulinwise has also not shown any appreciable effect on lowering insulin.  I believe they do offer a money back guarantee if it doesn't work so you may want to look into that.

Providing us with a copy of the hay analysis would be helpful but if the hay is over 10% ESC+starch it should be soaked prior to feeding. Is she on any hard feed other than the balancer? 




Cindy Q
 
Edited

Hello Gracie

Welcome to the group! 

We have a lot of relevant information for you in our official welcome letter below. It's a lot but take your time to read through it.

1) What you can do immediately is put her on the Emergency Diet. (Diet is the second section below) There's recommendation for soaking times, what else is safe to feed and amount to feed for weight loss (without being too little to cause other issues). Cut out all commercial balancers unless it is on the list of "acceptable" balancers below (still a 2nd choice to custom balancing)

2) The Emergency Diet also provides a list of safe carriers for your minerals/supplements. Popular examples are rinsed/soaked/and rinsed again beet (that has no molasses) or for an overweight horse, you want to use the minimal amount as a carrier that your horse will eat the minerals. Start with a small amount of minerals (might even be a pinch or 1/4 teaspoon if the horse is very fussy) and increase gradually.
2) You have done some diagnostics so try to get your test results up into a case history. Be specific with the numbers and unit of measurements.
3) Once you create a photo album, your xrays can also be uploaded for more specific advice. Your trimmer may have already advised you but look into getting some boots and pads. I personally like Easycare/ Easyboot Cloud boots which come with blue cushy cloud pads (replaceable). 

Here's the detailed welcome letter. Remember one step at a time. Ask questions if you are not sure. Start the Emergency Diet - it works!

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. 

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





@AngelaBelzner
 

Hello,

I have a couple of questions.  First about hay soaking.  I have been soaking all the hay for Gracie for an hour and then giving it to her.  I don't know how quickly wet hay goes bad.  I am wondering if I can soak the hay earlier in the day for an hour, hanging it up and then give it to the horse for dinner or do I need to give it to the horse right after soaking?  The high temperatures here in Arizona are in the 60s right now. 
Also, my vet said I should change from Bermuda to Teff hay?  Is that a good idea?  I have been told sometimes it's lower in sugar but I don't know if it's good to change when Gracie has eaten Bermuda her whole life. 

I haven't done Gracie's case study but I will get it figured out and done.

Thanks for your help!   Angela
--

Angela B Cave Creek Arizona 20222


Sherry Morse
 

Hi Angela,

A lot of people soak all their hay all at once and let it dry before feeding.  It takes more than a few hours at 60 for hay to start to go bad.  I wouldn't necessarily leave it for hours when it's a 100 but at 60 you should be ok.  As far as the type of hay you're feeding - if you test your hay and it's under 10% ESC+starch you shouldn't have to soak it unless you have a very sensitive horse. 



@AngelaBelzner
 


--Hi Sherry,

Thank you for getting back with me.  About getting my hay tested... I don't have room to get large amounts of hay.  I only have room to get 6 weeks at a time.   Is it worth testing or not?  Also, where I buy my hay from they said each order I buy comes from the same grower but different fields in each order.  I don't know if that makes a difference.

Thanks! Angela
Angela B Cave Creek Arizona 20222


Eleanor Kellon, VMD
 

Angela,

Would you consider getting a small garden shed to increase your storage space? It can be an inexpensive model with no floor, just use pallets to keep the hay elevated.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


@AngelaBelzner
 

Hi Eleanor,

I have those.  I have 3 horses so I have room for 6 weeks but can get 7 weeks if i stack it really high.

Angela
--
Angela B Cave Creek Arizona 20222


Kirsten Rasmussen
 

Can you test a larger batch for your IR horse and save that hay for her,  then get more frequent deliveries for your other 2?

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


@AngelaBelzner
 

Thanks Kirsten .......That's a good idea!  I will look into how to get my hay tested. 

Thank you! Angela
--
Angela B Cave Creek Arizona 20222


@AngelaBelzner
 

Hi Everyone,

I am stuck because i can't figure out how to download my case history into my folder. My case history is filled out and saved as aPDF.  I created a folder with a name but after that I am stuck.  Any help on what to do and how would be appreciated.

Thanks, Angela
--
Angela B Cave Creek Arizona 20222


Maxine McArthur
 
Edited

Hi Angela
Don't worry, it is a bit confusing at first but you'll soon work it out. You're doing great! For some reason, after you first create a folder and click save, the system eats it and it disappears from view--but it's not gone. Your folder is here: CaseHistory@ECIR.groups.io | Files
Click the blue 'New Upload' button, then 'Upload File'. Browse on your computer for your saved pdf, select it, then Add to the folder. 

One last thing--once you've done that, please open the case history in your folder, copy the URL, and add it to your signature box in the 'Subscription' tab on the main group (where we are now, not the Case History sub-group). Make sure you add a space at the end of the URL to make it 'live', and scroll down to click Save at the bottom. Then your case history link will appear in your signature.  
--
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

 


Sherry Morse
 

Hi Angela,

Here's the link to your folder: https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie (which is also what you'll add to you signature).  Go to that link and then click on the blue button that says "New/Upload" and then select "Upload File" and navigate to where the file is saved on your device.

If you need directions on adding the link to your signature you can reference this note: https://ecir.groups.io/g/main/message/273037




@AngelaBelzner
 


--
Thank you Maxine and Sherry,

I think I have it done now and hopefully correctly.  My next step I think is to figure out how to do a hay test.
Thanks for all your help! 

Angela B Cave Creek Arizona 20222
https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie 


Kirsten Rasmussen
 

For the hay test, most critical is that you pay a bit more to get a wet chemistry analysis.  Do not get NIR, which is cheaper,  because it can underestimate sugar and starch by as much as 30%.  We recommend the 603 Trainer test at Equi-Analytical, which is done by wet chemistry and covers all the major and trace minerals you'll need to balance the hay.  I also request that the lab add chloride, a cheap add-on, so I can calculate how much salt to feed.  However, if you are just worried about sugar and starch, and the hay will be changing frequently so testing will get expensive, you can do the 644 Carb Pack instead and feed one of our recommended ration balancers.  This is not ideal for balancing minerals, but is better than nothing. 

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


@AngelaBelzner
 

Thank you Kristen for the help!  I will do the 603 and chloride add on as you suggested.

Appreciate your help,  Angela
--


Angela B Cave Creek Arizona 20222
https://ecir.groups.io/g/CaseHistory/files/Angela%20and%20Gracie