sky high insulin , now what. Metformin?
|
First yes i have been trying to update my case history, but I cant figure it out. will keep at it..
Without posting a novel here is the short version cookie had a great summer , no lameness was back in light work , lunging , hand walking , some pony rides for the grands. out on the half mile track with her buddies . October 7th she had a mild colic , while we were there i decided to pull insulin to see where we were at, . took rads also which for the life of me I did not download and now they are gone. good sole , good connection , negative to hoof testers all around. so the insulin of 225 uU/mL was a shock!!! lab reference has a high being over 42.00; test taken in clinic , mid morning , and might even be during sedation, I was honestly just pulling blood while we were there not because I suspected anything. i realize now taking blood during a colic was probably stupid. -- but I'm not the vet.. there was no reason for insulin to be so high , pony on tight diet, tested hay 7.8% and custom minerals. so I started soaking hay for the fun of it. which lasted about a week. sorry not sorry just not going to soak hay if I don't need to. and I don't need to. she was moving fine I was just panicked that she would suddenly founder . We got a cold snap in mid November and Pony went down sore , no pulses , no heat, laying down 90% of the time . ( incidentally its the exact same time line that we had issue last year with her sore feet, to the week in fact ) the back of my mind was thinking get an ACTH to see where that is at, but the vet was not on board said to wait until January . that she has laminitis and to soak her feet in ice, give bute yada yada yada ... negative to hoof testers. no pulses no heat.
in the meantime i disregarded that advice and wrapped up Pony in medium blanket, wool socks, boots , and nice shipping leg boots on all four , no change , put felt in her cloud boots , no change , put neoprene in her cloud boots , a bit more comfortable but still down more that up. now we are in mid December and no change, its getting colder and snow with ice out and I'm getting worried why is this pony so sore spends all of her time laying down in her cozy shed.. still no heat no pulses negative hoof testers. Pony is now on j-herb, AAkg and Alcar .
I'm thinking the high insulin is obviously a factor and still cannot figure out why its so high for no apparent reason, when I decided I would do an experiment because what have I got to lose so I pulled a hail mary. a friends horse died and had a full scrip of pergolide left over , I started my pony on it 1 mg syringed in her mouth dissolved in water . because why not ?
4 days later pony is up and waking about comfortably not laying down hardly at all has a good appetite , its is still cold out, so now I decide to ask the vet if she would please come and pull and ACTH insulin glucose . she was a little miffed that I did not call her and consult but I reminded her she was unwilling to work with me on this when I asked about a trial of Pergolide to see if it would help... she had been on the pergolide for 14 days when this blood was pulled. I admit the insulin was not what I wanted it to be it was still sky high ( one other noticeable change was her swollen goopy eyes are gone ) 18th December 2022 ----155.00 uU/mL down from 225.in October 2022 but not the miracle I was hoping for ACTH is 13.00pg/ml ( over 15 -40 range ) glucose 98.mg/dl (70-120 range )
so now the vet says to drop her to 1/2 tab of pergolide for now and retest in February, she mentioned meds to help with the insulin I can not remember the name it starts with an R , I was looking at some of the posts on here about metformin, would that help her at all, I really cannot tighten up her diet anymore than I am . and am kinda at a standstill as what do do next. exercise is obviously a factor , and when the weather is warmer she is fine , but is still a bit sore when it drops below 30*f ( even wrapped up ) but I have been sick with RSV, pneumonia etc for over a month now and literally just watch my horses on camera and depend on my non horse son and the teenage girls down the road to help out now, and they don't know enough to see when a horse is too sore to walk so she is just hanging out waiting for me to not die..
yes I will continue to try and update my case history it just wont let me .
Thought on starting Metformin ? wait for another few weeks retest ? now what ?
Thanks for all the help..
|
|
|
|
Julie,can you tell us what your case history won't let you do specifically?How much can you update before it stops you?
Someone way more savvy than I am should be able to help,if we knew where you are getting stuck. -- Lorna in Eastern Ontario 2002 |
|
|
|
High Lorna ,
I can access my history but it won’t let me write anything anywhere . I’m sure it’s user error , I am absolutely handicapped with technical things and it’s all very confusing to me no matter how hard I try . but I did open it but when I click on the space to add the numbers nothing happens . -- Julie Boring , Oregon 2009 https://ecir.groups.io/g/CaseHistory/files/Julie%20Allen%20and%20Callie%20and%20Cookie Callie photo album:https://ecir.groups.io/g/CaseHistory/album?id=245704 Cookie photo album: https://ecir.groups.io/g/CaseHistory/album?id=271132 |
|
|
|
Hi, Julie. The version of Cookie’s CH in your folder is a PDF file. You need to dig around on your computer to find the Word document version that ends in .doc. PDF’s are a universal format easily read by any electronic device running any operating system, but they take special software to edit. |
|
|
|
Julie,
To update you have to have saved a version on your computer in a word program, then update that, delete the current version, convert the new one to pdf and upload it. She's young for PPID. Does she have any signs other than high insulin? What you are describing is classical for cold-induced hoof pain, which occurs in horses with EMS even if they have never had an acute laminitis episode. Have you titrated her Jiaogulan dose to make sure it is enough to make her gums and tongue obviously more pink? How are you giving it. How much AAKG and how often? We have had a number of cases here where the insulin number did not match the clinical picture, like your October reading. I would suggest the next time you test insulin send a duplicate sample to BET Labs. Make sure it is handled the same way. -- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
|
|
|
P.S. If she was sedated when the October insulin was pulled, that may explain the number. Also, cold can cause insulin spikes. Unless she worsens or shows more typical laminitis signs I would wait to retest until it warms up.
-- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
|
|
|
Hi Dr K ,
Should I keep up the 1/2 mg of pergolide ? Stop it altogether? It did seem to pull her over her hump In may have those mixed up I have not been able to get out the in a month and am depending on family and neighbor kids to help . once a day in her hay pellets |
|
|
|
Hi Julie,
I don't like to rattle the cage when things are working. Talk to your vet about keeping the pergolide until Spring, stop 3 weeks, then do TRH stimulation. The doses look right for your foot supplements. If the pain returns, go to twice a day. -- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
|
|