Re: Is anyone in the UK using Invokana

Kirsten Rasmussen

Another factor here is PPID.  Is Dewi on pergolide/Prascend and if so can you add it to your Case History?  You'll want to retest his ACTH 3 weeks after being on the full dose to make sure it is helping.  Uncontrolled PPID could really be compounding the high insulin, so you need to make sure this is under control.

Your vet probably just wants Dewi's insulin results to be comparable, so if he thinks you have fasted him in the past he is going to want you to continue to fast him for bloodwork so the numbers can be compared.  Again, point him to the EEG document saying testing should be done non-fasted, on pasture or hay only and tell him that's how Dewi needs to be tested going forward, so that you can see how his diet is influencing his insulin.  Yes, it would be nice to test after a specific meal to see if the beet pulp is a trigger, but testing is also expensive so that may not be something you want to pursue.

Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Re: Is anyone in the UK using Invokana


Thanks Eleanor and sorry I have been so slow to respond. My vet has spoken with Andy Durham at Liphook and seems more prepared to consider writing me a prescription for Invokana. But Andy said he has never used Invokana. Andy Durham’s advice is to blood test Dewi one hour after different meals to see what is triggering him. But Dewi is only on soaked hay and unmolassed beet pulp to carry his minerals so I don’t know if that is worthwhile? I guess we could take blood an hour after his beetpulp but could that be a trigger? It’s low ESC and starch. 

He has already had a blood test done whilst on hay (unbeknown to my vet as I ignored the advice to starve) although it was done in the morning and Dewi had run out of hay when I arrived, so I wonder if a test done in the afternoon would be better when he has been consistently eating? 

 My vet also wants to blood test him while he is still on Metformin but wants me to fast Dewi first (arghh!). I presume that is an incorrect approach and I should feed him his usual hay ration? 


Jenny Comish
England, UK
Dewi Case History:
Dewi Photos:

Re: Platinum Performance for a IR laminitic horse

Trisha DePietro

Hi Leian. Welcome to the group! I have attached our welcome letter for your review. I have some questions, but first, to answer your diet question.. Your hay sounds really good ( except for the higher iron) and I agree with you, the Platinum performance product is not the best choice at this time.

If he were my horse, I would definitely trial him on the Emergency diet, because even though he may have tested negative for PPID- He can still benefit from the tightest diet right now.  The Emergency diet is not going to hurt him one bit and that will give you time to get the next step together which is your case history information. This document is soooo incredibly helpful to the volunteers that review your information to give you that "solid" advice that you are looking for. Here is your welcome letter...

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. 


Trisha DePietro
Aug 2018
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder

Re: Phytoquench pellets


Phytoquench pellets contain Devils Claw for its pain relief.  Perhaps she is just feeling better.
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


Platinum Performance for a IR laminitic horse


This is my first post....I am at my wits end.  I have a 16 yo Missouri Foxtrotter gelding who has struggled with laminitis for the past 3.5 years, recouping and then regressing back to lameness and pain.  He is in a laminitic state now with inflamtion and pain.  We just did his blood work and it only shows IR.  Having said that I wanted to place him on the ECIR emergency diet until he shows signs of improvement HOWEVER my vet reccommended not going with the beet pulp and additional salt, flax vit e. but to use Platinum Performance Wellness.  His hay is solid at an ESC of 5.8 and startch of .5 (iron is a little high at 652).  My dilemma is after calling the company and getting the ingredient list I feel it will not be beneficial.  The NCS is 10.25 per scoop and the startch is 14.8 % and the feeding dose is 2 well as the product contains molassas and whey (which is highly inflamatory).  Any solid advice would be appreciated! 
Leian Susee in WA 2021

Re: To much pracend ?acting a bit aggressive ,planting hay this season

Eleanor Kellon, VMD


I agree it's entirely possible, even most likely, he is simply feeling better and asserting himself to get a better social position. We've heard that story many, many times.

Step 1 with your hays is to treat the field as dictated by the soil analysis. If you speak to the testing lab and tell them you would like to aim for the upper end of the acceptable pH scale (limits iron), and let them know if you want more magnesium in the hay (can be substituted for part of the lime), they can customize your plan.

For ease of management I would go with a single grass type. That makes it easier to cut your hay with all the grass at the same stage of maturity.
Eleanor in PA 
EC Owner 2001

Re: Could this have been due to selenium deficiency?

Frances C.

Sorry about the little mule. Should have been easy enough to get him up with plenty of help. It really bugs me when I see horses rescued from pits. bogs. ditches, ponds etc. on television and everybody cheers. It seems that animals go down for a reason and often seek out water for this purpose. The problem is that the animal is compromised in the first place and subsequent struggling exhausts them beyond their ability to recover and they subsequently die. 2 horses 1 calf rescued from ditches and all dead or euthanized within 24 hours.
- Frances C.
December 2017, Washington & California
Case history:
Phoenix's Photo Album:

Phytoquench pellets

Michele Goldberg <ladipus@...>

Has anyone ever had Phytoquench pellets make their horse extremely spooky and wild?? I gave them to my mare Schimpie last night and this morning for the first time and she was absolutely bonkers ...she’s normally kicking quiet to ride ..decided to give them a try for the combo of allergy and arthritis benefits ..she gets Uckele Laminox, & GUT in addition to her diet of ODTBC/VB/Flax&Vitamin E..tested low sugar Timothy hay ...this is the only new thing added so I can’t help but think it’s a reaction from that??
Michele Goldberg
Bernville, Pa 
joined 5/19/2016

Re: Vet in North Texas?

Saucier Kathy

I recommend Dr. David Fazzino, Cold Springs Animal Hospital in Anna, TX.
I used to board in Celina and long time ago was my vet.  When my first horse became IR & C's he did the dex suppression test.  I educated him as i learned more from this group.  Later a friend, who also uses him, told me he had switched to the ACTH.  I gave him lots of literature way back then and he came around even back then to doing whatever test I asked but now does the preferred one and understands more of the protocol.  He is really nice and tell him I said hi.
Kathy Saucier
sorry can't remember my year joined
but promoting this group ever since!

Re: Clarification about type of testing to monitor ACTH on Prascend


That’s what I thought, but the vet said I was wrong, so I wanted to make sure I do the right thing going forward. Thanks so much for your help, Dr. Kellon.
Joined May 21, 2018
Location: Ocala, Fl

Re: To much pracend ?acting a bit aggressive ,planting hay this season

Sherry Morse

Hi Tara,

I have no comment on the hay portion of your question but if the current Prascend dose is helping Gavi feel better than he has in a long time the attempt to change his position in the hierarchy may be related to that.  You could call it a side effect of the medication I suppose, but only in a very roundabout sort of 'hey I no longer feel yucky' sort of way.

To much pracend ?acting a bit aggressive ,planting hay this season

Tara Smith

Hi 2 topics ..Gavi has reached a 5.3 pracend sweet spot that he has been doing well on.  He will have more blood work in the next couple weeks . Symptoms have much improved. He is usually the lowest man on the total pole and he is being aggressive towards top horse and ponies .Pracend potentially having this side affect?Also we are trying to plant our own hay this year to ve specific for the horses .Low iron ,nitrogen ,esc,starch etc. I have to choose grass blend to get in the ground for next week..I'm thinking orchard Timothy blend ?I was told they have a finer Timothy blend as well to choose from any thoughts  I can custom blend the seeds /tuples of grasses that will be best for them . Hoping for input please?
Tara and Gavilon
Mass.  Nov 2017

Re: Faith in Crisis

Sherry Morse

Hi Karen,

Looks like you got your case history loaded so could you please get a signature in place and add the CH link when you do that.  Instructions on the signature:

1) Go to this link to set up your auto-signature:

2) Look at the bottom of that page for the window to type your name/location and CH link (you can copy/paste this and amend as you like):

Victoria Australia
March 2021

3) Make sure the case history link is "live". You may need to add a space after the link or hit the enter button on your keyboard to turn it blue.

4) IMPORTANT: Scroll to the bottom and hit SAVE!

As far as your bloodwork results - sounds like her PPID is reasonably well controlled but her IR is not.  Using pulses (or even heat) to gauge whether or not a horse is laminitic isn't always accurate - Dr. Kellon recently mentioned this here:  Getting blood results for insulin and glucose would be really helpful at this point in addition to getting pictures and x-rays posted.  If you need help with those just let us know where you are getting stuck.

Re: Could this have been due to selenium deficiency?

Eleanor Kellon, VMD

Cutting to the bottom line, you'll never know what happened. It is a little difficult to picture an animal getting their head stuck trying to get to grass but it's possible. He may also have been cast and ended up under it when struggling. Selenium deficiency wouldn't have helped things but from your description this mule was still in a semi-starved state with little reserves. This can also affect the heart. I agree he would have shown signs if he had a twisted gut - assuming anyone was watching. He could have had a fracture somewhere, e.g. cervical spine but virtually anywhere, and died from a fat embolus from the fracture - or internal injuries with bleeding or clot formation - or a heart issue like fatal arrhythmia - or ruptured his aorta - or fatal hypertriglyceridemia from the stress and struggling - or, or, or. No way to tell without necropsy.

As for white muscle disease, foals can be born with WMD when their mares are completely normal. It's not typically a disease of adults but wild animals with selenium deficiency can develop severe muscle breakdown with unusually vigorous activity and stress, like when being chased for capture. In those cases the muscle breakdown can cause fatal kidney failure.

I can't say selenium played no role here, but his poor general condition has to have been a major factor.
Eleanor in PA 
EC Owner 2001

Re: Equishure and Insulinwise

Sherry Morse

Hi Linda,

When you have a moment could you please update your signature with your CH link:

To do that:

1) Go to this link to amend your auto-signature:

2) Look at the bottom of that page for the window that has your name and location in it.

3) Add the link I included above on the line below your signature and make sure the link is "live". You may need to add a space after the link or hit the enter button on your keyboard to turn it blue.

4) IMPORTANT: Scroll to the bottom and hit SAVE!

You can do a search in the archived messages on Insulinwise as well as reading the study and Dr. Kellon's notes on it here:  The short answer is there's very little evidence that it actually works any better than getting the diet well controlled. 

From looking at your Case History it looks like Midnight had a decent amount of weight to lose to reach her ideal - has she lost any of that weight since your last update?  How much hay is she currently eating?  Are you soaking it or has it been tested?  Is she still eating alfalfa/timothy pellets?  (If so, I would stop those). 

Re: Allergy Test results

Maria Duran

Thanks a lot Dr. Kellon, that´s a wonderful explanation.

María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album

Re: need help with the next phase of care

Eleanor Kellon, VMD

I asked Dr. Bowker to review your films. He agreed no wedges, get him out of shoes, trim that toe and he also thinks there is the beginning of infection/white line disease at the long toe and potentially along the sole.

If you need a barefoot oriented hoof care professional, I reached out to Pete Ramey's office and have a list for you. Just let me know.
Eleanor in PA 
EC Owner 2001

Could this have been due to selenium deficiency?


I am posting about this to satisfy my own need to know since I was semi-involved in this situation.

Last summer we moved to southern Oregon, where I'm told the area is badly selenium deficient.  People bale and sell meadow grass but I've been warned it's poor quality stuff so I bought a stack of hay, mature orchard grass, sourced from Klamath Falls.  I use California Trace and so far so good for my guys.  However, I have some lady friends who live nearby, met through my herding hobby,  and they raise sheep and goats. They use a neighbor's meadow grass hay along with alfalfa.  They also supplement with sheep minerals.  I have detected a copper deficiency in the goats one has because the  the goats weren't given their own copper containing mineral supplement due to sharing space with the sheep!  Testing my own pasture, it is very low on copper and relatively high in iron.

At any rate, lady B owned a mini mule who had gotten obese and foundered, so they kept it at lady A's place in a paddock and fed him a strict diet of the meadow grass hay, declaring he could't have alfalfa because of the founder situation.  I didn't see any type of supplementing happening with this guy, but since these were new acquaintances I didn't feel confident to interfere.

They dieted the mule down too far, actually thin, before returning him to the lady B's property where apparently he was being kept in an indoor paddock.  On Monday night, lady A texted me to say that Jeffrey, the mini mule, had cast himself and they couldn't get him up.  My husband and I offered to come help.  There was a gap under the gate going outside, maybe 8-10", where lady B had found him with his head under the gate, and he had been thrashing for an unknown amount of time, possibly four or more hours.  They thought he stuck his head under there trying to get grass. They pulled him out but he couldn't stand.  His muscles were shaking.  When we arrived, they had him sternal, but he didn't have coordination to put his front legs out in front - they would fold back under him.  He would make feint attempts to stand, but his hind feet would not be in the right position, with hooves projecting backward, frog-leg style.  We would arrange his legs and hooves in the proper position to attempt to stand, but his hind legs would slip back again.  When offered hay, he would eat.

We got a flat strap to put under his belly and between two people lifting with that, one pulling up on the tail and one at the front, we got him standing.  He was on his knees at the front and so that person had to help him stand completely.  His muscles were trembling front and back.  I was dismayed by how thin he was through the hips, and he seemed wasted in muscle tone for a 13 year old mule.  A call was put in to the vet but she didn't answer.

He was eating and after 15 minutes or so the muscle quivering had quieted.  He began to shift his weight around in a more stable fashion so seemed to get stronger.  Conversation was around the fact that he had probably exhausted himself trying to get up for hours, and that he would be ok now.  I wish I had insisted they follow through with the vet, because I wasn't liking how uncoordinated and weak he was about getting himself up.  But, he was standing and eating and seemingly getting stronger.

I got a report later that night that he was still standing and eating.

I checked on Tuesday and lady A told me lady B found him dead the next morning!  She thought he had a twisted gut.

I'm a bit of a mystery detective and this whole situation hasn't sat well for me.  For instance, would a mini mule really get it's head stuck under a gate like that trying to seek grass?  When a horse eats off the ground standing, it would be difficult for it to get it's head turned and committed far enough under the gate in a standing position to then go down and be stuck.  I'm wondering if he went down for another reason near the gate and while thrashing trying to get up ended up with his head under it.

Also, wouldn't an equine with a twisted gut be showing dramatic signs of distress, including sweating, let alone not eat?

I am hypothesizing that this poor guy had white muscle disease due to a selenium deficiency and probably went down initially because of it and couldn't get up because of it.  Perhaps his heart gave out.

I don't find much about death in adult equines due to selenium deficiency and white muscle disease.  Is this a possibility?  

Re: New Member - Question - Acetyl L Carnetine

Eleanor Kellon, VMD

Thanks, Katrina.  Just checking.  There are some illegitimate tests out there.
Eleanor in PA 
EC Owner 2001

Re: Clarification about type of testing to monitor ACTH on Prascend

Eleanor Kellon, VMD


There is no reason to do TRH Stim  for either diagnosis or monitoring when ACTH is elevated.
Eleanor in PA 
EC Owner 2001

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