Insulin Dysregulation: What the Research Says
Evidence from 130 peer-reviewed studies
3 Systematic Review
19 RCT
62 Cohort Study
10 Case Report
34 Expert Opinion
2 Thesis
What Professionals Should Know
- •Consider age (≥15 years), hypertrichosis, and delayed hair shedding as primary indicators for PPID testing; use TRH stimulation testing for improved diagnostic accuracy over basal ACTH alone, especially outside autumn months
- •Recognize that breed and seasonal factors substantially influence ACTH values—interpret results using equivocal ranges and pre-test probability rather than fixed cutoffs to avoid false positive diagnoses and unnecessary lifelong therapy
- •Start pergolide treatment based on clinical signs and diagnostic results; monitor clinical improvement rather than strictly chasing ACTH values, as hormone levels may normalize without full clinical resolution and compliance with treatment is often poor
- •Identify insulin dysregulation in ponies with pasture-associated laminitis, as this endocrinopathic phenotype represents a distinct disease mechanism requiring targeted management
- •Recognize that laminitis can result from multiple different pathways (metabolic, inflammatory/septic, biomechanical), and naturally occurring cases may involve contributions from several mechanisms simultaneously
- •Understanding the cellular and molecular basis of laminitis pathogenesis can inform preventive strategies and treatment approaches targeting basal epithelial cell stress
- •Diagnosis of insulin dysregulation should investigate both tissue insulin resistance and enteroinsular axis function rather than relying on single tests
- •Account for breed, diet, fasting status, and seasonal variations when interpreting insulin dysregulation test results to avoid false negatives in at-risk horses
- •Focus on identifying horses with insulin dysregulation early to enable preventive laminitis management, as established laminitis remains difficult to treat effectively
- •Velagliflozin at 0.3 mg/kg once daily is an effective pharmacological tool for managing hyperinsulinemia in horses with insulin dysregulation, with substantial reductions in resting insulin levels
- •Monitor triglyceride concentrations during treatment as transient elevations occur, though no clinical complications were observed in this study
- •Expect weight loss in treated horses (approximately 1 BCS point over 20 weeks), which may be beneficial for insulin dysregulation management but requires nutritional monitoring
- •Phenylbutazone reduces GIP concentrations in horses with insulin dysregulation, but this does not explain its glucose and insulin-lowering effects, suggesting alternative mechanisms of action
- •The enteroinsular axis hormones measured (GIP, GLP-1, GLP-2) appear not to play a primary role in insulin dysregulation or phenylbutazone's therapeutic effects in affected horses
- •Clinicians using phenylbutazone for laminitis pain in insulin dysregulated horses may see metabolic improvements, but further research is needed to understand the underlying mechanisms
- •Phenylbutazone's clinical benefit in insulin dysregulation extends beyond pain management for laminitis—it actively improves insulin sensitivity at the tissue level
- •Horses with ID receiving phenylbutazone show reduced circulating glucose and insulin, potentially lowering laminitis risk independent of pain relief
- •Consider phenylbutazone as part of metabolic management in ID cases, not just as an analgesic for laminitis-related discomfort
- •When horses require corticosteroids, dietary management with high-protein ration balancers may have amplified effects on blood glucose and insulin; monitor metabolic response more carefully in steroid-treated horses
- •Standard recommendations for low-NSC diets in insulin-dysregulated horses may need adjustment when corticosteroids are administered concurrently
- •Consider more frequent glucose/insulin monitoring in horses on both corticosteroids and high-protein supplementation to detect dysregulation earlier
- •Essential oil supplementation may help manage insulin dysregulation in horses, particularly those with more severe cases, potentially reducing metabolic disease risk
- •The supplement appears to work through metabolic changes affecting amino acid and energy metabolism pathways rather than simple glucose clearance mechanisms
- •This nutritional intervention could be incorporated into management protocols for horses prone to laminitis or metabolic syndrome, though field efficacy and optimal dosing require further investigation
- •Consider nutraceutical supplementation as a prophylactic intervention for horses with known insulin dysregulation history, particularly those at risk of laminitis
- •Nutraceutical-supplemented horses cleared glucose faster and maintained lower insulin levels during starch challenges, potentially reducing laminitis risk
- •This intervention may allow horses with insulin dysregulation to tolerate higher starch diets more safely, though hay-based diets remain preferable
- •Phenylbutazone may have therapeutic benefits beyond pain relief in managing hyperinsulinemia-associated laminitis by reducing insulin secretion
- •The drug's effect on glucose and insulin regulation appears specific to horses with insulin dysregulation, not healthy controls
- •Further investigation is warranted to establish optimal dosing and protocols for metabolic management of laminitis-prone horses
- •GPC may be a useful additional tool for screening horses with suspected insulin dysregulation, though it produces higher insulin responses than OST so reference ranges will need to be established
- •Timing of blood sample collection is critical for both tests; a single time point may miss diagnostically important insulin peaks, so multi-point sampling protocols are necessary
- •Most horses readily consume the pellets, making GPC practical for field use, though individual variation in insulin response timing requires careful protocol standardization
- •AMPK agonist therapy with resveratrol, metformin, or aspirin should not be relied upon as effective treatments for insulin dysregulation in horses—consider alternative therapeutic approaches
- •Horses receiving glucocorticoids require baseline metabolic testing to identify insulin dysregulation early, as 14 days of dexamethasone significantly impaired glucose regulation and caused clinical laminitis in some animals
- •The combination of three different AMPK agonists failed where individual agents might have been expected to work; current evidence does not support their use for managing metabolic syndrome in horses
- •Consider oligosaccharide supplementation as a potential dietary intervention for geldings with Equine Metabolic Syndrome and insulin dysregulation, particularly as a laminitis prevention strategy
- •Be aware that treatment response may differ between geldings and mares; this sex-dependent effect warrants further investigation before applying to all horses
- •Recognize that gut microbiota composition and diversity correlate with insulin status and laminitis history, suggesting microbiome assessment may help identify at-risk horses
- •Sirolimus shows promise as a potential therapeutic agent for managing hyperinsulinemia in horses, with measurable reductions in post-glucose insulin responses within 24 hours of administration
- •The drug's long half-life (approximately 2.5 days) supports feasibility for practical clinical dosing schedules
- •Further investigation with longer treatment periods and larger sample sizes is needed before clinical implementation; this preliminary evidence warrants monitoring for potential application in horses with metabolic syndrome and insulin dysregulation
- •Keep total NSC intake below 0.1 g/kg bodyweight per meal for insulin dysregulated horses to minimize laminitis risk; this translates to roughly 5 g NSC per 500 kg horse per feeding
- •Use of low-NSC pelleted feeds as a base diet, with careful titration of any supplemental carbohydrate sources, allows better control of postprandial insulin spikes in ID horses
- •Not all horses respond equally to carbohydrate restriction—monitor individual insulin responses rather than applying blanket dietary rules to all horses on your property
- •GLP-1 agonists like exenatide show promise as a pharmacological intervention to reduce laminitis risk by improving insulin metabolism in dysregulated horses
- •A single dose of exenatide meaningfully lowered insulin spikes following carbohydrate intake, which could translate to reduced laminitis trigger in susceptible animals
- •This research supports further investigation into GLP-1 mimetics as a therapeutic option, though clinical efficacy and dosing protocols for field use require confirmation in larger studies
- •Vatinoxan co-administration should be considered when using detomidine for sedation in horses with insulin dysregulation to prevent adverse glucose and insulin fluctuations
- •Clinicians using detomidine in horses with suspected or confirmed insulin dysregulation should monitor blood glucose and insulin concentrations, as hyperglycaemia and hyperinsulinaemia can occur within 2-4 hours
- •Detomidine monotherapy causes significant metabolic derangements in insulin-dysregulated horses; combination therapy or alternative sedatives may be safer choices for this population
- •Velagliflozin offers a promising pharmacological option for preventing laminitis in insulin-dysregulated horses and ponies by significantly reducing hyperinsulinemia
- •This treatment could be particularly valuable for high-risk animals during spring/summer when pasture NSC content is elevated, or for those on concentrate-based diets
- •Safe medication profile with no observed adverse effects means it could be incorporated into laminitis prevention protocols alongside dietary management and exercise
- •Exercise-based weight loss protocols may offer metabolic advantages over diet restriction alone, particularly for improving insulin sensitivity—consider recommending exercise as part of obesity management in practice
- •Both approaches achieved similar morphometric improvements, so diet restriction remains a viable option when exercise is contraindicated, though metabolic benefits may be inferior
- •Neck circumference measurement appears more sensitive to exercise effects than other morphometric measures, potentially useful for monitoring exercise-based weight loss programs
- •Velagliflozin offers a pharmacological option for managing insulin dysregulation in ponies when dietary management alone is insufficient, with established safety profile over extended use
- •Practitioners should note this SGLT2 inhibitor requires daily oral dosing and response should be monitored via standardized feeding challenges rather than fasting insulin alone
- •Effects appear reversible upon withdrawal, suggesting the drug controls rather than resolves the underlying condition
- •Gymnema sylvestre at 10 mg/kg may help reduce insulin spikes in insulin-dysregulated horses fed carbohydrate-rich meals, though effects are modest (~25% reduction)
- •In vitro efficacy does not guarantee in vivo effectiveness (lactisole example), so clinical testing is essential before recommending new supplements
- •This is early-stage research; practitioners should await further optimization of dose/delivery methods and direct receptor testing before implementing these compounds in practice
- •Obesity itself may not be the primary driver of insulin resistance in horses—other dietary or management factors warrant investigation before assuming overweight horses are inevitably insulin-dysregulated
- •High-fat diets did not confer metabolic protection against obesity-related insulin changes, challenging assumptions that low-glycaemic feeding prevents insulin problems in obese individuals
- •Once-daily glucose feeding unexpectedly improved insulin sensitivity markers; feeding patterns and meal frequency may be more important metabolic factors than previously recognized
- •Understanding the role of GIP in fat metabolism may help manage obese ponies and those at risk of laminitis through targeted dietary interventions
- •The strong postprandial response of insulin and GLP-1 to feeding suggests that meal timing and composition are critical factors in managing insulin dysregulation
- •Monitoring triglyceride levels may provide practical insight into GIP-mediated metabolic dysfunction in at-risk horses
- •Activin A should not be relied upon as a screening tool for laminitis risk in pony populations—continue using established insulin testing protocols
- •Basal serum activin A testing does not add clinical value to existing metabolic assessments for laminitis prevention
- •Focus on traditional oral sugar tolerance testing and fasting insulin levels as evidence-based methods for identifying at-risk ponies
- •Horses with a history of laminitis show exaggerated insulin responses to pasture grazing and oral sugar challenges; monitor these horses more closely during high-NSC seasons and consider restricted grazing or NSC-limiting diets
- •Regional adiposity (cresty neck score) correlates with insulin dysregulation in laminitis-prone horses; weight and condition management should be prioritized year-round to reduce metabolic risk
- •Monthly or seasonal insulin testing via oral sugar test may help identify at-risk horses earlier and guide nutritional interventions before clinical laminitis recurs
- •Laboratory reference ranges for insulin should account for seasonal variation, with winter baseline values expected to be higher; adjust clinical interpretation accordingly
- •Breed-specific insulin profiles matter clinically—Shetland and Welsh ponies are inherently higher insulin responders and require lower thresholds for metabolic disease concern
- •Sex and age influence insulin levels; older females will naturally have higher concentrations, which should inform your laminitis risk assessment and management strategy rather than trigger unnecessary treatment escalation
- •Monitor adiponectin and insulin response in native-breed ponies on pasture, as obesity-independent insulin dysregulation can develop rapidly; six of seven ponies developed problematic adiponectin levels despite starting with normal baseline insulin
- •Pasture management is critical for insulin sensitivity—avoid both overgrazed short grass and rank lush growth; intermediate pasture quality appears optimal for maintaining tissue insulin sensitivity
- •Ponies can develop insulin dysregulation and laminitis risk factors before reaching obese body condition scores (ID appeared at BCS 7/9), so early metabolic screening is warranted during weight gain phases
- •Breed differences significantly affect HPA axis and metabolic hormone interpretation—reference ranges for ponies should not be extrapolated from horses, particularly for ACTH and insulin in fall months
- •Ponies show elevated insulin and ACTH in fall/winter, suggesting heightened metabolic and endocrine challenges during these seasons that may increase laminitis and metabolic disease risk
- •Consider seasonal timing when performing endocrine testing in both ponies and horses, as results vary substantially between spring and fall sampling
- •Current EMS diagnosis relies on limited tools (basal insulin, OST); new plasma biomarkers may offer more reliable detection in field settings
- •Understanding EMS pathophysiology at the protein level may lead to better preventive strategies and earlier intervention before laminitis develops
- •Consider that multiple factors (diet, age, stress, season, medications) affect insulin testing—new biomarkers could provide more consistent results
- •Over 60% of Shetland and Welsh ponies in this Australian cohort had insulin dysregulation; cresty neck and high body condition score are practical visual indicators of metabolic risk in ponies
- •Insulin dysregulation and insulin resistance are significant independent risk factors for laminitis in ponies—metabolic testing should inform preventive lameness management strategies
- •Older ponies and those perceived by owners as overweight warrant metabolic screening; consider PPID testing as PPID status strongly associates with laminitis risk
- •Pre-treatment with metformin before feeding may reduce problematic insulin spikes in ID-affected horses, offering a practical timing strategy for practitioners
- •This approach could help manage laminitis risk in insulin-dysregulated horses by mitigating post-meal hyperinsulinaemia without requiring continuous medication
- •Consider discussing timed metformin dosing with veterinarians as a targeted intervention for horses with confirmed insulin dysregulation experiencing recurrent or persistent laminitis
- •Joint injections with triamcinolone may trigger metabolic changes that increase laminitis risk even in metabolically normal horses—consider timing and monitoring protocols
- •Monitor for clinical signs of laminitis more closely following intra-articular corticosteroid injections, particularly in horses with any metabolic predisposition
- •Alternative or adjunctive joint treatments should be considered for horses at higher laminitis risk, despite the cost and efficacy advantages of corticosteroid injections
- •Obesity assessment in native-breed ponies should consider adiponectin status as part of metabolic syndrome evaluation, as dysregulation may contribute to laminitis risk independent of insulin alone
- •Weight management and metabolic monitoring are critical preventive strategies, as insulin dysregulation occurs in all affected animals and may be linked to adiponectin abnormalities
- •Veterinarians should consider adiponectin testing alongside traditional insulin and glucose assessments when evaluating obese ponies for metabolic syndrome risk
- •PZI can be used as a practical substitute for RHI in insulin-tolerance testing since it is veterinary-approved and more accessible to practitioners
- •When using PZI for insulin-tolerance testing, apply a 40% glucose reduction threshold at 30 minutes rather than the standard 50% to improve diagnostic accuracy for insulin resistance
- •No safety concerns were observed with either insulin formulation, making PZI a viable alternative for practitioners without access to RHI
- •Oral sugar testing with 60-minute insulin measurement can help identify ponies at risk of laminitis before clinical signs develop, enabling preventive management strategies
- •Simple physical characteristics and owner observations may help veterinarians prioritize which ponies warrant formal insulin dysregulation testing, reducing unnecessary testing
- •Understanding metabolic marker associations with insulin response can guide nutritional and management interventions for at-risk individuals
- •Connemara ponies show high prevalence of obesity and metabolic dysfunction; breed-specific screening and management protocols should be considered routine practice
- •Oral sugar testing detected hyperinsulinaemia more effectively than basal insulin measurement alone—clinicians should use both methods for comprehensive assessment in at-risk ponies
- •Nearly half of these ponies have laminitis history; aggressive weight management and metabolic monitoring are essential preventive strategies for this breed
- •GLP-1 measurement should not be added to diagnostic protocols for identifying insulin dysregulation or resistance in ponies, as it does not differentiate affected from unaffected animals despite correlating with insulin levels
- •High non-structural carbohydrate feeds (glucose tests and breakfast cereal) consistently trigger GLP-1 responses within 30 minutes; this may inform timing of metabolic testing protocols
- •The strong GLP-1-insulin correlation confirms the incretin effect operates in ponies, but this relationship alone does not help identify dysregulation cases
- •Do not assume non-obese stock-type horses are safe from insulin dysregulation—approximately 1 in 20 may be affected; consider oral sugar testing regardless of body condition score
- •Morphometric neck measurements alone are poor predictors of insulin response and should not be used as screening tools; formal metabolic testing remains necessary for accurate assessment
- •Sex differences exist in baseline insulin levels; mares warrant particular attention for ID screening given their higher pre-insulin concentrations
- •OGT and IV insulin response tests detect different aspects of insulin dysregulation; OGT identifies hyperinsulinemia while IV tests identify peripheral insulin resistance — use both or choose based on clinical suspicion to avoid missing cases
- •A modified 2-step IRT with porcine zinc insulin may over-identify insulin resistance compared to oral testing; interpret results cautiously and consider combining tests for comprehensive metabolic assessment
- •Not all hyperinsulinemic horses demonstrate proportional peripheral insulin resistance, so a normal IV glucose clearance does not rule out metabolic dysfunction or laminitis risk in susceptible breeds like Icelandic horses
- •EMS is highly prevalent in Nigeria affecting 43% of sampled horses; farriers and veterinarians should screen horses for laminitis signs (divergent rings, widened white lines) and conduct insulin testing to identify at-risk individuals
- •Obesity is the primary modifiable risk factor, but not all EMS cases are obese—ensure regular exercise beyond walking only, with frequency at least monthly rather than every 5 months, as infrequent exercise significantly increases EMS risk
- •West African Barb breed and stallions require heightened vigilance for metabolic issues; examine for abnormal neck crest as a clinical indicator and avoid constant tethering management that limits movement
- •Choose your insulin dysregulation screening test based on clinical context: basal insulin is most specific but will miss cases; OST provides good balance; ITT identifies more positive cases but has lower specificity
- •Basal insulin and oral sugar test results are associated with laminitis risk, but insulin tolerance test results alone should not be used to predict laminitis without additional clinical assessment
- •All three tests are well-tolerated field options, but combining tests rather than relying on a single test may provide more complete insulin dysregulation assessment
- •ACTH alone should not be used as a sole diagnostic indicator for PPID; insulin status and dysregulation must be evaluated concurrently for accurate diagnosis
- •Aged horses and ponies with elevated ACTH but no clinical PPID signs may have insulin dysregulation as a confounding factor, requiring comprehensive endocrine assessment
- •Request both insulin and ACTH testing in aged animals with metabolic concerns to differentiate between primary PPID and secondary ACTH elevation from insulin dysregulation
- •Request basal and 60-minute post-glucose insulin testing (corn syrup challenge) for nonlaminitic ponies to stratify laminitis risk; high fasting insulin (>45.2 µIU/ml) or stimulated insulin (≥153 µIU/ml) warrants aggressive dietary/management intervention.
- •Monitor hoof growth patterns as a clinical predictor—divergent growth is associated with increased laminitis risk independent of metabolic markers.
- •ACTH testing alone is not useful for laminitis risk prediction in nonlaminitic ponies; focus on insulin parameters instead.
- •GC pellets offer a practical field-friendly alternative to traditional glucose challenge tests, eliminating the need for naso-gastric intubation while maintaining diagnostic accuracy for identifying insulin dysregulation
- •The GC syrup formulation provides flexibility for practitioners who prefer syringe administration and correlates excellently with tube OGT results, making it suitable for horses that resist oral tubing
- •Standardized carbohydrate formulations (0.5 g/kg body weight) enable more reliable and comparable diagnostic results across different practices and geographic regions
- •Carbohydrate pellets offer a palatable, practical alternative for oral glucose tolerance testing in horses and ponies; expect better acceptance in ponies than horses
- •Use 120-minute post-consumption serum insulin measurement at the 83 μIU/mL threshold with the IMMULITE 2000XPi assay for standardized insulin dysregulation diagnosis
- •The short median intake time (4 minutes) and high acceptance rate make this test more practical and reliable than previous glycemic challenge methods with variable dosing routes
- •Obese horses with insulin dysregulation have increased clotting tendency, which may elevate thromboembolism risk—weight management and metabolic control become cardiovascular risk reduction strategies
- •Body condition assessment is relevant to thrombotic risk; horses scoring ≥7.5/9 on the Henneke scale warrant metabolic evaluation and closer clinical monitoring
- •Consider hypercoagulability as an additional systemic consequence of equine obesity and metabolic syndrome when assessing comorbidity risk in these patients
- •ID horses respond disproportionately to even small amounts of NSC-containing feeds; feeding low-NSC pellets (<6% NSC) significantly reduces dangerous postprandial insulin spikes and laminitis risk
- •High-protein or balanced ration formulations do not meaningfully reduce insulin responses in ID horses compared to high-NSC grains—NSC content must be the primary selection criterion
- •Dietary guidelines for managing ID horses cannot be safely based on responses in healthy horses; ID horses require individualized feeding strategies focused on NSC minimization
- •Use the 60-minute oral sugar test (T60) rather than resting insulin alone for more consistent diagnosis of insulin dysregulation across seasons—94% vs 56% accuracy
- •Expect ID horses to show higher insulin concentrations in spring; seasonal variation exists but should not prevent diagnosis if using the full OST protocol
- •Monitor body condition and cresty neck scoring in spring through fall as these measurements correlate with insulin dysregulation status and laminitis risk
- •Commercial protein supplements may stimulate muscle protein synthesis more effectively than forage-based proteins of equal amount, potentially supporting muscle development and recovery
- •Insulin-dysregulated horses can still activate muscle-building signaling pathways normally after protein feeding, suggesting protein quality rather than metabolic dysfunction limits their response
- •Consider higher-quality protein sources for ID horses requiring muscle support, as their amino acid and anabolic signaling responses remain intact despite insulin dysregulation
- •Ergot alkaloid exposure (via bromocriptine or endophyte-infected pastures) appears to worsen insulin sensitivity in horses and should be avoided, particularly in horses already prone to insulin dysregulation or metabolic syndrome
- •Use caution interpreting ergot alkaloid effects based on research from other species—equine metabolic responses differ significantly from humans and rodents, making direct translation of treatments inappropriate
- •Monitor pasture quality and avoid endophyte-infected fescue and other toxic grasses, especially for metabolically compromised horses, as natural ergot alkaloids share structural similarity with the detrimental effects seen here
- •Resting plasma amino acid concentrations, particularly citrulline, GABA, and methionine, differ significantly between obese horses and those with insulin dysregulation and laminitis, potentially offering a new diagnostic tool for laminitis risk assessment
- •These findings suggest amino acid metabolism is altered in hyperinsulinemic states and laminitis, which may warrant investigation of targeted dietary supplementation strategies for at-risk horses
- •Current evidence is preliminary; larger prospective studies are needed before plasma amino acid profiling can be reliably used in clinical practice for laminitis prediction or prevention
- •Repeated oral sugar tests throughout the year may be warranted for horses with variable insulin dysregulation status, as single testing may miss affected animals
- •Exercise appears protective against insulin dysregulation regardless of season; prioritize consistent movement programs for metabolic health
- •Monitor cresty neck score, adiponectin levels, and body composition in older horses as these are linked to insulin response; combine with clinical assessment rather than relying on seasonal patterns alone
- •Ponies with insulin dysregulation have disproportionately elevated biologically active cortisol relative to total cortisol, suggesting breed-specific hormonal mechanisms that may require different monitoring or management strategies
- •Baseline ACTH is naturally higher in healthy ponies, so reference ranges should not be directly compared between horses and ponies when evaluating HPA axis function
- •Assessment of insulin dysregulation risk in ponies should consider that breed-related hormonal differences may amplify cortisol's antagonistic effects on insulin signaling
- •Resistin measurement may be useful as a biomarker for inflammatory status in horses with metabolic conditions, but should not be used as a standalone indicator of insulin dysregulation severity
- •Horses presenting with metabolic syndrome should be evaluated for concurrent inflammatory conditions, as resistin elevations suggest inflammation-driven pathology rather than pure metabolic dysfunction
- •Serum amyloid A measurement alongside resistin may provide complementary inflammatory markers for monitoring horses with metabolic and inflammatory disorders
- •Insulin dysregulation in laminitis-prone horses may cause amino acid imbalances that compromise hoof tissue integrity; monitoring insulin status becomes increasingly important for prevention
- •Dietary amino acid supplementation or insulin management strategies targeting hypoaminoacidemia may offer therapeutic potential for endocrinopathic laminitis cases
- •Understanding the hyperinsulinemia-hypoaminoacidemia-laminitis pathway helps explain why insulin control is critical in laminitis management
- •Sphingolipid profiling may help identify horses at risk for insulin dysregulation earlier than traditional glucose tolerance testing
- •Understanding ceramide-insulin relationships could inform nutritional or management strategies to improve insulin sensitivity in susceptible horses
- •This research supports monitoring metabolic markers beyond glucose alone when assessing insulin-related problems in equine practice
- •Glycerophospholipid and glucose metabolism alterations may serve as early warning biomarkers for laminitis susceptibility, potentially enabling preventive intervention before clinical signs develop
- •Metabolomic testing could complement or replace dynamic insulin testing (which requires specialist facilities) for identifying high-risk ponies—particularly useful for practitioners managing animals on pasture or high-sugar diets
- •Further validation studies are needed before these biomarkers can be incorporated into routine clinical screening protocols
- •Overfeeding horses rapidly induces metabolic dysfunction including elevated cholesterol and insulin dysregulation within 5 months, indicating feed management is critical for metabolic health
- •Monitor blood biomarkers (cholesterol, lipoproteins, fructosamine) and glucose tolerance testing in horses receiving high-calorie diets to detect early metabolic changes before clinical disease develops
- •Restrict caloric intake in horses to prevent obesity-related metabolic complications; even moderately overweight horses (BCS 2.9) can develop significant lipid and insulin abnormalities
- •Cresty neck score is a practical clinical indicator for identifying horses at risk of insulin dysregulation; horses with CNS ≥3 warrant metabolic screening
- •Traditional morphometric assessment (BCS, CNS) remains more reliable than emerging biomarkers for identifying EMS in this population; body condition evaluation should guide management decisions
- •Horses with mild-moderate EMS signs may not show elevated inflammatory markers, so absence of elevated cytokines does not exclude metabolic dysfunction
- •Fasting insulin and proxy calculations (particularly RISQI and QUICKI) can be reliably used to screen for insulin resistance in clinical practice, avoiding the need for expensive and time-consuming clamp testing
- •Use established cut-off values from this study when interpreting fasting insulin and proxy results to identify horses requiring dietary and management interventions for metabolic syndrome
- •Sampling on consecutive days shows good repeatability, so single-day fasting samples are adequate for clinical assessment; serial monitoring does not require multiple testing days
- •Obesity and sedentary lifestyle are modifiable risk factors; increasing exercise and pasture time can reduce EMS risk and laminitis incidence in susceptible ponies
- •Screen female native ponies and cobs aged 3-14 years with a history of laminitis for EMS, as they carry substantially elevated risk
- •Monitor hoof growth rings and supraorbital fat scores as clinical indicators of EMS; these are more frequent in affected animals and warrant further investigation
- •The standard low-dose OST (0.15 mL/kg BW) is sufficient to differentiate ID from NID horses; practitioners do not need to use higher doses for better diagnostic discrimination
- •Fasting status affects baseline insulin levels but not the diagnostic response to the OST, allowing more flexibility in test timing and management protocols
- •ID horses consistently show exaggerated insulin responses regardless of fasting or dose variation, making the OST a robust diagnostic tool for identifying metabolic dysfunction in practice
- •Horses with high insulin responses show specific metabolite abnormalities (low arginine and carnitine) that could be therapeutic targets to manage insulin dysregulation
- •A simple baseline blood test using 7 metabolites may reliably identify insulin-dysregulated horses without the time and expense of oral glucose testing
- •Evidence of low-grade inflammation during glucose challenges suggests metabolic monitoring and anti-inflammatory management strategies warrant consideration in insulin-dysregulated horses
- •Alpha-2-agonists (e.g., dexmedetomidine, detomidine) may have unpredictable metabolic effects in horses with insulin dysregulation and should be used cautiously in this population
- •Clinicians should consider alternative sedation or anesthesia protocols for horses with metabolic dysfunction to avoid potentially adverse glucose and insulin fluctuations
- •Blood glucose and insulin monitoring may be warranted if alpha-2-agonists must be used in metabolically compromised horses
- •Regular body condition scoring (BCS ≥8 indicates elevated risk) should be implemented as a practical monitoring tool to identify horses at risk of insulin dysregulation and subsequent laminitis
- •Owner education on obesity recognition and management is critical, as 60% of this Finnhorse population was overweight or obese, suggesting widespread underrecognition of the problem
- •Consider oral sugar testing for overweight/obese horses to identify insulin dysregulation before clinical laminitis develops, allowing for preventive management interventions
- •A synergistic polyphenol-leucine supplement may help reduce hyperinsulinemia and associated laminitis risk in EMS/insulin dysregulated horses at a lower cost than high-dose formulations
- •Monitor baseline adiponectin levels and insulin response to oral challenge as practical markers of supplement efficacy in your EMS cases
- •Weight loss occurred alongside metabolic improvements, suggesting this supplement may support overall metabolic health management in affected horses
- •Ponies and horses respond differently to overfeeding at the microbial level; weight management strategies may need to be species-tailored, particularly for 'easy keeper' ponies
- •Microbiota changes during weight gain may contribute to metabolic complications like insulin dysregulation and laminitis risk; monitor high-risk individuals more closely
- •The relationship between microbiota composition and obesity-related diseases in equines is still emerging—microbiota assessment could become a useful diagnostic tool for metabolic health in the future
- •Weight loss programs directly improve insulin regulation—track body weight changes alongside monitoring laminitis risk in susceptible horses
- •Oral glucose testing can objectively measure whether your weight loss intervention is actually reducing insulin dysregulation, not just pounds
- •For high-risk breeds like Icelanders, even modest weight reduction yields measurable metabolic improvements
- •Overfeeding energy to ponies rapidly causes insulin dysregulation and obesity within weeks; restrict concentrate intake and ensure diet matches maintenance requirements
- •Insulin dysfunction can develop in healthy, non-obese animals on high-energy diets—metabolic health requires dietary control independent of current body condition
- •While insulin abnormalities improve with hay-only feeding, susceptibility to rapid relapse means long-term dietary management is essential for metabolically predisposed animals
- •Insulin dysregulation should be routinely investigated in all equids diagnosed with PPID, as it was present in over three-quarters of cases tested
- •Maintaining adequate body condition and consistent pergolide administration are fundamental management strategies for improving survival in PPID cases
- •PPID clinical signs vary geographically; clinicians in lower-latitude regions should specifically monitor for anhidrosis and increased drinking/urination alongside traditional PPID presentations
- •Elevated post-prandial EGF in insulin-dysregulated ponies suggests a potential biomarker worth monitoring, though its direct role in laminitis development requires further research
- •EGFR signalling upregulation is not the primary mechanism driving hyperinsulinemic laminitis, so therapeutic targeting of EGFR alone may not prevent or treat laminitis in these horses
- •Insulin dysregulation and post-feeding metabolic changes warrant closer investigation as alternative pathways in laminitis pathophysiology beyond the EGF system
- •High protein feeds may exacerbate insulin response in EMS horses and should be avoided or carefully monitored in affected animals
- •When managing insulin-dysregulated horses, evaluate total dietary protein content alongside traditional focus on non-structural carbohydrates
- •Amino acid composition of feed may play a previously underrecognized role in triggering hyperinsulinemic responses in metabolically compromised horses
- •Assess cresty neck appearance as a key screening tool for insulin dysregulation in ponies — it's more reliable than general body condition score alone
- •Ponies with obvious neck crests warrant metabolic testing and management intervention even if overall body condition appears normal, as they have 5-fold increased risk of insulin dysfunction
- •Regional fat distribution (neck crest) matters more than total body fat for identifying metabolic risk in ponies; focus management strategies on reducing regional adiposity
- •Fasting insulin testing alone at standard cut-offs (20μIU/mL) will miss many horses with insulin dysregulation; consider dynamic testing (CGIT) for suspect cases or use lower cut-offs (5.2μIU/mL) if relying on fasting values
- •Obesity and advancing age are risk factors for insulin dysregulation; prioritize weight management and metabolic screening in older, overweight horses
- •Fasting insulin correlates well with dynamic test results, making it a practical screening tool when standardized to appropriate fasting periods and cut-off values
- •EMS may be influenced by environmental chemical exposures beyond traditional risk factors—consider farm location and potential contamination sources when evaluating horses with metabolic syndrome
- •Horses on farms within 100 miles of Superfund sites showed altered EDC profiles; farm environmental audits may be warranted for EMS-prone herds
- •Current EMS management focusing only on diet and exercise may be incomplete; chemical exposure reduction strategies warrant investigation as part of comprehensive EMS prevention
- •Paso Fino horses should be considered at higher risk for insulin dysregulation and endocrinopathic laminitis regardless of apparent body condition; breed-specific screening may be warranted
- •Weight management is critical in Paso Finos, as even moderate obesity significantly worsens insulin dysregulation and laminitis risk
- •Veterinarians should perform baseline insulin and glucose testing in Paso Fino horses presenting with laminitis or as part of preventative health assessment, particularly for overweight individuals
- •Metabolic traits associated with EMS have substantial genetic components, suggesting selective breeding strategies could reduce disease prevalence in high-risk breeds like Welsh ponies and Morgans
- •Insulin and adiponectin show particularly high heritability, making them potential genetic markers for identifying at-risk animals before clinical signs develop
- •Genetic testing and familial screening may help identify predisposed horses earlier, enabling preventive dietary and management interventions
- •Plasma metabolite profiles (trans-4-hydroxyproline and methionine sulfoxide) may serve as biomarkers for identifying horses with insulin dysregulation before laminitis develops
- •Understanding metabolic pathway involvement in insulin dysregulation could inform dietary and management interventions to prevent hoof complications
- •Early detection of metabolic dysfunction through targeted metabolomics may enable preventive strategies in at-risk horses
- •Owner perception of body condition significantly underestimates obesity risk; use objective scoring systems alongside owner assessment to identify at-risk horses
- •A breed-specific quantitative scoring system combining physical measurements and blood work (insulin, leptin, ACTH, glucose, lipids) may improve early detection of EMS in Arabian horses before severe clinical signs develop
- •Simplified field-applicable diagnostic protocols using common variables can effectively risk-stratify horses for metabolic syndrome without complex testing
- •For horses prone to laminitis or insulin dysregulation, teff may be a safer pasture option than alfalfa or cool-season grasses, particularly in fall months
- •Monitor individual horses' responses to different forage types, as NSC content and metabolic effects vary seasonally and by species
- •Consider rotating or substituting pastures with teff for insulin-sensitive or metabolically challenged horses as a practical management strategy
- •OGT and OST cannot be used interchangeably for assessing insulin sensitivity in the field; choose one protocol and use it consistently for individual horse monitoring
- •OST produces lower and faster insulin responses than OGT, so different reference thresholds for insulin dysregulation apply to each test
- •When using either test, be aware that 15% of horses/ponies may be misclassified depending on which test is chosen; consider clinical context and repeat testing if borderline results
- •Feeding cereal-based concentrates poses greater insulin dysregulation risk than equivalent caloric fat-based feeds, even at the same body weight gain — consider fat-rich alternatives for at-risk horses and ponies
- •Ponies and Andalusians appear genetically predisposed to lower insulin sensitivity regardless of diet; these breeds warrant stricter caloric control and glycaemic load management
- •Weight gain alone does not necessarily cause insulin problems if achieved via high-fat diets; the type of calorie source matters more than total caloric load for metabolic health
- •Know which insulin assay your laboratory uses—results are not interchangeable between assays, and clinical reference ranges must match the specific assay method
- •When diagnosing insulin resistance or dysregulation, ensure your diagnostic criteria (basal values, response to oral glucose tolerance test) align with the assay used by your lab
- •Request species-specific assays when possible, as porcine-specific assays appear more reliable for equine samples than human-specific assays
- •Maintaining horses at BCS <7 is associated with lower plasma insulin and reduced laminitis risk, making body weight management a practical preventive strategy
- •Overweight horses show markers of oxidative stress and dyslipidemia; regular condition scoring and feed management should be routine practice
- •Elevated insulin in obese horses is a modifiable risk factor for pasture-associated laminitis, providing actionable guidance for clients managing at-risk animals
- •When investigating behavioural changes and anestrus in mares, consider equine metabolic syndrome and insulin dysregulation as differential diagnoses alongside ovarian pathology—appropriate dietary and exercise management may resolve both metabolic and behavioural issues
- •Mild or borderline elevations in AMH and equivocal ovarian ultrasound findings should prompt investigation for concurrent systemic conditions (metabolic syndrome, neoplasia) rather than defaulting to granulosa theca cell tumour diagnosis
- •Monitor thyroid gland size during routine examination of mares with metabolic syndrome, as this case suggests a possible association between EMS and thyroid neoplasia that may impact performance and behaviour
- •IA betamethasone injections suppress systemic cortisol and ACTH for 24-48 hours; clinicians should consider timing of diagnostic tests when evaluating horses post-injection
- •Horses with insulin dysregulation may respond differently to IA betamethasone than metabolically normal horses—monitor glucose and metabolic status more carefully in ID horses receiving joint injections
- •This pilot study is underpowered and preliminary; larger investigations are needed before changing clinical practice protocols for IA corticosteroid use in metabolically compromised horses
- •Circulating total adiponectin may not be a reliable short-term biomarker for monitoring insulin dysregulation or dexamethasone effects in ponies; measurement of high-molecular-weight adiponectin or receptor expression patterns may be more informative
- •The disconnect between stable adiponectin levels and upregulated adiponectin signalling receptors during dexamethasone challenge suggests the relationship between adiponectin dysregulation and laminitis risk may be more complex than direct hormone concentration changes
- •Clinical monitoring of laminitis risk in insulin-sensitive ponies requiring dexamethasone therapy should not rely solely on adiponectin concentration changes to predict adverse metabolic effects
- •Genetic testing for these SNPs may eventually enable early identification of Finnhorses predisposed to insulin dysregulation, allowing preventive nutritional and exercise management before clinical signs develop
- •Results suggest insulin dysregulation has heritable genetic components in addition to environmental factors, supporting the need for selective breeding practices that consider metabolic status
- •Further validation across larger populations and other horse breeds is needed before clinical implementation of genetic screening
- •Salivary insulin testing may provide a viable non-invasive screening option for horses with suspected insulin dysregulation or endocrinopathic laminitis risk
- •Current commercial assays cannot reliably measure adiponectin in saliva, so serum/plasma remains necessary for adiponectin assessment
- •This method could improve compliance in difficult-to-handle horses or those with needle anxiety by eliminating venipuncture stress
- •Do not store forage samples at room temperature as carbohydrate values can decrease significantly within 24 hours to 1 week, compromising accuracy of NSC analysis critical for ID horses
- •Transport fresh forage samples on ice immediately after collection to a refrigerated location (3°C) and keep refrigerated until shipment for analysis to maintain nutrient integrity
- •Avoid ultra-cold freezing (-80°C) for forage samples as this storage method can paradoxically alter starch and protein values, making results unreliable for dietary management decisions
- •This foundational work suggests dopamine may modulate insulin secretion in horses similarly to other species; future research may reveal dietary or management strategies to manipulate this pathway for laminitis prevention
- •The presence of dopamine in stomach contents implies the gastrointestinal tract is an active site of dopamine production—nutritional or probiotic interventions targeting this system warrant investigation
- •Current findings are descriptive only; do not change clinical practice until dynamic studies clarify dopamine's functional role in equine insulin regulation
- •Metformin and sitagliptin can be safely administered together orally to horses; metformin requires more frequent dosing (shorter half-life) while sitagliptin provides sustained effect over 24 hours
- •This combination appears well-tolerated in healthy horses and may warrant consideration as a treatment option for equine insulin dysregulation, pending further efficacy studies in clinical cases
- •Current evidence is limited to pharmacokinetics in healthy horses; consult with an equine internist before using this combination in horses with metabolic disorders, as clinical effectiveness has not yet been established
- •Pioglitazone shows promise as a pharmacological option for managing insulin dysregulation in horses and ponies, with positive effects on insulin sensitivity markers within 28 days
- •The improvement in HMW adiponectin and reduced insulin response suggests potential benefit for equine metabolic syndrome management, but requires larger clinical trials before routine clinical application
- •Treatment was well-tolerated with only mild hepatic enzyme changes, suggesting reasonable safety profile for short-term use in equids
- •If your practice uses FSIGTT testing for metabolic evaluation, the lower dextrose dose (100 mg/kg bwt) provides more reliable results with reduced urinary glucose loss that can confound interpretation
- •The new optimized protocol is more practical for clinical use as it reduces complications from excessive glucose spillage while giving the same diagnostic information
- •UGS is a real phenomenon in standard FSIGTT that can affect results—ensure your laboratory or diagnostic facility uses the optimized protocol for accurate glucose and insulin dynamics assessment
- •Screening for insulin dysregulation should be a priority in horses at risk of metabolic syndrome to prevent laminitis development
- •Practitioners now have access to improved diagnostic tools and management options beyond traditional approaches for hyperinsulinemic horses
- •Early intervention in insulin dysregulation cases can significantly reduce laminitis morbidity and mortality in your practice
- •Consider SGLT2 inhibitor therapy (ertugliflozin) when administering intra-articular corticosteroids to horses with insulin dysregulation to reduce hyperinsulinemia and laminitis risk
- •Horses with existing ID warrant enhanced metabolic monitoring following IA corticosteroid injection
- •SGLT2i drugs offer a pharmacological strategy to mitigate an important side effect of a common therapeutic intervention
- •When discussing elevated insulin levels with colleagues, use 'insulin resistance' rather than 'insulin dysregulation'—the evidence supports this terminology and improves clinical communication
- •Understand that hyperinsulinaemia in horses reflects failure of insulin-sensitive tissues to respond normally to insulin, not a separate metabolic condition
- •Be aware that terminology matters in practice: using precise, evidence-based language helps standardise diagnosis and management of metabolic disease across the equine industry
- •Orientin may represent a novel therapeutic approach for EMS by enhancing the regenerative capacity of stem cells compromised by metabolic dysfunction
- •This in vitro research provides early-stage evidence supporting further investigation into plant-derived flavonoids as adjunctive treatments for insulin dysregulation and tissue repair in metabolically affected horses
- •Results are preliminary; clinical trials would be needed to determine efficacy, dosing, and practical application in living horses with EMS
- •If your clinic switches to ADVIA Centaur XPT for insulin testing, you must use new reference ranges adapted from this study—results will be systematically lower than previous Immulite 2000 XPi measurements, but interpretation remains clinically comparable
- •The strong rank-order correlation (0.92) means the new analyzer reliably identifies which horses have dysregulated insulin relative to others, which is the critical clinical decision
- •The 0.82 kappa suggests good agreement for classifying horses into normal vs. abnormal insulin status, supporting use of this newer analyzer for metabolic syndrome screening
- •Screen horses for signs of metabolic syndrome and obesity as part of routine preventive care, as early intervention can prevent severe laminitis
- •Understand the relationship between insulin dysregulation and laminitis risk to better counsel clients on management and dietary modifications
- •Familiarise yourself with current diagnostic tests and clinical recognition criteria for metabolic syndrome to enable prompt identification and treatment initiation
- •Understand that EMS is a multi-factorial condition affecting obese horses with insulin dysregulation; screening for these components is essential in practice
- •Stay updated on emerging treatment options beyond traditional weight management and dietary restriction
- •Recognize the critical link between metabolic dysfunction and laminitis risk to enable early intervention and prevention strategies
- •Screen at-risk horses for insulin dysregulation as part of EMS or PPID workup—early detection and management prevents most cases of endocrinopathic laminitis
- •Coordinate closely with farrier and vet on foot biomechanics and pain management alongside treatment of the underlying metabolic condition for best outcomes
- •Stay current on endocrinopathy diagnostics and therapeutics as this field is rapidly evolving with new testing and treatment options
- •Implement regular exercise conditioning programs as a primary intervention to improve insulin sensitivity and facilitate weight loss in obese horses at risk for metabolic disease and laminitis
- •Even single exercise sessions provide metabolic benefits through improved glucose disposal, making consistent work schedules important for metabolic management
- •Weight management through exercise is critical for laminitis prevention, particularly in horses with documented insulin resistance or obesity
- •Screen sedentary horses for insulin dysregulation using staged diagnostic approach (basal insulin/glucose followed by dynamic testing) to prevent laminitis development
- •Implement weight management as first-line treatment: restrict feed to ~1.25% body weight daily combined with individualized exercise programs tailored to horse's fitness level and breed
- •Consider pharmacological support (metformin, levothyroxine) for obese horses unable to exercise due to laminitis or those not responding adequately to diet and exercise alone
- •Screen donkeys for metabolic disorders early, especially obese individuals and those with recurrent laminitis, using baseline insulin and ACTH, then dynamic tests if results are borderline
- •Be aware that donkey-specific diagnostic thresholds differ from horses—consult current donkey reference ranges rather than equine cut-off values when interpreting hormone tests
- •Expect PPID prevalence in aged donkeys; monitor for classic signs (hypertrichosis, regional adiposity, laminitis, weight loss) and use appropriate dynamic testing for diagnosis
- •Experience alone does not drive preventative weight management—target intervention messaging toward owners of metabolically-affected ponies, as they demonstrate higher adoption of feeding and exercise protocols
- •Simply building owner confidence through education may not be sufficient to change behaviour; focus instead on demonstrating practical benefits and disease-risk pathways specific to individual operations
- •Consider developing preventative care packages or protocols for native pony owners that address the gap between knowing best practice and acting on it before clinical disease develops
- •Recognize EMS early by looking for obesity, local fat deposits, bilateral lameness, and characteristic hoof rings—these warrant insulin/glucose testing
- •Manage affected horses through strict diet control and consistent fitness work; medication and regenerative therapies are not yet standard protocols
- •Understand that laminitis secondary to EMS is a major performance-limiting consequence, making prevention and early intervention critical for owners
- •Insulin results from different laboratories and assay types can now be converted and compared using this web app, improving diagnostic interpretation of insulin dysregulation
- •Be aware that the same assay may produce slightly different values between laboratories due to technical variation, even when converting between standardized assays
- •This tool helps standardize insulin dysregulation diagnosis across different testing facilities, reducing confusion when reference labs differ from your preferred diagnostic centre
- •Maintain mares at optimal body condition score before breeding—obesity-related metabolic dysfunction impairs fertility and compromises pregnancy outcomes, affecting both mare and foal health
- •Monitor insulin status in overweight or insulin-dysregulated mares, as hyperinsulinemia during pregnancy increases foal susceptibility to developmental orthopedic disease and metabolic problems later in life
- •Consider weight management and metabolic assessment as essential preventative strategies for reproductive success and long-term foal welfare, not just a cosmetic or general health issue
- •When evaluating insulin levels in your horses, know which assay method your laboratory uses—reference ranges are NOT interchangeable between methods
- •The Immulite® 1000 offers a practical alternative to RIA for insulin testing with good reliability, potentially improving availability of hyperinsulinemia diagnosis
- •Always request assay-specific cut values from your laboratory when interpreting insulin results for metabolic syndrome assessment
- •Obese horses carry excess workload burden from adipose tissue alone, requiring adjusted training and conditioning protocols
- •Excess weight directly impacts gait mechanics and arthritis risk—body condition management is preventive orthopedic care
- •Challenge clients and competition judges on aesthetic preferences for adiposity; educate on performance and welfare costs of overweight athletic animals
- •When discussing endocrine disease diagnosis with veterinarians, understand that research case definitions may differ from clinical diagnostic standards used in practice
- •Be aware that diagnostic recommendations for PPID, EMS, and insulin dysregulation are evolving, so clinical protocols should be reviewed regularly
- •Request clarification on which diagnostic methods and decision limits your veterinarian is using, as this affects consistency in monitoring and management of endocrine cases
- •OGTT and OSTT protocols validated in horses and ponies may now be applicable to donkey patients for screening insulin dysregulation, improving diagnostic capability in this species.
- •Understanding the enteroinsular axis response in donkeys helps clinicians interpret postprandial glucose and insulin patterns when evaluating metabolic disease risk.
- •Donkey-specific reference ranges for insulin and incretin responses are now available, preventing misinterpretation of results using equine standards.
- •Endocrine testing for insulin dysfunction should be a standard part of your laminitis diagnostic protocol, as this is now recognized as the most common cause of field laminitis
- •Stay updated on evolving understanding of insulin's role in laminitis pathogenesis, as treatment approaches continue to change based on recent research
- •Consider regional best practices when developing your laminitis management protocols, as approaches vary between North America and other regions
- •Increase vigilance for early PPID signs in your patients—early diagnosis and treatment initiation significantly improves quality of life and outcomes
- •Be aware that basal ACTH testing alone may miss cases; consider TRH stimulation testing where available and combine with clinical assessment for better diagnostic accuracy
- •Recognize PPID as a systemic endocrine condition linked to insulin dysregulation and laminitis; manage metabolic comorbidities alongside pergolide therapy
- •When evaluating donkeys suspected of metabolic syndrome, IVGTT appears more sensitive than CGIT for detecting insulin dysregulation, though both tests warrant consideration
- •Existing equine metabolic syndrome diagnostic criteria show promise for donkey assessment but cannot be directly applied without establishing donkey-specific insulin thresholds
- •Baseline serum insulin and leptin concentrations should be evaluated alongside dynamic testing, as single measurements may not adequately capture metabolic dysfunction in donkeys
- •Endocrine testing for laminitis cases is now standard practice among UK equine veterinarians; ensure your veterinarian performs appropriate screening (insulin, glucose, ACTH levels) at initial and follow-up examinations.
- •If your horse is diagnosed with an underlying endocrine condition (PPID, EMS), targeted treatment of the endocrinopathy significantly reduces the risk of recurrent laminitis episodes.
- •Clear communication with your veterinarian about endocrine test results and their management implications can improve both case outcomes and your understanding of long-term hoof care strategies.
- •Do not assume equine reference ranges and diagnostic criteria apply to donkeys—use donkey-specific reference values for insulin, glucose, and PPID testing to avoid misdiagnosis
- •Weight management and exercise are first-line treatments for donkey metabolic syndrome; monitor for laminitis and hypertrichosis as key indicators of PPID requiring pergolide therapy
- •When performing dynamic endocrine tests in donkeys, expect different responses than horses; consider seasonal variations and use species-appropriate interpretation thresholds
- •Effective endocrinopathic laminitis prevention depends on controlling insulin levels through diet and exercise, with promising new drug classes (SGLT2 inhibitors) emerging to complement these foundational approaches
- •Until lamellar-protective drugs become available, pain management with established NSAIDs like phenylbutazone remains the most reliable pharmacological tool for acute cases
- •Future laminitis protocols will likely combine dietary management, exercise, endocrine-targeting drugs, and pain relief in a coordinated strategy rather than relying on single interventions
- •Screen horses for insulin dysregulation through appropriate laboratory tests; this is your main lever for preventing laminitis in metabolically predisposed horses
- •Combine diet (calorie and sugar restriction) with consistent exercise as the foundation of EMS management—these address the root problem, not just symptoms
- •Partner with your veterinarian on long-term monitoring; EMS control requires sustained owner discipline and professional guidance to succeed
- •Do not diagnose PPID based on elevated ACTH alone—always consider the horse's age, breed, season, body condition, and health status before starting lifelong medication
- •Recognize that EMS diagnosis requires identifying which type of insulin dysregulation is present (resistance vs. postprandial excess) as this determines appropriate management strategy
- •When interpreting endocrine test results, use clinical judgment and contextual horse factors rather than treating numbers in isolation to avoid unnecessary long-term drug therapy
- •Obesity management in horses should be prioritized as a preventive strategy against insulin dysregulation and laminitis risk
- •Practitioners should recognize that insulin dysregulation is a key mechanism linking metabolic dysfunction to laminitis, requiring targeted dietary and management interventions
- •Understanding inflammatory pathways related to adiposity and oxidative stress may inform future therapeutic approaches for laminitis prevention and management
- •If using the oral sugar test to screen for insulin dysregulation in ponies, consider adopting the 0.45 mL/kg bwt corn syrup dose rather than the standard 0.15 mL/kg, as it better identifies insulin-dysregulated animals at risk of laminitis.
- •Using area under the curve (AUC) rather than single time-point insulin values improves test reliability and repeatability.
- •The test does not require strict fasting protocols—ponies can be tested while on pasture, making clinical application more practical.
- •Insulin dysregulation in horses may involve intestinal factors beyond simple dietary management; understanding GLP-2's role could inform new prevention strategies for laminitis
- •Current feeding and management approaches for ID horses may need to account for altered intestinal nutrient absorption pathways, not just caloric restriction
- •Horses with ID and laminitis risk may benefit from veterinary assessment of digestive and metabolic function beyond standard insulin/glucose testing
- •Monitor insulin levels and body condition in at-risk horses; obesity and insulin dysregulation are modifiable risk factors for laminitis
- •Restrict high-NSC forage (cereal grains, rich pasture) in horses with metabolic syndrome to reduce systemic insulin spikes and lamellar stress
- •Understanding the IGF-1 receptor mechanism offers potential therapeutic targets for preventing or treating endocrinopathic laminitis
- •Consider Andalusian breed as a risk factor when screening for metabolic syndrome; prioritize weight management and adiposity assessment in this population
- •Monitor insulin regulation and metabolic status carefully in Andalusian horses showing signs of regional fat deposition or early laminitis
- •Further epidemiological research is needed to establish definitive prevalence and risk factors specific to this breed
- •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
- •PPID is a lifelong condition in older horses that cannot be cured but can be managed; excessive or abnormal hair coat shedding should prompt diagnostic testing in horses aged 15+ years
- •Test PPID-affected horses for insulin dysregulation as laminitis risk is directly associated with hyperinsulinaemia; dietary management specific to insulin sensitivity is essential alongside pergolide therapy
- •Combine pharmacological treatment (pergolide) with tailored nutrition and symptomatic management (e.g., clipping, unrestricted water access) for optimal clinical outcomes
- •Jejunal glucose absorption and GLP-2 secretion may contribute to post-prandial hyperinsulinaemia in horses with insulin dysregulation; dietary strategies targeting jejunal glucose handling warrant investigation
- •This foundational work on equine intestinal GLP-2 physiology opens potential therapeutic avenues for managing insulin dysregulation and laminitis prevention through intestinal hormone modulation
- •Further research may eventually enable targeted nutritional or pharmacological interventions at the jejunum to reduce hyperinsulinaemia risk in susceptible horses
- •A new drug treatment (velagliflozin) may soon become available as the first registered veterinary therapy for insulin-associated laminitis, offering prevention rather than just management
- •Risk stratification tools are being developed to identify horses at high risk of laminitis, enabling targeted preventive strategies
- •These advances shift the paradigm from treating symptomatic laminitis toward prevention in insulin-dysregulated horses
Key Research Findings
PPID prevalence in horses aged ≥15 years is 21-27%; basal ACTH diagnostic accuracy ranges 88-92% in autumn and 70-86% in non-autumn depending on pre-test probability
TRH stimulation testing shows superior diagnostic accuracy (92-98% in autumn, 90-94% in non-autumn) compared to basal ACTH testing
Pergolide improves most clinical signs and lowers basal ACTH in majority of affected horses, but does not alter insulin dysregulation measures in most cases
Multiple factors including breed, latitude, diet, and coat colour significantly affect ACTH concentrations, requiring use of equivocal diagnostic ranges rather than fixed thresholds
Basal epithelial cell stress is proposed as a central event common to all three categories of equine laminitis
Insulin dysregulation is a key mechanism in endocrinopathic laminitis, with prolonged insulin and glucose infusions experimentally inducing laminar pathology
Multiple molecular pathways contribute to laminar lamellar pathology in naturally occurring laminitis with varying contributions from endocrinopathic, sepsis-related, and supporting limb mechanisms
Interactions between different laminitis-associated pathways have been identified based on 15 years of experimental model research
Insulin dysregulation encompasses both tissue insulin resistance and dysfunction of the enteroinsular axis in horses
The equine enteroinsular axis plays a major role in insulin secretion and hyperinsulinaemia development
Multiple factors including breed, diet, fasting state, and season significantly influence diagnostic test results and must be considered during interpretation
Early detection of insulin dysregulation is critical for laminitis prophylaxis as treatment options for established laminitis remain inadequate
Velagliflozin treatment reduced resting insulin concentration to 71 µIU/mL compared to 157 µIU/mL in placebo group (p<0.0001), with an average treatment effect of 155 µIU/mL reduction
Horses previously receiving placebo showed further insulin reduction to 50 µIU/mL when switched to velagliflozin in the open-label phase (p<0.0001)
All horses experienced transient increases in serum triglyceride concentration during velagliflozin treatment with no reported clinical abnormalities
Evidence Base
BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction.
Menzies-Gow Nicola J, Banse Heidi E, Duff Aimi et al. (2024) — Equine veterinary journal
Systematic Review
A review of cellular and molecular mechanisms in endocrinopathic, sepsis-related and supporting limb equine laminitis.
Elliott Jonathan, Bailey Simon R (2023) — Equine veterinary journal
Systematic Review
The diagnosis of equine insulin dysregulation.
Bertin F R, de Laat M A (2017) — Equine veterinary journal
Systematic Review
Effects of the Sodium-Glucose Cotransporter-2 Inhibitor Velagliflozin on Insulin Concentrations in Horses With Insulin Dysregulation.
Thane Kristen, Voth Rebecca, Klee Rebecca et al. (2025) — Journal of veterinary internal medicine
RCT
Effect of phenylbutazone administration on the enteroinsular axis in horses with insulin dysregulation.
Kemp Kate L, Skinner Jazmine E, Bertin François-René (2025) — Journal of veterinary internal medicine
RCT
Effect of Phenylbutazone Administration on Insulin Sensitivity in Horses With Insulin Dysregulation.
Kemp Kate L, Yuen Nicholas K Y, Skinner Jazmine E et al. (2025) — Journal of veterinary internal medicine
RCT
Corticosteroid Administration Enhances the Glycemic, Insulinemic, and Incretin Responses to a High-Protein Mixed Meal in Adult Horses.
Palmer Allison T, Watts Mauria R, Timko Kathryn J et al. (2025) — Journal of veterinary internal medicine
RCT
Essential oil supplementation improves insulin sensitivity and modulates the plasma metabolome of hyperinsulinemic horses.
Loos Caroline M M, Zhao Shuang, Li Liang et al. (2024) — Frontiers in veterinary science
RCT
Nutraceutical Supplement Mitigates Insulin Resistance in Horses with a History of Insulin Dysregulation During a Challenge with a High-Starch Diet.
Loos Caroline, Castelein Annette, Vanzant Eric et al. (2024) — Animals : an open access journal from MDPI
RCT
Effect of phenylbutazone on insulin secretion in horses with insulin dysregulation.
Kemp Kate L, Skinner Jazmine E, Bertin François-René (2024) — Journal of veterinary internal medicine
RCT
Comparison of a customized glycemic pellets challenge with the oral sugar test to measure glycemic and insulinemic responses in horses.
Thane Kristen, Sonntag Johanna, Warnken Tobias et al. (2024) — Journal of veterinary internal medicine
RCT
Effect of 5'-adenosine monophosphate-activated protein kinase agonists on insulin and glucose dynamics in experimentally induced insulin dysregulation in horses.
Pinnell Erin F, Hostnik Laura D, Watts Mauria R et al. (2024) — Journal of veterinary internal medicine
RCT
Oligosaccharide feed supplementation reduces plasma insulin in geldings with Equine Metabolic Syndrome
Alexandra Von Münchow, Sarah Torp Yttergren, R. R. Jakobsen et al. (2023) — Frontiers in Microbiomes
RCT
Effect of sirolimus on insulin dynamics in horses.
de Tonnerre Demia J, Medina Torres Carlos E, Stefanovski Darko et al. (2023) — Journal of veterinary internal medicine
RCT
Identifying possible thresholds for nonstructural carbohydrates in the insulin dysregulated horse.
Macon Erica Lyn, Harris Patricia, Bailey Simon et al. (2023) — Equine veterinary journal
RCT
Effect of a GLP-1 mimetic on the insulin response to oral sugar testing in horses.
Stefanovski Darko, Robinson Mary A, Van Eps Andrew (2022) — BMC veterinary research
RCT
The effects of an alpha-2-adrenoceptor agonist, antagonist, and their combination on the blood insulin, glucose, and glucagon concentrations in insulin sensitive and dysregulated horses.
Box J R, Karikoski N P, Tanskanen H E et al. (2021) — Veterinary journal (London, England : 1997)
RCT
The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies.
Meier, Reiche, de Laat et al. (2019) — PloS one
RCT
Effects of Diet Versus Exercise on Morphometric Measurements, Blood Hormone Concentrations, and Oral Sugar Test Response in Obese Horses.
Moore Jennifer L, Siciliano Paul D, Pratt-Phillips Shannon E (2019) — Journal of equine veterinary science
RCT
The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies.
Meier A, de Laat M, Reiche D et al. (2019) — BMC veterinary research
RCT
Show 110 more references
Sweet taste receptor inhibitors: Potential treatment for equine insulin dysregulation.
de Laat Melody Anne, Kheder Murad Hasan, Pollitt Christopher Charles et al. (2018) — PloS one
RCT
Effect of increased adiposity on insulin sensitivity and adipokine concentrations in horses and ponies fed a high fat diet, with or without a once daily high glycaemic meal.
Bamford N J, Potter S J, Harris P A et al. (2016) — Equine veterinary journal
RCT
Temporal variation in incretin and insulin secretion in ponies in association with dietary macronutrients.
Andrews K E, Sibthorpe P E M, Fitzgerald D M et al. (2026) — Veterinary journal (London, England : 1997)
Cohort Study
Plasma Activin A concentrations are not a useful biomarker for detecting insulin dysregulation and predicting laminitis risk in ponies.
McGuire C J, Knowles E J, Harris P A et al. (2025) — Journal of equine veterinary science
Cohort Study
Horses with previous episodes of laminitis have altered insulin responses to seasonal oral sugar testing and grazing compared to horses with no known history of laminitis.
Kaufman K L, Suagee-Bedore J K, Johnson S E et al. (2025) — Journal of equine veterinary science
Cohort Study
The Seasonality of Serum Insulin Concentrations in Equids and the Association With Breed, Age, and Sex.
Lopes Ana, Huber Laura, Durham Andy E (2025) — Journal of veterinary internal medicine
Cohort Study
Effects of pasture consumption and obesity on insulin dysregulation and adiponectin concentrations in UK native-breed ponies.
Barnabé, Elliott, Harris et al. (2025) — Equine veterinary journal
Cohort Study
The Effect of Season and Breed on Hypothalamic-Pituitary-Adrenal Axis Hormones, Metabolic Hormones, and Oxidative Markers in Ponies and Horses.
Vaughn Sarah Alison, Lemons Margaret B, Hart Kelsey A (2025) — Journal of veterinary internal medicine
Cohort Study
Quantitative proteomics unveils potential plasma biomarkers and provides insights into the pathophysiological mechanisms underlying equine metabolic syndrome.
Espinosa-López E M, Ortiz-Guisado B, Diez de Castro E et al. (2025) — BMC veterinary research
Cohort Study
Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia.
Clark Brianna L, Norton Elaine M, Bamford Nicholas J et al. (2024) — Equine veterinary journal
Cohort Study
The effect of pre-dosing with metformin on the insulin response to oral sugar in insulin-dysregulated horses.
Colmer Sarah F, Adams Amanda A, Adam Emma et al. (2024) — Equine veterinary journal
Cohort Study
Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation.
Boger Brooke L, Manfredi Jane M, Loucks Abigail R et al. (2024) — Equine veterinary journal
Cohort Study
Relationships between total adiponectin concentrations and obesity in native-breed ponies in England.
Barnabé Marine A, Elliott Jonathan, Harris Patricia A et al. (2024) — Equine veterinary journal
Cohort Study
Evaluating insulindysregulation in horses: A two-step insulin-tolerance test using porcine zinc insulin.
Grob A J, Delarocque J, Feige K et al. (2024) — Veterinary journal (London, England : 1997)
Cohort Study
Factors associated with insulin responses to oral sugars in a mixed-breed cohort of ponies.
Knowles Edward J, Harris Patricia A, Elliott Jonathan et al. (2024) — Equine veterinary journal
Cohort Study
Obesity and obesity-associated metabolic disease conditions in Connemara ponies in Ireland.
Al-Ansari Ahmed Saleh, Golding Emma, Walshe Nicola et al. (2024) — Equine veterinary journal
Cohort Study
Investigation of glucagon-like peptide-1 response to six oral carbohydrates in ponies.
Carslake H B, Pinchbeck G L, Argo C M et al. (2024) — Veterinary journal (London, England : 1997)
Cohort Study
Prevalence of insulin dysregulation in the non-obese stock-type horse and relationship with morphometric neck measurements.
Heaton C P, Cavinder C A, McClure E N et al. (2024) — Journal of equine veterinary science
Cohort Study
Comparison of a modified 2-step insulin response test performed with porcine zinc insulin and an oral glucose test to detect hyperinsulinemic Icelandic horses.
Frers F, Delarocque J, Huber K et al. (2023) — Veterinary journal (London, England : 1997)
Cohort Study
Occurrence of equine metabolic syndrome, clinical manifestations, and associated risk factors in Nigeria
O. Akinniyi, A. Sackey, G. E. Ochube et al. (2023) — Journal of Equine Science
Cohort Study
Evaluation of field-testing protocols to diagnose insulin dysregulation in ponies using a Bayesian approach.
Clark B L, Stewart A J, Kemp K L et al. (2023) — Veterinary journal (London, England : 1997)
Cohort Study
Association between insulin dysregulation and adrenocorticotropic hormone in aged horses and ponies with no clinical signs of pituitary pars intermedia dysfunction.
Li Fang I, Spence Robert J, de Laat Melody A et al. (2023) — Equine veterinary journal
Cohort Study
Predictors of laminitis development in a cohort of nonlaminitic ponies.
Knowles Edward J, Elliott Jonathan, Harris Patricia A et al. (2023) — Equine veterinary journal
Cohort Study
Palatability, glycemic, and insulinemic responses to various carbohydrate formulations: Alternatives for the diagnosis of insulin dysregulation in horses?
Warnken Tobias, Schaub Claudia, Delarocque Julien et al. (2023) — Journal of veterinary internal medicine
Cohort Study
Carbohydrate pellets to assess insulin dysregulation in horses.
de Laat Melody A, Warnken Tobias, Delarocque Julien et al. (2023) — Journal of veterinary internal medicine
Cohort Study
Thromboelastography in obese horses with insulin dysregulation compared to healthy controls.
Lovett Amy L, Gilliam Lyndi L, Sykes Benjamin W et al. (2022) — Journal of veterinary internal medicine
Cohort Study
Postprandial insulin responses to various feedstuffs differ in insulin dysregulated horses compared with non-insulin dysregulated controls.
Macon Erica L, Harris Patricia, Bailey Simon et al. (2022) — Equine veterinary journal
Cohort Study
Seasonal Insulin Responses to the Oral Sugar Test in Healthy and Insulin Dysregulated Horses.
Macon Erica Lyn, Harris Patricia, Barker Virginia Day et al. (2022) — Journal of equine veterinary science
Cohort Study
Differential effect of two dietary protein sources on time course response of muscle anabolic signaling pathways in normal and insulin dysregulated horses.
Loos Caroline M M, McLeod Kyle R, Vanzant Eric S et al. (2022) — Frontiers in veterinary science
Cohort Study
Effects of Bromocriptine on Glucose and Insulin Dynamics in Normal and Insulin Dysregulated Horses.
Loos Caroline M M, Urschel Kristine L, Vanzant Eric S et al. (2022) — Frontiers in veterinary science
Cohort Study
Plasma Amino Acid Concentration in Obese Horses with/without Insulin Dysregulation and Laminitis.
Stoeckle Sabita Diana, Timmermann Detlef, Merle Roswitha et al. (2022) — Animals : an open access journal from MDPI
Cohort Study
Variation in insulin response to oral sugar test in a cohort of horses throughout the year and evaluation of risk factors for insulin dysregulation.
Karikoski Ninja P, Box Justin R, Mykkänen Anna K et al. (2022) — Equine veterinary journal
Cohort Study
Circulating Hypothalamic-Pituitary-Adrenal Axis Hormones and Insulin Concentrations in Horses and Ponies.
Vaughn Sarah A, Norton Natalie A, Hart Kelsey A (2022) — Journal of equine veterinary science
Cohort Study
Measurement of Plasma Resistin Concentrations in Horses with Metabolic and Inflammatory Disorders.
Fuentes-Romero Beatriz, Muñoz-Prieto Alberto, Cerón José J et al. (2021) — Animals : an open access journal from MDPI
Cohort Study
Plasma amino acid concentrations during experimental hyperinsulinemia in 2 laminitis models.
Stokes Simon M, Stefanovski Darko, Bertin François-René et al. (2021) — Journal of veterinary internal medicine
Cohort Study
Associations of plasma sphingolipid profiles with insulin response during oral glucose testing in Icelandic horses.
Leung Yue Hei, Kenéz Ákos, Grob Anne Julia et al. (2021) — Journal of veterinary internal medicine
Cohort Study
Metabolic profile distinguishes laminitis-susceptible and -resistant ponies before and after feeding a high sugar diet.
Delarocque, Reiche, Meier et al. (2021) — BMC veterinary research
Cohort Study
Changes in metabolic and physiological biomarkers in Mangalarga Marchador horses with induced obesity.
Ribeiro Rodrigo M, Ribeiro Debora S, Cota Leticia O et al. (2021) — Veterinary journal (London, England : 1997)
Cohort Study
Morphometric, metabolic, and inflammatory markers across a cohort of client-owned horses and ponies on the insulin dysregulation spectrum.
Ragno Valentina M, Klein Colby D, Sereda Nicole S et al. (2021) — Journal of equine veterinary science
Cohort Study
Evaluation of fasting plasma insulin and proxy measurements to assess insulin sensitivity in horses.
Lindåse Sanna, Nostell Katarina, Bergsten Peter et al. (2021) — BMC veterinary research
Cohort Study
Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors.
Carslake Harry B, Pinchbeck Gina L, McGowan Catherine M (2021) — Equine veterinary journal
Cohort Study
Effect of Dose and Fasting on Oral Sugar Test Responses in Insulin Dysregulated Horses.
Lyn Macon Erica, Harris Patricia, Partridge Emma et al. (2021) — Journal of equine veterinary science
Cohort Study
Metabolic changes induced by oral glucose tests in horses and their diagnostic use.
Delarocque Julien, Frers Florian, Feige Karsten et al. (2021) — Journal of veterinary internal medicine
Cohort Study
Blood glucose and insulin concentrations after alpha-2-agonists administration in horses with and without insulin dysregulation.
Kritchevsky Janice E, Muir Genevieve S, Leschke Dakota H Z et al. (2020) — Journal of veterinary internal medicine
Cohort Study
Insulin dysregulation in a population of Finnhorses and associated phenotypic markers of obesity.
Box Justin R, McGowan Cathy M, Raekallio Marja R et al. (2020) — Journal of veterinary internal medicine
Cohort Study
Investigation of the Effects of a Dietary Supplement on Insulin and Adipokine Concentrations in Equine Metabolic Syndrome/Insulin Dysregulation.
J. Manfredi, E. Stapley, J. Nadeau et al. (2020) — Journal of equine veterinary science
Cohort Study
Changes in the faecal microbiota of horses and ponies during a two-year body weight gain programme.
Langner Katharina, Blaue Dominique, Schedlbauer Carola et al. (2020) — PloS one
Cohort Study
Weight loss is linearly associated with a reduction of the insulin response to an oral glucose test in Icelandic horses.
Delarocque Julien, Frers Florian, Huber Korinna et al. (2020) — BMC veterinary research
Cohort Study
Effect of long-term overfeeding of a high-energy diet on glucose tolerance in Shetland pony mares.
d' Fonseca Nicky M M, Gibson Charlotte M E, van Doorn David A et al. (2020) — Journal of veterinary internal medicine
Cohort Study
Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine pituitary pars intermedia dysfunction.
Horn R, Bamford N J, Afonso T et al. (2019) — Equine veterinary journal
Cohort Study
An investigation of the equine epidermal growth factor system during hyperinsulinemic laminitis.
de Laat Melody A, Spence Robert J, Sillence Martin N et al. (2019) — PloS one
Cohort Study
A high protein meal affects plasma insulin concentrations and amino acid metabolism in horses with equine metabolic syndrome.
Loos C M M, Dorsch S C, Elzinga S E et al. (2019) — Veterinary journal (London, England : 1997)
Cohort Study
The cresty neck score is an independent predictor of insulin dysregulation in ponies.
Fitzgerald Danielle M, Anderson Stephen T, Sillence Martin N et al. (2019) — PloS one
Cohort Study
Comparison of fasted basal insulin with the combined glucose-insulin test in horses and ponies with suspected insulin dysregulation.
Olley R B, Carslake H B, Ireland J L et al. (2019) — Veterinary journal (London, England : 1997)
Cohort Study
Associations between endocrine disrupting chemicals and equine metabolic syndrome phenotypes.
S. Durward-Akhurst, N. Schultz, E. Norton et al. (2019) — Chemosphere
Cohort Study
Glucose and Insulin Responses to an Intravenous Glucose Load in Thoroughbred and Paso Fino Horses.
Breuhaus Babetta A (2019) — Journal of equine veterinary science
Cohort Study
Heritability of metabolic traits associated with equine metabolic syndrome in Welsh ponies and Morgan horses.
Norton E M, Schultz N E, Rendahl A K et al. (2019) — Equine veterinary journal
Cohort Study
Lower plasma trans-4-hydroxyproline and methionine sulfoxide levels are associated with insulin dysregulation in horses.
Kenéz Ákos, Warnken Tobias, Feige Karsten et al. (2018) — BMC veterinary research
Cohort Study
Use of principle component analysis to quantitatively score the equine metabolic syndrome phenotype in an Arabian horse population.
Lewis Samantha L, Holl Heather M, Long Maureen T et al. (2018) — PloS one
Cohort Study
Glucose and Insulin Response of Horses Grazing Alfalfa, Perennial Cool-Season Grass, and Teff Across Seasons.
DeBoer Michelle L, Hathaway Marcia R, Kuhle Kerry J et al. (2018) — Journal of equine veterinary science
Cohort Study
Comparison of the in-feed glucose test and the oral sugar test.
Smith S, Harris P A, Menzies-Gow N J (2016) — Equine veterinary journal
Cohort Study
Effect of increased adiposity on insulin sensitivity and adipokine concentrations in different equine breeds adapted to cereal-rich or fat-rich meals.
Bamford N J, Potter S J, Baskerville C L et al. (2016) — Veterinary journal (London, England : 1997)
Cohort Study
Comparison of three different methods for the quantification of equine insulin.
Warnken T, Huber K, Feige K (2016) — BMC veterinary research
Cohort Study
Adiposity, plasma insulin, leptin, lipids, and oxidative stress in mature light breed horses.
Pleasant R S, Suagee J K, Thatcher C D et al. (2013) — Journal of veterinary internal medicine
Cohort Study
Hyperandrogenemia and behavioural changes in a mare with equine metabolic syndrome
K. Shell, A. Rijkenhuizen, I. Vervuert (2026) — Equine Veterinary Education
Case Report
Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses.
Page A E, Rauber-Ramos A M, Humiston M et al. (2025) — Journal of equine veterinary science
Case Report
Short-term induced hyperinsulinaemia and dexamethasone challenge do not affect circulating total adiponectin concentrations in insulin-sensitive ponies.
Barnabé Marine A, Elliott Jonathan, Harris Patricia A et al. (2024) — Equine veterinary journal
Case Report
Genome-wide association study suggests genetic candidate loci of insulin dysregulation in Finnhorses.
Weckman M J, Karikoski N P, Raekallio M R et al. (2024) — Veterinary journal (London, England : 1997)
Case Report
Insulin, but not adiponectin, is detectable in equine saliva using an automated, commercial assay.
Barnabé Marine A, Elliott Jonathan, Harris Patricia A et al. (2024) — Equine veterinary journal
Case Report
Effects of storage-handling methods on nutrient analysis of fresh-forage samples.
Kerley B S, Harris P, Lea K et al. (2024) — Journal of equine veterinary science
Case Report
Evidence for dopamine production and distribution of dopamine D2 receptors in the equine gastrointestinal mucosa and pancreas.
Galinelli Nicolas C, Bamford Nicholas J, de Laat Melody A et al. (2024) — PloS one
Case Report
Pharmacokinetics of Metformin in Combination With Sitagliptin in Adult Horses After Enteral Administration.
Cárceles-Rodríguez Carlos M, Fernández-Varón Emilio, Martín-Gimenez Tamara et al. (2019) — Journal of equine veterinary science
Case Report
Pharmacodynamic Effects of Pioglitazone on High Molecular Weight Adiponectin Concentrations and Insulin Response After Oral Sugar in Equids.
Legere Rebecca M, Taylor Debra R, Davis Jennifer L et al. (2019) — Journal of equine veterinary science
Case Report
Optimisation of the frequently sampled intravenous glucose tolerance test to reduce urinary glucose spilling in horses.
Tóth F, Frank N, Elliott S B et al. (2009) — Equine veterinary journal
Case Report
Practical management of insulin dysregulation and hyperinsulinaemia-associated laminitis
Sundra Tania, Rossi Gabriele, Rendle David et al.
Expert Opinion
Treatment with ertugliflozin mitigates the hyperinsulinemic response to intra-articular triamcinolone acetonide.
Page Allen E, McPeek Jenna L, McGreevy Ella et al. (2026) — Equine veterinary journal
Expert Opinion
Insulin resistance versus dysregulation—a distinction without a difference
Kellon E. M. (2025) — Equine Veterinary Education
Expert Opinion
Orientin Reverses Premature Senescence in Equine Adipose Stromal Cells Affected by Equine Metabolic Syndrome Through Oxidative Stress Modulation
Dominika Orzoł, M. Kępska, Magdalena Zyzak (2025) — International Journal of Molecular Sciences
Expert Opinion
Clinical evaluation of the ADVIA Centaur XPT chemiluminescent immunoassay for equine insulin measurement.
Rey-Conejo R, Toribio R E, Möller S et al. (2025) — Journal of equine veterinary science
Expert Opinion
Equine metabolic syndrome: part 1
Philip J Johnson (2024) — UK-Vet Equine
Expert Opinion
Equine metabolic syndrome: part 2
Philip J Johnson (2024) — UK-Vet Equine
Expert Opinion
Understanding, diagnosing and managing endocrinopathic laminitis
Grenager Nora (2024) — UK-Vet Equine
Expert Opinion
Effect of Exercise Conditioning on Countering the Effects of Obesity and Insulin Resistance in Horses-A Review.
Pratt-Phillips Shannon (2024) — Animals : an open access journal from MDPI
Expert Opinion
Focus on the epidemiology, pathophysiology, diagnosis, and management of insulin dysregulation in horses
Olumide Odunayo Akinniyi (2024) — Nutrition and Food Processing
Expert Opinion
Metabolic and Endocrine Insights in Donkeys.
Mendoza Francisco J, Toribio Ramiro E, Perez-Ecija Alejandro (2024) — Animals : an open access journal from MDPI
Expert Opinion
Confidence does not mediate a relationship between owner experience and likelihood of using weight management approaches for native ponies.
Ward Ashley B, Harris Patricia A, Argo Caroline McG et al. (2023) — PloS one
Expert Opinion
Equine Metabolic Syndrome: A Complex Disease Influenced by Multifactorial Genetic Factors
M. Stefaniuk-Szmukier, K. Piórkowska, K. Ropka-Molik (2023) — Genes
Expert Opinion
Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses.
Delarocque Julien, Feige Karsten, Carslake Harry B et al. (2023) — Animals : an open access journal from MDPI
Expert Opinion
The effects of obesity and insulin dysregulation on mare reproduction, pregnancy, and foal health: a review.
Hallman Isa, Karikoski Ninja, Kareskoski Maria (2023) — Frontiers in veterinary science
Expert Opinion
Clinical evaluation of the Immulite® 1000 chemiluminescent immunoassay for measurement of equine serum insulin.
Go Yun Young, Hazard Nicole W, Balasuriya Udeni B R et al. (2023) — Frontiers in veterinary science
Expert Opinion
Impacts of Adiposity on Exercise Performance in Horses.
Pratt-Phillips Shannon, Munjizun Ahmad (2023) — Animals : an open access journal from MDPI
Expert Opinion
Equine Endocrine Disease: Challenges With Case Definition for Research.
McGowan Catherine M, Ireland Joanne L (2023) — Journal of equine veterinary science
Expert Opinion
Characterisation of the oral glucose and sugar tolerance tests and the enteroinsular axis response in healthy adult donkeys.
Mendoza Francisco J, Buzon-Cuevas Antonio, Toribio Ramiro E et al. (2022) — Equine veterinary journal
Expert Opinion
Approaches to endocrinopathic laminitis in the field: Results of a survey of veterinary practitioners in North America.
Rumfola Elizabeth, Banse Heidi E, Atkins Megan et al. (2022) — Journal of equine veterinary science
Expert Opinion
Pituitary Pars Intermedia Dysfunction (PPID) in Horses
Kirkwood Naomi C., Hughes Kristopher J., Stewart Allison J. (2022) — Veterinary Sciences
Expert Opinion
Evaluation of the combined glucose-insulin and intravenous glucose tolerance tests for insulin dysregulation diagnosis in donkeys.
Mendoza Francisco Javier, Mejia-Moreira Sebastian, Buchanan Ben R et al. (2022) — Equine veterinary journal
Expert Opinion
Translating research into practice: Adoption of endocrine diagnostic testing in cases of equine laminitis.
Ireland J L, McGowan C M (2021) — Veterinary journal (London, England : 1997)
Expert Opinion
Pituitary Pars Intermedia Dysfunction and Metabolic Syndrome in Donkeys.
Gehlen Heidrun, Schwarz Bianca, Bartmann Claus et al. (2020) — Animals : an open access journal from MDPI
Expert Opinion
A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis
de Laat M. A., Sillence M. N. (2020) — Animal Production Science
Expert Opinion
ECEIM consensus statement on equine metabolic syndrome
A. Durham, N. Frank, C. McGowan et al. (2019) — Journal of Veterinary Internal Medicine
Expert Opinion
Diagnostic Testing for Equine Endocrine Diseases: Confirmation Versus Confusion.
D. McFarlane (2019) — The Veterinary clinics of North America. Equine practice
Expert Opinion
From Table to Stable: A Comparative Review of Selected Aspects of Human and Equine Metabolic Syndrome.
Ragno Valentina M, Zello Gordon A, Klein Colby D et al. (2019) — Journal of equine veterinary science
Expert Opinion
Effect of varying the dose of corn syrup on the insulin and glucose response to the oral sugar test.
Jocelyn N A, Harris P A, Menzies-Gow N J (2018) — Equine veterinary journal
Expert Opinion
Glucagon-like peptide-2: A potential role in equine insulin dysregulation.
de Laat M A, Fitzgerald D M, Sillence M N et al. (2018) — Equine veterinary journal
Expert Opinion
Lamellar events related to insulin-like growth factor-1 receptor signalling in two models relevant to endocrinopathic laminitis.
Lane H E, Burns T A, Hegedus O C et al. (2017) — Equine veterinary journal
Expert Opinion
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.
Martin Giménez T, Aguirre Pascasio C N, de Blas Giral I (2015) — Equine veterinary journal
Expert Opinion
Insulin dysregulation.
Frank N, Tadros E M (2014) — Equine veterinary journal
Expert Opinion
Equine Pituitary Pars Intermedia Dysfunction
McFarlane Dianne (2011) — Veterinary Clinics of North America: Equine Practice
Expert Opinion
Studies in vitro of equine intestinal glucagon-like peptide-2 secretion.
Sibthorpe P E M, Fitzgerald D M, Sillence M N et al. (2024) — Journal of equine veterinary science
Thesis
Equine insulin dysregulation and Laminitis: Developing a framework for testing treatment and preventive strategies
A. Meier (2019)
Thesis