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  1. #1
    Join Date
    Jun. 11, 2007
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    Minnesota
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    Default Test results back from Cornell... And a question.

    So, I had numerous tests done on Gus last week. We rechecked his Glucose/Insulin levels, his ACTH and his T3/T4 levels. Everything came back within normal limits. Yeah!

    Here's the results:

    Glucose: 98 (75-117 mg/dL ref. range)
    Insulin: 25.60 (10-40 uIU/mL ref. range)

    ACTH (Baseline): 21.6 (9-35 pg/mL ref. range)

    T4: 1.97 (1.5-4.5 ug/dL ref. range)
    T3: 0.54 (0.3-0.8 ng/mL ref. range)

    According to the paperwork, he's NOT IR and does not have Cushings. However, I did get a call from my vet stating that his glucose/insulin ratio is telling her that he still is severely IR. [Side Note: When he was diagnosed a year ago, he was compensated IR.] She said we could discuss diet if I can't get the weight back up after the move, but right now he's looking better then he did and he seems to feel pretty well.

    Any suggestions? I used the IR Calculator (found at www.freil.com/~mlf/IR/ir.html - hope that link works) and calculated these values:

    G:I Ratio - 3.83 [If the G:I ratio is less than 4.5, horse is severely IR. If the G:I ratio is between 4.5 and 10, the horse is compensated IR. A G:I ratio greater than 10 is normal.]

    RISQI - 0.20 [A RISQI greater than .32 is normal. A RISQI less than .32 indicates IR. A RISQI less than .22 indicates severe IR.]

    MIRG - 9.14 [Some horses will have a normal G:I ratio and RISQI but still be in danger if the glucose is over 100. An MIRG greater than 5.6 will indicate IR in these cases.]

    IR Status - Severe IR, high laminitis risk

    FWIW, he's never (least to my knowledge) had a laminitic episode.

    Diet (for those who want to know):

    2lb Progressive ProAdvantage Grass ration balancer
    1.5lbs alfalfa pellets
    8g MagOx 56%
    10g MSM
    100mg HA
    SmartGut (until it's gone - trying to rule out ulcers/pain cause he's cribbing again)
    1/2c (so 4oz) Cool Calories 100

    Plus about 20-25lbs mixed hay (mostly orchard/timothy stuff, I think).

    He's moving back to his old barn, so he'll be on their hay (and there is ABSOLUTELY NO WAY to soak the hay or give beet pulp, tried it before and it didn't fly) but I have total control over the grain, provided it fits into a baggie and can be easily dumped into his bucket.

    Suggestions? Just keep doing what I'm doing? Here's some recent photos (he is still ribby - but it's hard to tell with his winter coat).

    http://picasaweb.google.com/lh/photo...eat=directlink
    http://picasaweb.google.com/lh/photo...eat=directlink
    http://picasaweb.google.com/lh/photo...eat=directlink
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  2. #2
    Join Date
    Aug. 21, 2004
    Location
    Guanajuato, GTO, Mexico
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    2,474

    Default

    read this:

    http://www.thehorse.com/ViewArticle.aspx?ID=12588

    that IR calculator you posted is not valid. According to current research, your horse does not have PPID, and may have a tendency towards being IR, but is currently well controlled with current management.



  3. #3
    Join Date
    Dec. 16, 2003
    Location
    Staunton, VA, USA
    Posts
    2,487

    Default I agree with Katy

    That IR calculator you used is not considered a valid one by many experts.

    It looks to me as if you have a horse with tendency to IR who is currently managed well.

    Just keep an eye on his neck, any sign of crestyness or hardening of the crest and you should re-evaluate your diet.

    Also watch out for any abnormal fat pads developing above the eyes, tail head or shoulder region, all of these are symptoms of metabolic problems and should not be ignored.

    But other wise he looks fine, I'd say carry on as you are.
    MW
    Melyni (PhD) PAS, Dipl. ACAN.
    Sign up for the Equine nutrition enewsletter on www.foxdenequine.com
    New edition of book is out:
    Horse Nutrition Handbook.

    www.knabstruppers4usa.com



  4. #4
    Join Date
    Jun. 7, 2008
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    now in KCMO, and plan to stay there
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    2,998

    Default How neat...

    Quote Originally Posted by Katy Watts View Post
    read this:

    http://www.thehorse.com/ViewArticle.aspx?ID=12588

    that IR calculator you posted is not valid. According to current research, your horse does not have PPID, and may have a tendency towards being IR, but is currently well controlled with current management.
    I clicked on the link and noticed you are the author. It seems that the 2 people you quoted (surely there are more than 2 sources you could have consulted with for this?) do not agree on very much. I did think this is worth quoting and sharing, although I do have to question the verbiage used by someone who is ostensibly a scientist, that he (Geor) 'does not have faith in' ...science should be fact based, not faith based, IMO.

    "Might a horse still be considered IR if test results for insulin are within the lab's "normal" range?

    Dr. Frank: For our laboratory we consider a blood insulin level > 20 µU/mL (microunits per milliliter) to be suggestive of IR and > 30 µU/mL defines hyperinsulinemia and therefore insulin resistance. We occasionally encounter horses with normal insulin levels and abnormal intravenous combined glucose-insulin test (CGIT) results. These patients suffer from mild insulin resistance that is likely to be exacerbated by pasture grazing, grain feeding, or seasonal changes.

    Dr. Geor: I do not place much faith in the reference ranges developed by some of the commercial labs. These ranges are sometimes based on very few animals. In general, I go with >20 µU/mL as suspicious and >30 µU/mL as more convincing evidence of hyperinsulinemia and an IR problem providing the sample was collected in an appropriate manner. "

    So, Dr. Frank does state that the insulin value found on OP's horse is in the IR range. Additional detail can be found at www.ecirhorse.com.
    Last edited by sdlbredfan; Mar. 18, 2010 at 03:35 PM. Reason: add punctuation and URL
    Jeanie
    RIP Sasha, best dog ever, pictured shortly before she died, Death either by euthanasia or natural causes is only the end of the animal inhabiting its body; I believe the spirit lives on.



  5. #5
    Join Date
    Jun. 11, 2007
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    Minnesota
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    Default

    Katy & Melyni -

    Thanks. That IR calculator has been previously "quoted" on here before so I guess I thought it was legit. Guess I was wrong. Glad to know that it seems like I'm managing Gus well enough... and it's not easy to do either, since he was an easy keeper turned hard keeper.

    And thanks for the link to that article. I read it back when Gus was first diagnosed.

    I guess I'll just keep up the same routine and call the vet if he doesn't gain weight this spring.
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  6. #6
    Join Date
    Jun. 11, 2007
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    Minnesota
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    Default

    Quote Originally Posted by sdlbredfan View Post
    So, Dr. Frank does state that the insulin value found on OP's horse is in the IR range. Additional detail can be found at www.ecirhorse.com.
    But each labratory has different standards for what is within the "normal" limits. Cornell states that Gus's insulin count is well within the limits... but his ratio is what is off (G:I). Least that's how I interpreted it.
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  7. #7
    Join Date
    Sep. 25, 2005
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    Default

    Well, it makes sense that the values would be within range, since you've been managing him correctly. That's the whole IDEA!

    My mares have normal values right now as well because they are well controlled. If I went back to the way they used to eat, the values would be high again, and they'd be laminitic again.

    That's the whole point of a maintenance program for an IR horse. So I guess I don't understand what you are confused about?



  8. #8
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    Default

    Quote Originally Posted by Auventera Two View Post
    That's the whole point of a maintenance program for an IR horse. So I guess I don't understand what you are confused about?
    I guess I'm confused as to why he's "severely IR" but how everything is normal (bloodlevels). I've now be told by Katy and Melyni that the IR calculator that I used to calculate the values is not considered accurate and I should not base anything off that.

    So my original post was about that. I guess the post is now pointless. I'm just happy to know that I'm managing Gus well enough to keep his IR in a moderate check.
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  9. #9
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    Default

    He can be severely IR but have numbers within the normal range if he is managed properly A severely IR horse will crash if not given the right diet and exercise, so it looks like you're doing a great job!



  10. #10
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    Aug. 21, 2004
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    Default

    Quote Originally Posted by sdlbredfan View Post
    It seems that the 2 people you quoted (surely there are more than 2 sources you could have consulted with for this?) do not agree on very much.
    Those 2 researchers are considered the best informed. If one goes to several conferences where EMS science is discussed and presented, one will learn that there is currently NO consensus as to how to define IR in horses. The more they learn, the more convoluted the whole syndrome becomes. They are also now realizing there may be several different forms, with different ways to diagnose each form.

    Katy



  11. #11
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    Default

    Quote Originally Posted by Auventera Two View Post
    He can be severely IR but have numbers within the normal range if he is managed properly A severely IR horse will crash if not given the right diet and exercise, so it looks like you're doing a great job!
    Whoohoo! Somebody says I'm doing a GREAT JOB managing my horse. Wish the future MIL (soon to be ex-BO to Gus) would see this. God, she thinks I'm a lunatic, but that's okay .

    I'll just keep up the same routine and recheck again in 6 months... that's really all I can do at this point.
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  12. #12
    Join Date
    Nov. 13, 2007
    Location
    NW Louisiana
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    5,190

    Default

    One question, just something you may not have tried. Your grass balancer probably is high in soy meal, correct? Have you at any point tried pulling him off the soy and replacing that with something like SmartVite and more alfalfa pellets?

    I know some horses are sensitive to soy. My mare is one who cannot have very much or she becomes a lunatic. She literally refuses to stand tied, and freaks out if you approach her from the front. Take her off anything with soy, and she turns normal.

    It has also been known to cause IR symptoms in some horses. The mare mentioned above is IR, though I have not noticed soy contributing to that.

    Just something to try if he doesn't pick up the weight.



  13. #13
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    Jun. 11, 2007
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    Minnesota
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    Default

    Quote Originally Posted by Hampton Bay View Post
    One question, just something you may not have tried. Your grass balancer probably is high in soy meal, correct? Have you at any point tried pulling him off the soy and replacing that with something like SmartVite and more alfalfa pellets?

    Just something to try if he doesn't pick up the weight.
    I haven't tried the "soy-free" diet yet. I do believe that the Progressive does have soy in it, but he's never shown any sensitivities to soy (before or after the diagnosis of IR).

    I will definitely keep that in mind though if I can't get his weight back up in the next couple months. The ration balancer is a relatively new change since I switched him of TC products (Senior and Lite). And his weight seems to be holding steady... just need that extra 100lb or so (mostly muscle now) and he'll be almost perfect.
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



  14. #14
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    Default

    You can really up his beet pulp to get some extra weight on him.

    Add: Oops, sorry, I re-read and it doesn't look like he's getting beet pulp? Well, you could start slowly and get him up to a pound or two of beet pulp a day, which is safe for IR horses, and it provides a lot of calories. Obviously you'd buy the stuff with no molasses.



  15. #15
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    Default

    Quote Originally Posted by Auventera Two View Post
    You can really up his beet pulp to get some extra weight on him.

    Add: Oops, sorry, I re-read and it doesn't look like he's getting beet pulp? Well, you could start slowly and get him up to a pound or two of beet pulp a day, which is safe for IR horses, and it provides a lot of calories. Obviously you'd buy the stuff with no molasses.
    I actually already have the BP... and Gus LOVES it, but sadly it's not feesible at either boarding barn. I tried... but they won't feed it (even if I pre-soak it and keep it in the barn fridge... just too much work for a 30 horse facility).

    I do plan on upping the alfalfa pellets to probably 3lb/twice a day. So that would be a total of 2lb RB (1lb/twice a day) daily and 6lb alfalfa pellets daily, plus the Cool Calories.

    So he'd be getting nearly 5000 more calories daily in concentrates alone, compared to the measly 3700 he's getting now (does not include the hay of course). Plus being fed twice a day should help his metabolism out a lot.

    We'll see. I do think I should be able to maintain him on the RB and alfalfa pellets alone (plus hay). I'm just happy my old BO is welcoming us back and still letting me manage his "grain" (she wouldn't before, hence the reason why we moved to begin with).
    Proud owner of Gus & Gringo.
    See G2's blog
    Photos



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