Cushings/Insulin - the differences and what to do.

[Mosh]

So I have a 30 year old, mostly welsh mare who is the light of my life.

She was diagnosed with Cushings/PPID about 3 years ago and has been managed accordingly since. Her levels on the ACTH test originally at the time of diagnosis were 400 and something which with management and medication we got down to perfect levels for a couple of years and she was feeling great generally.

I've just had her levels tested yesterday as I was noticing some changes and they have climbed back up to 60 ACTH. The vets are querying insulin levels as well but we have decided to increase the prascend to 2mg a day and then re test ACTH and insulin levels in a couple of months to see what if it's worked or it is insulin causing problems.

I've never had a horse with insulin problems before so don't know where to begin. I'm reluctant to change much as we won't know what the issue is if she improves if that makes sense?


She is currently fed a small feed of rowan and barberry mash with a small amount of thunderbrooks chaff (one with nothing in it) as it is the only chaff I can get her to eat consistently, she has a scoop of bosweilla and a scoop of tumeric which includes linseed and vitamin e.
She is turned out at night during the summer for about 12 hours but she needs the movement for her arthritis. She is still ridden 4/5 times a week for hacking and odd schooling session.

She isn't muzzled currently as haven't found one that suits and I've tried quite a few. Her hay isn't soaked currently as she won't eat it but she doesn't eat a lot of it in general and is generally sleeping when she is in.

If she is insulin resistant what do I need to know? Is it going to be at odds with her cushings management?

I can't win at the minute, she needs to be out but can't because of the grass, I've cut her feed down, I'm working her as much as I can without knackering her out. I try really hard to keep her healthy but I'm battling everything! I guess I'm just whinging but any advice moving forward would be beneficial!

 

[PinkvSantaboots]

I had a mare that had cushings and EMS and it was really hard to manage as she couldn't be ridden, although that was many years ago so not so many treatments then.

I believe now there are drugs that can help with this so I would speak to your vet about that.

 

[hollyandivy123]

have you tried a track............increases natural movement

 

[suestowford]

Hopefully the increase in Prascend will help.
I have one on that, he's had two increases in his dose so far. The vet suspects he also has EMS but we've never tested for it as she said she would recommend a low-sugar diet for that to begin with, and he was already having that. As long as his ACTH is good, then he seems to be happy enough, so if he does have EMS then it's not bothering him right now.
I've just had to start keeping him out 24 hours rather than having him in for the day. He's now arthritic so he needs to be out & moving. You can imagine how closely I'm watching his waistline these days! But I have reduced the area of field he's got access to in the hope that it won't send him back into fat camp again.
I think you are right to see how the increase in Prascend works. Change only one thing at a time, that way you will know what's working and what isn't.

 

[holeymoley]

I think you’re at that rock and hard place part. My EMS insulin resistant chap is out during the day and in at night. I tried him out overnight to keep him moving but he just can’t manage the extra hours at grass, he was starting to show some signs of his insulin being high.

Mine seems to be grand on day turnout 5-7 hours then in and on soaked hay. It’s much better for them to get large quantities of soaked hay than it is grass. Does she really need the mash? Mash is highly likely to be high in starch which is a no for ems types.

 

[Highmileagecob]

Agree you are between a rock and a hard place, and her age is against you too. Research has found that horses who were previously thought to be insulin resistant, were actually producing high levels of insulin to cope with the break down of sugar, and the high insulin level was directly linked to laminitis. Spring grass has a higher level of sugars than late season grass. Carbohydrates and starch are broken down by the body into sugars, and insulin is needed to break down the sugar. It is assumed that EMS is similar to type 2 diabetes, where the insulin and sugar balance goes haywire. Pracend is used to treat human Parkinsons Disease, and I think I am right in saying that Parkinsons is also linked to diabetes.
If you can keep her diet fibre based and low in starch, and monitor regularly, fingers crossed this is just a blip and things will come right. Has she had her teeth checked recently? Not chewing properly, even though she appears to be eating ok, will affect digestion and hind gut function.

 

[Mosh]

Thanks all. I feel like I am chasing my own tail trying to manage everything.

On top of all of this she can be colic prone which Is part of the reason I feed her mash. Its an easy way to ensure she has fluids and is a hay replacer as she has never been interested in hay. She'll pick at it but isn't one to demolish a haynet so I also need to ensure she has fibre! It's a mash which is low in sugar and starch.
It's this one: https://rowenbarbary.co.uk/readyfibre-mash.html

Her teeth were done in January after the latest bout of colic, still all there but slightly worn down. I'll be re-running bloods in August so will get them to look at her teeth then as well.

My YO aren't a fan of tracks/small paddocks but I will see if we can come to a compromise. Being only out for 7 hours would really affect her arthritis, she is currently bute free but would give her bute and keep her in more if this was her best interests but weighing up all options. I have a couple of different muzzles to try which friends are letting me borrow and some of my own which I can modify.

I'm hoping it's a blip but I'm slightly catastrophising this is the beginning of the end. I feel like I'm letting her down and should have clocked this earlier but it was only last week I saw changes I wasn't happy with.

 

[meleeka]

A track would be great if YO allows. It’s not really affecting the land as it’s usually only the edges which tend to be full of weeds anyway. That’s been the secret with mine. She sounds very similar to yours, but the track means she keeps moving and doesn’t have too much grass. She is coming in at night, so she can have her hay replacer, but if it wasn’t for that she could live out.

 

[Boulty]

I’d say there’s generally a management overlap with the 2 conditions. If she won’t eat soaked hay she won’t eat it so if she’s not actively laminitic it’s not an issue I’d force with her. May be worth looking into lower sugar hay but again if her teeth aren’t great it needs to be something she can eat.

Muzzle wise the flexible filly is really good or my previous horse got on well with the dinky muzzles but again you need to be mindful of her teeth and her actually being able to graze with it on.

A track would be ideal for encouraging movement (which would help her arthritis as well) whilst restricting intake but if you’re on livery and they say no then you’ll just have to manage the best you can with what you’ve got.

I wouldn’t write her off yet. See what the prascend increase does and continue working her if she’s happy as that will help with weight and it’s supposed to help with insulin regulation as well

 

[Highmileagecob]

Could you mix soaked speedibeet into the mash, to give her some extra fibre and bulk? Also damp Graze On or similar to replace the hay she is lacking? My old boy (borderline EMS) has this in big buckets in the winter, plus buckets of Silvermoor Veteran haylage, as he can't have hay. He can no longer wear a grazing muzzle due to the angle of his incisor teeth, but lives out with the herd very happily in summer. Trying to replicate trickle feeding, without long periods of standing with no food is a big step forward in managing EMS. Not easy to do, as they don't seem to have an 'off' button when it comes to appetite.....

 

[holeymoley]

Another one that would give speedi beet a go, mine has this in the Winter.

Just a point to note, if testing in August, expect high results as naturally their acth levels rise at that time of the year. It may be better to test later.