EMS management

Question 1

What is the aim for weight loss in horses with EMS each week?
How can you keep clients engaged?

Answer 1

Aim for 0.5-1% of body weight loss per week
Response is very variable!
* Working with clients to body condition score rather than to an ideal weight is best

• Weigh tape/photo diaries
• Portable weigh scales
• Use accessible resources to train BCS
• Address their concerns
  
  • Welfare, EGUS, behaviour…

Question 2

what is the ideal diet for a horse with EMS?
How much should they be fed?
What can you do if the diet isn’t working?

Answer 2

• Hay should be huge majority of diet
  
  • < 10% non-structural carbohydrate
  • Soaked (especially if analysis not available)
• Start at 1.5-1.75% BWT?
  
  • Used to recommend 1.25-1.5%
  • Weigh using luggage scales
• Add a low calorie balancer
  
  • No other hard feed!
• Easy to manage when on box rest!

If diet isn’t working:
* Check that compliance is there!
* Replace some hay with straw - Up to 50:50
* Get forage analysed - Only approx. £20

Question 3

How cna you managed food intake with a EMS horse that is grazing (once off analgesics and feet are stable if they were laminitic)?

Answer 3

• Sugar lowest in grass early in the morning
• Stressed grass is more sugary
  
  • Frost, herbicides, mowing
• Time restricted access = pony tries harder!!
• Track systems/strip grazing?
• Use resting insulin to assess response

Question 4

When can horses with EMS exercise?
Why should horses with EMS be exercised?
What type of exercise should they do?

Answer 4

• Need to be sound
• Off all analgesia
• Appropriately trimmed/shod as required
• Why Emphasise that it improves insulin sensitivity, not only weight loss

What type:
Gradually build up over approx. 4 weeks
Monitor for lameness
Soft surface if recently laminitic

• If No history of laminitis - 30min of low/moderate (canter) 5x per week
• History of laminitis - 30min fast trot/canter on soft surface 3x per week

Question 5

What do SGLT2 inhibitors do?
how are they used?

Answer 5

• Block glucose resorption at the proximal convoluted tubule
  
  • Increased glucose in urine, reduced insulin production
• New drugs in equine medicine - Evidence they reduce insulin

Use
* Needs to be combined with diet and exercise management
* Not a lifelong medication
* But duration varies, lacking data
* Usually a few months
* Reduce dose: 50% for two weeks, then 25% for two weeks

Question 6

What are the side effects of SGLT2 inhibitors?

Answer 6

• Polyuria and polydipsia
• Hyperlipaemia
  
  • Common
  • If remain clinically normal can wait and most improve
  • If dull/lethargic, inappetent etc then stop
  • Implement dietary changes before starting medication

Assess liver/renal parameters before starting and after approx. one week of treatment

Question 7

What is levothyroxine?
How does it work? and specific for EMS?
What are the disadvantages to using it?

Answer 7

• Synthetic thyroid hormone
  
  • Increases basal metabolic rate
• Leads to weight loss and improved insulin sensitivity
• Will make horse hungry/harder to box rest effectively
  
  • Diet has to be well controlled
  • Is this a welfare issue?
• Taper dose when stopping medication

Question 8

What is metformin?
Is it used in EMS management? Why?

Answer 8

• Human anti-glycaemic drug
  
  • Poor oral bioavailability – does that matter?
  • Short duration of action (give close to turn out)
  • Effect wanes with time?
• Largely no longer used
• Weak evidence
  
  • May be useful combined
• with SGLT2i? TBC!

Question 9

How is EMS monitored?

Answer 9

• Repeat testing when management changes
  
  • Is this reliable?
  • Evidence suggests OST results vary throughout the year
  • Need to do tests under same circumstances
• Clinical assessment
  
  • Harder with lean phenotype – ultrasound abdominal fat?
• Foot health
  Actually quite difficult to do objectively!