Cushing and IR horse not eating

Kelli Land

Hello Group,  I have a 23 or soyear old grade quarter horse... who was diagnosed with cushings and borderline IR 5 years ago. He has been on prascend and diet change since...his diet is LMF sr low carb complete, and burmuda pellets.  He gets his teeth checked every 6 months  and due in 2 weeks for a check, he takes 1.5 prascend sept to dec and 1  tab rest of the year.  so right now he is on 1.5 tab.  He is normally a very food motivated horse and eats hardily. He is also very seasonal with his coat and on cue grew in his winter coat already.

the last month he has been off his food so I mixed it up for him. he wont eat anything with the burmuda pellets,, his last dental check no issues were noted.  He eats his LMF pellets well and I have added brewers yeast recently to his diet. Since he has been off his food I put him back on forage ,,,, and what I have right now is orchard / alfalfa 80/20 mix.

. He is eating that well and the LMF... I am not feeding him burmuda pellets right now. 

We ran a general health lab profile on him the abnoralities on him right now are glucose 164 high,,, tryglicerides 47 high, thyroid 1.2 no range was given from lab but what I have read is low.,RBC  6.26 low and Lymphocyte count 1570 low

The veterinarian I work for is working with me,,, she is a mixed animal practice but horses are not totally on her radar for the metabolic issues.  Our thought process is that he has developed more symptoms related to the IR with the low thyroid,,, and raising his ability to process the glucose with the IR being more of a factor. The weight loss is in spite of him eating and me amping up the food anti to things he likes more. The equine dentist we use asked he not eat forage due to his missing teeth. He seems to be doing ok with eating it and I see no hay balls from him NOT being able to masticate the forage. So weight loss is my biggest concern,, he is ribby thru his winter coat, he is eating his food,, thou not as heartily but he is finishing it now that I dropped the burmuda pellets and added the hay 

Any ideas would be of use on direction to go. We were thinking probably a current IR would be beneifially ,,, shall we be adding thyroid supplentation?  Any thoughts are welcome to what we are already thinking.  I recently lost my 26 year old, he went down and was not discovered till the evening, I was away on vacation and I am having a bit of worry and concern over my other senior going down as well. Thank you 

Kelli L. in CA 2020


Welcome to the ECIR group, Kelli.  I will address a few of your concerns and send along a copy of the group welcome which includes lots of reading material about the ECIR group and how best to care for your IR or PPID horse.  It also includes many links so allow some time to look everything over.

Your horse was diagnosed with PPID and possibly IR five years ago.  How was that determined?  Have you done any blood testing to confirm this and any recent testing to ascertain how well he is doing?  PPID is a progressive disease so it’s quite possible that, although he was doing well on your dosing regimen five years ago, his pergolide needs might have changed considerably since then.

Horses with uncontrolled PPID are frequently fussy eaters.  What they devour one month might have no appeal the next.  They also tend to lose musculature so that their ribbiness  becomes more apparent.  Thyroid supplementation is frequently started to help an overweight IR horse lose some weight.  Low thyroid levels are often a result of the IR/PPID and will resolve once you have better control there without supplementing the thyroid.  IR is a frequent result of uncontrolled PPID and should improve with more appropriate pergolide dosing.  

When you read the material in the welcome letter, you may notice some changes you can make to make his diet more appropriate.  I have a barn full of seniors and some of those are fed soaked Timothy Balance Cubes, sold by Triple Crown and Ontario Dehy in Canada.  They have appropriately low sugar and starch and are mineral balanced.  My horses love them.  It’s not clear whether you’re feeding hay now but that should be analyzed to make sure its sugar and starch levels are low enough, soaking if not.  

Please get started on your Case History so we have a better idea of what the situation is and get some blood testing done so that a diagnosis is confirmed.  I’m sure others will add some of their own thoughts.  What follows is the group welcome.  Enjoy the reading and don’t hesitate to let us know of any questions you might have.


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 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: 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



My advice would be to send the bloodwork results to a second opinion vet, and get their input, since your usual vets knowledge/expertise on metabolic issues is limited. Also, those numbers could be related to a different underlying health issue going on, and you might waste precious time and resources hunting down the PPID/IR hole and miss something else really important.
Allison in Ontario 2020

Case History:
Photo Album:

LJ Friedman

I didn’t spend a lot of time reading your case history but why don’t you switch over to Timothy pellets? Horse. has to eat. I know you can’t switch over because he’s not eating the Bermuda pellets any longer.
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos


Eleanor Kellon, VMD

 The first thing to do is check ACTH and insulin. Low lymphs, triglycerdes, weight loss and diabetic range glucose could be out of control PPID. Every diabetic horse I have worked with has weight problems.
Eleanor in PA 
EC Owner 2001

Eleanor Kellon, VMD

On Thu, Oct 22, 2020 at 09:46 PM, Allison wrote:
those numbers could be related to a different underlying health issue going on, and you might waste precious time and resources hunting down the PPID/IR hole and miss something else really important.
What issues did you have in mind?
Eleanor in PA 
EC Owner 2001

Eleanor Kellon, VMD

P.S.  T4 1.2 is normal in most labs. You don't want to supplement a horse with low weight.
Eleanor in PA 
EC Owner 2001

Frances C.

You could try teff or timothy pellets
- Frances C.
December 2017, Washington & California
Case history:
Phoenix's Photo Album:


I"m sorry Dr. Kellon, I wasn't reading clearly and got confused.
I think my judgement is clouded by my own recent experiences, wherein I thought my horse was losing weight due to PPID, when it was in fact something far worse.
Allison in Ontario 2020

Case History:
Photo Album: