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Equine Medicine > Unit 3 - Equine Metabolic Syndrome > Flashcards

Unit 3 - Equine Metabolic Syndrome Flashcards

1
Q

What is equine metabolic syndrome (EMS)?

A

A collection of risk factors for endocrinopathic laminitis, and the term syndrome is used because multiple factors contribute to risk of laminitis developing in an individual horse, pony, or donkey

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2
Q

What is the current accepted term for EMS?

A

Hyperinsulinemia-associated laminitis

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3
Q

True or False: Any horse can develop EMS if exposed to sufficient inciting factors.

A

True

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4
Q

What are the risk factors for EMS?

A

Insulin dysregulation, increased adiposity, hypertriglyceridemia, altered adipokine production, and cardiovascular abnormalities

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5
Q

What is the central endocrine disorder of EMS?

A

insulin dysregulation

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6
Q

Insulin dysregulation encompasses the different glucose and insulin alterations observed in affected equids, including:

A

Fasting hyperinsulinemia (HI), postprandial/post sugar HI, and tissue insulin resistance (IR)

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7
Q

What the most common form of insulin dysregulation in equids?

A

compensated insulin dysregulation

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8
Q

What is compensated insulin dysregulation?

A

hyperinsulinemia with euglycemia

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9
Q

What is uncompensated insulin dysregulation?

A

hyperinsulinemia with hyperglycemia as a result of pancreatic insufficiency

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10
Q

What is another term for uncompensated insulin dysregulation?

A

Type 2 diabetes mellitus

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11
Q

What breeds are more commonly affected by EMS?

A

Arabians, Morgans, Paso Finos, Tennessee Walking Horses, Saddlebreds, Spanish Mustangs, ponies, and warmbloods

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12
Q

What is obesity?

A

An increase in body weight as a result of excessive fat accumulation within the body

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13
Q

What BCS correlates with obesity?

A

BCS greater than or equal to 7

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14
Q

What is regional adiposity?

A

The increased accumulation of adipose associated with certain body regions including the crest of the neck, overlying the shoulders and craniodorsal thorax, adjacent to the tail head, prepuce/mammary glands, and periorbital regions

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15
Q

When may subclinical laminitis be present?

A

When laminae undergo structural changes without overt lameness

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16
Q

What is it important to distinguish EMS from even though they can occur concurrently and influence one another?

A

pituitary pars intermedia dysfunction (PPID)

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17
Q

What plays a role in EMS development?

A

Genetics

Environmental factors - diet and exercise

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18
Q

Feeding what to an EMS susceptible animal is enough to induce obesity?

A

Feeding grain and the grass consumed on pature

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19
Q

How does EMS commonly present?

A

Laminitis, divergent hoof rings, generalized and/or regional adiposity, infertility, and sheath/mammary swelling

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20
Q

Genetically predisposed animals to EMS are reported by their owners to be what?

A

Easy keepers or good doers

Sorry this is a terrible question

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21
Q

Most horses, ponies, and donkeys, with EMS are _______, and a thicker than normal ______ crest is noted on physical exam.

A

Obese - neck

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22
Q

True or False: Hyperglycemia is common in EMS affected horses.

A

False - it is uncommon, however it may be more likely when animals are challenged by systemic disease and hospitilization

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23
Q

When persistent hyperglycemia is noted, it is appropriately termed as what?

A

type 2 diabetes mellitus

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24
Q

What is a common misconception about horses that are obese because obesity is associated with this condition in horses and dogs?

A

Primary hypothyroidism

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25
Q

What do the thyroid levels look like in some horses with EMS?

A

Low tT3 and tT4

Most of these animals have normal TRH

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26
Q

When should thyroid hormone supplementation be reserved in EMS patients?

A

For cases with persistently low free T4 concentrations and abnormal TRH stimulation thyroid test results

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27
Q

What PE testing should be done for EMS suspect patients?

A

Measures of adiposity should be performed, including BCS, cresty neck score, and ultrasound measurements of abdominal or subcutaneous fat depth

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28
Q

What main tests can be done for evaluation of insulin concentrations in EMS suspect patients?

A

Basal insulin concentration, oral sugar test, insulin tolerance test

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29
Q

Why is basal insulin concentration most often used as a screening test for EMS?

A

Because it has low sensitivity and high specificity - only identifies severely affected ID animals

30
Q

What basal insulin concentration confirms EMS?

A

A high insulin concentration (>50)

31
Q

Does a normal basal insulin concentration rule out EMS?

A

no

32
Q

What is the current recommendation for basal insulin concentration in regards to feeding?

A

The patient should remain on hay and/or pasture, with only grain withheld for 6 hours prior to blood collection

33
Q

What is the preferred diagnostic test to screen for insulin dysregulation?

A

Oral sugar test (OST)

34
Q

What does the oral sugar test measure?

A

glucose and insulin levels

35
Q

What should be done with patients prior to oral sugar testing?

A

Fast them for 3-6 hours

36
Q

Why would you want to test the fasting blood glucose during OST?

A

To detect for diabetes mellitus

37
Q

A dosage of what improves the OST?

A

using a high dose of corn syrup

38
Q

When are blood samples collected during an OST?

A

at 60 minutes and/or 90 minutes after oral sugar administration

39
Q

What levels should always be tested when insulin concentrations are measured?

A

Glucose levels

40
Q

What plasma glucose level indicates uncompensated insulin resistance or diabetes mellitus?

A

> 125 mg/dl

41
Q

When the OST is repeated to monitor the progress of an individual patient with insulin dysregulation, what results are considered to be significant?

A

Dichotomous results

42
Q

What does the insulin tolerance test (ITT) evaluate?

A

hepatic and/or peripheral tissue insulin sensitivity

43
Q

True or False: Insulin tolerance testing does not require fasting.

A

True

44
Q

What measurement aside from insulin does the ITT require?

A

blood glucose levels

45
Q

What is the procedure for ITT?

A

Collect blood measurement at time 0 and administure insulin IV
Recheck the blood glucose at 30 minutes and feed immediately after

46
Q

What ‘other’ screening test for ID effectively measures adiposity?

A

Leptin testing

47
Q

True or False: An increase in triglycerides is a consistent finding in EMS cases.

A

False

48
Q

Individual horses that are genetically predisposed to EMS readily _____ ______ and have_______.

A

gain weight, hyperinsulinemia

49
Q

Why is EMS often associated with a systemic, low-grade inflammatory state?

A

Because adipose tissues secrete inflammatory cytokines as obesity progresses. Obesity and ID have been loosely positively correlated with plasma concentrations of TNF-alpha and IL1

50
Q

Reduced ______ insulin clearance may play a role in hyperinsulinemia.

A

hepatic

51
Q

What are the 3 approaches to the management of ID?

A

Reducing the sugar and starch content of the feeds provided to the horse
Limiting or eliminating access to pasture until ID improves
Increasing exercise

52
Q

What is the ultimate goal of managing ID?

A

reduce the risk of endocrinopathic laminitis

53
Q

If obesity is present, what is the initial focus of ID management?

A

Reduce caloric intake and achieving weight loss

54
Q

When trying to decrease surgar and starch in EMS patients, what feed is recommended? How much?

A

Low nonstructural carbohydrate (NSC) hay at 2% of body weight initially

55
Q

If they aren’t losing weight by 4 weeks, what is the recommendation for feeding?

A

Reduce to 1.5% of the ideal body weight and if that doesn’t work reduce to 1 - 1.2 % of the body weight

56
Q

Why don’t you want to feed less than 1% of body weight?

A

It would be severe calorie restriction and increase the risk of inducing dyslipidemia

57
Q

When on hay only diets, what supplementation is recommended?

A

Supplementation of trace minerals, protein, and vitamin E is recommended when on hay only diets

58
Q

Which is more influential in raising blood insulin levels?

a. Starch
b. Fructans

A

Starch > Fructans

59
Q

What is the goal when feeding hay?

A

To feed hay that is less than 10% NCS (as-fed basis)

60
Q

What can be done to the hay to reduce the sugar content?

A

Soaking hay in cold water for 30-60 minutes may reduce the sugar content of hay

61
Q

Why do you want to limit or eliminate access to pasture until ID improves?

A

Grass is an unregulated source of sugar and starch, so these carbohydrates will continue to exacerbate ID

62
Q

If you are going to allow pasture access in an ID patient, how long should they be able to be out there?

A

Limit to short periods in the very early morning hours except after a hard frost

63
Q

When should you consider dry lot confinement?

A

In severe cases of hyperinsulinemia

64
Q

In what cases of ID should exercise be increased?

A

If active laminitis is not present, daily exercise should be performed to increase energy consumption and accelerate weight loss

65
Q

When is exercise contraindicated in ID cases?

A

Foot soreness or suspicion of active laminitis

66
Q

How can most cases of EMS be managed?

A

Lowering the sugar and starch content of the diet, reducing body fat mass, instituting an exercise program, and limiting or eliminating access to pasture

67
Q

What are the 2 indications for pharmacotherapy to manage EMS in horses?

A

Management of weight loss resistance and management of refractory hyperinsulinemia

68
Q

How is weight loss resistance managed?

A

Levothyroxine

REMEMBER - it is not prescribed because the patient is hypothroid

69
Q

How is refractory hyperinsulinemia managed?

A

Metformin and canagliflozin

70
Q

What is the main action of Canagliflozin?

A

It increases renal excretion of glucose

71
Q

When is Canagliflozin contraindicated?

A

With liver disease and hypertriglyceridemia

72
Q

What is the indication for using pergolide?

A

When PPID is concurrently involved

Equine Medicine (27 decks)

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