Questions about Metformin


@AngelaBelzner
 

Hello Everyone,

I have told my vet about this group from the start.  Yesterday, he came to draw blood to retest Gracie because she's been on Metformin for 15 days.  He stated he has never had a horse on Metformin before so he doesn't know much about what we would do next.  He wants me to ask this group the following questions.

1.  If Gracie's insulin has improved would we keep her on Metformin and if so for how long?
2.  Do you stop Metformin all at once or taper her of it slowly?
3.  If the insulin has not improved to we keep her on it a little longer to see if it will start working and how long before we would retest?

Thank you for your help and guidance!
--

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'm sure you'll get more feedback, but here's what I have.

1.  Keep her on Metformin as long as repeat testing shows that it is working, or until you make a major dietary or exercise change and you want to see if she is ok without the Metformin.  In that case I'd taper her dose down and watch her very closely for signs of laminitis.  Try to think of Metformin as temporary, until she's sound enough to institute an exercise program or until you can access lower sugar hay.  It's effectiveness wears off over the months in most horses so you want to be in a better place management-wise before that happens. 

3. No, if insulin has not improved by 15 days then it's not working and you can stop it without tapering.  The next step for intractably high insulin is one of the "-flozin" drugs.

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


Nancy C
 

Hi Angela

I just want to say: Hooray for your vet!

Good work.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



@AngelaBelzner
 

Thank you Kirsten!! I appreciate the information.
--

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
 

Hi Kristen, Nancy or anyone who knows the answer,

I am not sure if I should have started a new topic or replied to this one that I had already started.   I received Gracie's blood results back this evening.  Her insulin went down from 102.63 to 73.38 ulU/mL that was two weeks on Metformin.  My vet again asked me to ask this group what to do next?  Do we keep her on Metformin since it's helping some?  If so how long before we retest her blood?  Also, he thinks it would be good for me to give Gracie less hay each day, a pound or two so she will lose more weight.  I am thinking I will go down a pound and a half. Gracie is 14.2 hands and I think her ideal weight is about 950.  Right now she's getting 2%.  I am currently giving Gracie one and a half pounds of Stadul 1.  I had to increase it from the pound I was giving her so she would eat all her Metformin.  When I increased that I cut her hay from 18 to 17 and a half.  I am thinking I will go down to 16 pounds of hay each day.  That would be a total of 17 and a half pounds of food going in to her mouth each day.  I am also trying to continue to increase her exercise.  

Thanks in advance for your help and guidance!
--

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
 

It's ok to carry on with the same Topic since you're still asking about Metformin.

That's a good decrease but insulin is still too high to be safe from laminitis.  Keep her on it since it is helping, but...  Are you already soaking her hay?  If not, I would try making that change.  I noticed her insulin went up after you stopped soaking it in the spring.  I would also try to replace the Stabul 1 with TC TIMOTHY Naturals Balance cubes.  The Stabul 1 can be a trigger for some horses. 

I agree with the hay reduction.  Use your judgement about how much to reduce it.  Weight loss should be slow and may occur in spurts but expect to see progress if you weight tape every 2 weeks.  When it stalls, reduce hay by another 0.5 lbs.  Soaking the hay also lowers the calories a little bit.  My 900 lb horse (ideal and current weight) eats 1.7% of BW in hay.  If I fed him 2% he'd balloon back up to 1100+ lbs.

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


@AngelaBelzner
 

Thank you Kirsten!  I appreciate your help.  I will keep Gracie on the Metformin and reduce her hay.  I will also try the TC Timothy cubes again.  Before she wouldn't eat the beet pulp or the TC Timothy cubes.  She doesn't like anything wet so I had even tried breaking the cubes up dry and feeding them that way and at first she ate them but after a few days she wouldn't eat them that way anymore either. 

I am soaking her hay.  I have been since I found out her insulin was 102 so I will keep the soaking up.  The hay I have for her is less than 10%.  It's 6.4 ESC and 1.3 starch but I will keep soaking it.  I have the hay tested,  balanced and order from HorseTech the supplements.  I get new hay every 2 months and do it all again.  I am wondering if I am doing the right think or not because I am changing her supplements so often and there's always an over lap?  I am usually feeding the old supplement with the new hay until I get the new supplements.  It always takes 3 weeks to get the hay tested, balanced and get the new supplements ( this time it's taken 4 weeks) so this time I ran out of the old and put her on the emergency diet so she would have something nutritional.  Would it be better for me to stop balancing the hay and have Gracie on one supplement consistently?  Also, when should I retest Gracie's blood again?

Many thanks!!




--

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


 

Hi Angela,
How different are your hay test results?  I have my horses at home now and my hay comes from the same farm every year.  I choose a base such as California Trace or the Uckele U-Balance Foundation I’m using now, whichever product comes closest to meeting my needs, and have my balancer let me know what I need to add to perfect it.  I have smaller containers of copper, zinc and phosphorus and add those to the meals as directed.  That way, if there’s a small change needed in the amount of copper I need to add, I do that, without having to reorder the entire mix.
When you have time, you could sign up for Dr. Kellon’s NRC+ course, which teaches you how to balance hay yourself.  I have taken the course and balanced my hay a few times but I don’t do it frequently enough to feel comfortable using my results so I generally have someone else do the balancing for me as well.  You could do the mixing daily, weekly or monthly.
You might also think about a way to have your hay source set more aside so there’s tested hay reserved for you which will last you a longer time. 
--
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
 


--Thank you Martha!!  When do you think I should have Gracie's blood tested again? 

My hay is from the same farm each time so it's pretty close each time. Same farm but different fields they tell me.  It's a good idea about having a base and then adding what the Balancer tells me to.  I will check into that.  Thanks for sharing.!  And I have thought of taking Dr. Kellon's class for my own knowledge but I think I will always have someone balance it for me to make sure it's done correctly. 

Do you think getting Gracie's blood drawn in a month would be good?

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,

So you started soaking hay and started Metformin together before your last test result.  That means it could be the hay soaking that helped and not the Metformin.  For retesting, I'd say every 3 months is nice if you can manage that, or sooner if you see a change in hoof comfort.

I'm surprised her insulin is still so high on that low sugar hay. Getting her weight down might help but usually it takes more than that.  I can think of 3 options.  Maybe others will have better feedback...

1. If/when she is sound get her exercising, a lot.  You want her heart rate elevated for 30 min so it's a real workout, at least 5 days a week.  This means cantering on a lunge line, riding at a fast trot or canter, doing hill work, etc.  Even if you can get her lunging at a fast trot for 30 min a few times a week, that should help.  But only if she's sound.

2.  Try increasing her pergolide.  It could be that her ACTH is not reflective of the degree of her PPID since we know there are other hormones involved that increase insulin.  Does she have physical signs of PPID that worsen in the fall?  Topline loss, polyuria/polydypsia, soft tissue injuries, abscesses, skin issues, etc.  Onset of hoof pain in in late summer to fall with no other management changes is another indicator of uncontrolled PPID.  These might justify a higher pergolide dose even if her ACTH looks good.

3.  Consider Invokana.  If you cannot get her insulin below about 40 uIU/mL with hay soaking, low sugar hay and Metformin (and lots of exercise if she's able), you could ask your vet to email drkellon 'at 'gmail 'dot' com to get some information on the feeding and testing protocols she advises for trying Invokana.

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


@AngelaBelzner
 

Thank you for the feedback Kristen!! You don't know how much I appreciate it.  

For now I will go with option number one.  I have been trying hard to increase her exercise.  I know I won't be able to get as much exercise as you wrote but I will give it a good try.  This week I added ponying her twice for 45 minutes each time at a walk and trot. Plus I continued her normal daily walks and ground work. Wish me Luck!

Thanks!!
--

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
 

Ok good luck!  Again, make sure she's sound, her trim is in good order, and you protect her feet with boots and pads or just keep her on soft arena footing.  You mentioned she started to get foot sore in August so I'm be a bit concerned as that wasn't very long ago.  You don't want her hooves to take a pounding if she's still recovering from laminitis.  We recommend at least 6 months of healthy hoof growth before serious exercise begins.

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