Equine Metabolic Syndrome-Mallicote

Question 1

EMS definition

Answer 1

1. Insulin resistence
2. Obesity and/or regional adiposity
3. Prior or current laminitis-founder rings on feet
4. easy keeper

Question 2

Insulin responsible for

Answer 2

glucose movement into cells that can then be stored as glycogen or fat

Question 3

Common triggering factors

Answer 3

1. grazing lush pastures esp spring or fall
2. feeding concentrates high in simple surgars/starches
3. Interference with seasonal weight loss

Question 4

Insulin resistance and laminitis

Answer 4

1. Impair glucose delivery to hoof keratinocytes
2. Alter blood flow or endothelial cell function in foot
3. Lead to pro-inflammatory or pro-oxidative state

Question 5

Resting serum insulin concentration

Answer 5

IR horses will have compensatory hyperinsulinemia
If grass hay overnight insulin > 30 micU/mL is positive
If fasted > 20 microU/ml positive
*don’t test horses in stress/pain/acute laminitis

Question 6

Oral Sugar Test (OST)

Answer 6

Karo lite syrup PO (150 mg dextrose-derived digestible sugars/kg)
Higher BG > 115 mg/dL and
Higher insulin > 60 micU/mL positive for insulin resistence

Insulin < 45 is normal
Insulin 45-65 equivocal

Question 7

Oral Sugar test also used for dx

Answer 7

malabsorptive disorders

-horses fasted

Question 8

Combine glucose and insulin test (CGIT)

Answer 8

Will detect IR in some horses with normal resting insulin levels
-the time it takes for glucose conc to return to baseline is measure insulin sensitivity

Question 9

TX EMS

Answer 9

1. Reduce body fat

2. Avoid feeds high in starch and sugar

Question 10

Goal of EMS tx

Answer 10

Improve insulin sensitivity

Raise threshold for laminitis

Question 11

Managing Weight loss

Answer 11

1. Simple diet hay and low-calorie ration banacer
2. Hay fed at 1.5% body weight
3. THen lower hay to 1.5% ideal body weight
4. Can soak hay cold water 30 min before feeding

Question 12

Managing Insulin resistence

Answer 12

1. Restricted pasture access
2. Grazing early in morning safest
3. No grazing after frost
4. Exercise if healthy enough

Question 13

Managing horses with regional adiposity

Answer 13

1. Feed hay < 12% NSC,
2. soaked molasses-free beet pulp
3. balanced vit/min supplement
4. 0.5 cup rice bran oil/corn oil BID

Question 14

Levothyroxine

Answer 14

Thyro-L

1. Can accelerate weight loss
2. Increase insulin sensitivity

Question 15

Metformin

Answer 15

Enhances action insulin at post-receptor level

Question 16

Chromium

Answer 16

No proven efficacy

Question 17

Psyllium

Answer 17

Adjuct

Initial pos. studies not since repeated

Question 18

Corticosteroids

Answer 18

Be cautious and obtain owner consent when using in patients with ongoing insulin resistence.