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Was: Please explain new blood test results Now: Retested Insulin Results

taskerudet
 

I had my most recent Cornell blood test results retested for Insulin. The initial value was 198.86 uIU/mL and the retest value is 270.89 uIU/mL (How is this possible?).  Since glucose was omitted on the initial sample, I had that added and it is 88 mg/dL.  I was wondering if Lyme disease could be a factor in the huge increase of his insulin from 1 year ago and an increase from 65.03 uIU/mL just a month ago even with an increase in his compounded pergolide.  His CP dose is up to 4.5 mg as of today based on Dr. Kellon's advice. I have him scheduled for ACTH, Insulin, Glucose the second week of September - would adding Lyme be advised?  Also, can iron overload have an affect on insulin?  We moved to Washington State 1 year ago and have a well. I read many of the files about iron overload and did not see it stated specifically if insulin values are directly affected.
I want to be sure and test for anything that may be a culprit in this crazy insulin rise. Thank you for all suggestions.
--
Ellen
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645

LJ Friedman
 

My insulin tests are listed as >200 when over 200.  What is your reference range, etc
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LJ Friedman  Nov 2014  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Eleanor Kellon, VMD
 

IME, Lyme doesn't *usually* cause these huge rises but it's worthwhile checking the panel at Cornell. With the timing I would be most suspicious of the seasonal rise. Iron could certainly be contributing. A review of effects in other species here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648340/ .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

taskerudet
 

Thank you Dr. Kellon - I will have the vet test for Lyme's and Iron along with the ACTH, insulin and glucose.
--
Ellen
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645

Lavinia Fiscaletti
 

Hi Ellen,

If you are going to test for iron you need to send the sample to KSU to get serum iron, ferritin and TIBC done. KSU is the only lab that can do the ferritin part of the testing. Serum iron alone won't tell you much other than give an indication about the iron content of the most recent meal:

https://ecir.groups.io/g/main/files/Iron,%20Iron%20Testing,%20Iron%20Overload/KSU%20Iron%20Submission%20Information.pdf

http://www.ksvdl.org/laboratories/default-sample-submission.html

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

ferne fedeli
 

A few months back, I asked my vet to ask Cornell to retest ACTH and Insulin (because they were higher than usual) and they both came out higher too.  It may be because the samples were sitting around longer.  The last tests were better (after an increase in CP).
--

Ferne Fedeli

No. California

Regional Members Database Coordinator

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Lorna Cane
 

Hi Ferne,

Usually results will be lower if samples are mishandled.
It seems the CP increase ,and better results, may have helped answer that question .

--

Lorna  in Kingston, Ontario, Canada
ECIR Moderator
2002
https://ecir.gro
ups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf


 

taskerudet
 

Hi Lavinia,

Yes, I am aware about submitting the sample to KSU.  I will download the paperwork and give that to my vet. 
Thanks for making sure I do the right thing!
--
Ellen
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645

taskerudet
 

I received my latest test results from Cornell and KSU.  I meant to have Lyme tested but it didn't happen.
Just as in the previous two Cornell tests, Crackers' Insulin is still sky high but the ACTH is 23.2 pg/mL which based on his history is not bad for him. He is still at 4.5 mg pergolide which seems to work for the ACTH.  Insulin came in at >200 uIU/mL with glucose at 86 mg/dL.  Leptin is high at 22.36 ng/mL.  All results have been entered into his case history.  The KSU results according to my vet do not indicate iron overload; however, I would like an ECIR opinion. Also, even though I requested Dr. Kellon be e-mailed the results that did not happen.  I can e-mail the results if desired. 

Serum Iron 244 ug/dL  Ref. Range 91-240
TIBC 620 ug/dL            Ref. Range 270-500
Ferritin 164 ng/mL        Ref. Range 85-726

My vet is concentrating solely on the ferritin results but the other two exceeded the reference range.  As far as the insulin she is willing to try metformin.  When I start the metformin, how soon should I schedule a test of his insulin?  Do I need to get ACTH, glucose & insulin or just insulin? 

I know the sustained increase in insulin is affecting his feet - his front feet are especially sensitive to gravel.  I have since purchased Cavallo mini-boots and that has helped him tremendously.  Thanks to all for shoe suggestions.  He will have radiographs soon as requested by my farrier. 

When discussing these test results with my vet (she is a new vet at the practice and my case has been handed off to her by my previous vet), I explained about the ECIR group and how Dr. Kellon welcomes patient discussion with a vet.  I just wish she would - instead she is going to talk to some colleague back in Kentucky.  I've begun to think they consider me some kind of crazy ECIR groupie!  I'm not sure if they even looked at the website after I provided them the exact info.  I'm just thankful I get my pergolide prescription and hopefully the metformin. (Please excuse my venting!)  I am going to offer to my veterinary clinic a paid in full trip to the No More Laminitis conference.  When will all that information be out?  Perhaps if they take me up on it, they might listen and learn.

--
Ellen
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645

Eleanor Kellon, VMD
 

Hi Ellen,

I agree with giving metformin a try, 30 mg/kg, twice daily (so 60 mg/kg total daily dose). Retest in 1 week and if you continue it at 6 weeks.

I'd also consider increasing the pergolide a bit more since the timing of this spike correlates with the seasonal rise. Did anything else go on such as rapid weight loss or gain? Period of not eating? Have triglycerides been tested? Liver enzymes? The minis are more prone to liver involvement. It might be wise to reduce the flax to 1 oz to reduce fat in the diet.

Your serum iron is probably high because of overabsorbing iron. The high transferrin is good - means he is compensating for that and the ferritin is normal.

The good news on iron is a paper I wrote with Dr. Gustavson has been accepted for publication and once that comes out you will have something to print out and give to your veterinarians.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

taskerudet
 

Dr. Kellon,

No rapid weight gain or loss has occurred and he has never stopped eating - in fact, he is constantly looking ahead to that next feeding.  He has not been tested for triglycerides or liver enzymes.  Is there specific guidance for these tests, i.e. feeding protocol, time of day, specific labs to submit blood etc? Do we only test for insulin at 1 and 6 weeks after starting the metformin and send it to Cornell or will the vet's normal lab be sufficient?

I will reduce his flax to 1oz. and increase his pergolide by .5 mg.  My new vet was shocked by the amount I give him but again I referred her to the ECIR group for more information on that and pointed out that it is apparently working due to his ACTH value decreasing from the previous test.  And I am glad to hear he isn't iron overloaded and can't wait to print out your new paper. 

Again, thank you for all you do for us and our compromised horses.
--
Ellen
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645