Insulin dysregulation is a factor in pituitary pars intermedia dysfunction and equine metabolic syndrome, both of which can lead to laminitis. In fact, the most common form of laminitis encountered in equine veterinary practice is hyperinsulinemia-associated laminitis, and postprandial hyperinsulinemia is thought to be the greatest risk factor for laminitis associated with insulin dysregulation. Thus, nutritional management of insulin dysregulation is central to minimizing the risk for laminitis. In some cases, medications may supplement nutritional management to treat severe insulin dysregulation and decrease the risk for laminitis; however, nutritional management remains the most effective therapeutic intervention for equine insulin dysregulation and should be implemented, in some form, for all patients.<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Obesity and its associated health complications in humans and veterinary species are epidemic in industrialized countries, and horses are no exception. Additionally, as horses are now routinely living into their third and fourth decades, the prevalence of diseases of aging\u2014such as pituitary pars intermedia dysfunction (PPID), sometimes referred to as equine Cushing\u2019s syndrome\u2014is also increasing. <\/span><\/p>\n Equine obesity and PPID are both associated with insulin dysregulation (ID), a state of disordered insulin and glucose dynamics that encompasses basal hyperinsulinemia, exuberant pancreatic response to carbohydrates, and tissue insulin resistance. Affected horses can display 1\u00a0or more of these abnormalities, and equine ID is pathophysiologically and contextually diverse. However, given the established link between hyperinsulinemia and laminitis, as well as the fact that any<\/i> manifestation of ID can result in hyperinsulinemia, ID is an important point of intervention for therapy and prevention of laminitis in the setting of equine endocrine disease. Establishing a diagnosis and characterizing the severity of ID are essential to implementing and monitoring therapy, and the first line of therapy for mitigating hyperinsulinemia must be nutrition and diet management.<\/span><\/p>\n ID is a clinicopathologic finding that can be observed in diverse clinical situations (e.g., obesity, sepsis, corticosteroid administration, endocrine disease); yet, in equine practice, ID is most often associated with equine metabolic syndrome (EMS). EMS is a collection of clinical findings that includes hyperinsulinemia-associated laminitis (<\/span>FIGURE 1<\/b><\/span>), ID, and obesity (generalized or regional adiposity); together, these findings predict risk of future hyperinsulinemia-associated laminitis. Given the prevalence of EMS, signalment, physical examination findings, and clinical history can be highly suggestive of ID; however, definitive diagnosis requires specific screening and dynamic tests measuring glucose and insulin concentrations.1<\/sup><\/span><\/p>\n\n
Establishing a Diagnosis<\/h2>\n
Diagnostic Testing for Insulin Dysregulation<\/h3>\n
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