Are these Insulin and aCTH levels acceptable?

 Question: I wanted to ask your advice once again about my 18 year old Welsh pony mare who recovered completely from the winter laminitis( I am still giving her jiaogulan daily) I had my vet come out and take blood from her the results were- ACTH 45.9 pg/mL
Insulin baseline  142.45 uIU/mL
He then told me to give her 1/2 tablet of prascend and test her again next spring I question this to another vet at the clinic and she told me the blood reading are not that high for Cushing but with the winter laminitis it could be the case but also body score and coat plays a big part, she would like to see her in june to see how she sheds out- since she is sound we work her daily even if it's just hand walking, she only eats 10 lbs hay daily,cup of ration balancer, 2 scoops of quiessence and 1/2 scoop of jiaogulan- (hay was grass/clover now alittle of that hay with some real crummy 1st cut hay that looks like straw, she hates it but eats most of it) my question is what would you suggest?
Dr. Kellon: The ACTH is definitely positive and I agree with treating but don't wait until next spring to recheck. Check again mid August and if she isn't down to mid-20s discuss a dose increase.

The insulin is dangerously high too. Being a pony there is a good chance she had some degree of insulin resistance to start with and the pergolide alone won't control this but you don't have to use poor quality hay just avoid alfalfa or clover, get a grass hay and have it tested. If you haven't joined ECIR yet I would suggest you do that. Until your hay results are back, Glycocemic EQ will give you a start on balancing and already contains Jiaogulan.

Question: I wanted to aske you advise once again about my 18 year old Welsh pony mare who recovered completely from the winter laminitis (I am still giving her jiaogulan daily) I had my vet come out and take blood from her the results were

  •  ACTH 45.9 pg/mL
  • Insuline baseline 142.45 uIU/mL

He then told me to give her 1/2 tablet of prascend and test her again next spring I question this to another vet at the clinic and she told me the blood reading are not that high for Cushing but with the winter laminitis it could be the case but also body score and coat plays a big part, she would like to see her in june to see how she seds out - since she is sound we work her daily even if it's just hand walking. She only eats 10 lbs hay daily, cup of ration balancer, 2 scoops of quiessence and 1/2 scoop of jiagulan (hay was grass/clover now alittle of that hay with some real crummy 1st cut hay that looks like straw, she hates it but eats most of it). My question is what would you suggest?

Dr. Kellon: The ACTH is definitely positive and I agree with treating but don't wait until next spring to recheck. Check again in mid-August and if she isn't down to mid-20s discuss a dose increase. 

The insulin is dangerous high too. Being a pony there is a good chance she had some degree of insulin resistance to start with and the pergolide alone won't control this but you don't have to use poor-quality hay just to avoid alfalfa or clover, get grass hay and have it tested. If you haven't joined ECIR yet I would suggest you do that. Until your hay results are back, Glycocemic EQ will give you a start on balancing and already contains Jiaogulan. 

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