OLIVER VERY HIGH INSULINE LEVEL >200 NEED HELP NOW FOUNDERING


Lori Ricigliano
 

Hello 

I also own a Half Arabian/ Half Oldenburg 2005 Gelding named Oliver. 
He became foot sore in January 2022 - I felt a bounding pulse in first his RF then a lighter bounding pulse in his LF
We did just get in a new load of alfalfa hay. He has always been on alfalfa hay since his last owner ( 5 plus years) 

Called vet and farrier , Farrier hoof tested suspected absess was told to put on bute or banamine for a week and soak in epson salts. 
no absess came. Pulse continued lameness in front , obvious head bobbing when walking. 
Farrier trimmed in Jan and horse improved with stall rest and walk.

He was on thyrol L from previous owner at 1g a day. We pulled TT4 on April 26, 2022 it was 1.8 pg/dl . Vet said to increase to 2g a day

Horse was only on stall rest and hand walk was on Safe Choice special diet and beet pulp with grass/alfalfa hay.  no turnout 

We pulled a cornell Metabolic test April 22, 2022 but only recievd it back the end of June after my farrier trim. 
In this we found out he was SEVERELY METABOLIC <200 ulu/ml Insuline but not PPID

Horse was trimmed June 27, 2022 and next day pulse returned and was not as lame but could see "footy"

At this time I found this group. Removed the safe choice, began salt with iodine and older grass hay with a little alfalfa in it  ( not tested yet) but 
we are SOAKING it prior to feeding. He is eating soaked beet pulp.
We also put him on Banamine for the last 2 days. 

He has the cresty neck and slight fat on his croup. Still "footy" you can still feel a light pulse in both his RF and LF 

From what i'm reading this is critical we should lower his Insulin level now to stop this.
 My vet is not familiar with this... but I mentioned 
that i'm seeing we need to put him on METAFORMIN asap . Get his accurate weight to do so?

We have not taken radiograps yet, she wanted to wait until the pulse subsided from the first incident and then when it did we did a normal
farrier trim and now it started up again . Unfortunately we did not know his insulin level prior to this. 

My case files are below OLIVER and I included the PDF from Cornell . 

I don't want him to go into a full Founder , but I believe he is trying to .
Please tell me what to do. I don't want him to become worse. Should we put him on Metaformin and if so what is the dosage we should start at?
What form of Metaformin? 
Vet says she can call in a script tomorrow ( Monday) if I need to. 

Steps I've taken from the cornell results: Soaked hay, 10lbs 2x a day, stall rest , He's on Banamine now since the bounding pulse just started, 
iodine salt, 2000 IU vit E in Soaked Beet Pulp once a day  NO GRAIN OR TREATS. 

Please help thank you. 





--
Lori R in MN - 2022

Owner of 3 Metabolic Horses 

MYA Photos:

 https://ecir.groups.io/g/CaseHistory/album?id=276519

MYA CASE HISTORY : PEND

OLIVER CASE HISTORY LINK:
https://ecir.groups.io/g/CaseHistory/files/LORI%20and%20OLIVER 

OLIVER PHOTOS: PEND 



Lavinia Fiscaletti
 

Hi Lori,

You need to get his insulin down ASAP. Starting Metformin would be a good idea, along with getting his diet as tight as possible. Metformin dosing is 30mg/kg, twice daily, so es, you need to know his weight. You can get it from any local pharmacy, as it's a common diabetes medication. Check around for the best pricing - Walmart, Costco tend to have the best local pricing. Online, Farm Vet has one of the best prices:

https://www.farmvet.com/Metformin-HCL-Tablets?location=&quantity=1&pharmacy-size=29&pharmacy-attribute=237

Get the 1000mg tablets (NOT the extended release version). Some horses will eat it in their meals, others won't - you can try crushing it up and mixing it in to see if he will accept it that way. If not, will need to syringe it in. Here is the link to more info in the files:

https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

Soaking untested hay is a good idea. Alfalfa makes some horses foot sore and soaking won't help that issue. If possible, see if you can source hay that doesn't have alfalfa in it. Also need to add ground flax to provide him with omega 3's.

Posting hoof photos will allow us to see if the trim is optimal or not.

Banamine won't help EMS-driven laminitis as this isn't an inflammatory condition. Lowering his insulin levels is the key here. His glucose is getting close to diabetic level, which suggests this has been "simmering" for more time than this obvious episode indicates.

Generally, low thyroid is secondary to other issues, rather than being a primary problem. Dietary imbalances (inadequate iodine intake, very common in horses) is one major reason. Thyro-L won't help with lowering insulin.

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


Eleanor Kellon, VMD
 

I wouldn't wait to get radiographs. They are important to guide the trim and will confirm laminitis. Given his age at the first appearance of laminitis and cresty neck I would consider putting him on Prascend at least through December. You could do a TRH stimulation test first. It might be  difficult to interpret but we do have some information. Also, there is no reason he couldn't have abscess AND laminitis. In fact, that's very common.  Banamine is preventing abscess exiting.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001