Managing The Horse With Cushing’s

The vet has diagnosed it and the reality begins to sink in – your horse has Cushing’s disease. Now what?  Cushing’s is an endocrine disease caused by a tumor on the pituitary gland that is most often seen in older horses and ponies. This tumor results in high cortisol and is most often exhibited by  hyperglycemia (high glucose), excessive thirst, excessive eating, excess urination and a shaggy haircoat.  At this time there is no cure for Cushing’s but by keeping a close eye on nutrition and management, we can improve the quality and possibly lengthen the life span of a Cushing’s horse.

Routine is important to the Cushing’s horse because changes in diet, medication, etc. can have negative effects on health.  Cushing’s horses have a compromised immune system and for that reason, seemingly small or mundane parts of their care become very important.  There are a few management practices that are particularly important: 

  • Deworming – Cushing’s horses can be more susceptible to parasites because of their weakened immune system.  Work closely with your vet to develop a deworming schedule and program that is catered to your horse. Your vet should also be seen regularly for dental care and wellness exams.
  • Farrier Care– Regular farrier visits are important because certain types of leg and foot conditions are more likely with a Cushing’s horse, such as abcesses of the hoof and laminitis. Signs of laminitis can be a tender footed stance and the horse acting like he is “walking on egg shells”. 
  • Grooming – Hair coat and temperature regulation are problems in Cushing’s horses so you will want to help your horse as much as you can by preventative grooming practices. Consider body clipping in hot/humid weather and be mindful of temperature and weather changes. When blanketing, make sure the hair coat is dry and clean to help reduce the incidence of skin issues. Prompt treatment of any wounds or infections is essential.
  • Feeding– One of the main goals in feeding the Cushing’s horse is to control the starch + sugar (NSC) content per meal. This helps to regulate the blood glucose and insulin levels.  The NSC content of the concentrates fed to the horse is important, but even more so is the content of the hay /forage and the combination of the two together. Some guidelines have suggested an NSC maximum value of 10-13% based on the total diet (forage + concentrate). Testing your hay will give you a good idea of the NSC values.
  • Consider a feed that is fortified with lysine, methionine, biotin, vitamin E and complexed trace minerals (copper, zinc, manganese and selenium) to help maintain muscle mass, support hoof growth and support the immune system.

Following these tips will help improve the quality and possibly length of life for the horse diagnosed with Cushing’s.  If you have specific questions regarding your horse, please work with a qualified nutrition consultant or your veterinarian.

22 Replies to “Managing The Horse With Cushing’s”

  1. I am looking for ideas on feeding the dentally challenged geriatric horse during winter months. My 30 yr old pony is on soaked Tim/Alf pellets and does very well weight wise but he finishes them in about an hour and then has nothing to eat until supper. I work during the day and can’t split up his feedings so he goes about 12 hrs in between. The teeth he has left are glass smooth and I won’t give him hay due to impaction concerns which I had with another horse with the same issues. Any ideas?

    1. Hi Karen, Here are a couple ideas to ponder, others may comment with more! You might try adding a very large smooth stone to his feeding pan, this would at least slow him down some more as he eats. Also, if you provided him some hay in a small hole hay net, he would just eat the fine pieces that fell through and it would reduce his boredom (you’d just have to empty the stems every so often and feed to other horses).

      There are a few companies selling “timed release feeders”. Our SafeChoice Senior is designed with a softer pellet that is easy for horses with poor dentition to chew so you could get away without soaking it and it would flow through the feeder. I had a gelding that lived on dry SafeChoice Senior till 37, had no teeth and never choked; however each horse is an individual. This would be ideal; however the timed release feeders are certainly an investment.

      Thank you ~ Gina T.

      1. I have a 28 yr old OTTB, he has cushings and very few teeth. In the winter I soak about 5 lbs of alfalfa pellets and feed them to him. I do this at his am feed and then again around 9:30pm. He doesn’t eat them all at once he goes back several times. I also feed him Nutrena Safe Choice Senior soaked. I guess he’s lucky that I board him at a barn that will give him alfalfa mid day in the summer. Can’t leave the alfalfa soaked out in the summer due to it spoiling.
        I do give him hay, he rolls it and spits it out but it does give him something to do in between feedings and when he has no alfalfa left.
        Maybe you could find someone to go over in the afternoon. And give him soaked alfalfa.
        If I lived close I would be more than happy to do that for him and you.😘

    2. I recently adopted a very senior (late twenties at least)14.1hand pony who is approx 100 lbs.underweight and has teeth missing /too worn to properly eat hay,even high quality grass hay.I had him tested for Cushing’s and the ACTH came back 134.So now he has Cushing’s on top of everything else,which is no surprise.
      I have been feeding him a combination of soaked beet pulp(no sugar),Nutrena Senior Safechoice feed,Blue Seal’s extruded Sentinel feed,hay stretcher pellets from Tractor Supply,soaked alfalfa cubes,and a small daily bran mash.My kitchen is cluttered with tubs and buckets of soaking feeds.
      Now that I now he has Cushing’s,how should I feed him differently?Should I switch to timothy hay cubes soaked instead of alfalfa?I will also be looking into getting him the Pergolide medication for his condition.
      I work for a small animal vet practice and my DVMs are not familiar with any of this.
      I am on a tight budget and would be most grateful for any advice you could possibly give me.
      Thank you for your time and effort,
      Suzanne D.

      1. Hi Suzanne,
        Thanks for sharing your challenge. First, we recommend staying closely tied with your equine vet to manage a preventative health care program, as these horses can have special needs for wound care, blanketing or body clipping, parasite management, and so on.

        For feeding, Cushings or Equine Pituitary Pars Intermedia Dysfunction (PPID) horses have a lower ability to digest and tolerate nonstructural carbohydrates (starches and sugars). Consider appropriate complexed trace minerals and vitamin C in your horse’s diet. It is recommended to limit starch to <2g per kg of body weight per each meal.

        Since timothy grass pellets or alfalfa pellets can vary in starch and NSC ranging from 9 to 18%, and beet pulp also ranges and averages 7-17% NSC, we would recommend removing these from the overall diet of your horse. Our recommendation to simplify your feeding program would be to slowly transition to the Nutrena Safe Choice Senior over the course of 10-14 days, eliminating the other feed stuffs, while monitoring your pony’s response and progress.

        Feeding rate recommendation on the SafeChoice Senior, when fed without forage, is 1.2 to 1.4 pounds of feed per 100 pounds of body weight, so you can calculate the total amount for your pony based on his body weight. At that feeding rate, we do recommend splitting the total into 3 to 4 meals per day, as this helps keep a steady flow of nutrients, and you would not exceed the 2 grams of starch per kg body weight guidelines.

        Since your pony has poor dentition, the SafeChoice Senior does soak to a mash relatively quickly and can be fed as a complete diet. This feed is ideal for hard keepers, rehabilitation, horses with poor dentition and also has a very nice trace mineral package as well as the Vitamin C that these metabolic horses need.

        Best of luck!
        Heidi A.

  2. Has there been research with cushing’s and magnesium deficiency? I started care for a clients aged gelding with cushing’s in January. He did not shed out in the spring like the other horses and was being supplemented with pergalide(sp?) and chromium. When I began care I supplemented with cattle mineral that was formulated for fescue pasture, in other words, this mineral has a higher level of magnesium. Over the next winter I began to eliminate the other supplements and in the spring for the first time in 5 years this horse shed out just like all the others. I have this idea minerals are very deficient I all of our diets, human and critters alike.

    1. Hello Susan, Thank you for the question. Low circulating levels of serum magnesium have been reported in some horses with Cushing’s Disease, and this deficiency may contribute to decreased insulin secretion. Supplementation with Mg and Chromium is thought to help improve insulin sensitivity or counteract insulin insensitivity, but does not have an impact on (elevated) cortisol secretion, therefore does not correct the root cause. Typical daily Mg requirements are around 10 – 15 g/day and it has been suggested that supplementation up to the max daily requirement and that achieves a target calcium:magnesium ratio of 2:1, can be beneficial. Supplementation of chromium picolinate (2.5 – 5 mg/d) may also be helpful to support improved insulin sensitivity if your horse is IR as a result of the Cushings disease.

      Although controlled research to verify efficacy in horses is lacking, these nutrients are helpful in the management of type 2 diabetes and insulin resistance in humans, and may be beneficial in equine cases complicated by insulin resistance and hyperglycemia. Additionally, ensuring that the entire diet (hay, pasture, concentrate, treats) is balanced (energy, amino acids, vitamins and minerals) is also important to ensure some of the symptoms are not nutritionally induced due to other imbalances or deficiencies. Before adjusting or adding anything to the diet, it is recommended to consult with a trusted equine veterinarian and equine nutritionist.
      Thank you ~ Emily L.

  3. I have a horse at my stable that has been diagnosed with Cushing’s. He is on Prascend 1 pill/day for the past year, but he is still extremely difficult to put weight on. The pill does help control his excessive urination and thirst, but he is ravenous all the time. He’s a 25 yr old retired paint gelding, 1100lb. He gets 6lbs of Senior feed along with free choice hay each day, and he easily consumes a bale per day. (Alfalfa/grass mix that we custom bale for our farm). I’ve had the vet recommend in the past for another horse at our barn with Cushing’s to possibly double the pill dosage if the horse’s condition is getting worse, but wanted to know if the feeding was appropriate?

    1. Hello Victoria, Thanks for reaching out with your question. A couple things to consider, how is his dentition, is he having any difficulties chewing the hay, any quidding going on? Is he in a paddock with any other horses who might be challenging him? You might think about having your hay analyzed so you know the actual caloric content of the hay as well as the Non Structural Carbohydrate content. This way you would know for sure the calories going in.

      If his ideal weight is 1100#, 6# of senior feed is likely the bare minimum amount he needs per day to balance basic requirements missing in his hay. You would need to check the specific feeding recommendations on the tag of the senior feed you’ve chosen as they are not all formulated the same. We would recommend increasing this amount by 0.5#/day until you get him up to 11#/day to increase the calories and nutrients he is receiving. You might also consider adding a high fat extruded supplement at 2#/day to add more calories in a condensed form.

      Please consult with your Equine Veterinarian regarding his medications to support his condition.

      Thank you ~ Gina T.

  4. My horse is fuzzy year round but I have not noticed the excessive drinking or urinating. Could it be something else? I do have to limit her pasture time due to foundering.

    1. Hello Vindy, It is possible for it to still be Cushing’s, even though only some of the symptoms are displayed. It is impossible for us to say for sure, though, so we would suggest you contact your vet for a test, to make an official determination.
      Thank you ~ Gina T.

  5. I have a 26 year old Paso/Arab. This Summer he did not shed out and has a crested neck. He also had a sore feet for a couple weeks. The vet has diagnosed him with cushings. Is it best to blanket him this Winter? He had a difficult time with the heat this Summer so I hosed him down and sweat scraped him if I saw he was sweating. He also has a fan that blows in his stall when it is warm.But what about the Winter?Will he need a blanket? If so do you have recommendations as to how heavy or what style to get. Should I take the blanket off several times a week for brushing and measuring for weight loss and checking for any sores? These are the many questions going through my hear right now!

    1. Thank you for your interesting series of questions about your 26 year old Paso/Arab. Interesting cross of breeds. If he has been diagnosed with Cushing’s Syndrome/PPID, then you need to make certain he is getting an adequate level of low non-structural carbohydrate forage and consider the use of a ration balancer to give him a complete balanced ration. It is very important to monitor body condition.

      These horses generally grow a fairly heavy hair coat and handle the cold well if kept dry, so key management practice is to make certain he has shelter if there is cold rain. You did not indicate what area you live in, so it is a bit of a challenge to make blanket recommendations. As long as horses are in about Body Condition Score 5, have adequate forage and access to unfrozen water, they handle cold temperatures pretty well. The water is essential! The low critical temperature for mature horse per the 2007 NRC is -15 degrees Centigrade, which is 4 degrees Fahrenheit. Below this temperature, he may benefit from a medium weight blanket. You determine blanket size by measuring from the center of the chest to the point of the buttock. You want to remove the blankets and groom regularly, which also helps you monitor body condition. It is easy for a horse to lose weight and the loss not be noticed when they have long hair or are blanketed or both.

      As these horses shed out slowly, they frequently benefit from body clipping in the spring. If full body clipping is not feasible, what is called a “blanket clip” or “trace clip” may be a good idea to get rid of the long hair in the areas where he sweats. This will help him keep cool in the summer along with the measures that you are taking.
      Best wishes,
      Roy J.

  6. My cushing horse tested high over the base line values. Should I feed her Nutrena special care (low starch-low sugar )or Nutrena senior?? She is about 20 years old. shaggy coat, drinks a lot of water and pees
    a lot to. We just started her on pergolide mesylate. she eats quality grass hay, and one hour on winter pasture. please advise asap. thanks tina

    1. Hi Tina,

      Thank you for your question about your 20 year old that tested above baseline values and has just been started on pergolide. I would probably start with a forage test assessment of your quality grass hay to determine the non-structural carbohydrate content of that forage. You could have that done at Equi-Analytical or check to see what forage are in your area. If the forage is relatively low NSC, you could use a ration balancer such as Empower Balance or you could use Special Care. We have had very good success with horses as you describe using SafeChoice Senior when their teeth do not allow effective forage consumption.

      Best wishes,

      1. I feed my 28 year old OTTB Safe Choice Senior and Safe Choice Special Care. I just started the Special Care. He has cushings and doesn’t eat hay. He’s on Prescend 1 tablet daily. I also soak alfalfa pellets for him. He eats about 10# of feed and about 10# of alfalfa daily. I feed him at least 3 times a day. I give him hay, he doesn’t eat it but it keeps him from being bored.

  7. I have a 21 yo MFT gelding diagnosed with Cushings, has been on Pergolide for about 5 mos..he exhibited some behavior probs when I ride him so I discontinued the pergolide about 3 weeks ago….Last summer, before taking the pergolide, he lost large patches of hair…this past week he is losing hair rapidly…can it have anything to do with taking him off pergolide? Am also wondering if it can be thyroid issues, he was tested last yr and showed normal…Just trying to find out why he is losing all his hair….Help!!!

    1. Hi Judith,
      Thanks for reaching out! It sounds like this issue may be best addressed by your veterinarian, for a comprehensive recommendation.

      Best of luck!

  8. Hi I have an 6yr old miniature dartmoor and he has been recently diagnosed with Cushing’s ,he’s a pet wandering around a few acres,we noticed him becoming stiff and with a typical laminitis gait,vet taken bloods and his levels for Cushing’s were sky high,since then he has been in on soaked hay half tab of perogilde farrier coming regularly worming up to date, I would like to turn him out on limited grass he is so fed up being winter I thought it would be ok?

    1. Hello Jayne, Thanks for the question. You might try a grazing muzzle on him, to limit his grass intake as well. We’d suggest checking with your veterinarian as well.

  9. I know this blog is over a year old but I thought I would leave my thoughts and comments anyway. My 22 yo Arabian was diagnosed with cushings/ir last year, the right diet for him has been the biggest challenge. As he refused any and all low starch/low sugar feed. Here is what I came up with: am/pm plain beet pulp shreds soaked mixed with 1 qt timothy/alfalfa pellets, 2 oz glanzen 3 and 4 oz ration balancer. In the morning I add Remission and Vitamin E, evening feed I add 1 scoop Silver Lining Pituitary support. Afternoon feeding 2 qts pellets and pergolide. I get this in a powder, mix it with unsweetened applesauce place in a two oz syringe, shake well and squirt it down his throat. He also has grass hay 24/7 that has been tested for NSC etc, water and a salt block. My understanding of this disease is that these horses have a hard time regulating their body temperature. So this year I started blanketing him in mid October with a mid weight blanket, in January I put the heavy weight blanket on him, complete with belly wrap and neck cover. While he does have some winter coat, at least he doesn’t look like a woolly mammoth. He is shedding out a little, so next month I will likely give him a blanket or trace clip and remove any remaining guard hair.

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