Equine Metabolic Syndrome

Question 1

List the 4 main features of equine metabolic syndrome

Answer 1

Insulin resistance
Dyslipidaemia
Abdominal obesity
Hypertension

Question 2

What is the role of insulin?

Answer 2

To drive glucose into cells when the levels are high so if cells are responding to insulin they glucose isn’t being driven into cells

Question 3

What are the 3 consequences of insulin resistance?

Answer 3

Diabetes
Obesity
Dyslipidaemia

Question 4

Describe compensatory hyperinsulinaemia

Answer 4

• Increased triglycerides from liver, abnormal lipoprotein profile, endothelial dysfunction, pro-coagulant state
• Cardiovascular disease, hypertension, fatty liver etc

Question 5

Give a definition of equine metabolic syndrome

Answer 5

Collection of risk factors for endocrinopathic laminitis

Question 6

What is the most important factor of equine metabolic disease?

Answer 6

Insulin dysregulation - cells fail to respond to insulin

Question 7

What factor predisposes to equine metabolic syndrome?

Answer 7

Obesity

Question 8

What is the clinical effect of equine metabolic syndrome?

Answer 8

Laminitis

Question 9

What happens in a horses gut when something sweet is eaten?

Answer 9

In horses gut endocrine cells cause an exaggerated insulin response when something sweet is eaten

Question 10

Where does obesity show most obviously in a horses body?

Answer 10

Bulging supraorbital fat, enlarged crest, fat pads

Question 11

Other than laminitis what foot problems are caused by equine metabolic syndrome?

Answer 11

Frequent foot abscesses, white line disease, lamellar rings, seedy toe, dropped sole

Question 12

Describe the relationship between insulin and laminitis

Answer 12

Obesity and/or PPID
-> Insulin resistance/Dysregulation +CHO (NSC) = hyperinsulinaemia
-> Laminitis

Question 13

How is equine metabolic syndrome diagnosed?

Answer 13

Diagnosis can be confirmed using resting hyperinsulinemia
Unfasted >20 µIU/ml
Fasted > 5 µIU/ml

Question 14

Name some dynamic testing options for EMS

Answer 14

Oral sugar or oral glucose tests* most common
Two-step Insulin tolerance test
In feed sugar tests

Question 15

Describe how to carry out in feed sugar tests

Answer 15

• Fast for 6-12hr (need to be hungry)
• Offer small amount (1/2 scoop) of forage chaff with 1.0g glucose powder per kg body weight added in
• Take blood sample 2hr later and measure insulin

Question 16

Compare EMS and PPID

Answer 16

Both have laminitis
Both have high insulin
Both have budging supraorbital fat
Long coat in PPID
PPID = older horses
Horses with EMS will have a negative PPID test result

Question 17

How is obesity management used in horses with EMS

Answer 17

• Reduce caloric intake – 1.5%-2% BWT Hay (fresh)
• Soak hay to reduce NSC 8-16 hours (50% reduction)
• This is a STRICT diet so must be monitored
• Provide roughage, protein, vitamins and trace minerals plus salts if soaking
• Exercise – better than diet only if possible
• Recognise & manage obesity and teach your clients to also

Question 18

How can you reduce hyperinsulinaemia/ improvement of insulin sensitivity (regulation) in horses with EMS?

Answer 18

• Exercise
• Diet
• Drug therapy
• Nutraceuticals

Question 19

Put the following in order of importance in managing EMS:
- Diet
- Drugs
- Exercise

Answer 19

Exercise
Diet
Drugs