advice on buying a horse with abnormal glucose test


I am looking at an 11 year old Paint mare who recently had an abnormal result on an insulin oral sugar test.  Horse was fasted overnight and then given 75 ml of Light Karo syrup.  Blood test taken one hour later showed a result of 117 (according to vet normal is less than 60).  Not sure the units of measurement.  

Horse is very slightly overweight.  Not cresty, although I see slight fat pads behind the shoulders.  No previous history of laminitis or founder.  Feet are good on x-ray.  Management of horse was changed to turnout with grazing muzzle and addition of Thyro L one month ago.  

So, am I looking to buy trouble?  This horse is a unicorn otherwise.  I sure would like to work it out if possible, but don't want to buy heartbreak.  I will, of course, do a PPE.  Are there further tests that would help me make a decision?  Thank you all for your help.  

Eleanor Kellon, VMD

A glucose of 117 would be normal. That's insulin which has an upper normal of 60, not glucose. This horse has EMS if it's 117 insulin. It does't have to mean trouble with lots of exercise and correct feeding.
Eleanor in PA 
EC Owner 2001


Thank you so much for your prompt reply. It was insulin level which was 117, so horse has EMS. She is currently on 2 scoops Thyro L in am and 1 in pm, for a total of 36 mg daily. The mare has been on this for approximately one month. Would you continue this at the present dose, and if so, for how long?

Mare is currently on Pro-Elite ration balancer, mixed fescue/Timothy hay, and grazing muzzle when out. I will need to change hay to a mixture of Coastal Bermuda/Timothy since fescue is not available here. Would you continue her on ration balancer or go to something like California Trace Plus with Timothy pellets or soaked beet pulp?

Again, thanks so much for the help.



I don't think anyone can give you recommedations for this horse without having more info.  So much depends on many factors. Thyro L can be useful to jump start weight loss in obese horses, but it is not a magic bullet to 
"fix" EMS. You do not want to simply discontinue it however, as now the horse is dependent on supplemental thyroid hormone, and suddenly discontinuing it could cause a metabolic crisis. If she is not to continue the ThryroL you will want to wean her slowly off of it.
Regarding the Pro Elite and a different balancer, again, the horse's total diet will have to be analyzed and then recommendations made. The hay the mare will be on, where you are located, and how much of that hay will make up her diet will factor into it. You would want to consider whether or not you are going to graze her, even with a muzzle, it's a roulette wheel right now with her diagnosis. How much she weighs, how much she should weigh, her work load, etc. will all factor in. 

As Dr. Kellon said, EMS is not a disease, rather it is a type. Horses of this type need to be managed appropriately for the thriftiness built into their metabolism. Do that and they should be fine. With all the horses out there with lameness or poor training/problems, finding one that's a unicorn makes the EMS not an issue in my view. 
If you do indeed buy her, please update the list. You will find lots of help here.
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History


Hi, Susan, and welcome to the group!  I am glad you found us :) 

You have gotten some good responses so far, and there is more to come. 

Regarding the Pro Elite: 6.5% starch is too high, because starch packs more of a wallop than simple sugars (starch breaks down to 100% glucose, while sucrose is 50% glucose, 50% fructose). You might be able to get away with this if the recommended feeding rate were a few grams of product, but feeding a pound a day would certainly contribute to issues. Also, a pound of the Pro Elite provides only 1 mg of copper and 272 mg of zinc, so not really enough to even meet the bare minimum NRC requirement, let alone balance any hay. Add in the 318 mg of iron, and the advantage of the added copper and zinc are tossed out anyway.  

Your instinct to switch out to a better balancer is right on the money. As Dawn says, the best route is hay analysis and get an appropriate balancer for your hay. In the meantime, there are some good (and safe) balancers out there: (you can find this list in the Diet Balancing folder in the files:  )

Acceptable Ration Balancers (but very much second best to hay analysis and custom mix). These all have no added iron, a very important consideration for our metabolically challenged equines.

Uckele U-Balance Foundation  (some horses don’t like the taste)


California Trace Plus  (will need to add magnesium)


Colorado Mix  (no selenium) (will need to add magnesium)



Colorado Se Mix (will need to add magnesium)





  VifArgen Le Cheval au Naturel 


Mad Barn AminoTrace+


  For areas where added manganese is necessary:

Mad Barn Omneity Powder

Mad Barn Omneity Pellet

Mad Barn Trace Mineral Pack



Sport Horse Grass

Equi-Base Grass

Arizona Copper Complete (contains manganese) (will need to add magnesium)


Note that one should find out if one is in an area needing selenium, or if you are in a selenium-rich area; the same applies to manganese. Your agricultural extension office should be able to tell you.

Here is the official welcome letter. It is full of information, so grab a cuppa and take your time. There are some changes to one's horse-keeping routines when dealing with an EMS horse, but some of those changes are hugely beneficial to any horse (such as analyzing hay and balancing the diet).

The ECIR 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.

In order to help you and your equine quickly and effectively, we need you to explain your equine's situation by following the instructions you were sent upon joining. Your completed case history form and ECIR Signature will save days of back and forth questions. If you haven't done so yet, please join our case history sub-group. Follow the uploading instructions so your folder is properly set up and then upload your case history. If you have any trouble, just post a message or email the case history group explaining specifically 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, substituteadiponectin 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.

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.

We ask all members to sign their first name, general location, date of joining and link to the case history and photo album every time they post. It helps us to find your info faster to answer your questions better. You can set up an automatic signature so you don't have to remember to do it. 


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

Ask any and all questions, and, again, welcome!


 Jaini Clougher (BSc, BVSc)

Merlin and Maggie (over the bridge), Gypsy, Ranger
ECIR mod/support, BC 09 .

Susan Bonner <susantbonner@...>

Very, very helpful. Thank you all.