HIgh Insulin - looking for recomendation


My 21 year old, Lusitano ( I suppose one of the many poster horses of EMS) was diagnose in July as ESM.  As mention in case history, I thought it was a fluke, but the following month his insulin rose from 69 uIU/mL to 114 uIU/ml at Cornell.  In August, started exercising more at a trot in round pen  starting at 10 minutes trot  working our way up to 15 minutes 2 to 3 times a week. The other days I rode mostly at a walk 30 minutes. One day off a week.  Lab results beginning of September even higher at over 200. (waiting for exact number). Currently up to 20 minutes trotting 3 times a week, the  other 3 days riding mostly walk for 45 minutes. 

Other information, not lame, but I admit could  be sub-clinical laminitis.  Always been very forward horse, but lethargic the last week or so, not sure if pain or increase in exercise is slowing Dante down.  His timothy hay is 7.7 ESC plus starch.  On a bare pasture for 8 hrs a day with hay and buddy . Today removed all weeds on fence line, which could of contribute to problem,   Plan to retest beginning of October.
So my questions are 1) how long do I continue exercise before I throw in the towel and say this isn't the answer for him.2) what else is recommended?

Thanks in advance

SW Washington
January 25, 2020

https://ecir.groups.io/g/CaseHistory/photo/268141 Dante photo

Tasha photo album
Case History

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