Well, I thought I had copied my post just in case but I didn't and lost the entire thing
Ditto Deserthorsewoman and I might try the Remission.
Are you sure you're dealing with Equine Metabolic Syndrome or true Insulin Resistance? There is a slight difference between the two.
EMS is a/k/a "Peripheral Cushings" and I think that is because EMS causes a loss of muscle mass.
I have one of each; ie, an EMS horse and a horse with true insulin resistance.
The EMS horse is now a hard keeper but the IR horse just won't lose weight, his insulin stays in the outer stratosphere and he finally foundered big time in March, 2012.
Mr. EMS was diagnosed May, 2007 and has never had a laminitic episode.
Mr. IR diagnosed in June, 2010 and always did get ouchy hooves in the Spring.
While they have low NSC in common, that's where it ends as the EMS fella is now a hard keeper.
The IR fella eats McCauley's M-10 Balancer, which is a soy/oat/corn-free ration balancer. He gets 40 measured ounces of straight timothy pellets. I measure dry, then add water. He gets that three times a day, plus the best orchard grass/mix hay I can buy.
I have tried nearly all the over-the-counter products to control his insulin and to no avail. The only thing that is working for him is a prescription herbal blend called "Hot Hoof 1" from Dr. Xie. It can only be bought by a vet who has taken Dr. Xie's course.
It was either the herbs or Thyro-L for this horse, so I chose the herbal route. It's been 2-1/2 months and the IR horse has lost some weight and his cresty neck is gone. The real truth will be when Spring grass comes on. He will still be wearing a grazing muzzle, as well.
Dry lotting is something that is recommended but that depends on the lay of your land and if you board.
My property is impossible to build a dry lot because I would then have to build this horse his own shelter. Everything in an area, in the blistering sun, where he could see the other horses so he wouldn't try to jump the fence ---yes he's done that too and it cost me a vet bill and chiro bill
If you've reached the end of your over-the-counter-products-rope, my only thoughts are Thyro-L (which is only temporarily given and the horse must be weaned off), or the herbal blend Hot Hoof 1 which I have been assured causes no harm to vital organs. All I see my horse do is drink more water, eat more salt, lose some weight and that cresty neck
Here's the link to Dr. Xie (Hot Hoof 1). Check the bar on the left to see if any vets in your area are qualified to sell his products, if you're interested. It's not cheap. 3 lbs cost me $120 but it lasts around two months; I forgot to date the previous tub but it's at least 8 weeks. Welcome to Dr. Xie's Jingtang Herbal
And there's no guarantee the Hot Hoof 1 or something else would work on your horse. It was a last resort for my horse that, thankfully is working so far