Cornell panel back, should I treat?

Kerry Isherwood

I just got the Cornell ACTH results back and I'm desperate to know if I should start pergolide.  I can no longer control my mare's insulin levels with diet & exercise alone.  I am working on her finishing her case history ASAP, hopefully posted by tonight.  Quick summary:

20yo QH/draft cross
diagnosed IR summer 2013, well controlled with diet & maint levothyroxine

performed very well at shows in 2014 until August, performance fell sharply, insulin & BGs thru roof (we event, so mare gets lots of exercise, e.g., we do 10-mile rides for fitness) despite "starvation diet" (e.g., emergency diet). 

suspect early Cushings, so sent panel to Cornell (sample obtained & handled/shipped correctly; drawn at a zero stress situation for mare)

endogenous ACTH:  36.6pg/mL  (ref 9-35)
insulin:   64.99uIU/mL  (ref 10-40)
glucose:   113  (ref 71-113)
leptin:  still pending.

mare has not been on pergolide, and has not been on a higher levothyroxine dose since last summer.
current diet is Timothy Balance cubes, beet pulp, and iodized salt

are these numbers indicative of an early PPID horse?  Her pattern is feeling good under saddle until her insulin reaches the 60s (uU/mL) at which point she becomes very lethargic, bodysore, prone to stumbling, depressed, PU/PD, won't walk on rocks, etc).  Her insulin recently got as high as 120uU/ml, the highest its ever been.  Needless to say, I was deathly afraid to stress her and I'm worrying myself sick that she's no longer controllable with diet and begin a downward spiral ending in laminits.  The above numbers reflect her being back on the restricted diet (ie, not being fed extra for energy for competing (ie, more beet pulp).

I am desperate for advice on treating with pergolide.  I will finish my mare's case history ASAP but I wanted to get the conversation started so at least I feel I'm doing something (says the typical means-well-but-nonetheless-neurotic-horseowner)

Kerry, NY, Sept 14

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