The heart of treatment, diet and trim, is the same for any level of insulin. Horses that continue to have high insulin and hoof pain after that may need medication.

As for vaccinations, speak with your vet about limiting them to the core vaccines and anything else where your horse is high risk.  For example, some diseases are only high risk in certain areas or in crowded barns with high traffic.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001