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Understanding Lab Results

JouleT
 

Hello! I’m sorry I have not had time to figure out the CH yet, but I have lab results for Tandu and I would like help understanding. I plugged numbers into the calculator and:

G:I says compensated IR,
RISQI says uncompensated IR, and
MIRG says High Insulin Responder.

On top of that ACTH was 14.6 pg/ml with a lab range of 9-35, so that’s good, right?! 

Tandu is a 17 year old mostly QH gelding. 

At the time of testing (mid-March) he was eating Timothy/alfalfa mix hay (tested, safe), 1/2 c flax, 1/2 c AminoTrace+ (as per hay analysis), 1200 addition IU vit E, and 4 tsp iodized blue salt. I have since switched him to straight grass hay and traded out the AT+ for minerals & vitamin E balanced to hay.

I promise I will get this all into a CH, but in the meantime, I just want to understand the lab results and discrepancies in the calculator. 


Thank you!
--
Joule Tallman
Barefoot Trimmer
Saskatchewan, Canada 🇨🇦 
Member since 2019

Sherry Morse
 

Hi Joule,

Without actual numbers for insulin and glucose or a case history I'm not sure what you're asking.  Based on the calculator results alone there's an indication that tighter diet control is needed.



JouleT
 

Ok, sorry, I’m new to testing and just want to be able to interpret results. It is confusing when I am told that my horse is both compensated and uncompensated at once - I assume this means he’s borderline. 

Numbers (Cornell)

Serum Glucose 46 mg/dl - ref 71-122
Plasma Insulin 20.09 ulU/ml - ref 10-40
Plasma Leptin 5.42 ng/ml

Plasma ACTH 14.6 pg/ml - ref 9-35
Serum T4 2.14 ug/dl - ref 1-3

Joule

On May 22, 2020, at 6:52 AM, Sherry Morse via groups.io <sherry_morse@...> wrote:


Hi Joule,

Without actual numbers for insulin and glucose or a case history I'm not sure what you're asking.  Based on the calculator results alone there's an indication that tighter diet control is needed.




--
Joule Tallman
Barefoot Trimmer
Saskatchewan, Canada 🇨🇦 
Member since 2019

Sherry Morse
 

Hi Joule,

I'd like to hear Dr. Kellon's thought on that glucose because it's low enough that I wonder if something happened with testing - which could be throwing off the G:I ratio in the calculator and be one of the reasons you're getting mixed results as the RISQI only looks at insulin and not glucose. For the horses we see here that's a decent insulin level (as well as Leptin and ACTH) so I would continue the same management/feeding that you're using at the moment and just keep a close eye on him to make sure he's not developing any signs that the IR is becoming an issue.  



Eleanor Kellon, VMD
 

I agree that glucose is far too low to be accurate - probably delay in separating the cells from the serum. The insulin is clearly abnormal for a low S/S diet but not in the acute laminitis risk range. Insulin is more tolerant of handling errors.  ACTH though is also very  sensitive to handling so you can't trust that result.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

JouleT
 

Thank you both for your input! He has zero visible signs of IR or PPID but has had frustratingly thin, sensitive soles and weak WL for many years, despite all sorts of protocols and trim changes. S l o w l y improving, but I thought it best to rule out the hormones. I will have him retested when the covid blows over and vets/labs get back to normal flow. I notice the report was generated a full month after the bloods were drawn, so that seems fishy. 

As for ACTH, I have read all the material here and it is still unclear to me whether it is better to test during the seasonal rise or not? My vet seemed to think it is the only time to accurately test. 

I also learn better by doing, and want to be able to competently help my clients through this process. 

Joule

On May 22, 2020, at 10:34 AM, Eleanor Kellon, VMD <drkellon@...> wrote:

I agree that glucose is far too low to be accurate - probably delay in separating the cells from the serum. The insulin is clearly abnormal for a low S/S diet but not in the acute laminitis risk range. Insulin is more tolerant of handling errors.  ACTH though is also very  sensitive to handling so you can't trust that result.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Joule Tallman
Barefoot Trimmer
Saskatchewan, Canada 🇨🇦 
Member since 2019

Kirsten Rasmussen
 

Hi Joule, my understanding is that testing during the seasonal rise can be helpful to tease out early PPID cases with exaggerated seasonal rises that otherwise have normal ACTH at other times of the year.  That might be the best time for you to test if he has no signs of PPID, but if you're doing insulin blood work at any other time it doesn't hurt to add on the ACTH test anyways to monitor it, other than a little more money for the actual test and some more effort from your vet to prep the ACTH sample. 

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