Cushings/Insulin Resistance Information

Cushings/Insulin Resistance Information

I am creating this page to help others who have horses with Cushing's Disease (ECD) or Insulin Resistance (IR).

Haven't heard of these diseases? Take a moment to read about them and the symptoms that are associated with them.

This is a very basic overview of these diseases. Please seek professional veterinary help if you suspect that your horse may have ECD or IR.

One other place where you can learn more about ECD and IR is located at the website:

http://pets.groups.yahoo.com/group/EquineCushings/

Cushing's Disease or Equine Metabolic Syndrome?

http://www.thehorse.com/ViewArticle.aspx?ID=16042&src=VW

Managing Insulin Resistance Through Diet and Exercise
http://www.thehorse.com/ViewArticle.aspx?ID=17166

Understanding Cushing's Can Help Treat Cushing's-Related Laminitis

Read more here: http://www.thehorse.com/ViewArticle.aspx?ID=17088

Fw: [EquineCushings] Special Notice to All Equine Cushings and IR li

Posted by: "Marge" redmm97@cox.net redmm97

Thu Jul 23, 2009 11:47 am (PDT)
----- Original Message -----
From: goddess03259
To: EquineCushings@yahoogroups.com
Sent: Thursday, July 23, 2009 2:18 PM
Subject: [EquineCushings] Special Notice to All Equine Cushings and IR list members.
We need your help.
The Equine Cushing's and Insulin Resistance list is rapidly approaching two very important landmarks. December of this year marks ten year anniversary of the list on Yahoo Groups and in the upcoming months the list will top 8000 members.
Historical milestones include discovery that soaked hay reduced sugar content beneficial to IR horses, early recognition of Cushing's seasonal rise, establishment of the Diagnosis, Diet, Trim and Exercise protocol, FDA approval of compounded pergolide as a veterinary drug, early concern of efficacy of some forms of pergolide, early recognition of high insulin and the compromised hoof, use of herbal and nutraceutical treatments with documented positive outcome, and most importantly, thousands of better informed owners with healthy horses leading productive lives.
The EC group now manages four additional sister groups, ECPhotos, ECHoof, ECHistory and ECHistory2. As of today EC list archives contain 130,000 messages with over 1000 Case Histories.
The EC list Owners and Support Team need your help to celebrate the many achievements of this unique member-driven group in the coming months. We are seeking photos of horses who have been helped by the list. We wish to compile a photographic essay to honor owners and horses and use examples of before and after pictures in planned upcoming media releases.
Two good examples can be found at the links below. We know there are many, many more out there.
Cushing's Example
<http://f1.grp.yahoofs.com/v1/IAJmSo213lW0KB9CkP8o3UK9_WzxWEBNG8I-5Lk2K2PRx5IFwphCykMKMBOlUdJE7LKvCXL_1szteP-YaCU/Success%20Stories/TAMERA.pdf>
IR Example
<http://f1.grp.yahoofs.com/v1/IAJmSiOEZra0KB9Ck-WK8jCmW67CwWZ_XfQFvEHhZIcl5h1exFnVNcszSAlButCdEa4KQN8ImU20QP3j3aw/Success%20Stories/JOE.pdf>
If these links do not work for you got to the FILES, scroll down to the Folder "Success Stories" and look up Tamera (Cushings) and Joe (IR).
Can you help us celebrate? We wish to share your story too.
Send your pictures and/or any questions to
Nancy C (EC and ECHoof Moderator)
threecatfarm@cyberpine.net (threecatfarm @ cyberpine.net)
on behalf of Robin, Dr Kellon, and the EC support Team

Herbal Insulin Resistance Treatment Options Reviewed

Posted by: "Marge" redmm97@cox.net redmm97

Mon Jan 3, 2011 2:57 pm (PST)
Herbal Insulin Resistance Treatment Options Reviewed
by: Stacey Oke, DVM, MSc
December 10 2009, Article # 15386 Print Email Add to Favorites ShareThis
Insulin resistance has profound consequences for affected horses, yet there are currently no licensed treatment options. Management of the condition is primarily aimed at modifying the affected horse's diet, maintaining a healthy body condition score, and instituting a regular exercise program.
”There is a distinct lack of equine-specific research (on IR),” said Glenys Noble, BAppEquineSci, PhD, a lecturer in Equine Science at Charles Sturt University’s Wagga Wagga campus in Australia.
In response, Noble and her colleagues reviewed the use of herbal remedies that have been researched for the treatment of IR in humans. According to Noble, “The aim of the review is not to advise clinicians or horse owners about what to use, but to inform equine scientists contemplating research in this field.”
Research on the safety and efficacy of potential treatments in horses/ponies is the focus of Noble’s PhD student Kellie Tinworth’s work with insulin-resistant ponies, carried out in collaboration with WALTHAM Centre for Pet Nutrition.
“Appropriate treatment for IR is controversial,” said Noble,” But the effective management of IR may prevent the crippling disease, laminitis.”
Currently, management is primarily aimed at modifying the affected horse’s diet, maintaining a healthy body condition score, and instituting a regular exercise program. For most, this is effective; however, there are instances when pharmacological intervention for IR may be warranted, to enhance insulin sensitivity in an effort to prevent laminitis. But, according to Noble, “Naturally-occurring treatments for IR should also be considered, particularly since many can be administered in feed and are often more acceptable to owners than synthetic compounds.”
Some herbal agents with the potential for aiding management of insulin resistance in horses include:
a.. Panax (ginseng, japoncicus, quinquefolius, eleutherococcus, Asian ginseg, Radix ginseng) and flaxseed (Linum usitatissimum), which are thought to modulate lipid metabolism;
b.. Soy protein, grapefruit, beet or beetroot, and brindleberry, classified as anti-obesity compounds;
c.. Chaste tree, Chasteberry, Milk Thistle, St. Mary's Thistle, caiapo, and curcumin proposed to have antioxidant properties;
d.. Fenugreek, Aloe vera, and Amorphophallus konjac believed to slow carbohydrate metabolism;
e.. Insulin-receptor activators including Chinese cinnamon and Grifola frondosa, and
f.. Stimulators of glucose uptake berberine, Momordica charantia, corosolic acid, and Indian Kino Tree.
Some of these compounds are marketed for other uses, such as anti-inflammatories, anthelmintics, muscle builders, and coat conditioners. Scientific evidence demonstrating any beneficial effect of these herbs on insulin resistance in horses is lacking.
Noble and her coauthors emphasized, "The aim (of this review) is not to advise clinicians or horse owners about what to use, but to inform equine scientists contemplating research in this field."
Considering the increasing recognition of IR and the important consequences of the condition, including chronic laminitis, additional research in this field is certainly warranted.
In-depth information regarding these herbs in the treatment of IR are available in the article, "Potential treatments for insulin resistance in the horse: A comparative multi-species review," scheduled to be published in an upcoming edition of the journal Veterinary Record. The abstract is available on PubMed.

What are Cushing's Disease (ECD) and Insulin Resistance (IR)?

     ECD is a disease that affects the pituitary gland. It is often caused by a tumor in the pituitary gland, but not always. The main sign of ECD is the increase of Cortisol in the blood. The production of Cortisol is produced in the adrenal gland. Why does the body begin to overproduce Cortisol?  Cortisol is a hormone that is commonly produced by the adrenal gland during times of stress (otherwise known as excitement, fear, pain, trauma, exercise, and transport, to name a few). In the case of ECD, there is an abnormally high level of Cortisol in the body. It is typically caused by the over production of ATCH, a hormone produced by the pituitary gland. Why is this a concern? High levels of cortisol are a concern because they can impair the immune system functions, cause resistance to insulin, impare the ability to use protein in the body, and cause electrolyte abnormalities.

     There is also a condition in conjunction with ECD called precushings. This is where a horse may have some of the symptoms of ECD, but ECD cannot be confirmed with testing.

     IR is is similar to type 2 diabetes in people. It is a condition where the cells in the body cannot respond to insulin the way they should. Insulin is a hormone produced in the pancreas that allows the body to take in glucose from dietary carbohydrates and proteins (amino acids). This is necessary to manufacture enzymes, cell structures, and muscle. When glucose and and proteins are not taken in correctly, the body produces more insulin than normal to try to correct the situation. IR can be seen with ECD, but it can also be seen in conjunction with hypothyroidism.

What is the difference between ECD and IR?

     The difference in ECD and IR can be found when you look at the bloodwork that your vet will take when your horse is diagnosed.  You must look at the ACTH, serum insulin, and glucose. Remember, IR can be present without ECD and vice versa.

     In an ECD horse there is an elevated ACTH level in the blood. If the ACTH level remains high for too long, it results in an elevated level of Cortisol. This cortisol is what causes IR in horses with ECD. Cortisol causes the insulin to not work quite right.

     In IR without ECD, we find that the insulin is elevated while the ACTH level is in the normal range. The high levels of insulin in the body cause chemical and vascular changes in the body which can lead to laminitis.

What are the symptoms of ECD and IR?

ECD Symptoms:

     1. Abnormal hair coat (longer than normal, often curly) that does not shed

          out normally in the spring.

     2. Mammary enlargement and/or milk production in some mares

     3. Fatty sheath and/or heavy sheath secretions in some geldings

     4. Any or all of the symptoms listed below for insulin resistance and/or

           hypothyroidism

IR Symptoms:

     1. Easy weight gain

     2. Abnormal fat desposits such as a cresty neck or lumpy, cellulite-like fat

         at the tail base. These fat deposits will usually persist even if the horse

         loses weight elsewhere on his body

     3. Puffiness (fat) in the hollows above the eyes

     4. History of laminitis – commonly induced by grass

     5. Advanced symptoms include increased thirst and urination, loss of body

          condition, especially muscle, weakness, low energy levels

Symptoms of Hypothyroidism:

     1. symptoms are VERY nonspecific and many overlap considerably with

          those of insulin resistance.

     2. Slow shedding/longer than normal coat may be seen.

     3. Energy levels poor, exercise tolerance poor.

     4. Horse may be irritable and sensitive to touch.

     5. Cannot be diagnosed with any certainty by symptoms alone. Need to

          do blood tests.

Symptoms of Laminitis:

      These vary greatly depending on the severity of the laminitis. From least severe to most they include:

      1. Less spontaneous activity

2. Less spontaneous trotting/cantering

3. “Depression”

4.   Reluctance to turn (puts more weight on one foot)

5.   Reluctance to move forward when lead

6.   Lying down more than normal (when pain severe, stay down most of the time)

7.   Standing with the front feet further in front of the body than normal and the hind feet further under the body than normal

8.   Stiffness in the shoulder muscles

9.    Buckling at the knee

10. Refusal to move

11. Hind end muscles tightly bunched up (shifting most of their weight to the hindquarters)

Examination of the feet may show (usually worst in front feet):

      1. Feet feel warmer/hotter than usual

2.   Pulses in the arteries running over the sesamoid bones at the back of the ankle are very strong and pounding

3.   Puffiness or redness at the coronary band

4.   Pain on sole pressure about ¼ to ½ inch in front of the point of the frog

5.   A bruised appearance to the sole

6.   Red or black discoloration of the white line

7.   Widening of the white line

      8.   Appearance of rings on the feet that are close together at the toe but

            get progressively wider over the quarters and heels

How can ECD and IR be diagnosed?

     There are several ways that ECD and IR can be diagnosed. All of them are tests done by your vet.

     1. Blood ACTH: This is the test that is typically used to diagnose ECD.

          Remember the ACTH level can be elevated due to stress, but not nearly as

          high as the levels of ACTH in a horse with ECD.

     2. Cortisol Rhythm Test: This is a screening test for ECD. Unfortunately this

          test can show false positives and false negatives. The rate of false

          positives is approximately 35%. This test involves sampling the blood

          twice in one day. Once in the am and once in the pm.

     3. Dexamethasone Suppression Test: This is another type of screening test.

          it involves the injection of drug dexamethasone into the horse. There will

          then be a collection of blood samples in either an 8 or 12 hour period. This

          test can potentially increase the risk of causing or worsening laminitis.

          There is a potential for false positives and negatives, but this test is felt to

          diagnostic by some veterinarians.

     4. TRH Stimulation Test: This test involves the injection of TRH into a horse.

          The TRH causes a spike in cortisol in a horse with a pituitary tumor.

          Samples are drawn between 15 and 30 minutes after TRH is injected. This

          is probably highly diagnostic for ECD.

     5. Combined TRH test and Desamethosone test: Involves both tests

          described above.

     6. Urinary Cortisol Creatinine Ratio: This is a test of the cortisol levels in

         urine. This test is not 100% diagnostic, but it is highly suggestive because

         it is more accurate than blood cortisol levels in determining increased

         production of cortisol.

     7. Blood Insulin Test: A test that shows the levels of insulin in the blood.

     8. T4 and T3 Test: These tests measure the function of the Thyroid.

     9. Chemistry Screen: This screening checks for organ function, dehydration,

          blood sugar, and electrolyte abnormalities. This test should be used in

          conjunction with testing for blood cholesteroland triglyceride levels for ECD

          and IR horses.

Care and Management of ECD and IR can be easy. You need to determine the right diet for your horse and be able to balance it properly. If you plan to feed hay from a local distributor, you will need to have each bale of hay analyzed to determine the NCS (nonstructural carbohydrate level- this is primarily the sugars in the hay.) You will want to use grass hay only with Timothy or Timothy mixed with Orchard grass being your best choice. You may also choose to add beet pulp that does not have molasses to the hay. This is in replacement of all grain!

You will also want to examine the minerals in your hay to determine what supplements that it needs added to be balanced. One supplement that can help tremendously is Chasteberry. It comes either in powder form or berry form (the berry form will need to be ground.) for more information on feeding a horse with ECD or IR, please see the website http://pets.groups.yahoo.com/group/EquineCushings/. On this website you can find an emergency diet for a horse with ECD or IR as well as information on feeds, information on distributors in your area, a glossary of abbrevations and terms, and most importantly you will be able to get advice from one of the leading authorities on ECD and IR, Dr. Eleanor Kellon, DMV.   Please join the list and take a moment to read through all the starting files, fill out a Case history for your horse, and then post to the group for information and support as you begin the process to help your horse live and flourish despite one of these diseases.

If you have a horse diagnosed with ECD or IR and have trouble finding a feed store in your area that is willing to carry the products that you need for your horse, feel free to email me and I will give you a copy of the letter that I am sending to my feed stores. This letter is my way to help educate the owners and buyers at the feed stores on ECD and IR. It gives them statistics on the numbers of horses that could possibly be diagnosed with ECD and IR (to show the amount of business they can gain by carrying the products needed), a list of products that can be used by horses with ECD and IR, a description of the diseases and their symptoms, and an understanding that these products do not need to be used solely by horses with ECD or IR, but also for horses that do not have these diseases, but could possibly be predisposed for these diseases. You cannot predict what horses get these diseases, but you can begin balancing a horse's diet early in an effort to limit the side effects of thse diseases.

Examples of products that might be used for horses with ECD and IR (please be sure to check labelling for the NSC level and the guaranteed analysis):

Ontario Dehy Timothy Balanced Hay Cubes

Beet Pulp without Molasses

Chasteberry Pwder or Berries

Blue Seal Hunter

Blue Seal Carb Guard

Poullin Carb Safe Complete

Sterett Low NSC Pellets (aka Mid Valley Milling)

Buckeye Safe and Easy

This came through on a yahoo group that I am on and is well worth reading if you suspect your horse may be Insulin Resistant.
Diagnosing Insulin Resistance: Q&A with Researchers

Posted by: "Marge" redmm97@cox.net redmm97

Sun Jun 14, 2009 9:04 am (PDT)
For those of you who are dealing with I.R. this is an excellent read.
Marge
http://www.thehorse.com/ViewArticle.aspx?ID=12588

Potential Biomarker for Equine Cushing's Identified

Posted by: "Marge" redmm97@cox.net redmm97

Mon Jul 12, 2010 12:06 pm (PDT)

Potential Biomarker for Equine Cushing's Identified
by: Stacey Oke, DVM, MSc
July 07 2010, Article # 16624
Lead a veterinarian to a horse with equine Cushing's disease and he or she will likely try to diagnose the horse by measuring blood levels of adrenocorticotrophic hormone (ACTH) in a single sample at a single point in time. Lead researchers from Pegasus Equine Diagnostics Ltd., in Nottingham, United Kingdom to the same horse and they'll measure ACTH levels over 24 hours at multiple times of the year and claim that ACTH is a biomarker for the disease.
Equine Cushing's disease (pituitary pars intermedia dysfunction, PPID) is a relatively common hormonal disturbance in older horses and ponies. Most affected horses have increased blood levels of ACTH, but because of normal, cyclical rhythms in the secretion of ACTH, blood levels can vary markedly over a 24-hour period and depending on the season. This makes diagnosing Cushing's disease challenging when only a single ACTH level is measured.
"While it is possible to diagnose equine Cushing's disease based on the ACTH concentration in a single blood sample, improper sample handling, stress, pain, and other factors can all affect the test results," relayed the researchers. "This is why reservations have been raised by experts in this field regarding the value of using ACTH to diagnose this disease."
Convinced of the merits of ACTH testing, the research team measured ACTH levels in healthy older horses over a 24-hour period and compared them to the ACTH levels in horses with Cushing's disease. ACTH was measured in blood samples collected in March, June, September, and December.
Key findings were:
a.. ACTH levels were significantly higher in horses with Cushing's disease than in the healthy horses over a 24-hour period;
b.. ACTH concentrations were significantly higher in September and December than in March and June in all horses; and
c.. Fluctuations in ACTH levels were larger in horses with Cushing's compared to normal horses.
According to the study authors, "This is the first study that systematically evaluates ACTH levels of a 24-hour period over the course of four seasons."
Together, the data suggest that ACTH does indeed have a role in diagnosing Cushing's disease but that the reliability of ACTH as a biomarker--a compound that can measure the progress of disease or the effects of treatment on clinical outcome--is enhanced if more than a single sample is assessed at more than one time point per year.
The study, "The use of adrenocorticotrophic hormone as a potential biomarker of pituitary pars intermedia dysfunction in horses," was published in the July 2010 edition of The Veterinary Journal.
The abstract is available for free on PubMed.
Marge

Cushing's: Pasture Management, Seasonal Awareness Key

http://www.thehorse.com/ViewArticle.aspx?ID=16893

Meet Fleet.

Fleet is the reason I have added this page to my site. He came into our family after the loss of Missy. He lived in a stable in Michigan where he was a lesson horse prior to joining our family. A worker from his stable saw my ad looking for a horse to be a companion to Missy's mom, CC, and told me about how he was facing euthanasia because he could no longer jump. The stable owner assured me that there was nothing else wrong with him. Fleet was only 18 at the time.



This is Fleet as he looked the day he arrived at our farm, 21 October 2006. We were not told about his Cushing's prior to his arrival.

Here is Fleet in March of 2007. You can see the weight loss that has occurred over the winter (all my other pictures show him in blankets, this was the first warm day we had). Although it is hard to see from this picture Fleet had four inch long hair all over.

In May 2007 we discovered that Fleet was having trouble shedding his winter hair coat in addition to the weight loss that he was still suffering with. At this point, we had increased his feed to triple what he started with. His teeth had been floated in October before he arrived and we were told they typically had them done once a year unless needed more.

In June 2007, we finally had a diagnosis of Cushings for Fleet. It took a lot of wonderful people helping us to pinpoint what was wrong. It turned out that once we mentioned the trouble losing his winter coat that a member of a rescue group that I was in contact with suggested it. Without that suggestion, we would have never even known what Cushings was. I didn't take any pictures this month, but Fleet had lost almost 200 lbs from the time he arrived in October. The weight loss began to be noticeable in December and continued until the middle part of July. It slowed down in July after the medication and the emergency diet for Cushings horses were started.

Fleet's previous owners will still not admit that they knew of his Cushings before he came to us. Looking at all the records that they sent with him, his feeding routine was almost exactly the diet used for Cushings horses along with many of the supplements used. The only thing missing is mention of Pergolide or Chasteberry, both of which are sometimes used for horses with Cushings (Note: Pergolide and Chasteberry cannot be used at the same time.).

Here is Fleet in August 2007. He was just starting to respond to the medication and diet for Cushings. You can see the dramatic weight loss that he faced from the Cushings. You can also see the beginning of his muscle wasting.

This is Fleet from the left side. You can see his ribs and how little barrel he has from all the weight loss.

This is Fleet from the rear taken Aug 2007. Note the protrusion of his hip bones.

Here is a picture of Fleet taken in October 2007. You can see that he has gained some weight back in his barrel area. The ribs are still noticeable, but the groove between them is not as deep. Fleet was also recovering from an illness in this picture. I hope to get more pictures if we can get a warm day. He gets too cold already this winter, so he wears a lightweight blanket during the day and a warmer one at night.

This Fleet from the rear in October 2007. His hip bones are showing still and the muscle wasting is more evident. He has not gained any fat on his top line yet. the good news is that the muscle wasting has slowed and he is starting to show some improvement in his chest and rump as time goes on.

I will continue to update the pictures of Fleet as we battle the Cushings. It is my hope that we can continue to increase his weight and his muscle mass with time and work. I only wish that I had been told that he had Cushings. It would not have mattered to me in the slightest, but it would have saved him suffering and he would still be that sleek shiny horse that he was when he arrived here. Fleet is a wonderful horse that loves our children and is so easy to be around. He brightens every day with his nickers. We will do all that we can for him until the time comes that he is ready to cross the rainbow bridge. We hope that the time for that will not come before he is at least in his 40's or later.
Here are pictures I took on a warmer day in January 2008

This is Fleet from the front. Fleet from the back (wondering what the heck I am doing standing behind him!)

Fleet left side and Fleet right side (somewhat). He was very happy with me when I gave him his blanket back after the photo session!
These pictures were just taken August 2008.

Fleet is still struggling somewhat with his Cushings. He lost weight again as spring came on, but is starting to gain it back again. These pictures don't show how much weight he has gained in his chest area! He has also started gaining just a bit along his topline. I mentioned how concerned I was to the vet and he said that he thought Fleet was doing very well. He couldn't believe how much Fleet changes each time he comes to visit. He also said that at Fleet's age, he may not get the topline back up the way it used to be.

Fleet is very much the dominate horse in his little group of him and CC. He doesn't show it unless it is time to eat though. For his age (which we learned is actually between 23 and 25 based on his teeth presentation (not the 20 he would be which was what the original owners claimed!), he is a happy and spunky horse. He still doesn't break a trot very often, but the other day when the heat and humidity had gone down quite a bit, I saw him out cantering across the pasture!

Fleet update 29 Oct 2009.
Fleet sure has come a long way! We have switched him over to Safe Choice feed (he gets 4 pounds a day split between 2 meals) and free choice Alfalfa. I am so grateful that our feed stores finally started carrying this wonderful product! It has made an enormous difference for Fleet!

Amazing isn't it?
He did have an issue with abscesses just before these pictures were taken (he found a way to sneak his buddy's feed and it cost him big time!). I think it is just the time of year and the massive amounts of rain and snow we have had this past month. I don't have boots for him, so he is wearing a diaper full of medicine, covered by a plastic baggie, which is then covered with duct tape (the duct tape helps keep his feet from cutting through the diaper and plastic so quickly!). His abscesses are almost healed at this point and he is feeling much better.
We recently were able to locate Fleet's original breeder. This boy has had an amazing life! The best news is that he is really 21 years old and his real name is Teddy. He answers to Teddy much better than he ever answered to Fleet...now if I can just remember to call him that!
Here are some pictures of him that his breeder sent from when he was younger.

Isn't he stunning? I sure think so.

Here are some pictures that we took in August 2010. This was right after we moved into our new house. They are a little farther away than I would like. When it warms up (it is 4 Jan 2011 and a brisk 15 degrees out!), I will take some updated pictures of him for on here.


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