Insulin dysregulation.
Authors: Frank N, Tadros E M
Journal: Equine veterinary journal
Summary
# Editorial Summary: Insulin Dysregulation in Equine Medicine Frank and Tadros' 2014 review consolidates our understanding of insulin dysregulation—encompassing both hyperinsulinaemia and insulin resistance—as a central mechanism driving equine metabolic syndrome and its most serious consequence, laminitis. The authors provide a comprehensive framework for recognising that insulin problems arise not only from established pathologies such as obesity, pituitary pars intermedia dysfunction, and chronic systemic inflammation, but also from physiological stress responses and pregnancy, meaning clinically normal-appearing horses may still warrant investigation. Diagnostic tools have evolved considerably: oral sugar or glucose tolerance tests now enable practitioners to assess individual dietary carbohydrate sensitivity in practice, whilst combined glucose-insulin tests or intravenous insulin tolerance tests quantify tissue insulin sensitivity by measuring glucose clearance rates following exogenous insulin administration. Importantly, the review highlights that hyperinsulinaemia itself—not merely insulin resistance—warrants active management, with emerging evidence suggesting incretin hormones play a significant role in postprandial insulin spikes and therefore may represent future therapeutic targets. For equine professionals, this work underscores that identifying and managing insulin dysregulation in all its forms, rather than waiting for clinical laminitis to develop, represents a practical and evidence-based approach to preserving soundness in at-risk populations.
Read the full abstract on PubMed
Practical Takeaways
- •Screen horses at risk of laminitis for insulin dysregulation using oral sugar or glucose tolerance tests to enable early intervention
- •Manage hyperinsulinaemia through dietary modification and weight control, as insulin dysregulation significantly increases laminitis risk
- •Consider insulin dysregulation in foals presenting with prematurity or systemic illness, as it can accompany these conditions
Key Findings
- •Insulin dysregulation encompasses hyperinsulinaemia and insulin resistance and is a key component of equine metabolic syndrome
- •Insulin dysregulation is associated with laminitis development in horses, ponies and donkeys
- •Causes of insulin resistance include obesity, systemic inflammation, pituitary pars intermedia dysfunction, stress, and pregnancy
- •Oral sugar tests and in-feed oral glucose tolerance tests are recommended diagnostic tools for assessing insulin responses to dietary carbohydrates