Re: IR or Not?

Nancy C

Great thread and excellent comments.

Would like to touch on the Trim portion of DDT+E which is so important and often misunderstood or delegated to a pro in whom the owner has faith.

With the horses who are too often assaulted by high insulin, keeping a tight balanced physiological trim is critically important to help them withstand what is thrown at them physiologically and to keep them moving.
Understanding what that looks like for your horses takes time and study. 

A good place to start is on Trim page.  Taking and reviewing lots and lots (and lots!) of digital hoof photos is a great way to get up to speed quickly.

Nancy C in NH
ECIR Moderator 2003
FACT: Blood flow to the foot passes to the rear of the foot, providing support and dissipating vibrational energy. See RM Bowker, VMD, PhD, The Vascular Cushion Of The Frog What Does It Do?  2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.



Re: Equishure Hindgut Buffer

Jody & John Bloom <johndbloom@...>

Thank you, Michelle.  I’ll give this a try.

Jody, Andariego & Sorpresa
NH 2014

On May 7, 2015, at 2:38 AM, Michele Cameron michelecameron57@... [EquineCushings] <EquineCushings@...> wrote:

If you have access to this type of muzzle, your horses could move around, drink, but not eat.... They will hate it, but if you  put a little cube of Timothy in the bottom when you put it on, it will help them to accept it. I used electric tape to turn my rectangular 1 acre  pasture into a grazing track to get our old Non-IR horse moving more. I can put the muzzle on and put my Ir horse in there for short periods to move around too. Usually, I stand in the middle though, and he runs around the track a bit, just for a change as I ride him every day anyway.... When I am on vacation though, this will be his only exercise for a week, so I want to get him used to the idea. The muzzle is frustrating at first, but start with short sessions and they should get used to it. Plastic Anti-Grazing Muzzle Tan
 Best of luck,
 Michele & Elijah Mustang, Everson, Wa, Jan.2015

Re: IR or Not?


Kerry - Thank you for this informative post.  I have been agonizing over Amber's last insulin results (41.12), the highest it has ever been and nothing has changed in her routine.  Her results range from 11.15 to the highest being 23.4.  I now have a good understanding of insulin and its fickle nature.  The vet came later then his usual time or it could of been she hadn't moved around much that day could of been the cause.  The vet did comment as to how well she made it through the winter.  I think I might have her tested again later this summer and I always test in September.  Thanks again - your have relieved my worrisome mind.

Jean and Amber
in South Carolina
August 2004
EC Case History 2




Hi Michele,

Welcome to the group!  It sounds like the changes that you have made to Mac's diet are doing him a world of good!!  To get the best help from the group, we ask that all members fill out a case history on their horse. To fill out a CH you will need to join one of our sister sites called ECHistory8, our "filing cabinet" that we can easily access at any time to help answer your questions.  It should not take long to get approved and then you can just follow the instructions on the main page to fill out a CH on Mac.  Here's a link to ECH8:  

It seems like you've been doing a lot of reading, and are probably somewhat familiar with our philosophy called DDT/E (Diagnosis, Diet, Trim, Exercise), but just in case, I'll give a quick explanation of it.

Diagnosis:  So you have a Diagnosis of compensated IR.  Age the age of 9, Mac is not likely to also have PPID, but you may consider including an ACTH with your next round of testing.  PPID and IR are two completely separate conditions, but have some similar and overlying symptoms.  PPID is a benign tumor or hyperplasia in part of the pituitary gland called the pars intermedia, usually not seen before the age of 10.  IR is a metabolic type of horse, usually, but not always described as easy keepers, with regional adiposity (cresty neck, fat pads in the rump, etc).  Any horse can have just PPID, just IR, or both, or neither. To get a full Diagnosis of PPID and/or IR, we recommend these four tests:  ACTH, insulin, glucose and leptin levels on a NON-fasting horse, preferably sent to Cornell. 

Diet:  The diet that we recommend is a forage based low sugar starch (tested to be under 10% sugar+starch) low fat (4% or under) mineral balanced diet.  We use grass hay, tested to be under 10% sugar+starch, with minerals added to balance the hay to the analysis and to replace what is lost during the hay curing process, we add Vitamin E and ground flax seed.  Until you get your hay tested we recommend that you use the emergency diet (found here on our website:  which involves soaking the hay for an hour in cold water or 30 minutes in hot water to remove up to about 30% of the sugar content.  Make sure you dump the soaking water where the horse(s) can't get to it.  We like to send our hay for analysis to this lab:  and ask for the #603, trainers' package for $54.  As important as what you DO feed on the IR diet is what you DON'T feed!  No grain, no pelleted or senior feeds, no pasture (even dead looking grass), no sugary treats (including carrots and apples), no molasses, no brown/red mineral salt blocks--white ones only.  

I looked at the limited analysis that is provided of the LMF stage 1 and I see they make 2 formulas, one for southwest and one for NW.  At 2% max starch and 6% max sugar, both formulas are within the acceptable range of under 10%.  I see a few things that would give me cause for concern.  The fat is listed as minimum 4% in the NW and 5.2% in the SW formula.  We recommend no more than 4% fat (closest to grass) in the diet.  I also looks like the fat comes from vegetable oil, which has an upside down Omega 3:6 ratio.  We use ground flax seed to replace the Omega's lost when grass is cured into hay because it has the closest ratio of Omega 3:6 as found in grass, about 4:1.  Additionally, there are some ingredients listed in the LMF that are not recommended for IR horses, thiamine, niacin and riboflavin.  More info in this post by Dr Kellon:  
It also lists Yucca as an ingredient and we avoid that in IR horses as well.  More info in this "avoid these items" file:   There is also alfalfa listed and we know that some horses get footsore on alfalfa.  Additionally, the LMF is unlikely to balance your hay. Some "safe" (i.e. less than 10% sugar + starch) carriers for your supplements are rinsed/soaked/rinsed beet pulp, dampened Ontario Dehy Timothy Balance cubes (ODTB's), Nuzu Stabul 1.  Lots more discussion about all of those if you do a search of the archived messages.

Trim:   A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. It's great that Mac is doing so well barefoot!!  We encourage you to post pictures of you his feet in the PHOTOS section of ECH8, so that we can help you to evaluate if he has a the most ideal trim.  Here's a site that shows how too take good hoof photos: 

Exercise:  The best IR buster there is!!  BUT--a laminitic horse should never be forced to move!  If Mac is footsore, boots and pads may be in order to help with pain relief.  

I see that your question about NSC has been answered.  Let us know if you have any more questions.  We ask all members to sign their name, date of joining and general location each time they post.  Also, once you get Mac's CH done, please include a link to it in your signature as well, like in my signature below.  It really helps us to find his CH faster and answer your questions faster!  Thanks!  Keep up the good work, Michele!   

Maggie, Chancey and Spiral in VA

Re: Equishure Hindgut Buffer

Michele Cameron

If you have access to this type of muzzle, your horses could move around, drink, but not eat.... They will hate it, but if you  put a little cube of Timothy in the bottom when you put it on, it will help them to accept it. I used electric tape to turn my rectangular 1 acre  pasture into a grazing track to get our old Non-IR horse moving more. I can put the muzzle on and put my Ir horse in there for short periods to move around too. Usually, I stand in the middle though, and he runs around the track a bit, just for a change as I ride him every day anyway.... When I am on vacation though, this will be his only exercise for a week, so I want to get him used to the idea. The muzzle is frustrating at first, but start with short sessions and they should get used to it. Plastic Anti-Grazing Muzzle Tan
 Best of luck,
 Michele & Elijah Mustang, Everson, Wa, Jan.2015

Re: Need Help ( Jasper's really sore 8 hours after joint injections )


Hi Corrine,

Did you get a chance to find out what the vet injected? I noticed you mentioned steroids in a previous post

Pauline & Spur

Sth West Vic

Australia Aug 07

EC Primary Response


---In EquineCushings@..., <sassafrass45@...> wrote :


Jaini,vet was here earlier today and no anwsers on why he's so sore,all we know is its in his hoofs very re active to hoof testers. Fetlocks seem to be fine no heat or swelling at injection sites. 

Re: Side affects of Pergolide


---In EquineCushings@..., <alison.elliott21@...> wrote :


I'm new to the group, I joined after doing a search regarding side affects to prascend.

Hello Alison,


Welcome to the group!  You've come to the right place for help, but what we really need you to do so that we have all the details we need to give you the best advice is to fill out a case history on him  To do that, you need to join one of our sister groups called ECH8.  Here's a link to that group: 

Once you get approved, which shouldn't take long, just follow the instructions to fill out a case history (CH) on your boy.  If you have any trouble joining ECH8, just let us know and we can send you an invite.  Meanwhile, I will tell our about our philosophy called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise,


DIAGNOSIS: Is done with blood work. We recommend having blood drawn to test for Insulin, Glucose, Leptin and ACTH. ACTH is used to diagnose PPID (Cushings) while insulin, glucose and leptin are used to diagnose Insulin Resistance (IR). The samples should be drawn at home and NON-fasting as fasting will produce artificially low results and are a holdover from human testing protocols. A horse can be only IR, only PPID, neither or both. PPID is managed using meds while IR is managed thru diet. Please post us the blood results of the tests you have done so far.  His ACTH is quite high at 200, but I’m inclined to agree with you with reducing the prascend dose. Best approach when introducing prascend is to start at ¼ (0.25mg) 3-4 days, bump up to ½ (0.50 mg) 3-4 days, then to ¾ (0.75mg) 3-4 days, then to full 1mg dose. Retesting should be done 3-4 weeks later once at the full dose. APF (Auburn Labs) is a God sent for horses when starting pergolide, as it helps minimize the pergolide veil. You know your horse the best and you are his advocate.

DIET: Low sugar/starch/fat, forage based with minerals supplemented based on your forage analysis. Until you can have your hay tested, we recommend using the emergency diet you were sent when you joined. This is a safe, temporary way to feed that won't do any harm but will definitely help an IR/PPID equine. As important as what to feed is what NOT to feed. No grain, pasture, red/brown salt blocks, apples, carrots, sugary treats, alfalfa. Soaking untested hay for 30 minutes in hot water or 60 min in cold water then dumping the water where the pony can't get it will help remove up to 30% of the sugars and make it safer to feed. Should plan to feed 2% of ideal bodyweight in soaked hay per day, divided into 3-4 feedings. Small mesh hay nets are a great way to make the hay rations last longer. You can use a small amount of rinsed/soaked/rinsed beet pulp as a carrier for the emergency diet (ED) items of salt, vit E gelcaps with oil in them, ground flax and magnesium. All of these ED items are available at your local pharmacy/grocery store or stock feed place.

TRIM: Toes backed and heels low so that the hoof capsule tightly hugs and supports the internal structures. This is one of the most common "missing links" when soundness is an issue. We encourage you to post pictures of your pony in the PHOTOS section of ECHistory8 so that we can help make sure the trim is optimal. If there are any lameness issues, we recommend boots and pads for comfort.

EXERCISE: Best IR buster there is, but never force a sore equine to move. Need to be especially careful if there  are any NSAID's being used as this will mask pain and encourage the equine to do too much too soon on compromised feet.

We  please ask that you sign your posts with your name, general location and year of joining. This helps us to give you ideas where to source items locally. Once you have your case history done we ask that you add the link to that to your signature as well so the volunteers can find your info easily.


For more in-depth info on both conditions please take the time to read our website:  


Pauline & Spur

Sth West Vic

Australia Aug 07

EC Primary Response


Re: IR or Not?


"A long tedious story but an important one. Insulin status can change day to day & be influenced by factors too numerous to count.Take it from me and my book of lab results: you're fine one day until you aren't."

NOT tedious - brilliant! Amen to all of it!

Kathleen (KFG in KCMO)
MO - USA - Dec 2005



Some clarification: ECIR does not consider ESC+starch as NSC (but we know what you mean!).

NSC (nonstructural carbohydrate) is the sum of WSC + starch. 

WSC is the sum of ESC + fructan (somewhat oversimplified).

When dealing with insulin resistance, the concern is, "What carbohydrate fractions stimulate a glycemic response (an increase in glucose and insulin)?" The answer is simple sugar (ESC) and starch - these carbohydrates are digested primarily to glucose (simple sugars) and entirely to glucose (starch). 

We don't have the same concern about fructan because mammals cannot digest fructan. Bacteria in the hindgut ferment fructan and this does not result in an appreciable glycemic response. The evidence to date suggests that the fermentation of fructan by bacteria does not increase insulin.

Therefore, if you consider NSC, you're basically adding fructan + simple sugar + starch and inflating your numbers. For example, if instructed to "keep the NSC of your hay below 10%" you would need to add WSC and starch values together. If the WSC were 15% and the starch 2% the sum would be 17%, You would discard this hay or spend a lot of time soaking it. 

However, if the values were:

ESC = 6%
WSC = 15% (WSC minus ESC = fructan, therefore, 15 - 6 = 11% fructan)
Starch = 2%

...then you can see that the fractions that involve a glycemic response (ESC + starch, 6 + 2 = 8%) are acceptable. 

Since roughly 85% of laminitis is caused by metabolic disease that involves hyperinsulinemia, it makes sense to pay attention to the carbohydrates that induce hyperinsulinemia. 

What is the percentage of documented cases of pasture fructan overload resulting in hind-gut acidosis leading to laminitis, you might ask? Good question! I'm still waiting for that answer.

Kathleen (KFG in KCMO)
Director and Research Advisor, ECIR Inc.
Missouri - USA - Dec 2005

Re: Commercial minerals

Michele Cameron

Hi, Oh, so sorry about your trouble getting supplies... I am lucky, we have storage, etc. & ODTBC's are fairly cheap here.
Don't give up though, Can you get set up to soak hay in small hole nets? That would help a lot... I don't know your situation, but maybe you can find someone in your area interested in doing the same type of feeding for their IR horse and you can  share & store tested hay, even if it is on pallets  (w/ plastic on the dirt) and covered with a tarp.... maybe you have a skill that you can barter for the use of a truck...
The folks in the group give great advice, but it can take awhile to get everything in place.... all the fuss as opposed to the high cost of vet bills may be worth it for you in the end.
Meanwhile, I salute you for dragging forage home in a car, and I am rooting for you and your horse to succeed.
Best wishes,
Michele & Elijah Mustang, Everson, Wa Jan 2015 

Re: Need Help ( Jasper's really sore 8 hours after joint injections )

corrine haffner


Jaini,vet was here earlier today and no anwsers on why he's so sore,all we know is its in his hoofs very re active to hoof testers. Fetlocks seem to be fine no heat or swelling at injection sites. 

Got his hoof boots on helps some, but still very sore and not wanting to move much,have xrays posted on echistory8 so hope someone who can read xray will chime in here soon.  He can hardly walk over hard ground without almost going down.

Corrine and Jasper
MN 4/2014



---In EquineCushings@..., <noonehorsegal@...> wrote :

 My question is, why are there two ways to measure NSC? WSC + Starch or 100-(water + protein + fat+ash +NDF)? I also want to know what you all think of LMF stage 1.

Hi Michele,

The important numbers for sugar and starch are - ESC plus Starch.  They should total below 10% to be safe and some horses need lower.   Thru the years of study and experience, ecir has found that NSC and WSC are not the numbers to use.  And if you have 2 very similar hays, good quality, etc., and the same "sugar" percentage, choose the one with the lowest starch because starch is "twice as bad" as  esc, so to speak.  Starch converts 100% to glucose and esc just 50% to glucose.

Sounds like you're making a good start with Mac.  And you're in the right place for info.  Have you had a chance to read thru the ecir website?  very good overview and info.  

Laura K. Chappie & Beau



Kerry Isherwood

ECIR measures NSC as ESC plus Starch only.

Sorry i cant add more, literally walking a horse in. Someone will chime in asap, dont worry



Michele Lane

All this is confusing....please help

Horse with PSSM/Possible IR


A girlfriend of mine just received the results from Cornell that show her horse is PSSM 1.  Both parents had it. He tied up last week.  Test from Cornell show a Glucose of 74 and Insulin of 14.  Vet says he is not insulin resistant?  IR Calculator shows he is compensated, which is correct?

Can someone help her with a diet?  So many people have interjected that she is totally confused as what to be feeding him.


Laura in CA



Re: ECIR Group Inc. 2015 NO Laminitis! Conf - Appv'd for Vet CE

Kerry Isherwood

FABULOUS!!!!!! So good to hear this!!!!


Re: updating info on file


Sorry - I just re-read this (below) and it looks confusing. Here's what it's SUPPOSED to say!
Reference range for ACTH is 9-35
Reference range for Insulin is 10-40

---- "kansteen5545@... [EquineCushings]" <EquineCushings@...> wrote:

Hi Maggie -
When I updated my case history and deleted the old one, I realized that also gone were last years results for ACTH and Insulin. Anyway - here they are.
20014 - ACTH - 35.9 Insulin - 18.42 Ref. Range - 9-35
20015 - ACTH - 31.7 Insulin - 27.25 Ref. Range - 10-40

ECIR Group Inc. 2015 NO Laminitis! Conf - Appv'd for Vet CE

Nancy C

Dear Fellow ECIR Yahoo Members and especially veterinary professionals

(Please feel free to share this post.)

The 2015 No Laminitis Conference has been approved by AAVSB/RACE for 13 hours of Continuing Education for Veterinary Professionals*.

Number of Hours of CE for Veterinarians: 13.00 (maximum for one veterinarian: 13.00)
Number of Hours of CE for Veterinary Technicians: 13.00 (maximum for one veterinary technician: 13.00)

When: The weekend of November 6-8, 2015, expanded this year to include a full day Friday and Saturday. Sunday events will conclude at 2 pm.  

Where: Georgetown, TX (just outside Austin with international access)

Speakers: Dr. Eleanor Kellon, Dr. Robert Bowker, Dr. Philip Johnson, Dr. Benjamin Buchanan, Dr. Kathleen Gustafson, Lavinia Fiscaletti and Daisy Bicking.

Lecture Topics:  
    PPID and IR Myths and Misconceptions
    Equine Metabolic Syndrome - Its Origins and Evolution
    Ovarian Abnormalities In Mares With Refractory Insulin Resistance
    Endocrinopathic Laminitis – Changing Perspectives and Recent Revelations
    Ancillary Supplements For Horses With Laminitis And Metabolic Syndrome
    Winter Laminitis
    Understanding the Equine Microbiome
    Why Is It Good For The Coffin Bone To Be Porous While In Women We Call It Osteoporosis?
    The Suspensory Apparatus Of The Coffin Bone: Its Functioning In Health And Disease
    The Vascular Cushion Of The Frog: What Does It Do?
    Nerves, Nerves, Nerves: Why Are They So Important To The Horse?
    Trim – The Essential, Missing Ingredient
    Building Successful Teams To Rehabilitate the EMS Horse
    Case Study Presentation of Successful Rehabilitation Using DDT&E and an Effective Team
    Forage Analysis - How and Why
    Understanding Variations in Pasture Grass

Attendees: Any professional or owner who has one or more horses in their care.

Tickets will be available mid May. Cost: $280. Early bird cost: $250. Once final details are in place, registration info will be announced to the group. Keep an eye out for conference updates on Yahoo, Facebook,, and IVIS.

Venue and accommodation info may be found on  
*This program was reviewed and approved by the AAVSB RACE program for 13 hours of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program's validity or relevancy to the veterinary profession. Participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of continuing education. Contact Nancy Collins at ecirgroup1@... for further information.

Nancy C in NH
February 2003
ECIR Moderator
ECIR Group Inc. Treasurer and Director

Re: Commercial minerals

Nancy C

Hi Merle

Forgive me, Merle, but you asked what to do to "balance" 19 pounds of Standlee. 

We're all on a budget.  The majority of us have had to spend many hours rethinking what we were doing to  get the best we can for our horses with the assets we had available.  That includes money, barn or storage space, available vets, farriers, etc.

For example, I have room only to store 80 bales at a time.  I've been here 12 years. Had to work step by step to find resources and approaches that get my horse what he needs with out going into bankruptcy.

The group knows what works for these horses from years of experience reported on 1000s of horses and how to do it most cost effectively. When you hear from the volunteers here is a bit from the philosophy they are working with as a foundation.

All too often members find our Yahoo discussion group after
significant, unresolved problems arise. Owners are very anxious to
quickly find something that works. We understand.

All ECIR groups are based in science and medicine. The approach is
called the Diagnosis, Diet, Trim and Exercise (DDT/E) Protocol.
Owners, moderators and responders on the discussion group strive to
deliver a clear, consistent message which you may find unfamiliar or
rigid. The advice is based on achieving the best possible outcome and
delivery will not deviate from that goal.

I have used ODTB Cubes as a complete diet fro my 31 y/o gelding.  The resuts were worth the effort even factor in the extra cost in reduced costs for vets for skin issues, choke, and more.

The issues with Standlee have been discussed many times.  Not guaranteed to be low ESC and Starch.  Not balanced. Can you use CA Trace?  Sure.  But your diet will most likely not be balanced for optimum health of your IR/Cushing's horse and you don't know how much simple sugar and starch he may be eating.  His insulin is affecting his feet, even if he has not had laminitis.

Could you use Mag Ox instead of Remission and save money?  You bet.

You are probably already doing this, but just in case...recommend you keep track of exactly how much you spend so you can compare.

Good luck!

Nancy C in NH
ECIR Moderator 2003

FACT: With knowledge of the nutrient profile of the forage and the animal's weight and level of work, one can supplement only what is needed to target nutritional needs.  See  Smithey and Gustafson, Nutrition Complexities and Mineral Profiles of Hay 2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.


Re: updating info on file


Hi Maggie -
Thanks for your comments. I didn't get a glucose or a Leptin done. Glucose I figured I'd wait on if/until her Insulin was out of range and Leptin because she really does seem to have a "shut off valve" - she'll eat some then leave it for a while and nibble on it later. She's not a hoover type.
The hay would be really hard to balance because its different all the time. Sometimes it's Timothy - sometimes Orchard grass - and sometimes it has some weedy things in it. That's the hay I have delivered - if I buy from the feed store it's different also. It's whatever they happen to get in. Maybe that's why the Insulin was higher?
I was thinking of trying California Trace for a supplement. As far as the Herballs - I will stop those.
Thanks again!

---- "spiral1957@... [EquineCushings]" <EquineCushings@...> wrote:

Hi Karen,

Great that you got your CH updated! I do see the 2014 lab results in there--same as you have listed here. I don't see a glucose, though. Do you know if one was done? Or a leptin?

I didn't know if you have any specific questions, but I have a couple of thoughts.

One, I looked up those herballs herbal treats and they contain wheat flour. I don't see a guaranteed analysis or ESC and/or starch listed, but the wheat flour could be a pretty significant starch contribution. S tarch converts 100% to glucose causing more of an insulin spike than sugar, as it converts only 50% to glucose. Without further analysis of these, I would stop feeding them. I know that you are not feeding many, but since her insulin is higher now, you want to tighten up her diet as much as possible. Could always send a few to EA for analysis of sugar and starch.

Also, your CH still lists the Dcarb balance, so I was wondering if you've tested and balanced your hay yet. I know that you already know this, but balancing the minerals to the hay is the best way to feed any horse, and is especially important for IR and /or PPID horses. In looking at the guaranteed analysis of D carb, it's unlikely to balance your hay. Plus it has some ingredients that you want to avoid in IR horses, riboflavin, thiamine to name a couple. Here's a note from Nancy with more info and a link to the B vitamins file:

Hope that helps! Let us know if you have any more questions.

Maggie, Chancey and Spiral in VA
March 2011
EC moderator/Primary Response

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