Metformin...any vets on here, PLEASE?

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Janesomerset

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To cut a long story short, my farrier and I both think my lovely pony might have equine metabolic syndrome. My vet doesn't seem to believe this exists! Pony had a blood test after overnight fasting, which said he was not insulin-resistant. I thought they had to have a test to see how quickly they then digested glucose, but this was not done. My friend's horse was on Metformin for EMS and is now 100% fit. Can Metformin be given to a pony without a definite EMS diagnosis? Or would that be dangerous? We are beginning to despair.
 
I would not be giving anything without a proper diagnosis. Why don't you just use another vet for a second opinion? Either from the same practice or from another practice. Much safer than second guessing and giving random treatment. In humans metformin is a very effective drug but I would not want it given on a "hunch" - the dose is quite important too.
 
Hi, thanks for your reply. No, I wouldn't dream of using him as a guinea pig! Our vet was reluctant to give him glucose as it would probably fire off his laminitis; I was wondering whether the glucose test is essential, or whether a diagnosis can be made without it, and medication given. Just trying to find out more, really.(Can't type too much or I get timed out!) We are in a rural area; the practice we use is the only one within 25 miles and I know our vet thinks a lot of our pony; I just wish I could find more info so I would be able to discuss things better! Thanks again.
 
It might be worth contacting Jackie Taylor at the The Metabolic Horse, I'm sure she'd be able to advise, she can also advise on controlling IR by diet and exercise along with feeding magnesium and some herbal supplements. I hope you get your pony sorted.
 
The majority of horses with EMS will have a high fasting insulin level, but you are right that some do not, and in these horses a glucose challenge test is needed. This involves fasting the horse, then giving a set amount of glucose in a feed, then blood sampling for insulin a couple of hours later.
I agree with your vet that feeding a large amount of glucose to a laminitic, whether they have EMS or not, is something that has potential negative consequences, and I understand his reluctance to do it.
Metformin is a fairly safe drug, and I have certainly used it "on a hunch", for example where funds have been limited. What signs do you see that make you and your farrier believe your pony has EMS?
 
Hi touchstone, thank you, I will most definitely contact her. At the moment, I cannot exercise our boy as he is on box rest, but diet advice would be great. I do give him magnesium oxide but maybe he needs more. Very many thanks!
 
Hello alsiola, thank you for replying. Our pony has had repeated attacks of laminitis over the 9 years I have had him, despite being in a grass-free paddock (mainly woodchipped) and being on a strict diet (currently 7 kilos of soaked hay per 24 hours, plus a few handfuls of Happy Hoof and high fibre nuts, both Laminitis Trust approved, with his magnesium oxide in.) He does not have a big belly but he has a cresty neck which varies in firmness from day to day, fat pads behind his shoulders, an "apple" bottom and sometimes his eyes seem puffy too. Most of the time the laminitis just comes out of the blue. I quite agree with not giving him glucose! but didn't know if Metformin could be tried without that particular test.
 
Is this latent Cushing's? Good advice already given to get on the Yahoo Groups 'themetabolichorse' which is full of excellent advice. Jackie JA Taylor really does know her stuff, and it's all extremely current.
 
Hi brighteyes, thank you for your message. He did test negative for Cushings; he is only 10 years old. He was doing really well till Christmas and we thought we were on top of things at last, but then it all fell apart. I will get in touch with Jackie!
 
I have done the glucose tolerance test on many laminitic ponies and it's actually very low risk. The medicine experts don't consider it a concern at all, its not actually very much sugar. At the end of the day its the only way you will know for sure. Metformin is a life long commintment and whilst it is cheap compared to other drugs it adds up in the long term. Also you have to make sure you are getting the dose right so unless you have a repeatable test you can use to check you won't even know if you doing any good. How much does your horse weigh? I would be feeding at 1.5% body weight - it sounds like you are feeding too much and are you soaking the hay for at least 12hrs?
 
Sam22 said:
Metformin is a life long commintment and whilst it is cheap compared to other drugs it adds up in the long term.
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Not necessarily. The role of metformin is to sensitise peripheral tissues (primarily skeletal muscle) to the effects of insulin. Sensitisation of skeletal muscle to insulin is a task also performed extremely well by exercise. For this reason I would tend to use metformin initially in laminitic ponies while they are on box rest for their lameness, but in the long term then management should be achieved through diet and exercise. I also find it useful to use prophylactically in EMS ponies that are box rested for any prolonged period (e.g. snow and icy conditions like this winter).
 
That was the original plan for metformin but unfortunately has not borne out in practice. Ponies that have come off the drug despite correct management have still been insulin resistant and therefore at risk of getting laminitis. If you don't believe me I suggest you do the glucose tolerance test.
 
Hello Sam, our pony weighed in at approx. 370kgs this morning. He is 14hh. We do soak our hay but currently only for about 6 hours, as it is very, very fine meadow hay and we have found if we soak it for longer it almost turns to mush and he won't eat it.
 
Hi alsiola, what you say is really interesting and ties in exactly with how my friend's cob was treated. He was on quite a high dose of metformin whilst he was too lame to be exercised, but as he got better, the metformin was reduced as his exercise programme was stepped up, and now he is on no drugs at all. He goes out with his grazing muzzle on for 6 hours per day most days, which is something I would love to be able to do with my boy. Thank you for your help.
 
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