The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where
you'll find tons of great information that will help you to quickly
understand the main things you need to know to start helping your horse.
Also open any of the links below (in blue font) for more
information/instructions that will save you time.
Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message
with info on how to use various devices and forms. If you have any
trouble, just post a message to let us know where you are stuck.
Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have.
Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR,
neither or both. While increasing age is the greatest risk factor for
developing PPID, IR can appear at any age and may have a genetic
component. Blood work is used for diagnosis as well as monitoring the
level of control of each.
PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.
fat-derived hormone leptin is also usually abnormally elevated in
insulin resistance but because there are many other things which can
lower or increase leptin ECIR is not recommending routine testing for
this hormone. Leptin is the hormone that says "stop eating".
In Europe, adiponectin is tested instead of leptin. Adiponectin
helps regulate glucose and fat burning, and maintain insulin
sensitivity. Low levels are associated with EMS. It has come to be
preferred over leptin because it is not influenced by things like weight
or exercise, and also because it was the only factor other than insulin
levels that predicted laminitis risk
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
remember to request copies of the results of all the tests done rather
than just relying on verbal information. Your vet should be able to
email these to you. If you have previous test results, please include
those as well. All should go in your CH, but if you are having any
trouble with the CH, just post in the messages for now.
is a metabolic type - not a disease - that is managed with a low
sugar+starch diet and exercise (as able). The super-efficient easy
keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are
some of the classic examples. PPID is a progressive disease that is
treated with the medication pergolide. Some,
but not all, individuals may experience a temporary loss of appetite,
lethargy and/or depression when first starting the medication. To avoid
this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The
best long term results are seen when the ACTH is maintained in the
middle of the normal range at all times, including during the annual seasonal rise. To
accomplish this, the amount of medication may need to increase over
time. Neither condition is ever "cured", only properly controlled for
the remainder of the equine's life. If your partner is both PPID and IR
then both medication and diet management will be needed.
DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
- low carb (less than 10% sugar+starch)
- low fat (4% or less)
- mineral balanced
use grass hay, tested to be under 10% ESC + starch, with minerals added
to balance the excesses and deficiencies in the hay, plus salt, and to
replace the fragile ingredients that are lost when grass is cured into
hay, we add ground flax seed and Vitamin E. This diet is crucial for an
EMS/IR horse, but also supports the delicate immune system of a PPID
*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).
The emergency diet is not intended for long term use, but addresses
some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing).
If you absolutely cannot test your hay and balance the minerals to it,
or would like to use a "stop gap" product until you get your hay
balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so
it is important you read all the documents found there. The emergency
diet involves soaking your untested hay for an hour in cold water or 30
minutes in hot water. This removes up to 30% of the sugar content, but
no starch. Starch is worse than sugar since it converts 100% to glucose
while sugar only converts 50%, so starch causes a bigger insulin
spike. Make sure you dump the soaking water where the equine(s) can't
get to it.
you don't feed on the EMS/IR diet is every bit as, if not more
important than, what you do feed! No grass. No grain. No sugary treats,
including apples and carrots. No brown/red salt blocks which contain
iron (and sometimes molasses) which interferes with mineral balancing,
so white salt blocks only.
products containing molasses. No bagged feeds with a combined sugar and
starch of over 10% or starch over about 4%, or fat over about 4%.
Unfortunately, even bagged feeds that say they are designed for IR
and/or PPID equines are usually too high in sugar, starch and/or fat.
It’s really important to know the actual analysis and not be fooled by a
name that says it is suitable for EMS/IR individuals.
do not recommend feeding alfalfa hay to EMS/IR equines as it makes many
of them laminitic. Although it tends to be low in sugar, many times the
starch is higher and does not soak out. Additionally, protein and
calcium are quite high, which can contribute to sore footedness and make
mineral balancing very difficult.
proper trim is toes backed and heels lowered so that the hoof capsule
closely hugs and supports the internal structures of the foot. Though
important for all equines, it's essential for IR and/or PPID equines to
have a proper trim in
place since they are at increased risk for laminitis. After any
potential triggers are removed from the diet, and in PPID individuals,
the ACTH is under control, the realigning trim is
often the missing link in getting a laminitic equine comfortable. In
general, laminitic hooves require more frequent trim adjustments to
maintain the proper alignment so we recommend the use of padded boots
rather than fixed appliances (i.e. shoes, clogs), at least during the
initial phases of treatment.
subclinical laminitis can be misdiagnosed as arthritis, navicular, or a
host of other problems as the animal attempts to compensate for sore
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
best IR buster there is, but only if the equine is comfortable and
non-laminitic. An individual that has had laminitis needs 6-9 months of
correct realigning trims before any serious exercise
can begin. Once the equine is moving around comfortably at liberty,
hand walking can begin in long straight lines with no tight turns. Do
not force a laminitic individual to move, or allow its other companions
to do so. It will begin to move once the pain begins to subside. Resting
its fragile feet is needed for healing to take place so if the animal
wants to lay down, do not encourage it to get up. Place feed and water
where it can be reached easily without having to move any more than
necessary. Be extremely careful about movement while using NSAIDs (bute,
banamine, previcox, etc.) as it masks pain and encourages more movement
than these fragile feet are actually able to withstand. Additionally,
NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after
the first week or so of use. If after a week's time your equine's
comfort level has not increased, then the cause of the laminitis has not
been removed and keeping up the NSAIDs isn't the answer - you need to
address the underlying cause.
There is lots more information in our files and archived messages and also on our website.
It is a lot of information, so take some time to go over it and feel
free to ask any questions. If you are feeling overwhelmed, don't worry,
you will catch on, and we are always here to help you! Once you have
your case history uploaded, we can help you help your equine partner
If you have any technical difficulties, please let us know so we can help you.