Hyperinsulinemic laminitis.
Authors: de Laat, McGowan, Sillence, Pollitt
Journal: The Veterinary clinics of North America. Equine practice
Summary
# Editorial Summary: Hyperinsulinemic Laminitis Hyperinsulinemia—elevated circulating insulin rather than insulin resistance itself—has emerged as the direct pathogenic trigger for a substantial proportion of laminitis cases in modern equine populations. De Laat and colleagues examined the metabolic and vascular mechanisms by which persistently high insulin concentrations compromise lamellar integrity, employing novel insulin infusion models to simulate the condition experimentally and dissect the underlying pathophysiology. Their findings shift focus away from peripheral insulin resistance as the primary culprit, instead implicating the direct effects of hyperinsulinaemia on lamellar metabolism and microvasculature. For practitioners, this distinction carries significant implications: management strategies should prioritise insulin control through rigorous dietary restriction and exercise rather than assuming that improving insulin sensitivity alone will resolve laminitis risk. Understanding hyperinsulinaemic laminitis as a metabolic emergency rather than merely a consequence of obesity or endocrine dysfunction fundamentally alters how we approach prevention and treatment in susceptible horses.
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Practical Takeaways
- •Identify and manage hyperinsulinemia in at-risk horses as a direct laminitis prevention strategy, not just as a marker of insulin resistance
- •Focus on dietary and metabolic management to reduce circulating insulin levels in horses with laminitis risk factors
- •Recognize that insulin-associated laminitis is increasingly common in modern equine populations and requires targeted metabolic intervention
Key Findings
- •Hyperinsulinemia, rather than insulin resistance alone, is the direct cause of insulin-associated laminitis in horses
- •Elevated serum insulin concentrations result in lamellar dysfunction through metabolic and vascular actions in the lamellar microenvironment
- •An insulin infusion model has been developed to investigate the pathogenesis of insulin-associated laminitis