Re-test?


colleen.m.morrissey@...
 

I'm a bit confused by my mare's 2nd round of glucose and insulin tests 7/23/22. I believe the ratios indicate her laminitis risk is now reduced, but her glucose level was much higher! Could this be an artifact of my not understanding the pre-test protocol and the fact that the July test was run 2-3 hours earlier (closer to breakfast?) than the first test 4/27/22? My routine is to feed beet pulp, mineral and joint supplements, Thyro-l, Equioxx for her DSLD and 1 cup of low starch grain in the am, along with hay. It is correct that I should feed only hay and the Equioxx on test morning? When should I re-test?

My folder also contains body condition photos from last night. Her exercise level has been increased since her 7/23/22 recheck and she has dropped some weight since then - I estimate 25-35 lbs. 

Thank you! 
--
Colleen M in CA 2022

https://ecir.groups.io/g/CaseHistory/files/Colleen%20and%20Isabella

https://ecir.groups.io/g/CaseHistory/album?id=277554


 

Hi Colleen,
Thanks for getting your mare’s case history posted as well as links in your signature.
I took a look at it before I saw your post and wondered about your question.  I don’t know what your pre testing protocol was but it definitely needs to be consistent, not so much wrt time but how her feeding is handled.  We like to test them as they might normally be found, not being fasted and not within 4 hours of breaking a fast.  So, after your mare is fed her breakfast and has had access to hay for 4 hours, she can be tested.  Anytime there is a fast of sorts, when she does not have access to food, her insulin will spike after feeding within the next four hours.  You don’t want to test insulin during this spike.  If your vet comes later than expected, keep feeding hay.  You can’t do anything about a super early vet other than being prepared with an early morning start yourself.  I don’t know why the glucose was much higher, other than being tested shortly after her meal.  Much of these feeding details are described in the Welcome letter we sent when you first posted.

I’m puzzled because you said she was diagnosed with PPID at the end of April this year but I don’t see blood testing results to support that.  It also doesn’t appear that she is on Prascend.  Could you please elaborate on that a bit?

In case you aren’t aware, we recommend ThyroL to jump start weight loss, although it is unlikely to maintain that loss.  It is often prescribed to decrease insulin which it does not do.
--
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
 


colleen.m.morrissey@...
 

Hi Martha,

I understand your comments. My horses typically fast overnight from 10 pm to 7am. I don't typically free-feed hay in between their 3 daily meals - Isabella would eat it all in the first few hours no matter how much I put out.  So if we saw a glucose spike (but not insulin) post-breakfast, maybe I should test later and provide additional hay between finishing breakfast and when the vet arrives? Will definitely talk to my vet about this. I am also going to request the next blood draw be sent to Cornell rather than done in-house, and have her Leptin checked. 

Isabella was diagnosed DSLD/ESPA and I/R in April 2022. No PPID. DSLD/ESPA is a degenerative, painful disease that typically first affects the suspensory ligaments but often progresses to all the connective tissues of the body. Hence the difficulty with exercise. DSLD/ESPA is not well understood and palliative care is the only treatment. Very sad. She was the most awesome trail and camping horse I've ever known. 

Isabella has been on Thyro-L since long before her I/R diagnosis this year due to testing low for T4 as a young horse and difficulties with getting pregnant (I stopped trying to breed her when she turned up with melanoma at age 5). She had been on a two-month Thyro-L "holiday" when the diagnosing vet saw her this past April. He said to put her back on immediately to help bring her weight down, which we did. Her dosage is on the medication list. 
--
Colleen M in CA 2022


Kirsten Rasmussen
 

Hi Colleen,

I wouldn't trust those latest test results, whether they are due to her feeding situation for that retest, or are an analytical error.  That insulin is more consistent with fasting, and that glucose is through the roof!

For "diagnosis" purposes we recommend forage only before the test because grain can skew the results.  However, if you already know she has EMS and you want to see if the little bit of grain she gets has an effect on her insulin, then by all means feed her the normal morning meal at least 4 hrs before the blood pull.

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


 

Hi Colleen,
Thanks for the clarification.  You should amend your case history so that it is more clear about the (lack of ) PPID diagnosis.   

I agree with sending your next blood draw to Cornell.  

Can you please add links to your case history folder and album to your signature.  They appeared in your first post in this thread but did not appear in your recent post so I took a look at your signature and I don’t see them there.  You can access that through the “Subscription” link.
--

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
 


colleen.m.morrissey@...
 

Thank you Kirsten.  Isabella's vet agrees we should re-test. He said it could be an error but also stress can spike glucose. For the next test, I will schedule the blood draw at home instead of trailering her to the clinic and have sent to Cornell. 
--
Colleen M in CA 2022


colleen.m.morrissey@...
 


 

Hi Colleen.  I did not know that she had been trailered for her blood testing.  Experience has shown us hat can definitely skew the results.  
--
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
 


colleen.m.morrissey@...
 

Hi Martha,

Yes, I have been trailering Isabella for her I/R and DSLD re-checks with the clinic owner since he is the only one (out of 15 vets!) who does DSLD ultrasounds. Good to know that can impact results. My local vet will come out and do the metabolic panel and send it to Cornell, so that is next up. I did update her file as well (moved the PPID info to the I/R line, where it belongs). 

I am about to post the case history, blood panels and photos for my other I/R horse. I see a link in the instructions for how to set up a folder for one owner/multiple horses. But when I click it it just takes me back to the group page. Should I be following a format for multiple horses? Just post post new horse files to my main folder? Rename the folder? 

Colleen M in CA 2022

https://ecir.groups.io/g/CaseHistory/files/Colleen%20and%20Isabella

https://ecir.groups.io/g/CaseHistory/album?id=277554


Sherry Morse
 

Hi Colleen,

You can change the name of your current case history folder but do note that you'll need to update your CH link in your signature as well.  Once you have renamed the folder you'll want to create a folder within your main folder for the new horse as well as one for Isabella.  Information on Isabella will go in her folder and the other horse will go in that folder.  

Moving folders and files within the CH can be annoying but to do so you'll click on the scissors icon next to the file name.  This will open a list of all the folders in the files. The fastest way to find the folder you want is to do a search on the folder name (for the PC I do CTRL+F and then type the folder name in the search box) and then select the folder and click ok.

If you have any questions on that just shout.