The Good Doer Flashcards
WHat is Equine Metabolic Syndrome (EMS) ?
- It is not a disease
- It is a collection of risk factors for hyperinsulinemia-associated
laminitis (HAL) - The key central and consistent feature of EMS is insulin
dysregulation (ID)
What other factors to EMS?
◦ Obesity (generalised or regional)
◦ Adipose dysregulation (abnormal adipokine concentrations)
◦ Cardiovascular changes (hypertension, increased heart rate,
cardiac dimensions)
How much of laminitis cases in practice are due to Hyperinsulinaemia-associated Laminitis?
80%
What are the three distinct endocrine conditions associated with laminitis?
o Equine Metabolic Syndrome (EMS)
o Pituitary pars intermedia dysfunction (PPID)
o Exogenous glucocorticoid administration (Steroids!)
-> these can occur individually or in combo
What actually causes laminitis ?
Hyperinsulinaemia
What EMS testing can be done?
- Basal testing
- dynamic testing
What is included in basal testing?
- Insulin (fasted? resting?) - will vary
- Glucose - helpful to rule out diabetes
- triglycerides (often mild & inconsistent)
- Adiponectin -> low C° ass with obesity and ID
What dynamic testing can we do?
- Oral sugar test
- Insulin response test (IRT)
- Combined glucose insulin test (CGIT)
Describe oral sugar test ?
- Admin either glucose/dextrose OR Karo Light syrup OR Dan Sukker glykossirap then
- Insulin measured 60-120 mins later
Describe the insulin response test?
- Involve taking a baseline measurement of glucose then injecting insulin and re-measuring the glucose at
specified times - More expensive and risks hypoglycaemia
Combined glucose insulin test?
- Involve taking a baseline measurements of insulin and glucose and injecting glucose then insulin and remeasuring the insulin and glucose at specific time points
- Again, more expensive and a small risk of hypoglycaemia
How can we treat laminitis?
- analgesia & anti-inf (phenylbut or suxibut)
- Other pain relief? -> paracetamol, gabapentin, opioid if severe
- ACP -> inc BF to feet, calming effect (dec stress)
- Support pedal bone
How can we support the pedal bone?
-> strict box rest
- until inf and pain under control
- At least 1-2 weeks if simple case
- Re-check sound and off NSAId before considering turnout /exercise
-> soft deep bed
+/- remove shoes
+/- sole and frog support
What remedial farriery might we considerr?
Once inflammation has settled ->
- Trim excess toes - Lower heels
- Reduce breakover
- Support frogs/take pressure off pedal bone
What show we consider with chronic laminitis with upright boxy foot ?
- You may have contracted tendons
- surgery may be needed -> ALDFT desmotomy or DDFT tenotomy
Diet to reduce insulin?
- Decrease non-structural carbs
- Soak hay to reduce NSCs - sugars dec <50% after 8-16hrs
- Mix hay with straw 30-50% (onyl if good Teefs; risk of impaciton in some breeds)
- Balancer
- Slow them down (small nets etc)
- Reduce DMI
How do we reduce DMI?
- Recommended for horses is 2-2.5% of BW in DMI but for weight loss, reduce to 1.5% for weight loss -> not ideal long term
How to measure if diet changes are working?
- MEasuring insulin in repsonse to diet -> Post prandial insulin (and measure basal)
- BUT how high is too high?
What medication options if diet alone not sufficient?
- Metformin
- SGLT2 inhibitors
Detail Metformin use?
- Decreases enteric glucose absorption
- Poor bioavailability in horses
Detail SGLT2 inhibitors?
- Block Sodium-Glucose cotransporter 2
- Normally stops glucose loss into the urine
- None licensed in horses
-> very new and not much trial data for long term use
Address obesity ?
- Aim for 1% BW loss per week
- Regular monitoring is essential
- EMS can be reversed in some cases if weight returns to normal
how do we ensure regular monitoring ?
- Ideally weighbridge
- Or weigh tape (girth, rump and neck measurements)
- Every other week – same time of day and person
- BFS/BCS (be aware horses need to lose approx. 10% of BW before dropping and BCS – so
not hugely useful for motivation)
what about reducing grass intake at turnout?
- Muzzle
- Strip grazing
- Track systems
- Get more horses/ponies!
- Co-grazing
