The Horse

OCT 2017

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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32 THE HORSE October 2017 are certainly beneficial in terms of keep- ing the insulin concentrations down," Frank says. This can be a challenge for many owners. "More and more horse owners just don't have the time to exercise their horses regularly, so they're essentially companion animals," Frank says. "But ideally, we recommend that ID horses get exercise every day or every other day, to a level that is producing significant work: trotting, cantering, etc. He needs to be breaking a sweat." Medications, As Needed Indeed, for the most part, good dietary and exercise management will do the trick for the ID horse. But some horses can be severely affected—and you can see that on tests revealing their insulin response levels. These horses might need drugs to keep their syndrome in check. "Severely ID horses are really chal- lenging to manage and tend to keep high insulin concentrations despite ideal management," Frank says. Synthetic thyroxine (a thyroid hor- mone) can speed up metabolism to help reduce the development of fat deposits. Meanwhile, metformin (an anti-diabe- tes drug) can help "blunt the insulin response to the sugar in the diet," says van Eps. "It seems to have a local effect in the gut to reduce the absorption of sugar, so it may be most helpful prior to mealtime or turnout time in horses that produce too much insulin in response to oral sugar." Both drugs are available by prescrip- tion only, so check with your veterinarian if you feel your horse needs some extra help. Anti-Surprise Screening An important part of managing an ID horse is regular evaluation—inside and out. Keep an eye on his body condition, making sure he's not gaining (or losing) too much weight, and don't forget to consider what you can't see. Periodic oral sugar/glucose testing can reveal how the horse's insulin reactions to sugars have evolved over time. "Age and body condition will affect insulin concentrations, so a yearly test would be wise in a previously diagnosed case," van Eps says. With age comes an increased risk of related diseases such as pituitary pars intermedia dysfunction (PPID, or equine Cushing's disease), adds Frank. This is particularly concerning in an already ID-diagnosed horse. Having a veterinar- ian test and evaluate your horse for early signs of PPID can give you a head start on management. Finally, don't forget hoof radiographs (X rays), says van Eps. "The laminitis you see in these horses can be really insidious, and the horse might not necessarily be overtly lame," he says. "Sometimes people are really shocked at how advanced the laminitis is on radiograph, so evaluations once or twice a year in an established (ID) case can avoid a nasty surprise." Staying Healthy The ID-affected horse isn't physically fragile. But he can certainly be more susceptible to laminitis if his condition is complicated by other health problems, says Frank. "It takes very little to push the severely affected horses back over the edge into laminitis," he says. Beware of disease processes that increase laminitis risk—infections, fevers, intestinal diseases. "In a horse that al- ready has very high insulin concentration, these events could push them up into the danger level," he says. "So good medical care is even more important." Genetics and New Therapies Researchers are honing in on equine ID's genetic components, with the goal of knowing what genes are associated with the syndrome and how we can manage them. "We might even be able to breed it out of some lines of horses, and that would be the Holy Grail," van Eps says. Other teams are studying the processes that cause the intestinal cells to signal the pancreas to produce insulin, says Frank, who adds that he is "optimistic" about these studies. "The question is, could we somehow block those hormones so they wouldn't stimulate release of so much insulin? Some new drugs, currently in the research phase, are aiming for that." And van Eps' group is working with collaborators on clinical trials for drugs that should interrupt insulin's effects on the feet. "In the next couple of years we could see some meds that arrest those negative effects on the lamellae," he says. Take-Home Message Insulin-dysregulated horses can lead happy, healthy, active lives and perform at upper levels just like any other horse. The key is ensuring that we manage their syn- drome in a way that's consistent with the latest scientific recommendations. Just as importantly, owners of ID and ID-prone horses need to have a grasp on what insulin is and does and how glucose can cause problems. Armed with these tools, they can offer their horses every chance for optimum health and welfare. h Horses with ID benefit from high levels of exercise every day or every other day, ideally. ISTOCK.COM The laminitis you see in these horses can be really insidious, and the horse might not neces- sarily be overtly lame." DR. ANDREW VAN EPS Grasping Insulin Resistance

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