Question: Have a 9 year old ISH that was laminitic this past spring. Looking for a good metabloic support supplement to help prevent another episode. They only levels that were up were the leptin levels on blood work. Currently we have him on large dose of Thryo-L and are concerned that during the winter months the owner will not be able to ride him because of energy levels on the current dosing. Any suggestion would be appreciated. Dr. Kellon: If leptin is elevated but insulin is not it may be because the horse is overweight (ISH are rarely insulin resistant). Insulin may also be falsely lowered if he was fasted before testing or if he  was eating a low sugar/starch diet at the time of testing but wasn't when he was laminitic. 
If this was a metabolic laminitis, the most important thing is a diet based on low sugar+starch hay and no grain products with starch+sugar levels over 10%. Beyond that, making sure antioxidants and minerals involved with insulin functioning are adequate is the best approach: https://uckele.com/articles/the-effect-of-minerals-on-the-ir-horse/ 
 
Glycocemic EQ is designed to do just that and also provide full support for thyroid function and good circulation to the hooves: https://uckele.com/glycocemic-eq-pellet-8lbs.html 
 
Agitation is a common consequence of hyperthyroidism caused by high doses of supplementation. The owner should discuss taking him off this with the prescribing veterinarian. It is possible to stop, but the dose has to be titrated down very slowly over several weeks.