Re: Elevated insulin levels, chronic founder, Cushing

Nancy C

Hi Anissa

You are getting a lot of info at one time and it can get overwhelming. I'd just like to clarify about Heiro, please, if I may.

The main ingredient in Heiro is magnesium, which is hugely important especially when dealing with metabolic horses. Many of us have seen good improvement when the correctly balanced amount of magnesium is added to the diet.  You are not hurting your horse by giving him/her Heiro. Magnesium is recommended in the emergency diet is an amount that will  get you started until yo can learn more about what is an amount required for your hay.

The big problem with Heiro is the marketing hype that promises many things like returning EMS horses to pasture.  I have lost count how many members of the ECIR Group have found Heiro does not live up to this promise in correctly diagnosed EMS equines.

Members can usually find magnesium in a more cost effective way. For example, I buy a 50 pound bag from a feed mill for $22.  Lasts forever as long as you keep it dry.

Hang in there.
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room

Re: Lavinia - mark ups requested

Lavinia Fiscaletti

Hi Lisa,

You're correct - with the shoes+pads, sole shots wouldn't make much sense. In general, the trim needs a huge amount of correction.

Would you please also get pix of the hind feet.


Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Lavinia - mark ups requested


Hi Lavinia!

Ok - i figured out the furry photos and have added them to the album. I did not add the sole photos since he is in shoes and pads currently & I made the assumption that they would not be super helpful. I can do that if necessary. 

My farrier is coming Friday, March 5 & I can get the sole photos then.  I will also post additional hoof photos once that trim is complete.

Is there anything I am missing? 

Thanks in advance,
Lisa and Haven
Independence, MN

Haven's case history: 

Haven's photos: 

Re: Managing hoof boots

Julie Thomas

Hi Sue.  I don't have much to add to Heather's extensive, great ideas.  My QH (Ike) been in boots close to 24/7 since June 2020.  I have two pairs of Cloud boots with cushions for each pair.  When the weather is wet (snow or rain), I change them daily.  I take the cushions out of the boots, clean out the boots with the brush end of my hoof pick, and put them on a Peet boot dryer.  This ensures I have dry boots by the next day if I need them.  I also use Gold Bond foot powder in the boots.  When the weather is dry, I only change boots as needed (approximately 3-4 days).  The only time Ike doesn't wear his boots is when he is in the round pen; the sandy footing doesn't seem to bother his feet like the hard ground of the dry lot.  Weather permitting, I try to put him (and his buddy Sparky) in the round pen to play for 1-2 hours; the play is good exercise & Ike gets time out of his boots.
Julie Thomas
September 2018, Seabeck, WA
Case Histories:  .
Ike Photos:  .
Sparky Photos:  .

Re: boots

Nancy & Vinnie & Summer


Daisy Shepherd

has anybody tried the new easy care sneakers? came out i think 12/2020.  thanks, daisy and tiko
Daisy, Tiko and Whisper
CO, April 2019
Case History: 
Photo Album:,,,20,2,0,0

Re: Upsetting Info on Equi-Analytical 601 & 603 tests

Eleanor Kellon, VMD


If you find a lab you are interested in but don't see a standard profile, I would call them or e-mail and ask if they offer DE horse and ESC, Starch by wet chemistry. Many labs are geared to dairy because that's where the vast majority of their customers are
Eleanor in PA 
EC Owner 2001

Re: Managing hoof boots


Hello. I am sure others will chime in here but thought I would share my experience with boots and living in Manitoba, Canada where we have winters full of snow and cold temps.

I have found in my experience for winter the best boots are the cloud boots as they are taller and help keep snow out of the boot.  My horse suffered from winter laminitis so I also like the pads in these boots as they are thick and provide extra insulation from the ground.  My horses are kept in dry lots during the winter and 2 of them are booted.  So far I have not had to add any ice studs for their boots as most times we have a good snow covering and if it does  get a bit slippery they are just careful.  But adding them is an option if you are worried about slipping.

The cloud boots are a heavier canvas type boot so i actually water proof my boots and reapply as needed. This helps keep them dry from the wet snow.  I usually change the boots out for a fresh pair every couple of days depending on weather and temps.  Sometimes more if we have extremely wet snow.

As my horse sufffers from winter laminitis I also add in a few more things for winter to keep her feet warm and dry.  This year I added a liner to her boots when we dipped down past -20C.  This was made from fabric bought from the fabric store which is used for lining coats or window shades. The fabric has an outside heavier fabric layer then a foil layer and finally batting layer. This has been a great addition for us.  I also use 100 - 80% wool socks which I actually found at a men’s work wear store close by.  What a a super sweet score that was as socks with that high of wool content seem to be hard to find these days.

I use 2 pairs of socks when we dip down past -25C.  A thinner wool sock under a heavier wool sock.  Then I add a shipping boot over as this keeps snow out and my horse’s legs warm. FYI I also water proof my shipping boots too. The addition of the liner helped a lot as previous to this in really cold temps her feet still felt cold.  Now they feel warm to the touch instead of cold.

Depending on weather temps during the day sometimes I take the shipping boots off and just leave the socks on.  I change socks out in am and pm and liners if needed. Liners can usually last a few days but socks need to be changed to ensure they stay dry I find.  

It’s important to make sure socks are not wet as can cause rubbing and makes feet cold and can create thrush issues too.  You can also add in gold bond powder to the sock that covers the hoof to which can help keep it dry.  

Hope this helps you a bit!  Ask if you have any questions on what I do.  Perhaps I added in more than u asked but wanted to give you the complete setup.  

August 5, 2017, Brandon, Manitoba, Canada



Case History


Re: Aragon's hoofs


Hi Myriam, 
I love to look at maps so I took a peak at where you live.  Fascinating.  My friends took their boat from Vermont down the St Lawrence to the ocean and then down the coast and it occurred to me that they may have stopped there to restock.
So, seeing where you live and your very low glucose report, I had the same concerns as Lavinia about getting your blood samples to the lab without degradation.  That is something I would definitely look into before having more blood drawn.  Do you have a small animal vet in town?  Many of our members have enlisted their help when drawing blood and getting it tested.  They, of course, would need to be aware of the same degradation concerns.
Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


Managing hoof boots


My horse, Boss, has recently been diagnosed EMS with insulin levels >200. He is very foot sore and I'd like to use hoof boots with pads to help alleviate this. He is in a paddock with ice and snow footing and has a run-in shelter with loads of shavings to provide some softer footing. He has been improving slowly over the past 2 months. First are hoof boots appropriate in this environment? I've looked for info on boots in this group but have been unable to find any, what have I missed. Also, if boots are used how often are they removed and put back on? Do they work on icy footing?  
Sue M in ME 2021

Re: Elevated insulin levels, chronic founder, Cushing

LJ Friedman

You are to be commended for coming to this group. Heiro  sounds like the greatest product on earth. Except it does nothing. So good for you for trying but they’ll be many better things that you will get from being here.  . welcome 
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos


Re: What else to manage pain?

LJ Friedman

insulinwise is herbs? reservatol? champagne?  its a mess,   many vets know zero about properly managing insulin.  If you knew how clueless many  are, you could say something like” no more insulin wise. I made my decision. Now I want to try Invokana, “  for example. Are you with me, my horse is suffering.  
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos


Re: Any new research or evidence on the effects of Laminil?


Thank you, Dr. Kellon!
Lisa Mittler
Barefoot Hoof Practitioner
South and Central Texas
January 2019

Re: Trying to understand the diet a little better


Thank you!  That helped a lot. 


Re: Aragon's hoofs

Lavinia Fiscaletti

Hi Myriam,

Thank-you for putting up all of Aragon's radiographs and some hoof photos.

The rads from 2017 show that the HPA on the LF was slightly broken back but the RF was fine. Both feet had thin soles, very long toes, underrun heels and some sinking. The trim was definitely problematic at that time. In the latest rads from Aug 2020, nothing about the trim had changed, his soles were still thin, sinking appears to have been about the same, the broken back HPA on the LF worsened and now the RF HPA is also broken back. Both coffin bones are just starting to develop ski tips, with the LF one being more advanced. This is due to the lever forces being applied to the coffin bone tips from the very long toes. You are correct that shoes are not going to fix any of this, esp. if the underlying trim isn't corrected first. I would recommend getting the shoes removed so you can get trims done on a more frequent basis. Boots and pads will likely make him a lot more comfortable, plus you can keep his feet warmer by putting socks inside of the boots.

His trim needs to be addressed by bringing his horizontal toe length back a lot and getting his heels moved back to where they should be. His soles and frogs need to be left completely alone to allow them to develop depth and calloused surfaces.

If you would like some mark-ups to help guide the trims, I'll need a full set of hoof photos (all four feet). Here's what is needed:

It's helpful if the laterals contain part of the cannon bone as well as the hoof. If you can get the shoes pulled before taking the photos that would be really helpful so that the entire sole is visible.

You really need to get his insulin tested, as well as a retest of the glucose and ACTH. Cortisol does not need to be tested as it is not valid for PPID or EMS/IR diagnosis. Glucose is very susceptible to handling errors and the glucose result from his last blood work is suspiciously low, indicating that there may have been a delay in separating the sample, or possibly some mishandling of the sample between the time it was drawn and when it reached the lab. This could also impact the ACTH as well, so it makes that previous result questionable. At 16yo, PPID is a possibility which could also be driving the pain in his feet. That would need to be treated with meds.

Hang in there, we'll help you get this sorted out for your boy.

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Re: Aragon's hoofs


Gaurdian Masks are great for the horses with blue eyes/pink skin. They block 95% of UV rays. They are a bit expensive but they last a long time. 
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

Re: What else to manage pain?


Hi Nancy!
Your suggestion is exactly what I have thought as well.  Trying to move forward and onl Thank you for sending the links
Marsha and Dame - Buzzy TN 2019

Re: Upsetting Info on Equi-Analytical 601 & 603 tests


Thanks for the link to the list of labs, Dr. Kellon. I have used Equi-Analytical for many years, but I was not happy with the length of time it took to get results from them last year and was considering using a different lab closer to my location this year. When I followed up on some of the labs on the list, they didn't appear to be geared to horses or to offer the same analyses as Equi-Analytical ( e.g., no ESC or Starch, just WSC).  Does anyone know of any reputable labs that measure the same range of variables as Equianalytical 603 for about the same price (or less!)? Western USA would be best but I am open to suggestions.
Annette and Alley
October 2018, Moscow, Idaho
Case History: .
Album:  .

Re: Elevated insulin levels, chronic founder, Cushing

Maxine McArthur

On Sun, Feb 28, 2021 at 06:03 AM, Annissa Koontz-Baldwin wrote:
I have a 10 yr old TWH mare that for the past 3 years has reoccurring founder episodes. The latest started in August she has rotated in all 4 feet. The worse is her RF at 11.6 degree of rotation. We just did another full blood panel and this time she tested positive for Cushings and her insulin count is 353. This is what I am giving her:
We had to do a resection of her from right as she also has white line disease. She’s on a hoof supplement, I soak her hay, lite and low feed which is approved for IR horses. She abscesses often. She is not overweight and has never been. I am following a couple websites that talk about herbs and how they are showing improvement in IR horses. Is that something I should explore more?


Annissa B


Hi Annissa
Bonnie has flagged that we need more information before we can offer specific advice, but while you are getting your case history together, please read through our welcome message below, as it explains our protocol of Diagnosis, Diet, Trim (plus exercise when able). Insulin resistance is controlled by diet, exercise when able, and PPID is controlled with the medication pergolide. Herbs can be a useful adjunct but they will not treat or control either condition. Being underweight and abcessing often is a red flag for her PPID not being controlled, so the sooner she starts pergolide medication, the better. You can also post photos of her feet and X-rays if you would like advice regarding her trim. All these instructions are below. Please let us know if you have further questions after reading. 



Welcome to the group! 

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 etiquettewhat 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.

The 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.

*Please 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. 

Treatment: EMS 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  

We 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 horse. 

*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. 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. 

What 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. 

No 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.

We 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.

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. 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.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

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.

EXERCISEThe 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 even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 



Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Re: How to get my IR horse eating his supplements

Lorna Cane

Hi Myriam,

Thanks for adding details to Aragon's case history !

Are you adding mag ox to his emergency diet ? 

To help him lose weight safely we recommend feeding either 2% total feed of his ideal weight or 1.5% of his current weight , whichever is more, until his ideal weight is reached . This should help with his comfort level,too,by taking weight of those feet.

Lorna  in Eastern  Ontario
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