IR Mare

shan taber

I originally posted this in the FB group and have been directed here for some assistance.

I have a 25 year old National Show Horse mare. She is IR as of November. Her ACTH has been normal but her Glucose was 97 in November and her Insulin was 48. Last week we re-did bloodwork and her Glucose was 194 and her Insulin was 92!!!! I have her on a diet of: Soaked alfalfa cubes and pellets, BOSS and soaked beet pulp (it's blue seal, and says no molasses, but the color has been reddish and stickier than the other brands I've gotten, so we will be switching back to Standlee product soon). She also gets 1st cut hay that has not been tested for NSC and I'm sure it isn't perfect hay, but it's what we have access too. It's a bit more grassy/green than I'd like to see, but it's hard to find the stuff at all around us and most people have 2nd cut. She is exercised a few times a week, but not a lot right now because of the weather we are in upstate NY and it's been frigid. She does spend time in her stall, but she has a very large airy stall and goats in the stall next to her so she's always occupied. Treats: She does get a carrot twice a day with her pill. She has heaves and takes dex 4 mg BID so I give her that with a small piece of carrot. Supplements: She gets TC 30 supplement 1.5 C a day and 1 scoop of selenium (it's natural kind not synthetic) with vit e. When I got this mare back after 15 years apart in November, she looked like crap. She'd been on pasture, her feet were horribly long, her teeth were sharp, she had untreated heaves and fatty lumps. She looks incredible now, shiny coat, fatty lumps gone, her heaves have improved on meds and changing her environment, and since she arrived, she's had little access to grass due to snow. So she's mostly been eating hay and her soaked feed and the occasional treat. What else could I do? Vet wants to put her on Levothyroxin or a reservatrol type product. I'm just not sure what else I can put her on to help...or what I can do. She is 25, but she loves life and has tons of energy now that she's getting proper care, but despite doing EVERYTHING "right", her numbers have gotten WORSE since she came!!!

(Update as of 3/6/15)

I switched to Standlee Beet Pulp pellets yesterday. They are grey, not sticky, and seem to have zero molasses, unlike the red mess I got from Blue Seal (which they SWEAR has ZERO molasses).

I will have her numbers re-checked when we get her teeth floated in May.

Any suggestions what I could be doing differently diet wise?

Does she need to be dry-lotted? Until November when she came back to live with me, for 15 years she had been out on pasture mostly. Thick, green, lush pasture at her old home...We have 10 acres of WOODS, so this might be beneficial that we don't have a huge grassy pasture for her. We will be fencing in some areas for her this year where the goats can clear out some brush but she won't have constant access to lush grass...

As far as the dexamethasone goes.... She takes 1 pill twice a day for now. If I get her off of it, she can hardly breathe. As in she's gasping for air. So I'm not sure that's an option to get her off of the dex.... It's also not feasible for me to soak her hay in the winter, so maybe with nicer weather coming and getting her outside more, and hopefully soaking hay again....I know lots of people will say dex could cause her to founder, but there has only been anecdotal evidence of that and her vet feels this low dose doesn't put her at any greater risk.

We are working with a natural farrier who specializes in barefoot trims and laminitis. She has foundered many years ago, and when she just came back to me in November her feet were a MESS> very long toes and high heels. He has gotten them nice and short with 2 trims and they are looking better and she's feeling better.

Any help appreciated....

Eleanor Kellon, VMD

There are a lot of issues to sort through here and I hope you can get a formal history up soon because that will help.

In the meantime, at her age I would always be suspicious of a potential component of PPID in poor IR control, regardless of the ACTH (which I assume came from Cornell???).

As you seem to already realize, there are multiple areas where her diet could be tightened up.  There's really no getting around that. 

It is well documented that dexamethasone induces insulin resistance in all species, including horses. Even topical dex can do this.  It is also well documented that elevated insulin will cause laminitis.  What hasn't been done experimentally, and I'm sure won't, is to deliberately give dexamethasone to IR horses to see if they are more likely to develop laminitis than non-IR horses on dex. The closest thing to this is many observations of laminitis after dex suppression tests or injection of arthritic joints.  There is also enough of a problem that manufacturers are required to put a warning on their package inserts.  It's really several cuts above an isolated anecdote.

Instead of dexamethasone you could consider trying her on clenbuterol or albuterol which are actually beneficial for IR.  Another option is Lung EQ:

Search results for: 'lung eq' - Uckele Health & Nutrition
Eleanor in PA
EC Co-owner
Feb 2001


Hi "shyde1982",

Welcome to the group!  You've come to the right place for help!  Please tell us your first name so we know what to call you.  You've given us quite a bit of information about your mare, but what we really need you to do so that we have all the details we need to give you the best advice is to fill out a case history on her.  To do that, you need to join one of our sister groups called ECH8.  Here's a link to that group:  Once you get approved, which shouldn't take long, just follow the instructions to fill out a case history (CH) on your girl.  If you have any trouble joining ECH8, just let us know and we can send you an invite.  Meanwhile, I will tell our about our philosophy called DDT/E, which stands for Diagnosis, Diet, Trim and Exercise, and make some comments on the information that you have already provided us.  

Diagnosis:  As I was typing away, I see that Dr Kellon wrote you a note with lots of the stuff I was including with regard to the ACTH, dex, etc.  So please read her post:( and I will go right to Diet.  

Diet:  The diet that we recommend is a forage based low sugar starch (tested to be under 10% sugar+starch) low fat (4% or under) mineral balanced diet.  We use grass hay, tested to be under 10% sugar+starch, with minerals added to balance the hay to the analysis and to replace what is lost during the hay curing process, we add Vitamin E and ground flax seed.  This diet is crucial for an IR horse, but it also supports the delicate immune system of the PPID horse.  Until you get your hay tested, we recommend that you start your horse on the emergency diet.  Details of the emergency diet can be found on our website here:  The emergency diet is too be used only temporarily until you can get your hay tested and balanced.  Since your hay is untested you should be soaking it for an hour in cold water or 30 minutes in hot water to remove up to about 30% of the sugar content.  Make sure that you dump the sugary water where the horse(s) can't get too it.  Soaking in freezing weather CAN be done!  Try using a large cooler with wheels and soaking in hot water.  Once drained, you can just wheel it over and feed right out of the cooler!  Make sure you drain the water where the horse(s) can't get to it!  Stop the BOSS, alfalfa cubes and pellets, and TC 30% for now.  Get down to the basics--soaked hay and the emergency ingredients as listed in rinsed/soaked/rinsed beet pulp.  Less is more!  And the soaking will give you a double whammy bonus!  Better for her airway AND better for her IR!!

We like to send our hay for analysis to this lab.   and ask for the #603, trainers' package for $54.  Once you get your hay tested, we will help you to get your diet balanced.  Just let us know when you get the results back.

As important as what you do feed on the IR diet is what you DON'T feed!  No grain, no pelleted or senior feeds, no pasture (even dead looking grass), no sugary treats (including carrots and apples), no molasses, as you already know. 

Trim:  Sounds like you are making great progress on the trim!  You are welcome to post pictures of your horse's feet in the PHOTOS section of ECH8 for one of our hoof gurus to look and see if your trim is spot on.  Here's a website that shows how to take good hoof pictures:  

Exercise:  The best IR buster there is, but a laminitic horse should never be forced to move!   You don't mention if your horse is  footsore, but if so, boots and pads may be in order for her comfort.

Hang in there!  Get your case history filled out so we have all the details to help you sort through all of this better!  Read the website, files, old messages...lots to learn here!!

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

Donna Coughlin

Dr. Kellon,

Your mention of clenbuterol or albuterol for a horse with COPD (or other breathing issues) caught my eye. In years past, you've given me recommendations for my IR COPD horse, Robin Goodfellow. He is a 15.2, 950 lb., 11 year old Welsh Cob/Arab cross. His case history is below. Aside from his breathing, and the persistent IR (insulin, leptin high on semi-annual blood tests, putting him at high risk for laminitis), he is very healthy and has never had any footsoreness. He is in moderate work 5 days a week. Case history link is below.

During the winter, his breathing problems lessen, but they still affect his desire and ability to canter for anything but short distances (a few 20 meter circles). He's relatively comfortable at the trot, again better in the winter. I might add, he's a wild man when free lunging, although it definitely causes abnormally heavy breathing. If past years are any indication, these breathing problems will worsen in the spring and summer. He is totally comfortable when not working. Obviously I worry that this impacts our ability to work him enough to bring down his insulin. I was very interested to read in your post that clenbuterol or albuterol lower insulin; I wasn't aware of that.

He is on steamed hay (thank you to Joan for THM article on steamers) and enough TC Lite to carry his supplements, which include minerals balanced to hay, j-herb, vit. E, iodized salt, flax, Mov-Ease, spirulina, ALCAR, chondroitin and MSM (the last amounts match those in Uckele's Lung EQ). Thanks also to your suggestion, he gets Jet Breath every day. Several years ago, I tried iodide salt (also at your suggestion) and it didn't help. Last year I was both steaming and soaking his hay (somewhat high s/s) and the soaking made no difference to his breathing. 

Once, we tried using an human inhaler (similar to one sold for horses) with albuterol, and that dose before being worked actually seemed to help, hard to say because we were only able to administer it once. He completely panics, and now even when he hears a soda can opening, he has a heart attack. So no inhaler!

A friend's trainer treats a COPD pony with albuterol sulfate syrup, brand name "High Tech." Pony loves it. I was wondering if you would recommend this and at what dose? Or would clenbuterol be better? Does it come as an oral med? If it's preferable, what dose? I would ideally like to give it to him before he works--does that make sense? If so, how long before he works?

Thank you again for this group and for all your help. I'm sure mini Duke would no longer be causing mischief and joy if it weren't for all of you!

Donna Coughlin, Duke, Robin and Obi
CT 2009

Eleanor Kellon, VMD

Yahoo acting up. Hope this isn't a duplicate.  I would try the human liquid Albuterol, 1 mg per 100 lbs body weight, 30 minutes before work.

Eleanor in PA
EC Co-owner
Feb 2001