Help !!! EMS

[Dam1]

Hi all
Don't post much but lurk a lot. I'm really struggling with this at the moment.
Horse diagnosed with ems in Jan as showed slight lameness short stride etc so tested for ems and cushings (fully expected it to be be Cushings as horse is 18 this year) but to my surprise (and horror) the cushings result was ok but insulin level was 110. Put on strict diet and tested again 4 wks later. Insulin 39. Just retested and insulin now 61 ??? Honestly I could cry and not sure where to go now. She's 16.1 and weight tape was showing 594 k and now 547k She did have a slight cresty neck and tiny fat pads at the top of her tail but they seem to have mainly gone. Have doubled her ridden exercise and she's in at night and in the school and a very small track during the day. She's on low sugar haylage at 1.5% of weightape measurement and has a bucket feed of light and healthy chaff with a sprinkling of hi fi cubes, benevit (no iron) supplement and p45 from Trinity Consultants.
Cant believe the insulin levels have gone up from last test.
Am I missing something ????
Am shocked and mortified that I've allowed this to happen. She's always been a good doer and I've always strip grazed in the summer and been careful, or so I thought, about restricting what she ate. I would never for instance have turned her out on grass for 24 hours .
I got a nutritionist round when first diagnosed as it seemed everything I thought I knew I didn't. All basically ok just needed to reduce quantities. The horse wasn't even on any grass when it first happened but out in the arena with hay as it was during the cold period in January and I didnt want her on frosty grass because of the sugar !!!!!!
Do I need to get her slimmer. One of the vets said no she's slim enough. The one I've spoken to today said keep going. I'm slowly going mad - I've read everything I can lay my hands on - a lot of its conflicting so feel completely stuck now .
Thanks to anyone whose made it this far
X

 

[PinkvSantaboots]

My guess is she still may have cushings the test it not that accurate I had 3 for my mare only third one was borderline although she did have symptoms.

So might be worth testing again or ask for a low dose of prascend if you suspect cushings, there are a few different drugs for ems and high insulin levels although I can't remember what they are without looking up.

My friends pony was put on a drug after a bad bout of laminitis the pony literally could not walk, then after a week on the drugs was completely sound and levels were right down,so I would definitely discuss this with your vet as she may need help if the levels are rising again and she is slim.

 

[Dam1]

That's a good idea - thank you. She's had a couple of cushings tests previously which were OK then the TRH stim test last year that came back inconclusive so think I will revisit that. X

 

[Dam1]

Just to add the vets prescribed ertugliflozin which she had for a couple of weeks but reading up on it it said not to give with bute which she was at the time and also after speaking with the vet today she said it's not registered for use on horses yet so is still quite experimental and as the horse was by now sound again I didn't feel I could take the risk of any bad side effects (she did have liquid poos by then) so I stopped it x

 

[holeymoley]

What changed feed/management-wise from the initial test with high insulin to the drop and the low result then the now high result? If nothing, it sounds like she could be highly sensitive to grass changes, perhaps medicating long term would work for her.

Mine’s insulin went to 300 (eeek!) in december when we had a week of -7c, frosts, unable to soak hay etc. I went back to soaking hay, exercising and put him on a course of L94 from Trinity Consultants for good measure and he tested again in February with results of 14.5. We’ve figured over the years mine can be managed through diet alone at this point. And hopefully for the forseable.

 

[Dam1]

Glad your horse is ok now.
Can't think of anything that's changed between the blood test results. She was on L94 and moved on to the P45 and is now on half a dose so may up that to a full dose to see if that helps. Was hoping to keep levels under control with management but so far not going to plan . Its very worrying for her future .

 

[maya2008]

We never got lower than 33 without drugs - that was on a 60% straw, 40% low sugar haylage diet. Added Ertugliflozin and the last test was within normal range. We’ve stayed clear of bute while on it and have not had any side effects so far (been on it a month now).

I would not combine the drug with any of the stronger supplements though, as you risk interactions between the two.

 

[Dam1]

We never got lower than 33 without drugs - that was on a 60% straw, 40% low sugar haylage diet. Added Ertugliflozin and the last test was within normal range. We’ve stayed clear of bute while on it and have not had any side effects so far (been on it a month now).

I would not combine the drug with any of the stronger supplements though, as you risk interactions between the two.

 

[Dam1]

Well that's made me feel a bit more positive - thank you and I'll perhaps have to go down that route if all else fails.

 

[holeymoley]

It may be that the haylage is just no good for her. Mine used to be okay on low sugar high fibre haylage but he had some that week In December when I couldn’t soak hay and I think it may have contributed to the higher levels. If you can source hay and soak for even an hour, that might just keep her low enough.

 

[Dam1]

Yes - I have noticed that each batch of haylage I use is completely different in smell/texture/moisture content etc and although it's meant to be analysed I can't believe they do it for every field so I think that as much as I don't want to I'll have to source some small bale hay and give it a try.

 

[HollyWoozle]

Definitely sounds like the haylage could be an issue. The hay farmer we use offers low sugar haylage but has all his forage analysed and his lowest sugar hay is still a far better choice for EMS. We soak ours well and it really makes a difference.

Hope you can get it worked out.

 

[Highmileagecob]

You are basically dealing with type 2 diabetes. Are you able to replicate trickle feeding - grazing mask, double nets etc.? And exercise - is she able to be worked? If you think of a horse's gut as a conveyor belt with a handful of grass added every few seconds and a couple of drops of insulin, it helps to see how the imbalance can occur if the horse is grazing faster and more and more insulin is released as a response. Exercise burns excess fuel and helps to balance things out, but I found with my cob that management is quite labour intensive, I could not leave him unworked for more than a couple of days. Good luck, I hope you find a system that works for your mare.

 

[Dam1]

She's not on grass at all at the moment - just in the school with hay and a small track that is basically a stoned path down to one of the paddocks. She gets doubled netted hay fed 4 times a day so its well spread out so I'm at a bit of a loss of what else I could/should be doing. Vet says carry on as I'm doing but it doesn't seem to be having much effect so am a bit unsure about nxt steps.
She's sound at the moment so have doubled up on exercise (like you I don't like to give her more than a day without doing anything).

 

[maya2008]

I would swap some of the (well soaked I hope) hay out for straw. That’s what my vet recommends and she specialises in laminitis and EMS.

 

[Highmileagecob]

May not be relevant to your situation, but I have noticed a difference in my old cob since I started adding more short chop fibre to his diet. I did this due to poor dentition, and also faecal water, which I could not clear up. Around the same time I had a gut biome analysis done (for the faecal water) which has returned results low in a couple of areas It is not clear whether this is usual for a winter diet. I have started giving him damp Graze On and Fast Fibre in addition to his normal diet. Faecal water has cleared up, no warm feet at all this winter, and holding condition far better than last year - he is 28. I was worried that retiring him from exercise may have an impact on his EMS but so far, he is happy and in the middle of the herd with his buddies.