Cushing's/IR in 4 Year Old? UPDATE: Positive for Cushings

We board retirees and have had many residents live 10+ years with Cushing’s, and these horses were not 4 when diagnosed (our youngest diagnosed with PPID was 10 but he’d probably had it for years at that point. I had to do a lot of pushing to even get him tested because he was “too young” for PPID). I am another in the camp that would want to know what reference range was used for the ACTH levels at this time of year. We routinely test at this time of year, but using the proper reference range for season as well as geographic location is important.

Heard from the vet yesterday, Bean’s leptin came back high. His ACTH was only mildly elevated. I have not seen the actual results yet, but have asked the vet to email them to me. The vet feels that we could wait to treat for Cushings, and retest in 6 months due to both his age, and the time of year. I am thinking this is what we will do. As far as the I/R, we are working on a plan to try to get that under control. Will also retest on that in 6 months.
Any suggestions on diet, supplements? Bean currently gets primarily Bermuda grass with some alfalfa. I am going to get the hay tested to see where the levels are, but it won’t be ideal, as my one and only supplier gets hay from two different places. But I think it will be a good place to start. I am okay with soaking the hay if need be.
In our area, anything other than Bermuda or alfalfa is difficult to get on a regular basis. I’m also wondering about insulin spikes, he gets fed 4 times a day, but does go for longer periods at night without feed. How to do you feed a horse that is I/R, tends towards being heavy, and avoid long periods without food? Bean will tend to ration himself if you give him enough hay, but I think it could cause him to get fat pretty quickly.
I’ve looked at some potential supplements, Heiro, Remission, Quiessence, etc. Am considering adding some type of supplement besides the High Point Grass I have him on now. I would appreciate input on this as well.
Bean has been out of work for the last month or so, we’ve been moving and I haven’t had the time to spend with him. He will be going back to work in the next week or so, as I know that exercise is important for these horses as well.

Leptin results: 11.98 ng/ML. Its a bit confusing on the report as to what the reference range is. It looks like the reference ranges changed in 2016, and it lists 'Additional Reference Ranges: Intermediate 10-20 High >20 ng/mL. Prior range lists high as >7.
Anyone with experience reading these results want to chime in?

Typical of IR, but doesn’t tell you anything about HOW IR he is. Any chance the owner and vet will run the Intravenous Glucose Tolerance Test? That would give them a good idea how bad the IR is, as it looks at how long it takes to return to the baseline glucose reading after administering IV dextrose

His ACTH was only mildly elevated. I have not seen the actual results yet, but have asked the vet to email them to me. The vet feels that we could wait to treat for Cushings, and retest in 6 months due to both his age, and the time of year. I am thinking this is what we will do.

That doesn’t sound like Cushing’s to me. Mildly elevated compared to the higher end of the seasonal rise elevation? Or mildly elevated compared to normal, as in, it’s a mild seasonal rise? The difference is critical.

As far as the I/R, we are working on a plan to try to get that under control. Will also retest on that in 6 months.
Any suggestions on diet, supplements? Bean currently gets primarily Bermuda grass with some alfalfa. I am going to get the hay tested to see where the levels are, but it won’t be ideal, as my one and only supplier gets hay from two different places. But I think it will be a good place to start. I am okay with soaking the hay if need be.
In our area, anything other than Bermuda or alfalfa is difficult to get on a regular basis. I’m also wondering about insulin spikes, he gets fed 4 times a day, but does go for longer periods at night without feed. How to do you feed a horse that is I/R, tends towards being heavy, and avoid long periods without food? Bean will tend to ration himself if you give him enough hay, but I think it could cause him to get fat pretty quickly.

Hay nets. You’ll just have to play around and see which one works for him but there are tons out there. That’s great that you can test the hay and soak if needed. Some IR horses do fine on alfalfa, some don’t, so make sure part of his regular handling is checking for heat in his feet, preferably at the same time of day each time, just to keep tabs on things. Check digital pulse regularly too - finding a small one will help manage and hopefully prevent something bigger.

I’ve looked at some potential supplements, Heiro, Remission, Quiessence, etc. Am considering adding some type of supplement besides the High Point Grass I have him on now. I would appreciate input on this as well.

I wouldn’t waste money on Heiro as a starting point. Remission and Quiessence are better places to start. I also like Uckele’s U-Balance Thyroid.

Bean has been out of work for the last month or so, we’ve been moving and I haven’t had the time to spend with him. He will be going back to work in the next week or so, as I know that exercise is important for these horses as well.

That will help a lot :yes:

Get slow feed nets and attach them between 2 planks in the paddock fence. Then you can just toss hay in the nets through the slats in the fence. You will need to cut some wood pieces to hold the nets in place. I typically use 2" by 2" by 8ft boards- cut those to size and run screws in them to hold the nets in place.