Equine Metabolic Syndrome And Elevated Insulin Levels

Abnormally high insulin levels are a hallmark of Equine Metabolic Syndrome (EMS) and increased risk of laminitis, but there is discrepancy between veterinarians on how to best test for abnormal insulin levels. Years ago, horses were fasted before blood was drawn to test the insulin level, but many horses were testing negative after fasting because horses don’t maintain high glucose and insulin levels. It was determined that EMS is not the same Human Metabolic Syndrome, or type II diabetes. Humans with type II diabetes have insulin and glucose levels that remain high after being fasted.

Also at issue was what was considered “normal.” In the fasting test, 20 uIU/mL was considered the baseline. If a horse was below 20 uIU/mL, he was considered negative for EMS. Recent studies have shown that 20 uIU/mL is a typical response to a gain meal rather than fasting: This high threshold resulted in a lot of the horses being correctly categorized as positive, but many more horses were categorized as normal that were not.

Challenge tests were then designed to identify positive EMS cases that were missed by fasting. These included feeding Karo syrup, glucose powder and grain—each of these took more time and money and were not without risk.

The better approach was to find a more-accurate fasting insulin level. This was determined to be 5.2 uIU/mL—significantly different than the 20 uIU/mL used previously. Scientists also pointed out that “normal ranges” of insulin should be defined by the feeding situation.

The Equine Cushing’s and Insulin Resistance Group Inc., (ECIR) recommends testing horses that are eating hay or pasture that is low in sugar and starch for their glucose and insulin levels, and classifying them from these results.  There is a calculator that can compute the proxies here. The proxies ECIR uses have been developed from what has become the “gold standard” in insulin resistance testing,

Read more here.

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