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Time of day influencing glucose levels

celestinefarm
 

I had Tipperary, Juniper, and my previously untested mare, Lovey, tested for ACTH levels, insulin and glucose. at MSU this past week.  I had my vet out three weeks ago to test and he offered to send to Cornell. I agreed, but didn't not realize he mailed the frozen samples out five days later by priority mail with tracking instead of overnight UPS. When the samples still had not arrived at Cornell last Saturday( ten days in transit), he called me and we set up for him to come on Monday of this past week, resample all and I would personally drive the spun and chilled samples to MSU .  
Did so this past Monday and received results last night via text, just the numbers, full report with endocrinologists notes will be mailed to me this week. 

I am aghast. All three have glucose levels above 100 mg/dl (normals 77-105). Tipperary is at 104, Juniper is at 129 and 193. Insulin at 37 for Tipperary with an IG of .37, his ACTH at 7mgs CP is 11.6, with range of 2-10, Juniper insulin at 200 with 8.8 ACTH on 1.5 mgs Prascend IG 1.55, and Lovey ACT 6 on no pergolide with IG of .72

They were all sampled at 7 am with no feeding. They had haynets with hay left in them, Tipperary doesn't have a haynet due to COPD, but had a little hay left over from the night. 

I am reviewing and reworking all feed and management, and am sending hay tests out this afternoon. (My hay has never been higher in fifteen years of testing that 7 % ESC and Starch,from the exact same fields but I can't ignore it) . These three get little to no actual exercise, wandering around a field with a muzzle on for two hours is not exercise.  That has to change also. 

The questions I have is could these numbers have been influenced by early morning testing with no eating for the few hours prior( I don't know how long they eat at night)?. Lovey's numbers are shocking. Other than being soft and about a 5.5-6 on body condition, she has NO outward signs of IR. No lumps of fat, no fat in suborbital sockets, no udder swelling, great feet and hoof, no eye tearing, itching has been almost eradicated with adminstration of DHA and Omega 3 oil. I'm dumbfounded.
Also, we have been in a three week extreme heat wave here in Michigan and all three have pretty much stood around and done nothing for days now. Does extreme heat influence the results?

Thanks.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

celestinefarm
 

Eleanor Kellon, VMD
 

Dawn,

Was Lovey's insulin 139?

It's REALLY nearly impossible to give you good feedback without up to date case histories but as a general comment when you see elevated glucose there is almost always uncontrolled PPID.

I would repeat ACTH at Cornell. I have had many vets tell me they got results within normal from MSU that were clearly abnormal at Cornell.

That said, I can't rule out an effect from environmental stress of high heat.  No data. Wouldn't count on it though and I'd repeat those ACTH ASAP and bump up pergolide as soon as the blood is pulled. Frozen samples in plastic tubes, overnight.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Eleanor Kellon, VMD
 

P.S.  Priority Mail has automatic tracking and guaranteed 1 to 3 day delivery.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

 

Dawn, 
Time of day affects both glucose and insulin levels IME. I saw a 25 point drop in insulin by testing at noon instead of 9:30AM.

For the source of high glucose input, I relearned for the third or fourth time what our problem is here. Maybe it will be instructive for you. I am comfortable attributing Cayuse's recent bout of springtime high insulin and high glucose to a porous dry lot. My own CH and hoof photos showing wall separation in May tell the story from other years. Spring grass is dynamite.  I scrape, I harrow, but like everyone else, I live on planet earth where green things grow and regrow in the springtime, where rain falls at inconvenient intervals for Roundup application and where rising temperatures increase ESC levels. There aren't enough hours in the day. Even after blocking her from large portions of her track where she could reach under the fencing, I found her getting her head under the bottom tape 8 inches off the ground. I removed the portable stakes and box scraped the growth, but it grew right back. 

I finally resorted to placing 2 ½-3 foot wide strips of tarp under the fence line and covering them with wet shavings from the stalls. I hate doing this, but it works. 

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

celestinefarm
 

Dr. Kellon, thank you for the response.

Yes, Lovey, who I have never tested as she never showed any signs of PPID except for a long coat in the winter that would completely shed in spring( so maybe normal for her?) tested at 139 insulin uIU/ml  with a glucose level of 193 mg/dl. She's 19 years old, her last foal was seven years ago ( she has had six) and she seems to cycle normally.

I will get a CH up for her as soon as I can, and possibly Tipperary also who just needs redone , I can't seem to update his. Juniper's I can update.

I will call my vet on Monday and get new draws of ACTH for Cornell.. I just spent $566 on testing the three and I will leave off the insulin and glucose for now?  Also, start 1mg Prascend for Lovey ( tapered on) until I receive results.


Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

celestinefarm
 

Yes, my vet said the same thing, but mail right now is about as screwed up as it can be. MSU has a warning on their lab site right now not to use mail services.

Shipping Notice: The MSU VDL has been experiencing intermittent delays in receiving packages from the United States Postal Service (USPS). These delays can compromise the quality of the specimen(s) shipped and impact our ability to perform the requested service. If your submission is impacted by delays in shipping using USPS, we will contact you. We continue to receive timely delivery from our overnight carriers, FedEx and UPS.

Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Bonnie
 

Thanks, Cass, for giving this method of blocking growth under the fence line. I have been trying discarded shavings alone, with minimal results: new grass pokes through. Will round up some trashed tarps and make strips ASAP.
--
Bonnie and Lad
North Ontario
Dec 2008
 

 

I have given up relying on the USPS for any critical mails lately.  It took them 6 days to deliver a letter sent to a place that is 10 miles from me.   I am pretty certain this is related to the new policies, and may even get worse as they have stopped postal employees from working any overtime.

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .

celestinefarm
 

Cass, thank you. Besides the high temps for July, we have also been experiencing a drought. I know they should not be in a pasture , even with a muzzle on, but it is my only turnout. I have an outdoor sand arena, but like you, we have to spray and drag and spray( I have to use Liberty to kill mares tail and succulents) so it's often off limits and they will just stand in it with muzzles, and without muzzles, they will pull up weeds, and reach under the fence, etc. It's not an option.  I have been turning them out in their respective pastures early am until about noon, and despite being out, they have opted to come into the run in portion of the barn and stand by 10 am due to the heat.  So they are out trying to pick at grass for about two hours.  Otherwise, they are in stalls with haynets for the next 22 hours. I have never kept horses in like I have the past few months but I'm trying to balance preventing exposure to high sugar grass to simply standing around doing nothing.  I haven't been riding in the past year but all three need to move more. 

All three of them have soft crests (Juniper and Tipperary have experienced hard crests , and fat lumps in the past.. Both of them look better right now than they looked this past winter as far as weight and overt signs) It's like I'm looking in Alice's mirror with the numbers.  Before I've had lower insulin and glucose in the face of obvious clinical symptoms.  I was pretty pleased with how things were looking and decided as a precaution to test early to get ahead of PPID increases. I was absolutely stunned when I got these numbers. 

--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Lorna Cane
 

Hi Bonnie,

Strips , as wide as needed, of cardboard work well, too. Often just  a taken-apart shipping box is an easy application.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

Deborah Ide
 

A few years ago I did much the same thing as using tarps and wet stall shavings. I started putting newspaper sheets down around the outside of the paddock and covering them with wet stall shavings. It worked!

--
Deborah
November 2012
Middle Tennessee
Case History: https://ecir.groups.io/g/CaseHistory/files/Deborah%20and%20Tara

Bonnie
 

Thanks for that addition to the stock of solutions, Lorna.
--
Bonnie and Lad
North Ontario
Dec 2008
 

 

On Sat, Aug 1, 2020 at 12:41 PM, celestinefarm wrote:
I was absolutely stunned when I got these numbers. 
I know the feeling. If you're interested in monitoring glucose,  a human glucometer seems to work well.  I won't claim it's cost effective but IME it's reasonably accurate. You can see comparisons in my CH's.

I'm probably in denial, but I have wondered if labs are experiencing materials shortages or have changed protocols. I did a quick online search with no reliable results. 
 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

celestinefarm
 

Cass, thank you , monitoring glucose myself is an option I may consider.   I discussed the situation and Dr. Kellon's recommendations with my vet over the weekend. and what we decided was to increase pergolide in all three first, and then retest in a few weeks. The rationale was that If I send to Cornell now, and immediately start increasing pergolide on the three, I will need to retest again in another three or four week period after to see if I have improvement. Just ACTH testing is over $300 for three horses, if I include insulin and glucose, I'm looking at almost $600. Plus the additional cost of Prascend to start for Lovey and using the tablets to increase Juniper and Tipperary. Then another $600 in three more weeks. 

$2,000 for testing and increased meds is a lot.  I had my vet drop off a 60ct.of Prascend today for Lovey, as Juniper's Rx is half gone and I have to use it for her and to increase Tipperary's dose since he is on CP and I have no way to correctly measure out capsules and know what I'm giving him. 

I started Lovey yesterday on .50 mgs. and she had zero issues with a veil, although I am starting her on APF(another expense) . I moved up Juniper also by .50 to 2mgs. and she presented with unusual behavior last night when I went to feed. I turned on the barn lights and she was standing in the corner(normal) but had her head down. Came over to her food bowl , sniffed it and walked off. Circled in her stall like she was going to lie down, but didn't . She had colic surgery for a nephrosplenic ligament entrapment years ago, and she scares me when she is not wanting to stuff her face. I panicked and gave her a dose of banamine, haltered her and started walking her.  She kept looking at me like, what's up with this? and when I put her back in her stall, she wandered to her bowl and began to eat. When I regained my senses, I realized she was experiencing a veil most likely from the increase, as there were several piles of manure, including pretty fresh in her stall, she had eaten hay, her soaked hay cubes were gone , etc.  Not to mention she might have been sleeping and I flipped on lights and woke her. So I backed off the increase today, and gave her APF and will increase in another day or so when I feel she is being helped by the APF. She was fine this morning. 


--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

 

Dawn, that's an eye-watering level of expense. With three PPID horses, will you and your vet will consider CP? I've seen very good results for Cayuse with Pet Health Pharmacy flavored pergolide capsules: easy to feed and obviously effective if her last ACTH of 22 pg/ml is any indication. We manage adjustments during the seasonal rise with Prascend. Everyone is happier.

Hope the APF works for Lovey. I keep it on hand. I'm going to try the human equivalent with wildfire season approaching.

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

celestinefarm
 

Tipperary is already on CP from Wedgewood. I will be getting his next Rx from Pet Health, as Wedgewood doesn't dispense capsules larger than 4mgs. So I have to get two scripts made , 4 and 3 and for 100 capsules it runs almost $450. Crazy. When this Rx is done, I'll switch.  
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .