Ertugliflozin

[Srhorselady]

Way to go Junior and Exvet!

[khall]

Yay Junior!

Metabolic wise Joplin insulin is good and she’s lost a bit of weight. Gaila looks perfect weight wise but we’re checking her acth levels did a stim test last week see if her ppid is managed. Especially with the seasonal rise coming. My sports vet suggested a glp1 instead of Flozen rather not have her founder. She’s now in the dry paddock though there is some grass out there. Mostly eating hay though. Will recheck both insulin in a month.

Well shoot got stim test results back and on the generic prascend form Gaila is not regulated at all. So switching back to original prascend and upping her dose. No wonder her insulin is high. So weird because she looks fantastic

[khall]

New drug Gaila is on is bexagliflozin It’s a glp1 drug I’m getting quite the pharmacy going!

Having some conflict between the Ecir group and my sport vet who btw was a farrier before becoming a vet. Ecir promotes compounded pergolide over prascend and my sport vet says nope and my holistic chiro vet and my local vet. They all feel like prascend is better at controlling symptoms. My sport vet says he sees much less ppid induced laminitis since prascend has been in use. Sigh. Have multiple vets is not always a good thing. Now my sport vet did say he’s finding the new generic prascend is not as effective in controlling ppid as prascend itself so switching back to original prascend.

Cha Ching!

[exvet]

Well no surprise that you get multiple different views = that's why I broke down and contacted Dr. Kellon. I will say that the risk of variation between doses of anything compounded is frightfully high. Hopefully the change in meds will be helpful.

[Josette]

exvet and Khall - thank you for these helpful updates. I've decided to contact my vet sooner rather than later for repeat labs. Physical appearance is so deceiving as we've learned and blood work will help guide medication and supplement changes. Exvet looking forward to good news for Junior's labs.

[exvet]

Well disappointed and not disappointed. Kidney values still all normal but slightly creeping up for what that is worth. Liver values that were abnormal are steady, no better and no worse. Triglycerides are still normal but those too are creeping up...........insulin is down a little from last time but not at their lowest which was after the first 2 weeks of treatment. He was 46.5 last time and now is 42.2; so, better but of course I would love to see it lower. What this means is I will go another month on the Ertugliflozin without a dosage change and remeasure. I will also keep him on the PP Metabolic Advanced Care.

[Josette]

exvet - it is good news that his other labs are stable and still within normal range. The lower insulin drop is also good news too because it went down showing that Junior is responding to all your health management. IMO you are certainly on the right track. Best Wishes!!

I actually dread repeating my guys labs (my fear issues) but we will see as he has a complex management situation.

[exvet]

As for all of us, the big gray area is when should I start to wean him down on the Ertugliflozin and is the PP metabolic advanced really helping. Too fearful and too superstitious to stop the Advanced since it's not causing colic and he's eating it. I will be discontinuing the InsulinWise and not purchasing more based on what Dr. Kellon said; however, do I wean him off or not? I guess I will because it won't likely hurt. I do feel that though his labs are stable that I need a plan to reduce the dose of Ertugliflozin and see if I can keep the Insulin down to 40 or below. It's an arbitrary number and I'm simply trying to find and walk the fine line. I'll feel a bit better about it once we get moved into our new place (September is the target) because there I will have better control in preventing his suicide attempts. I also will feel better when I see that first set of 'normal' radiographs.

[Josette]

Lab tests update - I had my vet stop by to repeat our blood work and review my feeding regimen. I'm very relieved to report his labs have improved further compared to his April report. I feel the recent increase in his Prascend medication to 1.5 tablets daily with diet adjustments show this good response. Last year, while I was trying to figure out hay follage products - I was feeding mixed chopped alfalfa timothy at lunch. He got soaked timothy hay cubes at breakfast and dinner. When I did labs (Nov or Dec) his Insulin result was just over 100 where I PANICKED. I forgot the ACTH result but I immediately stopped feeding the chopped alfalfa mix hay. I believe this lowered his Insulin value in his March labs (before we increased the Prascend dosage - April labs show after Prascend medication was increased).

August Glucose - 91 March Glucose - 80
August ACTH - 36 April ACTH - 96.3 March ACTH - 241
August Insulin - 28.3 April Insulin - 39.3 March Insulin - 53.13
August Leptin - 15.78 March Leptin - 25.86
August T4 - 1.73 March T4 - 2.47


Hopefully some of these details might help anyone with their management issues. I got my vet's office to release these labs before my vet has the chance to discuss with me. I'm guessing we will keep our feeding and medication regimen the same for now. I'm looking forward to hearing her feedback as I had mentioned the various supplement products to her.

[khall]

I just retested my two’s insulin. Unfortunately I’m not sure how good the information from the test results are. My local vet is now doing the tests in-house using Truforma machine. My sport vet says these particular machines do not give reliable results but ecir group says they do.
Joplin was at 38 up from 28 that was sent to Cornell
Gaila was down to 57 from 78. Joplin on half dose flozin Gaila on 1 1/2 prascend and glp1

I don’t know what to think or do. My sport vet is too far away to run tests reliably for me unless I pay part of their trip fee when they are in our area. He uses a snap test that he has determined gives reliable results. I had been preferring to send mine to Cornell using my local vet so I was getting consistent testing using same lab.

I also need to retest Gaila’s acth after switching back to prascend from generic form and upping her dosage. Which we will be doing first of September sending blood up to sport vet when Chex goes back up for ear surgery. He’s got we think sarcoids/swelling both ears after he had been treated several years ago with chemical injections in his ears.

Trying to make the best decisions for both of mine health wise. Switching up their diet right now seeing if they will eat Vermont blend vitamin mineral supplement. Tried mad barn Joplin said nope.

[Josette]

I forgot to mention that my guy also dropped some weight which I think is reflected in his decreased Leptin value.

Khall - all my lab testing is done at Cornell - but they are basically local to us being one state over. I think exvet's feedback for generic or compounded product versus Prascend is right on. Hopefully you will see some improvement switching back to Prascend.

My fall challenge last year was the giant bumper crop of acorns from all the oaks in my largest front paddock (almost an acre). I had to give up and move my guy to the smaller back turnout after I removed 6 large wheel barrows. Love the cool shade in the summer months but some years they really dump the acorns. We shall see this year after all the rain.....