The Chronicle of the Horse
MagazineNewsHorse SportsHorse CareCOTH StoreVoicesThe Chronicle UntackedDirectoriesMarketplaceDates & Results
 
Results 1 to 12 of 12
  1. #1
    Join Date
    Aug. 25, 2012
    Posts
    641

    Default Understanding Blood Results: Horse Has Low Glucose

    Hi, I've been having some health issues with my gelding. He has had some foundering issues and received his initial blood work back today. I felt sure it might come back showing something might be going on metabolically but the vet said there was nothing in his bloodwork to be concerned about.

    However, after looking at the results his glucose came up low. Could this point to a metabolic issue?

    Currently the horse is on costal hay that is soaked before he eats it and 2 pounds of grain that is free of cereal grains (corn etc) twice a day.

    The only reason outside of foundering I thought metabolically something was going is over the summer while in training he was switched to alfalfa/orchard grass hay and despite being in great shape developed a bit of a cresty neck, increased thirst, and increased urine output. Since switching his diet the cresty neck has decreased greatly and his thirst and urine output seem more normal.

    A few other aspects of his bloodwork were on the low or high side of the normal range also. I'd appreciate any thoughts or ideas about what the low glucose reading could mean.



  2. #2
    Join Date
    Sep. 23, 2009
    Posts
    573

    Default

    It's very rare for horses to have a truely low glucose. Chances are your vet let the blood sample sit too long before testing, and the blood cells utilized the glucose in the blood sample, making it read as a false low result.

    If you are interested in checking for Insulin Resistance, your vet needs to take a sample, put it on ice, and get it back to the clinic ASAP. It should be immediatly spun and the serum frozen, and then sent to Cornell for an insulin/glucose check. You then look at the ratio to decided if your horse is truely laminitic.



  3. #3
    Join Date
    Aug. 25, 2012
    Posts
    641

    Default

    Ok is there anything else in basic blood work that would rule out metabolic issues or do you specifically have to test insulin? My vet didn't seem concerned or interested in running more tests. Am I over reacting? I really thought something would come up.



  4. #4
    Join Date
    Sep. 23, 2009
    Posts
    573

    Default

    It is a different blood test that needs to be sent to Cornell Universities lab.

    A lot of vets don't understand IR, and what kind of testing is required to diagnose it. Honestly, from the sounds of your horse, I might just assume he's IR and start dealing with him from there.

    Go to the yahoo group, Cushings and Insulin Resistance run by Dr. Kellor. The information available to you from that group is amazing, and they will help you get his diet regulated and keep him from becoming or staying laminitic. If you want to pursue testing for him, they have specific instructions for how to go about it.

    Remember, your vet works for you. If you want a specific test run, she needs to run it. It's your money, not hers. If she won't, then I'd find a different vet that understands IR and metabolic diseases. I fired three vets before I found one that worked with me and my metabolic horse. All the others just kept telling to either feed him less, or that he couldn't be IR because he wasn't obese. *sigh*

    Good luck!



  5. #5
    Join Date
    Aug. 21, 2004
    Location
    Guanajuato, GTO, Mexico
    Posts
    2,504

    Default

    Quote Originally Posted by Kwalker024 View Post
    Ok is there anything else in basic blood work that would rule out metabolic issues or do you specifically have to test insulin? My vet didn't seem concerned or interested in running more tests. Am I over reacting?
    Basic blood work is not diagnostic for IR. You have to specifically test for insulin. Sometimes an appearance of disinterest is a cover for lack of knowledge. You are not overreacting. Get a vet who understands metabolic disease in horses. If your vet did not test for insulin, then he does not.
    None of the vets in my area understand metabolic disease, so I had to learn elsewhere, and had to learn the expensive way. Start by interviewing new vets with 'are you familiar with the diagnostic tests for metabolic disease in horses?' Then 'Do you have an account with a lab that tests for insulin in horses?' . If they don't, you're going to pay through the nose for them to learn at your expense.
    This article may be helpful.
    http://www.safergrass.org/pdf/LaminitisDefense.pdf



  6. #6
    Join Date
    Aug. 25, 2012
    Posts
    641

    Default

    Thanks for all the great advice so far! Below is the data from his blood work if anyone has any thoughts or opinions. Also, before I start questioning the vet do any of these results rule out metabolic issues? Thank you everyone again!


    Blood Work

    Total protein 6.1 * * * * * * 5.4-7.8g/dl
    Albumin 3.5 * * * * * * * * * *2.3-3.8g/dl
    Globulin 2.6 * * * * * * * * * *2.2-4.4g/dl
    AST (SGOT) 186 * * * * * *180-380U/L
    Alk Phosphatase 125. * * 50-250 U/L
    GGTP 9 * * * * * * * * * * * * * * * *1-35 U/L
    Total Bilirubin 1.3 * * * * * .8-3.2mg/dl
    Urea Nitrogen 14 * * * * * *8-26mg/dl
    Creatinine 1.1 * * * * * * * * 1-2.2mg/dl
    Phosphorus 2.3 * * * * * * *2-5mg/dl
    Glucose 55 * * * * * * * * * * 60-125mg/dl
    Calcium 11.6 * * * * * * * * 10.8-13.5mg/dl
    Sodium 139 * * * * * * * * * 132-146mg/dl
    Potassium 3.7 * * * * * * * *2.4-4.7mg/dl
    Na/K Ratio 38
    Chloride 102 * * * * * * * * * 97-108mE/l
    Cholesterol 80 * * * * * * * *50-140 mg/dl
    CPK 213 * * * * * * * * * * * * 100-300 U/L
    LDH 272 * * * * * * * * * * * * *150-450 u/l

    CBC

    WBC 6.3 * * * * * * * * * * * * 5.5-12.5 10^3/uL
    RBC 7.25 * * * * * * * * * * * *7-12 10^6/uL
    Hemoglobin 12.7 * * * * * *11-17 g/dl
    Hematocrit 35.3 * * * * * * *32-50%
    MCV 49 * * * * * * * * * * * * *34-58fL
    MCH 17.5 * * * * * * * * * * *12-19 pg
    MCHC 36 * * * * * * * * * * * 31-39g/dl
    Platelet Count 178 * * * * 100-400 10^3/uL

    Platelet EST * * * * * * * * * *ADEQUATE

    Differential * * * * * * * Absolute * * * * * %
    Neutrophils * * * * * * * * 3591 * * * * * * *57 * * * * * *2600-7500/uL
    Bands * * * * * * * * * * * * * *0 * * * * * * * * *0 * * * * * * * * 0-300/uL
    Lymphocytes * * * * * * *2457 * * * * * * *39 * * * * * * 1500-7700/uL
    Monocytes * * * * * * * * *189 * * * * * * * * 3 * * * * * * *0-1000/uL
    Eosinophils * * * * * * * * * 63 * * * * * * * * *1 * * * * * * * 0-1000/uL
    Basophils * * * * * * * * * * * 0 * * * * * * * * * 0 * * * * * * *0-290/uL

    Total T4
    T4 * * *2.2 * * * * *.5-3 ug/dL

    Fibrinogen (semi-quantitative)
    Semi-Quantitative261 * * * * * * 100-400mg/dl



  7. #7
    Join Date
    May. 30, 2006
    Location
    Little Rhody
    Posts
    3,576

    Default

    It's very common for glucose to be low if the vet drew the blood and let it sit for hours before separating the serum from the whole blood. The vast majority of IR horses have normal serum glucose, which is why, IMO, the condition is not closely related to type 2 diabetes in humans. IR horses almost always have elevated insulin levels though (sometimes extremely high).

    Good luck finding a vet knowledgeable about this stuff. In most cases, the best you can hope for is one willing to do the tests you request.



  8. #8
    Join Date
    Jan. 16, 2002
    Location
    West Coast of Michigan
    Posts
    36,321

    Default

    What rcloissone said--if the blood sat around for a while the glucose in the serum gets "eaten up" by the cells and will be spuriously low. Not worth being concerned over, but if there is genuine concern for metabolic disease then other tests are more appropriate than serum glucose level. A muzzle prick on a diabetic's glucometer should work if you were interested in a spot check.

    Things "on the low side or the high side of the normal range" are still NORMAL. It is really not generally worth obsessing over these minor variations, really really really.
    Click here before you buy.



  9. #9
    Join Date
    Aug. 25, 2012
    Posts
    641

    Default

    Ok just spoke to the vet and no other tests were run except for the ones above and based off that he didn't feel the horse was a cushings horse based off his thyroid levels but he did offer to do a dexamethasone suppression test if I wanted it. I then specifically asked about IR and he said like he said he didn't feel the horse had any Cushing problems going on but again if I wanted he would run the dexamethasone suppression test.

    To me it sounds like he feels IR and cushings are interchangeable even though they aren't. It would seem the best thing to do is find a vet with more knowledge about metabolic conditions.

    Any recommendations for vets near Charlotte NC?



  10. #10
    Join Date
    May. 11, 2009
    Location
    Dairyville USA
    Posts
    2,979

    Default

    I wouldn't cross the street for that glucose TBH. I'd specifically request a haul-in appt where the sample can be drawn and immediately prepared for shipment.
    Michael: Seems the people who burned me want me for a job.
    Sam: A job? Does it pay?
    Michael: Nah, it's more of a "we'll kill you if you don't do it" type of thing.
    Sam: Oh. I've never liked those.



  11. #11
    Join Date
    Sep. 23, 2009
    Posts
    573

    Default

    You need a vet that understands metabolic diseases.

    Cushings and IR are NOT the same thing. A horse can be IR without having Cushings disease (I am on my second one now). However, most horses with cushings eventually develop IR.

    You can not diagnose cushings disease (or IR for that matter) from a thyroid test. The only thing a thyroid test tells you is if the horses thyroid is out of whack.

    The gold standard cushings test is an ACTH test, which has to be handled in a VERY specific way, or you waste your money. Virtually no one does dex supression tests anymore because they can (and do) cause the horse to become laminitic. To test for IR, you need a test for Insulin and a good glucose reading done at the same time. The blood must be pulled, iced, and spun down within 2 hours (preferably sooner), then the serum needs to be frozen. It is then overnighted to Cornell on ice.

    The Chem and CBC that your vet pulled won't show you anything about his IR status. It is good information to have though, as a baseline if something else ever goes wrong.

    Good luck with your horse, and keep soaking that hay.



  12. #12
    Join Date
    Aug. 25, 2012
    Posts
    641

    Default

    Quote Originally Posted by Arrows Endure View Post
    You need a vet that understands metabolic diseases.

    Cushings and IR are NOT the same thing. A horse can be IR without having Cushings disease (I am on my second one now). However, most horses with cushings eventually develop IR.

    You can not diagnose cushings disease (or IR for that matter) from a thyroid test. The only thing a thyroid test tells you is if the horses thyroid is out of whack.

    The gold standard cushings test is an ACTH test, which has to be handled in a VERY specific way, or you waste your money. Virtually no one does dex supression tests anymore because they can (and do) cause the horse to become laminitic. To test for IR, you need a test for Insulin and a good glucose reading done at the same time. The blood must be pulled, iced, and spun down within 2 hours (preferably sooner), then the serum needs to be frozen. It is then overnighted to Cornell on ice.

    The Chem and CBC that your vet pulled won't show you anything about his IR status. It is good information to have though, as a baseline if something else ever goes wrong.

    Good luck with your horse, and keep soaking that hay.
    Thanks for all the great advice everyone. I have got a call into a new vet in the area to talk to about their experience with metabolic conditions and founder hopefully he will be more knowledgable.

    I'm also replacing his grain with rinsed and soaked beet pulp with a few supplements until we get a diagnosis one way or another as this seems like a popular option during situations like this.

    Again thank you everyone!



Similar Threads

  1. Blood results
    By Blondyb in forum Horse Care
    Replies: 92
    Last Post: Feb. 15, 2011, 04:04 PM
  2. Replies: 96
    Last Post: Dec. 8, 2010, 03:40 AM
  3. Blood work results: CBC, CMP, Vit B12 and Folate
    By Nikki^ in forum Horse Care
    Replies: 3
    Last Post: Jun. 5, 2010, 09:17 AM
  4. Replies: 8
    Last Post: Mar. 5, 2010, 08:01 PM
  5. High glucose level in blood, could be nothing......
    By Tanyanoel in forum Horse Care
    Replies: 16
    Last Post: Nov. 22, 2008, 10:30 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
randomness