Module 2: Clinical Aspects of Equine Metabolic Syndrome

Question 1

is a disorder associated with an inability to regulate blood insulin levels (insulin dysregulation)

Answer 1

Equine metabolic syndrome

Question 2

What does EMS look like?

Answer 2

*Average age = 8-15 y (adult)
*Obese (exceptions!)
*Regional adiposity
*Neck crest
*Tail head

Question 3

Who is at risk for Equine
Metabolic Syndrome?

Answer 3

 Overweight/obese condition is concerning for many
reasons:
 Poor fitness—horse may not perform up to its potential
 Exacerbation of conditions affected by body weight
 Arthritis
 Ligament and tendon injuries
 Pregnancy?
 EMS
 LAMINITIS RISK

Question 4

What species/breeds are predisposed?

Answer 4

• Ponies
• Donkeys
• Mules
• American Saddlebreds
• Tennessee Walking Horses
• Morgans
• Peruvian Pasos, Paso Finos
• Arabians

Question 5

 Basal insulin, glucose measurements
 Dietary preparation = grass
hay only overnight..

Answer 5

Simple blood tests

Question 6

 Oral glucose tolerance test, oral sugar test (OST)
 IV insulin tolerance test
 CGIT
 FSIGTT, EHC techniques
(research)

Answer 6

‘Involved’ tests

Question 7

What is the treatment for EMS?

Answer 7

Diet

Question 8

What is the goal of diet modification?

Answer 8

1. Encourage weight loss
    Decreased caloric intake…
2. Minimize increases in blood sugar, insulin
    Decreased NSC intake…

Question 9

What is absorbed in the small intestine and increases blood sugar?

Answer 9

• Non-structural carbohydrates
  
  • Sugars
  • Starches
  • Fructans

Question 10

What is fermented in hindgut to VFA’s and has minimal effect on blood sugar?

Answer 10

• Structural carbohydrates
  
  • Cellulose
  • Hemicellulose

Question 11

How can you restrict access to
pasture?

Answer 11

 Grazing muzzle
 Short, controlled turnout periods
 Early morning grazing = ideal
 plant sugars are higher in the late afternoon and lower in the early morning
 Shaded pasture

Question 12

 Thyroid hormone
 Increases basal metabolic rate
 Improves insulin sensitivity
 Encourages weight loss
 Temporary use!!

Answer 12

Levothyroxine

Question 13

 May increase insulin sensitivity
 Horses don’t absorb the drug well orally
 More study needed…

Answer 13

Metformin

Question 14

is under the control of neurons located in the medial region of the PVN that synthesize and release thyrotropin-releasing hormone (TRH) into the pituitary portal circulation

Answer 14

hypothalamic–pituitary–thyroid axis

Question 15

 COX inhibitors
 Phenylbutazone
 Flunixin
 Firocoxib
 Acetaminophen
 Opioids
 Gabapentin
 ‘Pentafusion’ – lidocaine, ketamine, detomidine, morphine, acepromazine

Answer 15

Analgesic medication - Therapy for Laminitis