Prascend, EMS PPID and Steglatro, why is insulin still high?!

M

mustardsmum

Well-Known Member
Joined
16 December 2012
Messages
632
Location
South West
Visit site
End of last year pony was diagnosed with EMS and PPID after a bout of lami in the autumn. He's 12 and had fat pads/cresty neck which he came with and which I have been battling to reduce for two years. He's managed as an EMS pony, so grazing muzzle/restricted grass, soaked hay etc. but fat pads were not budging. After the lami bout, vet did bloods and we started him on Invokana to reduce insulin levels and prascend to control the PPID. I started on one tab of prascend but he was so quiet and listless, we decided to half the dose (he's a 14.2hh NF, weight about 425kg, and ACTH was just under 60). However, insulin levels increased since starting tablets, so put onto steglatro (insulin is now just below 90). Does prascend help bring the insulin down, so should he be on a full tablet? I kind of thought start low and see where we get to, but if he's better on a whole tab then maybe it could help control the EMS. My vet said prascend doesnt affect EMS at all, and I have read conflicting reports as to whether prascend helps with EMS and insulin levels. For record, pony is now actually looking thin, no fat pads now and feet cold and pulse free feet.

Any EMS/PPID owners out there with any advice or similar issues? How do these two conditions affect one another? I was hoping getting the PPID under control, would mean the EMS was not such a problem but I am not sure. Although his insuling numbers are elavated, hes's the best he's ever been since going on Prascend. And I have heard of ponies whose levels are up in the hundreds, but I also know that around 90 he is ask risk of lami. For a lami prone pony, I am obvs worried. I am loathed to up the prascend to a whole tablet unless there is a benefit as he is going so well. Just the insulin numbers are not right despite being on Steglatro!
 
I can't comment on Steglatro as I've no experience of it. Mine is on Metformin to successfully manage Insulin Resistence which she has alongside PPID.

Definitely PPID and high insulin are linked and you won't control insulin levels until PPID is controlled via a theraputic dose of Prascend. It's not dosed by size or weight, the correct dose is whatever reduces ACTH to within range. I would titre up very slowly to one tablet and re-test blood.

Have none fasting bloods and test ACTH, insulin and glucose. On the lab ranges my vets use insulin above 21 puts you at high risk of laminitis but the ranges do differ by lab so your 90 may be ok. It's high insulin that causes laminitis, they don't have to be overweight, that's one of the complexities of PPID combined with EMS/IR.

If you're on facebook join the ECIR group (equine cushings and insulin resistence) and read, read, read. You will get to understand the link between the pathologies. Sorry you're dealing with this, 12 is young for PPID but probably the age mine started with hindsight. She was diagnosed at 15 and none symptomatic besides excessive drinking and peeing.
 
Prascend does help insulin. Your pony's PPID likely isn't controlled enough on a half dose, so cortisol is still driving insulin up. The tiredness from a full pill often fades. You need to increase the Prascend gradually to properly manage both conditions. Retest ACTH to be sure.
 
Thanks @Alexanderevan145 and @joelb your replies really have helped and you’ve both confirmed what I suspected. I did not appreciate that PPID could impact insulin so much but actually the high cortisol makes perfect sense. It would make sense that the cortisol isn’t under control - he’s actually a hat rack at the moment and I was shocked his insulin was so high. I will ask vet to do the ACTH test when we rest his bloods in three weeks time to see where his levels are and in meantime I will put him back on a whole tablet of prascend. I’d read somewhere that <20 was normal for insulin, but that 90 they were at very high risk of lami, It’s such a difficult road to travel but I am determined to get him sorted.
 
Cold weather will drop blood sugar levels, and if you are restricting sugar/starch as well, then his insulin levels may well be out of balance. EMS is very similar to type 2 diabetes. Do you think his EMS is linked to PPID or does your vet think there are two separate things going on? My thinking is that if it's linked, then it should level out once he starts responding to Prascend.
 
The PPID is not under control here. Some ponies need a lot to be symptom free; I have a 15hh on 1.75 pills a day and a 12hh on 2.5 pills a day and both now testing in normal range for basal cortisol and normal insulin
It's got a short half life of just 7-8hr so you may find it helpful to split the dose into twice daily, just make sure any increases in dose are done in small, slow increments (I do 1/4 a pill at a time)
 
I used high levels of Metformin first alongside Prascend for mine. Had lami 4 years ago and was diagnosed with EMS and PPID.
Levels came right down as he lost weight (over 100kgs). He's now just on 1 Prascend a day and bloods have just come back at ATCH level at 10.7 pg/ml.
Vet looking at full results as may be able to decrease Prascend.
He hacks 3 times a week. Lives out in pretty bare paddock with a bale of hay per day and veteran balancer.
It takes a while to get levels back down. He's a 16hh IDx.
 
FWIW my 15hh had insulin just under 500 and when PPID wasn't controlled didn't respond to any drugs that focused on insulin alone. Prascend was upped and she had a month on ertuglifozin, 3 weeks off then another month on and it's now 17 iirc. will be retested for cortisol and insulin in spring
 
maya2008 said:
My EMS pony can’t be controlled on drugs alone and must have sufficient exercise. Could yours do more - even in hand walks?
Click to expand...
He’s ridden pretty much every other day - proper hacking, with hill work etc. I even hacked today in the pouring rain …
Breather said:
How many miles does he do in a week?
Click to expand...
About 20km ATM but that increases with longer eves and nicer weather! He also does clinics once or twice a month.
Highmileagecob said:
Cold weather will drop blood sugar levels, and if you are restricting sugar/starch as well, then his insulin levels may well be out of balance. EMS is very similar to type 2 diabetes. Do you think his EMS is linked to PPID or does your vet think there are two separate things going on? My thinking is that if it's linked, then it should level out once he starts responding to Prascend.
Click to expand...
I wasn’t aware of this re the cold and sugar levels. ATM he’s on a very muddy field with very little grass, and soaked hay, so yes I am now restricting sugar and starch (which I wasn’t when he had the high insulin result). Vet thinks PPID and IR are separate but I quietly disagree - my feeling is they are linked. The improvement in him when he went onto Prascend was to me, quite visible, and after 3 years of the “not quite right pony” he’s great. Our old family horse was PPID so I am not new to the condition but she was not EMS/IR. His only clinical sign now is high insulin - nothing else! Fat pads and crest dissolved on the Steglatro/prascend. if we were not monitoring his bloods as he’s on Steglatro I would be a happy owner right now as in terms of ridden work, feet, loss of crest/fat pads, he is great!
 
It's a tricky balancing act sometimes. I was told my 17yo cob was probable EMS after several vet visits. So....restricted grazing, second cut haylage, rinsing haylage before feeding etc.. He started with faecal water, which was attributed to NSAIDS. Twelve years later, I inadvertently put sugar back in his diet, with a change of sugar beet brand. Dry, happy horse, weight staying steady. Hind gut fermentation needs sugar and yeast, and I hope more research will be done to work out what EMS is and how to treat, without disrupting something else.
 
Highmileagecob said:
It's a tricky balancing act sometimes. I was told my 17yo cob was probable EMS after several vet visits. So....restricted grazing, second cut haylage, rinsing haylage before feeding etc.. He started with faecal water, which was attributed to NSAIDS. Twelve years later, I inadvertently put sugar back in his diet, with a change of sugar beet brand. Dry, happy horse, weight staying steady. Hind gut fermentation needs sugar and yeast, and I hope more research will be done to work out what EMS is and how to treat, without disrupting something else.
Click to expand...
That's really interesting about sugar and yeast. Mine has faecal water at times and I use Gut Sponge but what you say makes sense.
 
mustardsmum said:
He’s ridden pretty much every other day - proper hacking, with hill work etc. I even hacked today in the pouring rain …
Click to expand...

Probably not what you want to hear, but my vet told me to get ours out twice a day initially to get the levels down - then once in faster work (summer work given we don’t have an arena) we got her fully sound on lots of fast work daily. Even on days off she had to go for a walk in hand though.

She is now on loan to a wonderful family who have access to an indoor as needed and an arena all year round and are fully committed to exercising her as much as she needs, even if that’s free schooling twice a day in the worst of winter.
 
maya2008 said:
Probably not what you want to hear, but my vet told me to get ours out twice a day initially to get the levels down - then once in faster work (summer work given we don’t have an arena) we got her fully sound on lots of fast work daily. Even on days off she had to go for a walk in hand though.

She is now on loan to a wonderful family who have access to an indoor as needed and an arena all year round and are fully committed to exercising her as much as she needs, even if that’s free schooling twice a day in the worst of winter.
Click to expand...

It’s not really but do I hear you, my old pony was also EMS and I had to ride him everyday to keep the EMS in check. He did not have PPID - so anyone following, yes I have had a horse with PPID and a pony with EMS but, lucky me, this boy has both! Back to PPID/EMS boy; I do generally ride most days but atm time is against me so hence only every other day and I do long fast hacks at weekend. I would just clarify, he is not over weight at all - he did have fat pads/cresty neck which the medication finally helped shift. We are not trying to get him to loose weight, just get his insulin levels lower. He looks ribby and not covered, some would say he looks poor but compared to the fat pad and crest he came with he’s improved a lot. I just thought the numbers would come down a bit quicker. I am hoping once the lighter evenings are here i can ride him more. I will come back and update after next bloods; but thanks everyone for your thoughts 🥰
 
It might help to do a bit of reading up about diabetes and insulin/blood glucose levels. Maybe discuss with your vet about trying a slow release carb diet to balance out the insulin, something like soaked sugar beet and a plain straw based chaff with as few additives as possible. If the PPID is keeping the insulin raised, then I appreciate a different approach will be needed.
 
Been following this, as just about to start pony on Steglatro. Have always treated her as ems, but became footy couple weeks ago. Tested insulin at 90.

May be of interest to you. Friends horse (19 yrs, connie x tb) tested for cushings and insulin in January. Results were acth 1250, insulin 160.
Some rotation.
Diet adjusted and other things addressed.
Started on prascend only.
Tested again this week.
Acth 160, insulin 11.4.

Does suggest that getting the cushings under control does help the insulin levels.
 
Britestar said:
Been following this, as just about to start pony on Steglatro. Have always treated her as ems, but became footy couple weeks ago. Tested insulin at 90.

May be of interest to you. Friends horse (19 yrs, connie x tb) tested for cushings and insulin in January. Results were acth 1250, insulin 160.
Some rotation.
Diet adjusted and other things addressed.
Started on prascend only.
Tested again this week.
Acth 160, insulin 11.4.

Does suggest that getting the cushings under control does help the insulin levels.
Click to expand...
We sound like we are in similar positions. Are you also treating PPID? I am, hoping having increased the Prascend will bring the insulin numbers down. Have a few more weeks Steglatro before next bloods are done and hoping I can come back with something positive!
 
FieldOrnaments said:
FWIW my 15hh had insulin just under 500 and when PPID wasn't controlled didn't respond to any drugs that focused on insulin alone. Prascend was upped and she had a month on ertuglifozin, 3 weeks off then another month on and it's now 17 iirc. will be retested for cortisol and insulin in spring
Click to expand...
That's interesting. They vet has always said she's surprised the Appy didn't drop weight on her drugs so I might get her retested for cushings this spring.
 
You must log in or register to reply here.
Top