Very worrisome insulin spike


Hi group,

just got an insulin of 154uU from Cornell on his EDTA plasma sample (ACTH was 10, on same sample).  Im an LVT and have been submitting these same samples for years, so i know it isnt handling error (and have no reason to believe Cornell was faulty).  

My horse has been consistently in insulin teens-20suU since midsummer on monthly checks (serum, to Antech; BG always fine).  His acute laminitis & rotation event occurred in Feb of this year with an insulin of 249uU.  

I sent a serum last night to Antech to confirm — just got results of 97uU — this is a huge spike for him despite *nothing* changing in management.  Perhaps an add’l 2-3 lbs of rough first cut (unsoaked) for the cold overnights so he has something (pretty thin body score; no fat reserves)

hes not at all clinical — hooves are not hot, no pulses, fully sound as has been in padded Clouds/Stratus, etc.  Even trotted a few steps in aisle last night and is totally sound.  Hes been on small paddocks T/O in boots for several weeks now.  

i increased his pergolide by 0.5mg today (been doing very well on 3.5mg PO SID for many months) and am now soaking hay (above freezing next few days but soon will be below)

ill update CH with all of this, but Im quite concerned about a spike this high at this time of year.  My older mare — as well as everything i know abt ppid from literature suggests the endogenous rise occurs Aug-Nov annually and begins to decrease in December.  My ppid mare always fell spart in Aug & Sept each year before diagnosis/treatment.

im sorry this is not proofread nor my CH updated; im so knocked over by this sudden spike, despite everything going so, so well now, i cant begin to think abt another rotation episode.  Pergolide definitely, *definitely* halted the laminitis episodes and he is exhibiting all the symptoms of advanced PPID (thick, rough coat; not shedding this year, etc) despite acth’s always being low.  

So hes a presumptive ppid despite low/normal acth, what im getting at is, do some atypical PPID horses exhibit annual insulin spike at different times if year than the typical autumn months of Aug-Nov?

lastly, my Antech results always state (as a general note): “evidence is mounting that cases of Insulin Dysregulation are occurring later in the year in months of Dec, Jan, Feb” — normally im not putting much stock in what Antech offers for diagnostics, but this gelding does fit that criteria.  So, what is insulin Dysreg vs hyperinsulinemia of Ppid occurring in Aug-Nov?  Is it two separate syndromes?

I know group prefers not to comment on particular cases w/o Ch, and that is fine — im just hoping to know if there are other cases that spike at later months than the typical.

kerry in ny
joined 2014

Re: Continue Thyrol-L and Remission, HS-35

Lavinia Fiscaletti

Hi Kim,

Thyro-L can help jump-start weight loss but the body will compensate for the excess thyroid hormone by dropping natural production, so any weight loss benefits fade away. The only way to keep his weight down is to feed him no more than he needs to maintain his body condition at 4.5 to 5. Any more food (of any kind) and he will gain weight. What should he weigh? Can create a photo album and put up some current photos of him?

Remission is just expensive magnesium - there's nothing special about it. You don't know if you need to supplement magnesium if you don't have a hay analysis done so you know what is/isn't in the hay.  Have you gotten the hay analysis done? If so, would you please post a copy in your case history folder. You can continue using it for the time being.

Any plain, ground, stabilized flax can be used. For a pony, he needs 2-3oz per day. Some possible sources include:  
ECIR member discount available, just mention you are member during checkout.

Stop the HS-35 as it has added iron and molasses. You can use some rinsed/soaked/rinsed beet pulp or soy hull pellets to carry supplements if needed.
You are dealing with the way his metabolism is, not a "disease" or problem that will go away or get "fixed". You need to make permanent adjustments to his management to match what his needs are.

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

Re: acth /trh

Lavinia Fiscaletti

Your testing was done correctly, Daisy.

Could you please provide the link to where you found the other information?


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

Re: Need comments on new X-rays showing more rotation, was Trim & Booting Advice Needed for Khan

Lavinia Fiscaletti

Hi Jessica,

I agree with Candice regarding the radiographs - the vet really owes you another set on their dime.

Although the rads are far from ideal, they do tell you that the pads in Khan's boots need to be flat - good that you removed the frog support part but you also need to cut the wedge off those Soft Ride pads so they are level. The wedge may be the reason it looks like there is some bony column rotation, although there's really no way to know for sure without getting proper rads taken with the feet bare and standing blocked correctly.

Her sole depth is definitely thin, toes are too far out ahead of where they need to be and there is sinking. The sinking and breakover issues have been the same all along - they haven't gotten worse. The trims are cosmetically improving the dorsal walls but are not doing anything about the toe being too far ahead at ground level. They are also continuing to remove sole where there is less-than-zero to spare - which is likely a large part of Khan's continued pain. Her heels are remaining severely underrun, which is adding to her discomfort.

You can certainly help the situation if you are willing to pick up a rasp. As mentioned, I'll need a full set of photos: the sole shots you have a re great; need a sole plane shot of each foot; laterals of the fronts from ground level rather than aiming down on the foot - like you did with the hind feet.

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

Re: New to the group, new to laminitis


Questions about Jiaogulan,

Just arrived and want to make sure I understand how to use it correctly. 

1/2 tsp and reassess 3 days later. Increase if needed. Give 20 mins before feeding twice daily. Anything else? 

Wilmary in southern, AZ, USA, 2021

David Case History:

Photo Album:

acth /trh

Daisy Shepherd

in the files it says  for trh test to draw baseline then inject trh drug then  draw blood at 15, 30, 60 minutes if i read it right.  when i did it for tiko we did  a pre blood then gave trh then in 10 minutes drew post blood.  what should i do ??  thank you daisy,tiko,whisper
Daisy, Tiko and Whisper
CO, April 2019
Case History: 
Photo Album:,,,20,2,0,0

Re: Continue Thyrol-L and Remission, HS-35


Here’s the link to QT’s case history folder.

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


Continue Thyrol-L and Remission, HS-35

Kim Utke

QT weight stable, neck roll gone, questions: (1)  continue with Thyrol-L forever for stabilizing weight? (2) Keep on with Remission as new container started  (3)  HS-35 mineral used 1/2 cup to add the supplements: (4) flax stopped first founder session, now find OK, which brand/type to use?
May 2021_Sheldon, ND 

Re: Chia Seed Omega vs Flax

Nancy C

Hi Rhonda

Chia vs flax gets discussed here all the time.  While some folks use it instead of flax, and some sources say it is better, it does not have higher Omega 3s. This is a good thread with sources to back up why and what ECIR recommends.

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021

2021 NO Laminitis! Conference Video Recordings available to new subscribers until 12.31.21

rate of insulin drop


Hello Everyone, I read within the group that a horses insulin levels should noticeably drop when going from dry hay to soaked hay and it should show in their numbers even as quickly as a week after switching..Can anyone tell me how long the insulin can continue to drop with a diet change?   After seeing a substantial drop within a month is it realistic to  hope for insulin  levels to substantially continue to drop for the next month or more after changing and improving the diet? Thank you.
Debbie Girard/Massachusetts/2021

Now: Case Histories: What You Need To Know - 12/04/2021 #cal-notice Calendar <noreply@...>

Case Histories: What You Need To Know


View Event


Your equine's Case History is the most important step to be completed upon joining the ECIR Group. It is critical for obtaining timely and specific advice from the support team.   


If you are a long time member, migrated from Yahoo, please be aware there are changes in how information is to be properly posted.  We also have a new case history form. If your case history does not contain the IR Calculator Table please transfer all your information on to the new form. The new uploading rules and instructions are located at the bottom of the case history form


We take the importance of accurate information very seriously. The information in our posts and case histories is of tremendous value to all our members. To help protect the data and your privacy only members of the main ECIR Group are granted access to the Case History Group.  If you are concerned about privacy you need only give your first name and general location.  The use of pseudonyms to keep your equine professionals anonymous is encouraged. Please review the ECIR Group Terms of Use and Privacy Policy


Don't delay posting or updating your case history. 

Missing information it can be added as you obtain it. The faster your case history is completed with what you currently know, the faster you will receive the best support from the support team. 


Please take the time to update your Case History.  An up-to-date case history is invaluable when an equine emergency crops up. Accurate documentation of management changes, the equine's responses, blood work results and links to the equine's photo album not only helps the ECIR Group gain the trust and respect of science-based equine professionals but can be used by vets who are on the ground trying to help your horse. Your Case History is the best way to effectively monitor and illustrate the results in PPID and IR management changes. 


Please leave all your information uploaded. When the time comes that you or your equine no longer need the advice of the ECIR Group, please leave your case history folder intact. Your information will be used in the future to confirm or re-shape ECIR protocols and help other members learn.  This is the best way to “give back” to the ECIR for the help you and your horse have received. 


Photos go in the Case History Photo Section.  Please help the Support Team work as efficiently as possible. Read How to Make a Photo Album for the rules and follow the Naming Pattern for photos so the Support Team can quickly locate the photos they need to see.  


Thank you for your cooperation, 

The Owners and Support Team of the ECIR Group


Re: Acth 45

Sherry Morse

Hi Lori,

If you trailered to the vet that could have elevated his ACTH.  Fasting is not something we recommend here for testing particularly for insulin and glucose. You can try a trial of pergolide for a few months with a plan on retesting at home to see if it helps but if you monitor symptoms you should see a difference in a month or so if it's actually doing something.  One last point - it's a waste of your money to split the dose.  If you decide to proceed with the trial you need to do the full dose all at once as close to the same time each day.

Acth 45


My IR 15 yr.Dusty has had a terrible fall with his itch. Partially due to warm fall, no frost to kill insects and extremely bad allergies. Vet suggested we re-ck ACTH it came back45. From reading on this group it does not seem to bad, but vet said it might help itch, immune system. So she suggested give 1 mg.  Half morning half night. Does this seem like too much. I only gave him a quarter morning and night learning from you all it was best to start low and slow..  my question is could it just be seasonal rise? A normal high? Really warm fall. If so should I continue pergolide, if so for how long,?how much,? When should I retest blood?
Sorry his history is not current with his latest test. Tested Acth only. He was trailered to vet
Not totally fasted.. will update history as soon as computer is out of shop.
Thank you
Lori, Abel, Bodie & Dusty


Redding, CA,,,50,2,0,0 .

Re: Need comments on new X-rays showing more rotation, was Trim & Booting Advice Needed for Khan

Candice Piraino

HI Jessica!

I want to comment on your latest xrays (rads) which I am going to be very blunt and honest. These rads are not doing anyone any good! To be honest, who ever took them needs to redo them free of charge - unless you didn't pay for these? You are missing part of the hoof in the picture. You should see part of the mounting blocks within the rads for a better picture. The feet should have proper markers to determine angles and sole depth (these are missing, and they should have at least marked the dorsal wall with a radio opaque concoction), and would include a known measurement marker. 

At the same time, I am also not shocked since many who use an xray machine, don't know how to properly take rads, especially of feet! I see these same issues a lot, and I tend to just mark up the feet myself before they block up the horse. Also, no boots should be worn during the rads, and both front feet should be blocked up to the same level. 

Is there a reason why your vet did the things they did with these rads do you know?

We need to eliminate the trigger of the laminitis. I will say that if your hoof care provider touched the sole of this horse's foot with a knife or even scraped too hard with a wire brush to clean it- that was not a good decision on there part. Need to retain as much material as possible. Can you locate a barefoot trimmer who specializes in laminitis? The soft rides may NOT be a happy place for Khan, and you might want to try another boot or even Equicast wooden/evo clogs. I have found that a lot of similar cases like Khan, that they do love the equicast wooden clogs. The Evo foam crushes down where the horse wants, yet providing great stability. These are casted on and stay on for several weeks at a time. They will need to be removed to continue the trimming and then recasted. 

Have you checked the PHCP website for a trimmer closer to you?

BUT you are such a great owner and trying to do all the things and keep pushing for Khan! Just listen to Khan and be the best ambassador you can be :) 

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer


Re: Need comments on new X-rays showing more rotation, was Trim & Booting Advice Needed for Khan

Jessica Gunderson

Yes, a trimmer I trust just told me that, wish my vet would have explained that to me.
Jessica and Khan
N.D., 2021 | | Album

Re: Need comments on new X-rays showing more rotation, was Trim & Booting Advice Needed for Khan

Sherry Morse

Hi Jessica,

As these x-rays were taken with her feet still in boots and not flat on a block they don't say a whole lot to me beyond she has no sole to spare and a ski tip on the left front which says these are not new issues with her feet.  To have Lavinia do mark ups again you will need a complete set of hoof photos as outlined in the Wiki:

Re: Hay analysis added

Sherry Morse

Hi Patti,

If this test was done using wet chem you should be fine with not soaking this hay but as always, you need to listen to what the horse tells you.  If she is at all sore on it or starts getting cresty it may not be suitable for her.

Was [ECIR] Chia Seed Omega vs Flax - now Welcome Rhonda in Sask.

Sherry Morse

Hello Rhonda,

Welcome to the group! As this is your first post you're getting our official welcome letter now.  Once you have questions that need answering we may refer you back to this note but please read it over now as it's full of information that you may find useful now.

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 (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. 

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.

Re: My horses don ´t eat Beet pulp


Hi Marie
Have you tried adding some flavouring to your beet pulp to make it more palatable?
Fenugreek would be a great one to try. Most horses love it and it is not only safe but actually beneficial for IR horses.
Usual dosage per 1100 pound horse is 1 Tablespoon per day and the maximum is 2 Tablespoons.
The following article gives all of the details for feeding and its benefits.
Hope this helps.

Rhonda in Sask 2021

Re: Chia Seed Omega vs Flax


Chia seeds can be used as an alternative to flax as a good second choice.
The ratio of Omega 3 to Omega 6 in chia is about 3:1, while flax is about 4:1.
Chia has a higher percentage of Omega 3 at about 63% as compared to flax at about 58% in the same sized serving.
Maintenance amount to feed is 1/2 cup per 1100 pound horse. You can feed more if you are front loading or addressing a medical issue but 2 cups is the recommended maximum.
You can use it dry as a top dressing or you can soak it and serve or mix in with other feed.

As with all other new things, introduce slowly and increase amount to full dose over a week or two.

Rhonda in Sask 2021

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