Fresh blood work, updated case history and disappointed


Got Salsa's blood work from last week back.  Case history is up-to-date.  Hay is balanced by Dr Kellon (and I took her class this year to learn that myself too).
You think you're doing at least "ok" and then....blood work.
Glucose 92 (71-122), Insulin 116.52 (10-40) and ACTH 29.2 (9-35) all at Cornell.  He was very skittish/agitated when the vet was here - more than usual (he always snorts).
His hay is a little over 10% nsc and I have a hay feeder machine that drops it every 4 hours. I keep a bath scale in the barn to weigh it often though not religiously.
Currently NO tender feet and supposed to go trail ride on the 25th (all walking - friend has a green horse she's working with).
I noted in mid July he was a little tender footed and that he had been same time in 2019.  With boots he'd run around and play.  After about a week - no more tender feet - boots off.
I also noted on September 8th this year that winter coat coming in around head/neck/shoulders.  Sept 14 I noted more drinking - that is now past and he's drinking normally.
My husband's job was "eliminated" in August (and we found out sometime in July - it's all a blur) - so that's why I didn't get the vet out sooner - I couldn't - we were reeling.
I suspect Salsa may need a little extra Prascend for the seasonal rise based on signs/symptoms even though his current ACTH is in range - even now in the rise.  Thoughts?  I think next year maybe early July (??) get the vet out to pull ACTH then to try to get a little ahead of the rise (right?).
I also know I need to exercise Salsa to deal with that insulin AND I suspect soaking the hay is in order. 
Like most of you I work, have a family and 2020 has generally kicked our behinds but time to ride/work Salsa will have to be prioritized and soaking the hay.

Does my plan to increase exercise, soak hay and NEXT year get ahead of the rise because of these symptoms seem right?
Hubby also got a new contract gig starting soon - so that is good - hopefully it goes permanent.
Thanks everyone!
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History

LJ Friedman

I don’t see anything wrong with that ACTH level this time of year? Thinking what else is causing the high insulin? Maybe it’s not the PPID?
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos


Sherry Morse

Hi Tracy,

The insulin is the most concerning to me because that is over the danger zone so I definitely would start soaking the hay and keep up with the exercise as he's not sore at the moment. Being agitated with the vet could cause a bump up, but that's quite a bump.  Would love to hear others' opinions on it.