Insulin resistant 8yr old gelding *need help!*

[S1969]

[QUOTE=heronponie;8653215]
To be honest, I’m a little prickly over the implication that you think my post was calling the vet and farrier idiots.

They’re humans. Humans sometimes miss things. That doesn’t mean they’re idiots. If they were infallible, they’d have the horse sorted already and the OP would not have needed to come online and seek other ideas.[/QUOTE]

I’m not saying that at all - I’m saying the OP needs to give us more information before anyone can actually make a guess. What little we have to go by doesn’t makes sense - if the sole was so clearly pared away by the farrier, it doesn’t makes sense that the vet ordered ACTH and IR tests. The vet actually examined the horse, and we have nothing but a few odd posts on the internet, so I’ll presume that the vet had good reasons to think the issue was metabolic and not just a hack job on the feet.

As for whether the horse is IR or not; I don’t know. I don’t have an IR horse but there seems to be some connection between the Glucose and Insulin numbers, since you can use an IR calculator like this one: http://ecirhorse.org/index.php/insulin-resistance/ir-calculator-leptin

Assuming I am guessing the units of measure correctly (and I may not be), the risk is high with Glucose of 107 and Insulin of 29.

[Gottalope]

Here is his time line:
4/7- new farrier reset him
4/8- injected hocks & stifles
4/19- more qualified farrier comes out and put the wedge and different shoe on.
4/20 vet out because hes rocking back on his heels bad and laying down for long periods of time. Vet takes xrays. Is afraid it’s founder hung fluids with dmso and banamine to reduce inflammation.
4/21 vet comes back and draws blood work. Glucose level 107
ACTH is a 5.9
Insulin is a 29
Vet diagnosed him as Insulin resistant.
Labs will be re drawn on the 27th. *It is a possibility that this was a steriod induced reaction
*initially was showing signs of being more lame of left then right, but was sore on both.
5/5- he’s starting to be more sore on rt then left, and now walking on toe. Talked with vet and he thinks he may be trying to pop an abscess.
-My horse has never been a horse to consider a “easy keeper” he gained weight over winter but but was worked and exercised regularly.
-he is now eating a stemy 1st cutting hay - free choice. Also gets grain made by purina called Enrich plus a ration balancer supossed to ok for IR horses. Only gets 2 lbs a day if that.

• he does not have under run heels or long toes.

[S1969]

Hmm, interesting.

So, what was the reason for the 2nd farrier to reset him so soon after the first farrier? And if he wasn’t having issues prior to the wedges, I would be concerned that the addition of wedge pads was related; but if he was sore before that, then perhaps not. Why did the 2nd farrier think he needed them?

[ladipus]

You need to put him on the emergency diet immediately…stop the Purina enrich…I would only give Triple Crown 30% Ration Balencer as its one of the lowest NSC’s available(starch/sugar) …only give him a tested low sugar 1st cut Timothy …I get mine from Heidel Hollow Farm in Pa …or Triple Crown makes a safe starch forage…in mean time you need to soak your hay first to remove the excess starch and sugar …keep him bedded deep in the stall…and duct tape styrofoam board pads to his feet for support …when was he last xrayed? I’d have vet out asap to re xray to ensure no further rotation …do not turn him out…I’d keep him on the Bute twice/day to reduce inflammation…you should also ask your vet about starting him on Metformin, Thyroid medicine, Isoxsuprine, and Prascend (Pergolide) this is the standard/normal protocol when they founder/have active lamintits …it’s what I just did with by 12yr old Tb who foundered out of the blue…,he’s finally now stabilized 3 months later …it’s a long road to recovery and extremely careful management …don’t mess around its critical in the early stages

absolutley no grass either

[ladipus]

[QUOTE=Gottalope;8654827]
Here is his time line:
4/7- new farrier reset him
4/8- injected hocks & stifles
4/19- more qualified farrier comes out and put the wedge and different shoe on.
4/20 vet out because hes rocking back on his heels bad and laying down for long periods of time. Vet takes xrays. Is afraid it’s founder hung fluids with dmso and banamine to reduce inflammation.
4/21 vet comes back and draws blood work. Glucose level 107
ACTH is a 5.9
Insulin is a 29
Vet diagnosed him as Insulin resistant.
Labs will be re drawn on the 27th. *It is a possibility that this was a steriod induced reaction
*initially was showing signs of being more lame of left then right, but was sore on both.
5/5- he’s starting to be more sore on rt then left, and now walking on toe. Talked with vet and he thinks he may be trying to pop an abscess.
-My horse has never been a horse to consider a “easy keeper” he gained weight over winter but but was worked and exercised regularly.
-he is now eating a stemy 1st cutting hay - free choice. Also gets grain made by purina called Enrich plus a ration balancer supossed to ok for IR horses. Only gets 2 lbs a day if that.

• he does not have under run heels or long toes.[/QUOTE]

drawing blood when the horse is already in that much pain is going to give you in accurate insulin levels because insulin gets elevated with a pain response

[S1969]

[QUOTE=ladipus;8656267]
You need to put him on the emergency diet immediately…stop the Purina enrich…I would only give Triple Crown 30% Ration Balencer as its one of the lowest NSC’s available(starch/sugar) …only give him a tested low sugar 1st cut Timothy …I get mine from Heidel Hollow Farm in Pa …or Triple Crown makes a safe starch forage…in mean time you need to soak your hay first to remove the excess starch and sugar …keep him bedded deep in the stall…and duct tape styrofoam board pads to his feet for support …when was he last xrayed? I’d have vet out asap to re xray to ensure no further rotation …do not turn him out…I’d keep him on the Bute twice/day to reduce inflammation…you should also ask your vet about starting him on Metformin, Thyroid medicine, Isoxsuprine, and Prascend (Pergolide) this is the standard/normal protocol when they founder/have active lamintits …it’s what I just did with by 12yr old Tb who foundered out of the blue…,he’s finally now stabilized 3 months later …it’s a long road to recovery and extremely careful management …don’t mess around its critical in the early stages

absolutley no grass either[/QUOTE]

Well, there would seem to be no reason to prescribe Prascend based on the horse’s ACTH numbers, so this standard/normal protocol might not be appropriate. Whether the horse is IR or not is still unclear to me because I am not an expert, but I agree that it doesn’t hurt to treat him as if he is for the moment.

[Alpha_Mare]

Dear OP: rocking back on his heels and lying down with hot feet does sound like laminitis as you and your vet thought. If the horse is STILL uncomfortable then he may be STILL having the inflammation and may need stronger meds to get it under control.

Suggest you do not pull shoes or otherwise mess with his feet until he is comfortable for a long time, like two months or so. The laminae may be very compromised if he has been sore for 2+ weeks and manipulating the foot by pulling the shoe may make it worse.

My mare had a bad episode last fall, took two weeks to get her comfortable. We did not remove shoes for 3 months (yes, her feet were very long). We put hoof casts on her with padding for the sole over the shoes. It took about 5 months for her feet to grow to the point where the damaged area was sloughing off with normal trimming/wear.

Purina WellSolve is made for horses that can’t tolerate carbs (IR, Cushings) and is mineral balanced. Also, you should be soaking the hay as ladipus recommended - not only does that help with sugar but it removes dust and other things that might cause inflammation - when the horse is in crisis like this it may be bothered by things that ordinarily don’t make a difference to him.

Note to those who don’t like the wedge heels - they are needed to reduce tension on the DDF tendon so that rotation is minimized.

OP, wishing you all the best with your horse and his recovery.

[ladipus]

Point being…you treat the horse as if it’s a Metabolic horse because you don’t no the cause of the lamintits-regardless…even though the acth indicated no issues for PPID/Cushings vets sometimes still prescribe Prascend because that in combo with all the other metabolic drugs often times help the horse get over the acute hump of active lamintis …then once the horse is comfortable and stable you start weaning off all meds…and when the horse is free of drugs and pain is when you pull blood for a metabolic panel …acth, insulin, glucose, leptin, thyroid etc …his insulin/glucose is going to be falsely elevated from the pain he’s in from the laminitis so bloodwork results are not accurate

[S1969]

[QUOTE=ladipus;8657847]
Point being…you treat the horse as if it’s a Metabolic horse because you don’t no the cause of the lamintits-regardless…even though the acth indicated no issues for PPID/Cushings vets sometimes still prescribe Prascend because that in combo with all the other metabolic drugs often times help the horse get over the acute hump of active lamintis …then once the horse is comfortable and stable you start weaning off all meds…and when the horse is free of drugs and pain is when you pull blood for a metabolic panel …acth, insulin, glucose, leptin, thyroid etc …his insulin/glucose is going to be falsely elevated from the pain he’s in from the laminitis so bloodwork results are not accurate[/QUOTE]

I have never heard of a vet prescribing meds for Cushings when the ACTH does not show even a slightly elevated result. Maybe you have, but I haven’t.

I agree that retesting for IR is reasonable, and I agree that treating as though the horse IS insulin-resistant for the time being is necessary until it has been ruled out.

I’d like to know exactly when the horse became sore. Was the horse sore before the reset and wedge pads, or was that only immediately afterwards?

[Ghazzu]

Throwing a handful of different drugs at the horse is not an optimum approach.

[sdlbredfan]

[QUOTE=heronponie;8652885]
Paring out soles to the point that they are thin on radiographs will absolutely make a horse as sore as described. A few degrees of rotation and a few degrees of wedge padding angles the coffin bone up onto its tip and the next thing you know, it’s pressing against a thin sole… this whole thing sounds textbook for shoeing induced lameness IME.[/QUOTE]

I agree.