I'm ready to pull my head out of the sand about Rusty and IR, if I need to. I've been following protocol so on some level it doesn't matter, but on another level, it does matter to me.

His blood test results from Cornell on blood pulled 11/4/22, 9 am, approx 55F: 40.39 ulU/ml (lab reference range 10-40). 

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Lasell (luh-SELL) ~ Virginia USA ~ September 2022
Fairlane Rusty https://ecir.groups.io/g/CaseHistory/files/Fairlane%20Rusty%20Case%20History
Sam - likely IR, Case History to come

Hi Lasell,
Yes, that insulin value suggests IR, especially considering he’s a Morgan and symptomatic.  A truly non-IR horse would be more likely to have an insulin level of 10 +/-.  As you are managing Rusty as though he’s IR, I would definitely continue to do so.  You can check both the insulin and the ACTH about three weeks after starting pergolide to see how they’re affected.  You should see improvement much sooner than that but some time to stabilize is good. 

Rusty would still be IR with those numbers if he weren’t PPID.  You don’t know at this point how much of his insulin value is due to PPID.  My horse, Logo, was PPID, on high amounts of pergolide but never showed an insulin value above 11 or so.  While I managed his diet such that his hay was balanced and he had the supplements he needed, I was not concerned about putting him out to graze.  

PPID and IR are grouped together here because IR horses with PPID will often have elevated insulin which can be better controlled with control of the PPID, using pergolide.  However the insulin increases, whether it’s through inadequately managed IR or poorly controlled PPID, doesn’t matter when it comes to laminitis and hoof pain.  High insulin is the cause of these symptoms and getting the insulin down is the goal.  If Rusty is PPID, you can likely accomplish a portion of that goal with pergolide.  The rest will need to come from the management advice we give here.
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Thank you, Martha. This helps a lot. 
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Lasell (luh-SELL) ~ Virginia USA ~ September 2022
Fairlane Rusty https://ecir.groups.io/g/CaseHistory/files/Fairlane%20Rusty%20Case%20History
Sam - likely IR, Case History to come

Lasell,

To put your insulin result in perspective, 40 is what you would see after a grain feeding in an insulin sensitive horse and is definitely too high for a horse on a low carb regimen.
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Eleanor in PA

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