Re: Vet on board with Invokana- actively laminitic and in season

Nancy C

Hang in Cass.
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 23 - 25, Harrisburg, PA

Vet on board with Invokana- actively laminitic and in season


Cayuse is actively laminitic this morning after an amateur fake out move two days ago acting like pads fixed everything. My vet is on the way to take radiographs with blocks. When I mentioned that my noncycling mare was actively cycling, he mentioned a shot of some estrogen-like medication. Are we familiar with it and is it worth a try? I’m thinking of taking blood samples again to check for mate issues. Will banamine interfere? 

No, I’m not breathing. 
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 

Re: Purina Equilibrium Optimal

Lorna Cane

Hi Sherry,

I do know someone feeding it. Her balancing was done by   a super knowledgeable balancer here, who was just as surprised as all of us that Purina would have a product which safely fit into her nutritional program,to provide a good mineral base.
Her horse has been on it since the Fall, and is not showing any red flags clinically. His recent bloods just came back, and I *think* his insulin is good,but there's some confusion(my mind) about units, just to be sure.
I agree with you about Purina, but I began an analysis  conversation, because it would be great if this product could fit into someone else's program,too. Especially since our choices up here( for difficult situations), although widening, are pretty slim.


Lorna  in Eastern  Ontario
Check out FAQ -


Re: Purina Equilibrium Optimal

Sherry Morse

Hi Lorna,

I can't recall, but did anybody respond that they're feeding this?  At this point I'd take anything Purina said with a grain of salt, but I think it would be worth sending a sample in to Equi-Analytical for testing.

Re: Purina Equilibrium Optimal

Lorna Cane

Purina wrote back to ask if knowing the starch number would be helpful,to which I replied yes.

They sent the sugar number today,which they estimate at 4%. No starch number.

I've asked about starch. I suppose they will have to say between 3 and 7,to concur with their first figures, but....I'll report back.
They also sent me outdated and incurrect info wrt NSC, fructans,IR horses,etc. but I can't get it to copy.

(I guess,in a way,it's a waste of time,since they are only talking  estimates.)


Lorna  in Eastern  Ontario
Check out FAQ -


Re: Understanding Lab Results

Eleanor Kellon, VMD

I agree that glucose is far too low to be accurate - probably delay in separating the cells from the serum. The insulin is clearly abnormal for a low S/S diet but not in the acute laminitis risk range. Insulin is more tolerant of handling errors.  ACTH though is also very  sensitive to handling so you can't trust that result.
Eleanor in PA 
EC Owner 2001

Re: Understanding Lab Results

Sherry Morse

Hi Joule,

I'd like to hear Dr. Kellon's thought on that glucose because it's low enough that I wonder if something happened with testing - which could be throwing off the G:I ratio in the calculator and be one of the reasons you're getting mixed results as the RISQI only looks at insulin and not glucose. For the horses we see here that's a decent insulin level (as well as Leptin and ACTH) so I would continue the same management/feeding that you're using at the moment and just keep a close eye on him to make sure he's not developing any signs that the IR is becoming an issue.  

Re: Understanding Lab Results


Ok, sorry, I’m new to testing and just want to be able to interpret results. It is confusing when I am told that my horse is both compensated and uncompensated at once - I assume this means he’s borderline. 

Numbers (Cornell)

Serum Glucose 46 mg/dl - ref 71-122
Plasma Insulin 20.09 ulU/ml - ref 10-40
Plasma Leptin 5.42 ng/ml

Plasma ACTH 14.6 pg/ml - ref 9-35
Serum T4 2.14 ug/dl - ref 1-3


On May 22, 2020, at 6:52 AM, Sherry Morse via <sherry_morse@...> wrote:

Hi Joule,

Without actual numbers for insulin and glucose or a case history I'm not sure what you're asking.  Based on the calculator results alone there's an indication that tighter diet control is needed.

Joule Tallman
Barefoot Trimmer
Saskatchewan, Canada 🇨🇦 
Member since 2019

Re: Vet suggesting euthanasia, any suggestions welcome...

Eleanor Kellon, VMD

We have quite a few horses on the group which have persistently elevated insulins, even without pain to that extent. The condition seems to progressively worsen in some horses but fortunately they respond to either metformin or Invokana. There have been no Invokana failures, even in horses that did not respond to metformin.

The pathophysiology of the pain is complicated and not completely understood but neuropathic changes to the nerves has been documented (acetyl-l-carnitine for that) and so has greatly elevated levels of endothelin-1, a potent vasoconstrictor that is higher in chronic than acute cases. Jiaogulan addresses that.

The Lyme cases I have been involved with have much greater pain and hoof damage than you would predict from relatively small elevations in insulin but that could be a different story in a horse with EMS at baseline.
Eleanor in PA 
EC Owner 2001

Re: Bali Update and the perils of change

Sherry Morse

Hi Mel,

Sorry you got sucked into that but just as a note, given Bali's ACTH of 48 in February, if she were mine I'd bump her Prascend dosage up and then retest to see if she's in the normal range before the seasonal range.  That result at this time of year says that the Prascend isn't enough to control her ACTH and since she already has a history of laminitis making sure she's as well controlled as possible will hopefully prevent a recurrence this year.

Re: Vet suggesting euthanasia, any suggestions welcome...

Alicia Harlov

Oh yes I totally agree, but we can't seem to find the source.. I keep telling her that we haven't found the trigger yet if she's still painful. 

Vet hasn't tested for Lyme. I've asked him 3 times. He says there isn't much evidence that Lyme causes laminitic pain. He mentioned a few studies of why some think that but I was trimming and not totally focused on what he was saying. He doesn't think it would cause 1.5 years of pain. He isn't against testing for it, I'm hoping he does test this next trim on Monday.
-Alicia Harlov in South Hamilton, MA 
PHCP hoofcare provider, The Humble Hoof podcast

Re: Understanding Lab Results

Sherry Morse

Hi Joule,

Without actual numbers for insulin and glucose or a case history I'm not sure what you're asking.  Based on the calculator results alone there's an indication that tighter diet control is needed.

Re: Vet suggesting euthanasia, any suggestions welcome...

Eleanor Kellon, VMD

I  hope this doesn't come across as sounding flippant but the only way to control the pain is to remove the source.
Eleanor in PA 
EC Owner 2001

Re: Article


Thank you Eleanor and Kathleen.  The article did look interesting but I didn't expect much.
Jean and Amber (over the bridge)

Nikki and Buster

South Carolina

August 2004

NRCPlus 0412; CIR 0813, 1211; NAT 0612

Re: Safe feed for my hard keeping gelding with laminitis


There is a list of Safe Bagged Feeds in the FILES section.  You want ESC + Starch = <10% 
It is each food.  
Ontario DHYTimothy Balance Cubes are safe cubes. (Or Triple Crown Naturals) 


Jeannean, Cricket & Prince Willy Mercuri ~ PHCP Barefoot Trimmer/Mentor

Ridge, NY 2011 

Re: Safe feed for my hard keeping gelding with laminitis


Hi Emma!  

Good to have you here!

I understand you are looking for a safe feed for your horse that will promote weight gain.  There is some confusion about what metric you should be looking at when choosing your feed.  The emergency diet we promote looks for an ESC plus starch at a combined level of less than 10%.  NSC is non structural carbohydrates while ESC is ethanol soluble carbohydrates.  There is a lot of reading that can be done on this topic and I will include our formal welcome here which has many informational links, including on diet.  Until you have had your hay analyzed, you will want to soak and rinse it.  There is a limited number of bagged feeds which meet our criteria and they are listed under ‘safe feeds’.  One of the more popular ones is Ontario Dehy Timothy Balance Cubes, which are tested and have minerals added to balance their assay and a bit of beet pulp as a binder.  Rinsed, soaked and rinsed again beet pulp is another option.

I am familiar with the issue of trying to put weight on your horse, given the circumstances, but first it’s important to get a formal diagnosis.  I gather your horse is having issues with soundness.  Has your vet taken a look and made a diagnosis?  We have a section on preparing your vet to take the correct blood samples if you suspect he is insulin resistant.  Your guy might also have PPID (Cushings) which requires a different treatment, as well or instead.  Now is a good time to gather that information, for a number of reasons.

I’m sure you will have lots of questions after digging into our resources.  We are here to answer them and guide you along the way, both in terms of navigating this site and managing your horse’s health.  We have many Canadian members here, including a number from Ontario.  Beginning your Case History is a good place to start so we can better understand the situation.

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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. 



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


Bali Update and the perils of change

Mel V

I wanted to provide an update on Bali.  I updated her case history and uploaded a new PDF into the folder below.

I have been taking pictures to document each time we re-shoe her, but the interface to upload onto the ECIR folders is very cumbersome for me, so I've been documenting in my Google Drive and have made the folder of Bali Feet shareable.  I've largely been following the naming convention, but sometimes there are a couple of pictures of the same angles.  

Feb 17, 2020, I'd gone in for a workup thinking that the puncture had some scar tissue, and my vet said  she'd been suffering from low grade laminitis from a "no grain" diet change I'd tried,

This diet is advocated by a Dr. Geoff Tucker, who runs a facebook page  "The Horse's Advocate"... and a his lengthy blog on nutrition. The long and short of this diet is that he recommends no grain, no supplements, and grass hay, alfalfa or alfalfa pellets and de-hulled soy bean meal (48% protein), Coolstance Copra or Whey if the horse needs more calories.  He is opposed to beet pulp, flax, and almost everything that is recommended for an ECIR horse here.  Well, the no-grain part is consistent.  I've thought of starting a spreadsheet comparing the recommendations, but essentially almost everything his diet recommends is on the "things to avoid" list here.  
He also has a nutritional "course" that you can sign up for and take, but I never took the course.  I have a couple of friends who are huge fans of this diet, but they do not have metabolic horses.

When I made this diet change, which is working quite nicely for my OTTB, I also had started Bali on Prascend, after the nail puncture/infection that triggered this entire cascading disaster for her feet/health.  We thought she was foundering last summer, but found the pocket of infection at Labor Day weekend. We'd tested her for cushings and she was off the chart (likely the pain). But, then when I switched to this Alfalfa pellet/SBM diet, I didn't realize I was triggering laminitis, and since she'd had that huge infection in her LF, then a massive abscess (likely a gravel) in her LH, I was blaming the lame steps on recovering from those to hoof traumas.  I also stopped the thyro-l as she'd lost quite a bit of weight on the Prascend and my vet thought it would be ok, she'd been on thyro-l since she was 8, and it does a fantastic job on her.  I've had 3 horses who I've had really good success with soundness using the very affordable Thyro-L as the only medication.  They go off it, laminitis, back on, comfortable.

With removing the alfalfa and SBM, putting her back on thyro-l and she went into the dry lots as spring was arriving early, the low grade laminitis appears to be gone, growth is looking normal.

I will  have her insulin, glucose and ACTH levels tested again later when the budget allows, and update her case history with results.  But for now, clinical soundness is what we were after, and that is where we are.  She does not flare up or get sore with 15-20 minutes of grass (after exercise usually) or a treat or two.   

She's currently getting the 7 shot Adequan series, she is 16 and I've found this helps.  Her last series was in 2016 or early 2017. 

Thank you for running the forum and while my vets and farriers didn't agree with 100% of the trimming recommendations suggested here, we have reached my end goal, which is a sound, happy horse.  It will be another 6 months to grow her foot completely out, but the new growth looks good.  
Mel & Bali
Joined ECIR 2/23/2020
Purcellville, Virginia, USA
Case History:
Updated Photos:

Safe feed for my hard keeping gelding with laminitis


Hi all.

I am trying to find a safe feed to add to my gelding's emergency diet as he is a hardkeeper and already gets as much hay and timothy cubes/beet pulp as he can eat in a day. The feed companies here in Ontario keep telling me that some of their feeds are safe because it is the total NSC consumed that should be under 10%. I have heard this is not the case - that you need to look as the NSC of EACH feed individually. Now I am at a loss for what to give him that will keep him from getting thinner but be safe for his feet!!

Any help is greatly appreciated!
Emma Pote, Ontario Canada, 2020

Re: Markups and Lavinia


Oops,  the other message sent without my message.  Thanks Lavinia for the markups and info! 
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History

 Photos,,,20,2,0,0  .


Case History




Re: Vet suggesting euthanasia, any suggestions welcome...

Lavinia Fiscaletti

Has she been tested for Lyme?

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

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