Prascend dose recommendation needed for Dot


We just did blood work again for insulin & ACTH on 11/11/22.  I’ve listed below all his recent numbers.  He is 14H Welsh Cob/Arabian, estimated weight currently 807-835 measured multiple ways, getting 1 mg Prascend per day.  I think he needs an increase but am not confident in the boarding barn staff handling half pills properly.  Can I safely up him to 2 pills/day for a few weeks, then retest both ACTH & insulin?  I plan to switch to a compounding pharmacy to get a more accurate dose, but need time for that to process and be delivered.  He was being treated with antibiotics for a liver infection from roughly Feb-May which may have affected his insulin level (per my vet).

Dr Kellon has balanced his hay and we are feeding TC Balance Timothy cubes with all recommended supplements.  Hay has been soaked for the last 3 1/2 weeks also, but Dr K said that was no longer necessary since the ESC & starch are low.  He is also no longer foot sore, so spending a lot more time out of the Cloud boots.

Thank you so much!!

All labs done by Cornell
11/11/22  ACTH     31.9 pg/mL           Insulin     132.03 uIU/mL
9/29/22    ACTH     30.1                      Insulin     >200
7/28/22    ACTH     21.2                      Insulin     128
3/14/22    ACTH     21                         Insulin     >200  (retest 3/28/22 was 80)
Nancy O, Colorado, 2022

Eleanor Kellon, VMD


I would probably wait until well after the seasonal rise to decide on a pergolide increase - recheck in March. Is he still on metformin? I suspect much of his insulin level is not actually directly related to PPID.
Eleanor in PA 
EC Owner 2001
The first step to wisdom is "I don't know."


I’m sorry, I mean to include that in my post.  We syringed metformin to him twice daily (eleven 1,000mg pills ground, BID) from May through September.  At first it dropped to 124 (early June), then 128 (late July) but at the end of Sept it was back up >200.  Since it appeared to not be effective the vet advised to discontinue.

A few days ago a link to the Member List wast included in a post.  Dr McCall, who is in the same town where Dot is boarded at, has been a member since 2005.  I have contacted him and will have him out for an opinion.  Interestingly, Dr McCall was out as the weekend back up for another vet in June 2021 for what seemed to be a viral infection.  He told me a lot of interesting things about PPID that I didn’t know what to make of at the time.  None of my previous vets had ever mentioned these symptoms or concerns.  Now I get it.
Nancy O, Colorado, 2022