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Equine Medicine Final > Equine Metabolic Syndrome > Flashcards

Equine Metabolic Syndrome Flashcards

1
Q

Obesity in horses

A
  • potentially associated with modern husbandry
  • Limited physical activity
  • Over-feeding
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2
Q

Equine Metabolic SYndrome

A
  • Describes a clustering of obesity
  • Generalized or regional
  • Insulin resistance (IR)
  • Prior or current laminitis**
  • Diet appears to play an important role
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3
Q

What are the three components of equine metabolic syndrome?

A
  • Increased adiposity
  • Hyperinsulinemia
  • Insulin resistance
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4
Q

Age of horses affected by Equine Metabolic Syndrome

A
  • 6-20 years old
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5
Q

Sex of horses affected with EMS

A
  • No predilection
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6
Q

Breeds associated with EMS

A
  • Ponies, Morgans, Paso Finos, Arabians, Saddlebreds, Quarter horses, and Tennessee Walking Horses
  • “Easy Keepers”
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7
Q

Other components of EMS

A
  • Dyslipidemia
  • Abnormal blood adipokine concentrations
  • Systemic inflammation
  • Seasonal arterial hypertension
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8
Q

Most common presenting complaint with EMS

A
  • Laminitis*

- Typically develops after animals have been grazing on pasture

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9
Q

Is adipose tissue metabolically active?

A
  • YES
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10
Q

EMS typical BCS and other physical exam findings

A
  • Severely affected horses have a BCS of 8 or 9
  • Marked expansion of neck crest
  • Regional adiposity score of 1-5 (scores of 3 or more often seen in EMS)
  • Preputial (obese geldings have preputial adipose tissue expansion and reduced lymphatic return) or mammary gland swelling (mares)
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11
Q

Laminitis in EMS

A
  • Thought to be catastrophic, but milder forms tend to be in EMS horses and ponies
  • Divergent growth rings are noted in these animals
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12
Q

Genetics and EMS

A
  • Some horses and ponies appear genetically predisposed to EMS
  • Anecdotal reports of EMS in related horses and ponies
  • Dominant pattern of inheritance for laminitis in ponies with EMS
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13
Q

EMS and weight

A
  • Horses with EMS appear to require fewer calories to maintain body weight
  • Indicating enhanced metabolic efficiency
  • Genetic predisposition for obesity may involve specific gene mutations
  • concept of “thrifty genes”
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14
Q

Insulin dysregulation in horses with EMS

A
  • Assumed that insulin dysregulation results form increased pancreatic insulin secretions in response to insulin insensitivity
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15
Q

Glucose concentrations in horses with EMS

A
  • NORMAL**
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16
Q

What’s the primary difference between EMS and diabetes mellitus?

A
  • Diabetes refers to inadequate insulin response from the pancreas and higher glucose concentrations detected
  • Not as common, but does occur
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17
Q

Liver changes in EMS

A
  • Some horses with EMS have higher GGT and AST and triglycerides
  • Lipid accumulation in hepatocytes
  • Can have hepatic lipidosis similar to humans with fatty liver
  • Reduced insulin clearance by the liver is manifested by hepatic insulin dysregulation
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18
Q

What mechanisms of insulin resistance exist in EMS?

A
  1. Defects in insulin receptors
  2. Defects in insulin signaling pathway
  3. Defect in glucose transporter 4 (Glut 4) synthesis, translocation, or function
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19
Q

How does insulin get glucose into cells?

A
  • Insulin stimulates glucose transport into cell membranes
  • Via Glut4 transporters in cell membranes
  • Results show translocation impairment of Glut4 transporters
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20
Q

What adipokines are released from adipocytes that contribute to inflammation?

A
  1. Leptin
  2. Resistin
  3. Adiponectin
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21
Q

Cresty neck and inflammation

A
  • Higher mRNA expression of IL-1beta and IL-6 in nuchal ligament adipose tissue
  • Helps support the cresty neck being important
  • Variety of research have had variable results
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22
Q

When is leptin released, and where is it released from?

A
  • Released by adipose tissues when energy supplies are plentiful
23
Q

Adiponectin role

A
  • Considered an insulin sensitizing adipokine

- blood concentrations are positively correlated with insulin sensitivity in humans and animals

24
Q

Adiponectin levels in obese horses or horses with systemic inflammation

A
  • Lower concentrations

- No way to test this really

25
Q

What receptors respond to leptin?

A
  • Receptors in the hypothalamus respond to circulating levels of leptin
  • Both appetite stimulating and satiety neurons express leptin receptors
26
Q

What does activation of leptin receptors do?

A
  • Causes down regulation and suppression of appetite

- Don’t seem to work well in horses with EMD

27
Q

Leptin levels in horses with insulin dysregulation

A
  • Tend to be higher
  • Possible leptin resistance?
  • Hyperleptinemia has been associated with obesity
28
Q

Screenings tests for EMS

A
  • Historical information
  • Owner reports horse is an “easy keeper”
  • +/- history of laminitis
29
Q

PE signs of a horse with EMS

A
  • Obese (BCS >7/9)
  • Pronounced neck crest (score >3/5)
  • Other evidence of regional adiposity (tail head, prepuce, mammary gland)
  • Divergent growth rings (founder lines) or lameness associated with laminitis
30
Q

Resting insulin test type

A
  • Screening test
31
Q

Method for resting insulin test

A
  • Can have hay in the morning
  • No feed for 4 hours and NO GRAIN OR CARBOHYDRATES
  • Collect blood in AM
  • Glucose concentrations above reference range of >110mg/dL
  • Fasting insulin concentrations >50uU/mL
32
Q

What would you expect the result of a resting blood glucose and insulin level to be for EMS?

A
  • Hyperglycemia and hyperinsulinemia
33
Q

Why do an ACTH test in a horse you think might have EMS?

A
  • Rule out PPID
34
Q

Leptin test overview

A
  • Fasting leptin concentration >7 ng/mL (diagnostic?)

- Keep sample cool

35
Q

Triglyceride levels in horses with EMS

A
  • Shown to be elevated in horse/ponies with EMS
36
Q

Dynamic oral glucose test procedures

A
  • Oral glucose test (fast horse before testing AKA leave one flake of hay after 10 pm)
  • Owner administers Karo Light Corn Syrup orally using two 60 mL catheter tip syringes
  • Collect blood sample 60-90 minutes later for insulin and glucose
  • Insulin values >45 uU/mL at either time point is insulin resistance
37
Q

Insulin tolerance teset

A
  • No fasting required
  • Only need a glucometer
  • Fed pasture or hay
  • Collect blood at time 0
  • Administer 0.1 IU/kg regular insulin
  • Collect blood 30 minutes later
  • Measure glucose and feed immediately
  • <50% decrease in blood glucose = insulin dysregulation
38
Q

Which test is the gold standard for EMS diagnosis?

A
  • Combined glucose-insulin test

- NOT PRACTICAL IN THE FIELD

39
Q

Combined glucose-insulin test procedure

A
  • Perform on a fasted horse (1 flake of hay after 10 pm)
  • Obtain a pre-infusion sample to measure baseline glucose
  • Inject 150 mg/kg bw 50% dextrose solution IV immediately followed by 0.1 U/kg BW regular insulin
  • Collect blood repeatedly (basically every 10-15 minutes until you hit 2.5 hours)
  • Measure insulin at 45 minutes
40
Q

Insulin resistant test result in combined glucose-insulin test

A
  • Insulin resistant if the blood glucose concentration is above baseline or insulin concentration is greater than 100 uU/mL at 45 minutes
41
Q

Should you manage EMS if you diagnose it? -

A
  • Yes

- manage with diet, housing, and exercise intervention

42
Q

2 Principle strategies of management for EMS

A
  1. Induce weight loss

2. Improve insulin sensitivity

43
Q

Diet changes for EMS

A
  • diet consisting of hay plus vitamin/protein/mineral supplement
  • Should receive hay in amounts equivalent to 1.5% of IDEAL body weight per day
  • Lower to 1.2% of initial BW after 1 month if no weight loss
  • Minimum amount recommended is 1.2% of BW/day
44
Q

Exercise program recommended for weight loss for EMS

A
  • Increased exercise promotes weight loss by increasing energy expenditure
  • 4-7 days a week for a minimum of 30 minutes excluding warm up or cool down
45
Q

Hay analysis for EMS

A
  • Analyze for carbohydrates
  • Select Hay with a NSC (Non-soluble carbohydrates) of <10% depending upon the severity of IR and hyperinsulinemia in the animal
46
Q

Which animals is it most important to do a hay analysis?

A
  • Very important in managing ponies and horses with fasting hyperinsulinemia >100 µU/mL
47
Q

Pasture access recommendations for horses with EMS

A
  • Free pasture access can cause many horses predisposed to EMS to become obese
  • Must limit this
  • Strategies include <1 hr turn out period 2x day
  • Confinement in a small paddock or round pen or enclosed area - dry lot
  • Use of grazing muzzle
48
Q

Levothyroxine for treatment of EMS

A
  • High doses can induce weight loss in horses

- Accompanied by increase in insulin sensitivity

49
Q

How does levothyroxine work?

A
  • induces weight loss via raising circulating levels of thyroxine and stimulating basal metabolic rate
50
Q

What other therapies must also be recommended with levothyroxine?

A
  • Weight loss enhanced by increase in exercise and calorie restriction
  • No pasture grazing should be permitted
51
Q

Metformin hydrochloride

A
  • Biguinide administered to control hyperglycemia and increase tissue insulin sensitivity in humans
52
Q

How does metformin work?

A
  • Suppresses hepatic glucose production by activating AMP-activated protein kinase
  • Inhibits gluconeogenesis and lipogenesis
53
Q

What cases might you use metformin in?

A
  • Refractory cases

- Extremely obese horses

54
Q

Dose timing for metformin

A
  • 1/2 hr before feeding up to 3x per day

Equine Medicine Final (10 decks)

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