Horse in Crisis - New Member
I am confused about the below section for the Emergency Diet that I put in italics. My horse was diagnosed with Cushings in October of 2018. As of January this year he had his vaccines and I have always had his feet trimmed every 4-5 weeks since I have got him 21 years ago. All other blood work was fine for function. His insulin was slightly elevated (60's). So him being lame all really started the past couple of weeks and he is in pain right now. He is on bute. Xrays show some rotation. He is 29 and was just diagnosed this week with IR with his insulin results being "greater than 200". Also worth noting he is on Pergolide. He was on Purina Senior and no forage (per my vets recommendation which I think looking back on it is wrong) which I took him off of this morning doing the Emergency diet. I went this morning to the feed store grabbed some Bermuda hay and soaked it for an hour. I am trying to find a place to get hay tested but I am at a loss at the moment. People look at me funny when I ask where I can get this done. Also, I am assuming unless I buy hay in bulk again I am going to need to constantly get it tested from the feed store correct? If I am soaking the hay for an hour and it still has glucose am I doing more harm? If I am soaking it do I need to worry about getting it tested? I have been reading so much I am starting to confuse myself. I need to stop the inflammation and bring his insulin down asap!!! Am I doing the right thing? I am also getting metformin this afternoon as soon as my vet says it has been delivered. If I am able to get this turned around do you have any recommendations for feed? I have been told by a few people Purina Wellsolve LS but I am open to other ideas.
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.--
Piera M in LA 2020
Eleanor Kellon, VMD
You will be getting a full welcome message soon but just a few things.
Assuming the units of measure on your insulin were uIU, the result in the 60s was already highly elevated. Try to locate a feed dealer than handles Triple Crown and get him on the Naturals Timothy Balance Cubes as a complete feed. If you can't locate a dealer, send a mail to ahenriques@.... They manufacture the cubes. You won't have to worry about testing hay or mineral balancing. Also need to make sure his pergolide dose is sufficient to get ACTH in a normal range.
Eleanor in PA
Welcome to the ECIR group. I’m sorry your horse is having troubles. We will do our best to help you get him more comfortable. Take a deep breath and let me help get you started. Please come back with more questions as they arise.
The best thing for you to do next is get your horse onto the emergency diet until you can figure out the next steps. You found some hay to soak and have done that. Be sure to rinse it well afterwards and not to leave the drainings where horses have access. You don’t really need to test anything on the emergency diet because that takes time you don’t have when things are bad. You mention that there are some parts of the emergency diet which confuse you. It may be that your italics did not transfer into your message but they aren’t obvious to me. Perhaps you can clarify those concerns?
Testing is done by sampling your hay and sending it to Equi-analytical for analysis. They are located in Ithaca, NY. There is lots of information on our site about getting this done. If you’re buying your hay a bale or two at a time, this will not work and you may need to get more creative. There is lots of discussion on our site among people with similar concerns.
I would not spend a lot of time polling others about what to feed. That will only confuse you at this point when you should be more concerned about what not to feed.
And the next thing that needs to happen after starting to feed your horse the emergency diet, is to assemble a Case History for us to review. We will link you to a form to fill out giving all sorts of specifics on your horse. The more you share in the form, the better. Information you put in posts like this will get lost before long but you can replace your CH with an updated version as often as you please.
What follows is an official ECIR welcome with links to lots of different information. It will take quite awhile to absorb it all so make yourself comfortable and don’t hesitate to check it again.
Welcome to the group!
The ECIR 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 etiquette, what 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, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.
*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.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
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.
EXERCISE: The 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.
If you have any technical difficulties, please let us know so we can help you.
Martha in Vermont
ECIR Group Primary Response
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)
Martha and Logo
Thank you for getting a case history posted. If you could please add the link to your signature (using the folder link:
Hi Again Piera,
Now that I've had a look at your Case History I have some questions for you:
Current ACTH level? I see you have him on 2mg of Prascend and you said his other bloodwork was ok, but having an actual number for that is really helpful to us
Ditto on glucose - was this test done and if so, do you have a result for it?
How much hay are you feeding Skip now? As part of the emergency diet we recommend feeding no more that 1.5% of current weight or 2% of ideal weight - whichever is greater. For Skip that would be 18 pounds a day (2% of 900 lbs.)
You'll find more complete information on the Emergency Diet on our web page (