New to the group

Keri BG

Just wanted to introduce myself I’m new to this group and have a 3 1/2 yr old mustang mare Raven, diagnosed as being EMS -Vet said bloodwork showed  borderline IR this was in August 2021 and she was in her 2nd laminitic episode. This was when we started weighing then soaking & netting her hay. Ferrier Came trimmed under sedation. Within a week she was in recovery mode though it took months of trims & diet. Things were going well and winter hit  below zero nights 10 degree days had to stop soaking hay as it all froze. Vet advised to switch to straight alfalfa from the Timothy with a dressing of alfalfa we had been soaking. Yes, another episode of laminitis hit! It wasn’t as bad as the first and her boots with pads had come. And then it got worse she could barely walk called vet out. This time she did X-rays which she sent to the Ferrier. No sinking/rotation Vet said Raven had nice thick soles! Advised me to test my hay ..hmm.. my Timothy came from different fields and 2 different cuts 2nd & 3rd. My Alfalfa came from same field but 2 different cuts 2nd & 3rd. I know that many factors can affect the sugars protein starch etc soil health, fertilizer application timing, extreme Heat which we had this summer, water etc. in a big field the hay from one area can test different from another area in the same field! We also live in an area with selenium poor soils . Oh did I mention  we are Hay Farmers most of our hay is exported to Japan! My point is that my Timothy was loaded into my barns mixed together potentially every dang bale could test different! And now I read that Alfalfa while lower in sugars is higher in starch than Timothy so soaking the alfalfa isn’t going to do anything for the starches and those are culprits in the laminitis? I’ve been making her worse instead of better 😭 Pulling hair out wondering what to do why wasn’t anything helping? called vet in tears before I read about the starch she ordered metformin to try. Yes, she was on bute this whole time..which Vet said she may have to stay on for life to manage her laminitis… see how frustrating this is almost everything I was told to do for her was actually hurting her.  I’ve weaned her off the bute this week and finally the weather is now allowing me to soak her hay again. I will begin to take her off the alfalfa tomorrow morning increasing Timothy .. so here we are and I know this was a rambling mess kind of like me and Raven right now.
Keri BG WA 2022


Hi, Keri. 
You will receive a detailed welcome letter soon, probably tomorrow morning, but I want you to know that you will figure this out! One of the odd things about alfalfa is that it makes some horses foot sore. We don't know why because sugars and starch don't seem to be the problem. So good job on transitioning her off alfalfa and onto soaked Timothy.

No one expects every bale to be identical to every other bale, but we've learned a lot about analyzing and producing hay with moderate sugar levels for our EMS horses. As a hay farmer, one thing you can do with the 2022 crops is put up a year's supply of hay especially for Raven all from a single cutting (I'm partial to 2nd cut) made as early in the morning as you can manage, when sugars are at their daily low. 

This group can help you sort through a management plan for your young mare. Gather together the bloodwork your vet has done along with images of the Xrays. Once you have a case history put together, the volunteers may have suggestions to get you and Raven.
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Hi Keri,
Welcome to the ECIR group!  Cass, as a west coaster, has started you off with some good tips and I, as a New Englander, am here to provide the welcome you’ve been eagerly awaiting!  It contains lots of good reading material to get you started on understanding and managing an IR (and/or PPID) horse.  You’ve made a few missteps with the help of your vet but nothing more serious than most of us have made before finding this group.  Insulin resistance shows up in thrifty, shorter breeds of horses just as they reach maturity and don’t need extra food for growth so I suspect the vet was spot on with the diagnosis.

You’ll find the emergency diet discussed in the welcome and I think that’s what you should be feeding Raven until you can come up with a better feeding plan.  The key feature is that the hay must be soaked until you can test it with wet chemistry and find that the ESC plus starch is below 10%.  I have soaked plenty of hay in freezing temps, often sub zero.  Yes, it freezes but hanging in a net, not too tightly packed, the water will evaporate and the horses don’t seem to mind their frozen haycicle.  One of the supplements she needs is iodized table salt.  If you sprinkle that on top of the hay, it will decrease the freezing point of the hay and both will become more palatable.  Leave the alfalfa out more now.  Many IR horses are sensitive to it, resulting in foot soreness.  Testing whatever you are feeding for hay now would be a good start and, as Cass said, you are in a great position to set aside the appropriate hay for Raven next harvest.  The correct testing will allow you to determine what your hay is lacking and supplement it appropriately as well as to balance its minerals against each other.

You’ll also learn about posting a case history and a photo album to help us communicate.  If you have digital copies of your blood work, please post those in the case history folder, as well.  The X-rays can go into the photo album with other photos as we request or you feel would be helpful.  Any information you add to your posts is helpful but please add it to your case history as well, if it seems pertinent.

You seem to understand where you’ve gone wrong and what needs to happen next so I will post the welcome letter next and leave you to ask any and all questions you have about what you’ve learned to date about this.  Keep your eyes open for information on Diagnosis, Diet, Trim and Exercise, or DDT&E, the foundation of our recovery plan.  “Borderline IR” means different things to different people and it’s important for us to know the actual testing results.  Exercise is important but not until everything else is in order and she moves well on her own.

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. 



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


Eleanor Kellon, VMD


I could tell from your post that you have been reading. In addition to the sugar and starch issues, the cold itself  could have triggered the pain. Put socks on her inside those boots and wrap her legs (lined shipping boots are best). Get her some Jiaogulan. If your hay is grown with irrigation, high nitrates may also be a problem. Those also soak out so it's another factor that could get worse when you stop soaking.
Eleanor in PA 
EC Owner 2001

Keri BG

Keri BG WA 2022
thank you for responding so quickly! It’s funny you mentioning what to do for next years hay.. it’s exactly what I told my husband I would most likely need to do, although, I hadn’t thought about cutting Timothy early in the morning! We generally cut in mornings after water sets have been changed on other fields anyway, but not unheard of to be cutting late either, not early like we do with alfalfa. I’m wondering if the way alfalfa is harvested versus Timothy is part of the reason sugars lower. Alfalfa is always cut very early mornings while dew/ moisture present so leaves stay intact. And after drying alfalfa baling is done in the morning as well to minimize leaf loss. At least it’s the way 3 generations have done it here lol! I’ve also always preferred 2nd cut Timothy smaller softer stems more leaf my horses prefer it to 1st (same with alfalfa). 2021 was a strange growing year we had 3rd cuts of Timothy, almost unheard of up here in The Pacific Northwest. 

I feel a bit overwhelmed by all the information but as a retired Sociologist I’ll just treat this as a graduate school class the end result being a healthy painfree  Raven a much grander outcome than a degree! 

I will begin to gather the  X-rays, blood work paperwork, get hay tested, take hoof and body pics to upload this week/weekend hopefully I can get this case file started with no tech issues 

Raven and I are so ready to start this healing journey 

Forever Grateful 
Keri & Raven

Frances C

For some reason I can't reply privately (???) Anyway if you are anywhere near Ellensburg and your hay tests low in ESC/starch and you sell locally I would be a likely customer. I have a Yakima Indian pony whose name was Raven (black of course) but she is a 7 year old. IR and laminitic. How about that!
- Frances C.
December 2017, Washington & California
Case history:
Phoenix's Photo Album:

Kirsten Rasmussen

Keri, if you can cut your hay before dawn (ie before photosynthesis starts) after a warm night (>40°F), you should be able to produce a very low sugar hay.  People with IR horses will pay a premium for this hay as long as it isn't overly mature or dirty/moldy or high in nitrates.  I have yet to convince a farmer to cut hay before dawn though...  :(

Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Keri BG


im chuckling here because I’ve been discussing early morning 2nd cutting of Timothy with my husband for last couple of days. He brings it up so I know he has been thinking about it a lot since I first mentioned it! Before dawn would be difficult… not impossible but because of the time of year for 2nd cut Timothy we would be starting to get heavy dews preventing cutting until it evaporated. With grass hays especially, cutting wet can ruin it causing severe bleaching mold etc. Regardless he said it’s possible under the right circumstances to cut early am if we have little to no dew when hay is ready. Keep your fingers crossed and pray to the hay gods we get perfect weather because he’s willing to try for me and my horses. I have Ravens mother, younger brother and 1 other Yakama Mustang along with my Azteca who could all benefit. I made him aware that there is a big market for low sugar/starch hay. Here in the Kittitas valley our Timothy hay growers/brokers developed specifically to cater to the Japanese race horse & dairy market(80% or higher is exported to Japan). The broker/exporter does do random sample testing of the hay by field, but their focus is on protein levels. I will ask them what all they test for, out of curiosity, it would be interesting to know average levels of sugars/starch in the hay we’ve grown.  Bob, my husband, has been talking with our broker so it’s possible we could maybe start a small market specifically for this.
Keri BG WA 2022

Kirsten Rasmussen

The dew is the same problem my farmers have mentioned here.  I thought if you turn the hay more frequently you can avoid molding, but of course I am not a farmer and don't understand the challenges of getting good hay.  Some years we are lucky to just get a 3-day window of sun for cutting, in which case I take what I can get...2020 was case in point.

Another thing to check for with west coast/high rainfall area hay is the iron content in the hay.  If the hay is clean and not contaminated with dirt, the high rainfall in this area in the winter can still acidify the soil causing higher uptake of iron in the plants.  Toxic iron in hay is at 500 ppm.  Usually when hay tests above 500 ppm, there is dirt on the hay that can be rinsed or shaken off before feeding.  But even if its not at toxic concentrations, we now know that high iron worsens insulin resistance (and over time it can destroy the liver) unless adequate copper and zinc are fed to balance it out.

Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Keri BG

Keri BG WA 2022

we are east of the mountains so rain isn’t quite as problematic for us and winter precipitation generally comes as snow freezing rain or freezing fog etc. annual average rain 9” snow 21”. 2nd cutting starts late August but weather delays can push finishing into 2nd week of September. Mother Nature doesn’t always play nice Ha! I’ve downloaded the CH forms/file and will get started on them as soon as I can. A bit overwhelmed with everything also dealing with ranch tax paperwork and in the middle of a messy legal corporate separation  (splitting the ranch) ugh threes right … things come in threes. Have call into vet to send copies of X-rays and labs will upload those as soon as I get them