Emergency diet questions


I have a 31 year old Arabian gelding diagnosed with cushings and laminitis on Friday 7/29.  The vet didn’t talk about anything regarding diet with me yet.  A friend directed me to this group and the emergency diet.  He has not been able to chew hay at all and really can’t chew grass very well at all for 3-4 years now due to missing teeth.  I’ve had him on patriots senior feed always soaked to a mash 1-3/4 pounds twice a day and I also soak stampede brand Timothy/alfalfa mini cubes soaked until they’re soft shards of grass for him to eat.  Is it ok for him to eat the hay cubes?  Do you recommend I stop the hay cubes and soak hay without alfalfa instead? Is it ok to feed him the partriots senior?  I also found here that bute is not good, but the vet prescribed me to give 2 grams twice a day and to start him on 1/2 pergolide tab until bloodwork comes back.  The vet is coming out Tuesday to put him in a boot.  I had started him on cosequinn joint supplement about a month ago & shortly after he started showing lameness.  Could that supplement  have caused laminitis?   Is that a good supplement? I’m so confused what’s right and what’s best for him at his age.  There’s so much information and so much to learn & I feel time is not on my side considering his age and how much he is hurting right now. Thank you for whatever information  you can offer.  
Crystal C in AL 2022

Bobbie Day

Hello Crystal and welcome to the group!
Because this is your first time posting I will be including your welcome message below, please take time to read through it, we know it's a l lot of information, but it will help you through this journey with your horse. The ECIR'S protocol is based on DDT/E, which stands for Diagnosis, Diet, Trim and Exercise (when able). It takes all these pieces to be successful in the management of PPID and or IR.
A couple of things first.
1- As soon as your able please fill out a case history for your horse, when the bloodwork is back ask the vet to send you copies of results, we are in the beginning of the seasonal rise right now so you do need to get him started on the pergolide now, I doubt that a half a dose will be sufficient but it's a good place to start until you have results. PPID is an age-related disease affecting the pituitary, Cushing's and Insulin Resistance don't always go hand in hand, but uncontrolled PPID can lead a horse to tip over the edge to laminitis etc. And you have an older horse and one of those thrifty breeds that we need to be careful of, but you won't know for sure if he has both until you get the results. Does he have any other signs of IR? What blood work did your vet do?
You have a little more wiggle room if he is not IR but since you don't know that I would treat him as so, that means taking him off the other supplements and feed until you know for sure. The timothy balance cubes are balanced to themselves so no worries about additional minerals when they are given for feed.
2- Your correct on the Bute, we do not suggest NSAID'S for laminitis pain because it isn't inflammatory. But that being said your boy could very well be suffering from arthritis as well given his age, we recommend devils claw for pain instead, you can get Phyto-quench (without yucca from Uckele) pellets that work great for this. You can also try some Jiaogulan if his trim is in good order. Here are some links for you on the subject. If your horse happens to have an abscess giving him Bute will just complicate things. 
Pain Relief Alternatives to Bute and Banamine (groups.io)
Why NSAIDs & Icing Are Not Recommended .pdf (groups.io)
How to Taper Off NSAIDs.pages (groups.io)  
It's important to taper off these however, don't stop cold turkey.
3- Emergency diet, yes, we do suggest this diet to new members until they can get things sorted out. We strongly suggest using feed from our safe feeds list, can you source some of the cubes listed on this list and add just a little water to fluff them up so he can chew them? Beet pulp is another great feed, just be sure you get molasses free and rinse/soak and rinse again. 
Safe Bagged Feeds.pdf (groups.io)
4- Feet, we do suggest boots not shoes for these horses as they need to be on a tight schedule trim wise, I would strongly suggest x-rays and pictures again as soon as you can manage so others can comment on his trim. It's very important that when they are trimmed that the farrier leave the sole alone until we see x-rays but I'm hoping our feet guru's will comment more. Again, I would source some devils claw for pain. If it does turn out to be joint pain you can use glucosamine, chondroitin and HA. But all this is speculation until we have more information.
Beyond Joint Nutraceuticals | Dr. K's Horse Sense (wordpress.com)
Insulin, ACTH and Pain | Dr. K's Horse Sense (wordpress.com)
5- Final thoughts, we know this is a VERY stressful time for you, we have all been in your shoes, that's how we all landed here, but take a breath, gather as much information as you can and get a case history done, gather blood work results, x-rays as soon as your able. Do boot your horse and make him as comfortable as possible. No grass and No supplements that aren't tested as safe. Just add magnesium and vitamin E to his diet for now. Source Timothy Naturals if at all possible. We're all here to help you and best part is we're all in this together and you'll get tons of support and good advice here. Please let us know if you have any additional questions. 


Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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. 



Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 



Eleanor Kellon, VMD

Cosequin does contain a small dose of glucosamine but not enough to cause laminitis. Time of year and age point to PPID with insulin resistance as the cause. The diet is inappropriate. Switch from the Senior feed to Stabul 1 - you can order from Chewy.com. Switch the hay cubes to Triple Crown Naturals Timothy Balance Cubes. I would go to their web site and give them a call to find the closest supplier.

In the meantime, stop the Senior Feed, find the largest laundry bag you can, like this one https://laundrybags.com/p-368-white-mesh-net-draw-string-laundry-bags-24-x-36.aspx?feed=Froogle&gclid=Cj0KCQjw852XBhC6ARIsAJsFPN1rlzOmCkDyO44C_8sg69w3sWhZTu846DI_iOtZiVn3tHEMHJ20xUsaAvZdEALw_wcB and soak the mini cubes for an hour in a generous amount of cold water before feeding.
Eleanor in PA

EC Owner 2001