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Horse is unique — he's a diabetic

CARLISLE — The glucose readings on the day-old foal made no sense. He was brought in by his owners because his mama wasn't producing enough milk for him, and the doctors at Hagyard Equine Medical Institute had prescribed all the right fluids and had turned a weak foal into a rambunctious baby overnight.

But his sugars were sky high.

Take away all the fluids, ordered Nathan Slovis, director of the Equine Emergency Response Team at the renowned veterinary center in Lexington.

The animal kept improving, but the sugars kept climbing.

Slovis rechecked the numbers and wondered, for the first time, whether maybe this horse was insulin deficient. That is, was he looking at a diabetic horse?

That doesn't sound all that dramatic until you realize that, if this colt were diabetic, he would be the only horse ever documented to have been born with Type 1 diabetes.

Tests showed the animal was urinating sugar. They then confirmed what Slovis had suspected: In every way medicine defines it, this horse has Type 1 diabetes.

A lifelong commitment

David and Monica Hufana have 19 horses, 12 dogs and cats whose number is hard to pin down on any given day. They named their 20 acres in Carlisle Sanctuary Farm by way of explaining their commitment not only to their own animals but to those they find that need help. There's the puppy they took in that was found at a crack house in Lexington and the one that was discovered wandering the road. There are six horses in their stable that they saved from slaughter.

So when the word came down that their newest foal, born Oct. 20, had Type 1 diabetes, they were not likely to put it down.

"Dr. Slovis said at any point if we want to stop (treatment), we were to let him know," says David Hufana. "But I wanted to know why he had this. How do you fix it?"

Slovis said caring for the horse would be a lifelong commitment. It would take a constant flow of money and time. He wanted to make sure they understood his position. It was a great opportunity for veterinary science but it was their responsibility, their bank account.

The Hufanas did not hesitate. The sick baby was the first colt by a Kentucky Mountain Saddle Horse champion named Justin Time. At birth, the foal had been named JustIncredible. Believing him still to be so, the Hufanas told Slovis to explain to them how to save their horse.

A big learning curve

JustIncredible lies down in the January cold when asked. It is time for him to have his ear pricked, yet again, to get a small sample of blood so the Hufanas might gauge the amount of sugar in it. Monica has put a flake of hay near the small horse's head so he can munch while he waits for the reading. It's 242. (His numbers, were he a normal horse, would read like those of a healthy human, between 80 and 120.)

The number tells David exactly how much insulin he needs to administer to the 3-month-old horse. But it's so cold that the insulin has frozen in the syringe, so everyone has to wait for David to warm it with his hands.

JustIncredible used to cry when he had to be stuck, but no longer. He waits and munches. So does his mother, who is close by. She, too, is used to what is now at least a twice-a-day ritual.

In the first few weeks of his life, after all, it was something that happened every two hours, every day, every night.

The Hufanas would check the foal's sugar, then try to adjust the amount of insulin to administer. They would send a chart of sugar readings to Slovis via e-mail; he would advise them about what to do next to keep the horse on track.

In Type 1 diabetes, the pancreas does not produce insulin, a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life. Too much sugar in the blood can cause permanent damage to essential organs. Too little can decrease brain function and respiration. The disease is lethal if not treated.

Figuring out how and when to dose JustIncredible was a huge learning curve for the Hufanas, who had to study when low numbers were acceptable and when a number required a boost of insulin. Sometimes when his sugars dipped dangerously low, JustIncredible had to be revived with "two big glugs of warm Karo syrup," Monica says.

At those times, his blood pressure might be crashing, his veins would be hard to find, it would be 3 a.m. and Monica would, she says, take a swig of Karo herself and "keep working on him."

Four times the horse had seizures, mostly early in the morning before he was old enough to eat grain.

"It was like having a special-needs baby," says Monica, the mother of three healthy children. "I was needle-phobic at first, so I was the one who strong-armed him, and David handled the shots."

Still, the Hufanas, who live in a small farmhouse with only a wood-burning stove for heat, soldiered on. Their veterinary bills mounted quickly to $5,000, which the Hufanas are working to pay.

A month's supply of insulin costs about $300. That's a yearly bill of about $3,600.

Then in December, Insulet and DexCom, two pharmaceutical companies that supply insulin products to humans, offered to develop a system to continuously monitor JustIncredible's sugars and to deliver insulin to him. The Hufanas and Slovis agreed to a trial.

It didn't work. The day after the pump system was attached to the horse's body, it had been removed, by his very inquisitive mother or his own playful activities.

JustIncredible is, by outward appearance, a happy colt. He is put out to a bare pasture in winter with both of his parents. The Hufanas' 15-year-old son, Griffin, is the horse's best friend, playing with him in the barn when JustIncredible must be sequestered there.

Now 31/2 months old and very fuzzy, he is beginning to turn the color he will be as an adult — rich chocolate with a flaxen mane, just like his father.

Surprisingly, he shows no ill will toward his handlers. Asked to lie down for the fourth time that day, to be stuck again for the sake of another blood test, he does.

Treated like a human

The problem with JustIncredible's pancreas is either hereditary or a fluke of nature. There's no way to know yet, says Slovis, who is also infectious disease chairman at Hagyard's McGee Medicine Center, which specializes in the critical care and treatment of horses.

What Slovis does know is that Type 1 diabetes in horses is so rare that no research has been done on it and no literature exists to help guide Hagyard's doctors or the Hufanas. (It is not rare in other domesticated animals such as dogs and cats, species in which it is well documented.)

It is, of course, possible that other horses have had Type 1 diabetes. If born with the condition, though, they did not survive long enough to be tested and probably died shortly after birth or were euthanized because they were so desperately ill.

Horses also can become insulin-resistant later in life, which is a separate condition from being unable to produce insulin.

Slovis knows that some of JustIncredible's pancreas is working. Tests have shown that the part of the organ that produces enzymes to digest foods is functioning as it should. The part of JustIncredible's pancreas that produces insulin, however, is underdeveloped and lacks the special cells that produce insulin. It is highly unlikely this portion will develop spontaneously and begin producing insulin, Slovis says.

He is not hopeful that the work done on the horse will lead to breakthroughs for human diabetes research. Rather, what Slovis and his team at Hagyard have had to do is apply the work on human diabetes to this horse's case. He is using the same insulin on JustIncredible that humans use.

His yearlong study of the horse, however, is expected to yield important research for veterinary medicine.

Praise and criticism

When the online horse and diabetes communities caught wind of JustIncredible's story, there seemed to be two kinds of reactions. One was genuine admiration for what the Hufanas are doing. The other was a kind of simmering discontent that this colt could get a free insulin pump within weeks of his diagnosis while many children who have lived with the disease for years have not gotten as much attention.

For their part, the Hufanas have offered up JustIncredible to research. "But our interest is in his quality of life," says David, "otherwise, what is the point?"

They also have been contacted by the American Diabetes Association and asked to bring the horse to summer camps for children with diabetes.

"I want children to be able to touch him," Monica says. "He would be a way of saying, 'You're not alone.' Imagine if they could see how happy he is. They could ride him. Absolutely."

Because they are show-horse people, the Hufanas expect to put JustIncredible in Kentucky Mountain Saddle Horse shows someday. They expect him to live for as long as it takes to cure diabetes.

But first they must learn what grass he can eat in the spring. They will have to find money to send their son Griffin to college. They will need to continue to breed their champion stallion and hope for the best with the foals that follow.

In the meantime, twice a day, in the morning and at night, JustIncredible will be like any other soul with diagnosed diabetes: He will submit to the pinprick and wait.