Help!!! needs suggestions!

[PLEASURE PASOFINO]

I will like to share something that as been going on for the past year with our mare. We have a mare that every 3 months she gets an abscess that usually pops out right on the coronet (LF)….. The vet has checked her for and against everything, they have done I don’t know how many x-rays checking even for air pockets and other stuff, and everything comes back NEGATIVE!!! but sure after 3 months…… she comes down with another one on the same spot!!!!! any suggestions? I am open for opinions!!!!!

Saludos

[Pinto Paso]

Felix, have you read the information on IR horses - I think that feet problems were part of the condition (since it is like diabetes that makes sense - wonder if it is a circulation problem as well??)

Is your mare overweight or have any of the other signs of IR or cushings?

I know you work with a good farrier so I am assuming her feet are otherwise healthy?

They can be so frustrating!! Good luck

[PLEASURE PASOFINO]

Thanks Stef, you have a good point there, we are doing a blood test next Monday for SUGAR!!! I also like yourself think is related, she seems not to have no signs of cushings!!! and her feet are great!!!!(thanks GOD for Brian) but I also think you are have a very good point there, oh, weight!!! we keep a very close diet on her!!! we are also soaking the hay ( straight TIMOTHY) for one hour before serving to reduce some sugars just in case.

Oh sorry, I forget to add, this mare has not been riden in around 7 years!!! we use her as brood!!! but havent breed her for 2 years!!!!by choice, never had any problems with her until a year ago, she was born at our farm( 1992)... I have never trained nor ride on concrete and there is no tight circles in MY CULTURE!! aslo lived out in Pasture until we had to bring her in and stalled her 14 months ago due to her condition.

[Pinto Paso]

make sure you do the actual IR test... I would also ask for a thermo scan on her feet (foot if only one) to check for heat, circulation etc of the entire area... it will detect deep absesses or other problem areas.

[PLEASURE PASOFINO]

I will just ask for an "INSULIN RESISTANCE TEST" just like that? or is there another name for that test?

[PLEASURE PASOFINO]

Stef, this is what I found...... thanks again for your guidance!!!

Saludos!




Insulin Resistance in Horses

--------------------------------------------------------------------------------
Click here for printable version
By Dr. Jenifer Nadeau, Equine Extension Specialist

University of Connecticut

Insulin resistance is a newly recognized problem in horses that may have been around a long time. You may be wondering what it is all about and how your horse may/may not be affected. It is probably not as common a problem as it may seem. This article will discuss insulin resistance including its causes, effects, diagnosis, treatment and prevention.

What is Insulin Resistance?

Glucose (sugar) normally functions to fuel many metabolic processes in the body and is the primary energy currency of the body. Insulin is normally produced in response to elevated blood glucose and is key to the regulation of blood glucose concentrations and glucose utilization. Insulin promotes glucose uptake by cells and promotes formation of glycogen or fat. Insulin resistance is defined as a reduced sensitivity of the body's cells to insulin's facilitation of glucose uptake.

Basically what happens in insulin resistance is that the cells become resistant to the glucose uptake action of insulin. Initially, this just means that more insulin is needed (hyperinsulinemia) to keep blood glucose concentrations within normal limits after a starchy or high sugar meal. If it is severe enough even super high insulin concentrations are ineffective and blood glucose may also be abnormally high. The problem is that not only does this limit energy availability to the cells but insulin also has other effects on the body that may be detrimental when it is higher than normal for prolonged periods of time. Unlike humans, horses rarely go into the second stage, where the pancreas becomes “exhausted” and no longer can secrete adequate insulin.

Causes

The exact cause of insulin resistance is still unknown. However, several possible causes include:

Diet - In a recent study, horses had increased insulin resistance when fed high sugar/starch feeds compared to high fiber and fat rations, especially when they were not obese.
Obesity - Overweight horses tend to be insulin resistant, as are “easy keepers” even if they are not obese.
Age - Old horses (>20 years) seem to be more prone to insulin resistance, probably secondary to pituitary dysfunction (Cushing’s disease) which is extremely common, especially in mares.
Breed - Ponies were found to have higher degrees of insulin resistance than Dutch Warmbloods or Standardbreds. Breeds that are prone to developing cresty necks and obesity, such as Morgans and some lines of Arabians, Quarterhorses, and Thoroughbreds may be more likely to develop the problem, although a study conducted at the University of Connecticut comparing exercising Morgans and exercising Thoroughbreds did not find a difference between breeds in insulin resistance.
Laminitis - Horses with a family history of laminitis and horses that develop laminitis without an obvious cause (grain overload, sudden access to lush, green grass) may be insulin resistant.


Effects of Insulin Resistance

Insulin resistance may result in:

· Loss of weight

· Loss of muscle

· Lack of stamina

· A condition similar to human Type II diabetes

· Laminitis


Diagnosis

Your veterinarian will be able to diagnose insulin resistance. A single blood sample drawn within 60 to 90 minutes of eating a meal of grain is a quick screening test for hyperinsulinemia. If the results are abnormal the veterinarian should perform a more reliable test by administering a glucose challenge orally or intravenously and measuring the glucose/insulin response over the course of two or three hours. This is not usually practical in the field and the horse may need to be referred to a clinic to get such tests done.



Treatment

Treatment may consist of the following:

· Weight loss through diet and exercise if the animal is obese

· Addition of a minimum of 30 min of exercise

· Limiting carbohydrate intake through elimination of grain and high sugar feeds

· Soaking hay if it is know to contain high amounts of sugars (> 10 to 12% soluble sugars)

· Feeding warm season grasses, such as Bermuda grass, or feeding beet pulp that does not have added molasses

· Cutting down on free choice intake of grass if the horse has a history of founder and is obese

Prevention

Preventative measures to reduce insulin resistance are:

· Feed primarily grass or legume mix hay or pasture. If the horse tends toward obesity, limit access to the forages and feed no grain at all!

· If concentrates are needed to maintain body condition, feed products formulated to have a low glycemic index. For example, oats are commonly used as the standard with an index of 100. Plain beet pulp has the lowest index in most studies and barley has the lowest index of the commonly fed grains.

· Test pastures and dry forages for amounts of sugars present.

· Soak high sugar hay in hot water for 30 min or cold water for 60 min

· Restrict grazing time but only if the horse has a pre-existing case of laminitis and grass is lush

· Add fat and fiber to the diet at 6-10% for fat and at least 12% for fiber.

Insulin resistance can be a serious problem, but actual statistics on insulin resistance are currently unavailable. An accurate medical diagnosis by a veterinarian is extremely important. As with most equine health concerns, prevention is better than treatment. By paying careful attention to diet and condition of your horse, you may be able to prevent insulin resistance from becoming a problem in your horse.



Sources:


1. A.J. Forhed and H. Dobson. 1997. Plasma glucose and cortisol responses to exogenous insulin in fasted donkeys. Research in Veterinary Science 62: 265-269.

2. R.H. Hoffman, R.C. Boston, D. Stefanovski, D.S. Kronfeld, and P.A. Harris. 2003. Obesity and diet affect glucose dynamics and insulin sensitivity in Thoroughbred geldings. Journal of Animal Science 81: 2333-2342.

3. J. Meszoly. April 2004. Danger in the grass: how you can protect your horse. The Horse p. 61-71.

4. S. Ralston. October 2004. Equine metabolic syndrome. The Horse p.30.

5. A. Rodiek. June 2003. Sugar levels in horse diets. Horse Journal p. 16.

6. L. Sellnow. April 2004. Obesity and Cushing's disease. The Horse p.83-90.

7. S. Wenholz. April 2005. A closer look at insulin. The Horse p. 91-98.

[Pinto Paso]

PM abajita (here on the board) she is a wealth of information on this subject and is maintainng horses with this condition.. she is who I would contact...

[PLEASURE PASOFINO]

Thanks for the reference!!!!


Saludos

[PLEASURE PASOFINO]

Ok- I did not realized that IR was discussed and the thread was only a few posts down! the test should be:

ACTH test. It measured ACTH and Cortisol and I also requested Insulin.)

And thanks Stef!! I did Pm Abejita, but, all my questions to Abejita where answered on that thread..... http://www.americanpasofinos.com/forum/viewtopic.php?t=13919&start=0 very interesting!!!! I think, or better said, NOW!!! with all information gathered, I feel prepared to meet the Vet on MONDAY!!!!!!

Saludos!!!!!

Thanks Abejita for the EDUCATIONAL Thread on IR, I have to admit, I knew very little on!!!! also, I must do some research on the PARTICULAR cause of it!!!! has to be all in the DIGESTIVE system? where all starts ?!!!!!lower intestine? wow!!! this fascinates me!!!!

[Pinto Paso]

See Felix, I told you it was in Abejita's threads on IR... it takes a lot of reading and we are lucky she is here to simplify and reduce it for us...

With this information you should be able to work with the vet and hopefully get answers...

[Abejita]

sorry I have not responded..been away since last night ,just got home..
Caliber, you would be best to talk to your vet before he draws the blood , because to do the test correctly, the blood has to be draw, chilled and spun down and frozen within 4 hours of the draw..so in case he isnt heading back to the clinic in enough time to do this he should know what you want.Cornell seems to be the miost popular lab for this test on the East coast, Your vet may want to do a low dose dex suppression test but that can in rare cases cause lamanitis, plus it entails at least two blood draws.This test is much easier.Cornell in NY seems to be the most popular lab to use for this test also.He may want to call them and ask about the protocol if he isnt sure

http://diaglab.vet.cornell.edu

ACTH/Insulin Combination Test
The combination of ACTH (Adrenocorticotrophic Hormone) and Insulin testing along with clinical signs and other test
results have been useful for the diagnosis of Cushing’s syndrome in horses. Post-treatment follow-up can also include
monitoring ACTH and/or Insulin levels along with clinical signs and DST testing if necessary.
Endogenous ACTH Testing
Note: Excitement and/or exercise can elevate ACTH concentrations.
1. Draw a single EDTA plasma sample (lavender or purple-top tube). Mix sample and anti-coagulant by gently
inverting several times and chill immediately by placing in either an ice bath or a refrigerator. ACTH is very unstable
in whole blood samples. It is most affected by heat and time spent on cells.
2. Centrifuge and separate plasma from cells within 4 hours after collection and transfer to a vial (plastic preferred)
suitable for shipping and frozen storage.
3. Freeze plasma promptly especially if not immediately sent to the laboratory. Sample should be received “at least cold
or partially thawed” to assure accurate ACTH testing. Sending the sample frozen with cold packs and using a two-day
or overnight courier service, will usually ensure the sample is received chilled.
Insulin Testing
Note: Pregnancy, large grain meals, and severe illness may cause elevations in insulin concentrations.
1. For combination testing the (plasma) specimen collected for ACTH can be used. For Insulin baseline testing alone,
draw a blood sample in either a plain red-top tube (serum) or a purple-top tube (EDTA plasma).
2. Follow the sample processing procedure for DST testing above, steps 4 to 6.

THIS IS FROM THE YAHOO WEBSITE/GROUP ON IR
Equine Cushings/IR members have found that the simplest way to test for possible insulin resistance to test blood glucose and insulin from the same blood draw. In order to be accurate the blood must be spun and separated and chilled by your vet in a timely fashion. Failure to do so may result in inaccurate (lower) glucose number. (See also files: Blood Testing for IR & Cushings Disease > Sending Blood Work To Cornell

More about the difference between the simple I/G test and other Glucose and Insulin Tests can be found below and in the New Member Primer/How to Get the Right Diagnosis.


92526 June 2, 2007
Re: I/G test

--- In EquineCushings@yahoogroups.com, "Eleanor Kellon, VMD"
<drkellon@...> wrote:

> A single blood draw for insulin (and glucose) is nothing in terms of hassle and expense >compared to placing a catheter for a 12 sample blood draw after injection of both dextrose >and insulin (with a risk of hypoglycemia).
>
> Even Dr. Frank stated that baseline insulin can/should be used for screening. The 3 hour > CGIT is only necessary for early or mild cases.

To elaborate a little bit here, in the same presentation Dr. Frank said that baseline elevation above the lab's normal range is also diagnostic. We've been saying that for years (i.e., in the absence of a reason for it, like a grain meal, an elevated insulin by definition means insulin resistance). He talked about lab ranges being too broad. Agree with that too, but the G:I ratio calculation takes care of that.

Get a glucose and insulin with nothing to eat except low NSC hay or soaked hay. If you want a copy of the Virginia Polytech study that compares predictive value of a G:I ratio to clamp studies let me know. I'll send you one.

Human medicine went through all this nonsense about testing 10 to 20 years ago and couldn't improve on the simple G:I ratio. Now veterinary medicine is reinventing that same wheel.

If your screening tests are inconclusive (insulin, glucose, G:I ratio) and you want to move on to more sensitive testing, that's fine, but you probably don't need to go to all that trouble. Dr. Frank also suggests that the catheter be put into the horse the night before the test, to minimize stress, which means another vet visit cost and the horse will have to be used to being stalled for the night or that too will be a stress. Do the math. Vet visit the night before to put in the catheter (has to be done at home by the way, shipping to the clinic for the test is definitely out on the stress factor), vet comes back the next day to inject dextrose, then insulin, pull a total of 12 blood samples over the next 3 hours to be
tested for glucose (assuming the horse didn't rub the catheter out overnight and the catheter didn't clot). Eleanor

[PLEASURE PASOFINO]

Thank you Abejita!!!! very informative! I do appreciate that!!!!


Saludos!

[PLEASURE PASOFINO]

Well, The Vet came!!!!! thank you Abejita and Stef for the most valuable information!!!!!!! Abejita, with the information that you gave me!!! thanks GOD!!!! the vet felt the need to contact the University here in Florida on the subject matter....... Abejita! you where very accurate and detailed in providing the information....... and the TEST was done accordingly!!!!!!

Thanks Again!!!! for all your help!

Saludos!

Ps. The Test could not be done on Monday!!!! they where not prepared!!!! so , It was done yesterday!!!!!

[Abejita]

Was wondering how it went..Let us know what the results are when they come in.

[Edurne]

did you get the results of the tests yet?

[motorgypsy]

We have a mare that we are fairly sure is IR or Cushings but IR is the most likely diagnosis. She had foundered multiple times with her previous owner. Previous diet, the old Omilene 200 (very sweet) and really lush pasture. Since we got her she has been on a beet pulp based senior feed and grass hay or unfertilized mixed grass pasture. All her fat pads disappeared and in six years she has not foundered once. We are HUGE proponents of beet pulp. It is the remains AFTER all the sugar is removed from beets. Even with molasses in it the glycemic index is extremely low. You can taste the beet pulp with added molasses and it has no sweet taste at all. Of course you can probably do a quick wash on the molasses added - add water over the level of the beet pulp, swirls around well for a minute or so, then dump out the water - if your horse is really really sensitive. But the tiny bit of molasses in the shredded beet pulp has not in any way bothered our IR mare.

[PLEASURE PASOFINO]

I have not forgotten this thread! all I have to say is, the vet shall be back tomorrow to re-test the 2 horses in question!!!!!! the previous testing was a disaster to say the least!!!! I even have some results with (ZERO) count!!!! hummmmmm!!!!!

Saludos

[Abejita]

what lab did he use? Cornell in NY is the on ethat seems to be recommended most, bu tit could also have been a mistake in handling of th eblood anywhere along the process..Good luck

[PLEASURE PASOFINO]

what lab did he use? Cornell in NY is the on ethat seems to be recommended most, bu tit could also have been a mistake in handling of th eblood anywhere along the process..Good luck


Abejita!!! the whole thing was just a JOKE!!!! they used a local lab!!!!!
Cheri, from Stunning Photos was at the farm today, I need to ask her exactly what went on!!!!!

They had instructions, and I they also claimed that the blood went from our farm straight to the LAB!!!! but, lets see what happends tomorrow!!!!
I feel like giving you there number!!!!! I dont know in what language I need to speak with them!!!! I also had forward the entire thread!!! for them to read!!!!! this is frustrating!!!!!! I am in MIAMI they are in OCALA :twisted:


Saludos!!!!