Managing Horses With Metabolic Problems - Ask The Horse

0:00Hi, everyone, and welcome to Ask the Horse Live. I'm your host, Hayley Peffer, digital managing editor at the horse.com. Managing a horse diagnosed with metabolic problems means understanding how conditions such as equine metabolic syndrome and insulin dysregulation increase the risk of serious complications, including laminitis. Horses with metabolic problems often benefit from controlled diets, low end sugars, and starches. Failure to prevent spikes in blood, insulin, and support healthy body condition. Regular exercise and weight management should be part of a comprehensive plan because activity can help improve insulin sensitivity and supports overall metabolic health. While there's no cure for these conditions, strategic research-based care can help improve your metabolic forces while being. This event is sponsored by DECRA. To answer your questions tonight, we are joined by expert panelists from Dr. Patrick Lowns of the University of Pennsylvania and Dr. Greg Schmidt with DECRA.

1:00Welcome to both of you. Thank you very much. Dr. Lowns, can you tell us a little bit about your background? Absolutely. So I attended the University College Dublin School of Veterinary Medicine in Ireland and graduated in 2020. I had grown up riding horses and knew pretty early on equine practice was where I wanted to be. And most of the first four years in my career and first opinion field practice, first with Rudin Riddell and Siretegas Springs, and then with the Penn's New Bolton Center, where I completed a field service residency program, and became boarded diplomat of the American Board of Veterinary Practitioners, specialized in equine practice. A little over a year and a half ago, I transitioned into a research position with the Van Neb's Laminatus and Endocrinology Lab here at New Bolton to further explore and interest in endocrinology and laminatus. Most of my research at the moment is focused on the improvement of early diagnosis, a management of equine metabolic syndrome with a focus on translational research.

2:00In other words, research that can be directly implemented into clinical practice. I look forward to answering some questions with you guys tonight. Thank you. And Dr. Schind, can you tell us a little bit about your background and your role with Decra? Sure. So I grew up in Ohio, where I was lucky enough to grow up with horses in my backyard. And I was a member of Pony Club, where as long as I can remember, as I got to be older, my question in sport of choice was eventing. And I also competed on the intercollegiate Gersache team in college. I graduated from the Ohio State University College of Veterinary Medicine. From there, I went on to do a private practice internship at BW Furlong and Associates in New Jersey. And then I practiced up and down the East Coast with a sports medicine-based practice for a few years. And then I moved across the country to Portland, Oregon, and was an associate at a practice called Columbia Equine Hospital

3:02for about four or five years there. And now I've been with Decra for five years. And I currently serve as the medical affairs lead for our equine team. So my role focuses on supporting the technical marketing and of our entire equine portfolio and leading our educational initiatives. And on a personal note, one of my family's horses Roy, he's been with us since 1998. When he was born, he has both PPID and EMS. So I'm very excited to be here tonight and look forward to the discussion. Oh, thank you. Before we begin answering questions, I want to remind everyone of our Ask the Horse Live format. We're starting with questions that were submitted during registration. If you're listening live and would like to submit a question, please do so via the chat window. We'll do our best to get to as many of your questions as possible. If you're listening to the podcast recording of this event and would like to join us live in the future, please visit the horse.com slash Ask the Horse Live

4:04to register for notifications. And with that, we're going to jump in. So our first question of the night is for you, Dr. Lounds. It's from Ryan and Florida who wants to know what the differences are between EMS, PPID and ID. Cool. Hi, Ryan. Thanks for a great question to get us started. So starting with insulin distribution. This is basically just an umbrella term referring to abnormalities in insulin dynamics, whether about the problems with insulin production and the pancreas insulin clearance liver, generalized insulin resistance or other insulin issues. With this, it typically boils down to, and the horse is hyperinsulinemia or elevated insulin concentrations in the bloodstream, which is what is responsible for causing endocrinopathic laminitis in these horses. Equin metabolic syndrome is a collection of risks factors for the development of endocrinopathic laminitis. The most important of these is going to be insulin dysregulation and the two terms have almost become interchangeable

5:05in every day use. However, another hallmark of EMS is abnormal fat accumulation, either regional, so that's your cresty neck, your fat pads on either side of the tail, around the shoulder, over the ribs, and behind the cell area. Or it can be generalized fat accumulation, so just overall obesity. Other features of equin metabolic syndrome include abnormalities and adipacines or fat hormones, particularly left and adipinectin, high triglycerides, altered reproductive cycles, and increased inflammatory markers. An important distinction between equin metabolic syndrome and PPID, is that equin metabolic syndrome doesn't have an age predilection, so it can occur in both young and older horses. For PPID, that's the cherry tree present to media dysfunction, also known as equincushions colloquially, and that's caused by a nine functional tumor or overgrowth on the cherry tree gland. This results in a production of excessive amounts of ACTH, and associated with clinical signs like abnormal haircuts or shedding,

6:06muscle wastage, weight loss, and general kind of ill thriftiness, abnormal sweating, which can either be anhydrasis or lack of sweating, or hyperhydrasis over sweating, increased water intake, and urination, decreased immune response, leading to increased rates of and severity of infections, such as dermatitis, non-healing core meal ulcers, abscesses, respiratory infections, and such, and we also see slower healing in these animals, PPID is typically a disease of older horses and their teens to 20s, where people tend to get confused between the three, is that it's quite common to have both PPID and metabolic syndrome concurrently in older horses. The jury is out, shown whether or not PPID truly induces insulin dysregulation of its own accord or if it just exacerbates it, and animals are already inclined towards metabolic issues, but it is generally accepted that the presence of PPID is associated with increased likelihood of having insulin dysregulation. That said, they are separate diseases,

7:07and not every horse with PPID has insulin dysregulation and vice versa, so it's important to establish the status of both diseases and animals when making management and treatment plans. Dr. Schmidt, Hanna in California asked how horse owners can tell if their horse might have metabolic problems, and are any horses in particular at a higher risk than others? Yeah, Hanna, and thanks for the great question. Basically, to simplify it, and as Dr. Lowns said, there is a distinction between insulin dysregulation and PPID, so I will start with the insulin dysregulation, equine metabolic syndrome, kind of category, where I think the best thing to look for is obesity, or specifically regional adiposity, or having these fat pads, so the things like the crusty neck and the fat pads on each side of the tail head are a really good clue. Also, any history of laminitis or hoofring changes

8:10can also be a really good clue that your horse may be dealing with a metabolic problem, and sometimes they're just an easy keeper who is resistant to weight loss despite diet and exercise strategies, so that can also be a clue to look for insulin dysregulation. For PPID, the most common early indication and the most easily recognized indication is a regional or patchy long curly hair coat and or delayed shedding. So you're definitely going to be want to monitor essentially just their hair coat and their shedding. That might look like retained guard hairs or those long, wispy hairs usually on the underside of their neck or belly. That can be a hint of that as well. And then PPID, another common sign is just a loss of muscle, so you might notice that the top line muscle is just attributing or lost in general there,

9:12or a change in attitude, things like lethargy, an abnormal sweating can also be a sign or a clue of PPID. And then regarding horses at higher risk, again, just strictly speaking about insulin dysregulation, there's sort of a long list of breeds that tend to be at a higher risk. So ponies, miniature horses, Iberian breeds, like and allusions and lucetanos, I feel like they all have a cresty neck, gated breeds, like saddle breads, pacifinos, morgans, Arabians, warm bloods, and I also would like to throw in just any easy keeper breed. This may be a horse that you don't know essentially what breed it is, but it is certainly an easy keeper. It may have a genetic predisposition to EMS or insulin dysregulation. Any horse can develop it too

10:12with improper management or a diet. So predispose breeds are certainly more susceptible, but any horse could develop insulin dysregulation with improper diet. For PPID, it really just comes down to age. It's more prevalent in horses that are older. It can be, it's reported as to affect 20% of horses 15 years of age and older and up to 30% of horses older than 30. So really, the risk factor there is, is really just older age. Dr. Lounds, Carrie in Australia wants to know what the process is for testing hay, and how to know if the hay is safe for metabolic forces. Okay. Hi, Carrie. Thanks for the question. So for some people that your hay provider may be actually able to provide you with a hay analysis, if they do it routinely anyway.

11:13But if they don't do them routinely, or you go your own hay, a good resource for getting your hay tested is often going to be reaching out to your local agricultural extension or agricultural school. Once you find somewhere to send your hay, they will likely walk you through exactly what kind of sample they want you to send. In an ideal world, you would test every single bail, but that's not usually practical in the real world setting. So you will take a representative sample of each batch. Instead, this usually means taking samples from 10 to 20 percent of the bales in the batch using a hay core. It's important to repeat the hay analysis for each batch because the analysis can change with season, year, or even area of the field. The hay was harvested from, if there's a difference in sun exposure, soil composition, composition, or moisture. Ideally, with metabolic courses, where Emmy per hay is within a season, or non-structural carbohydrates less than 10 percent, NSC trends lower in more mature hay

12:14and warm season grasses are a little game hay, but this isn't a hard and fast rule. And the only real way to ensure a hay is low NSCs to have it tested in terms of safety for your horse, you can also evaluate your horse's individual response to hay by having your veterinarian do a meal challenge if they have the availability and the schedule to do that for you. This would typically require fasting. The horse for about four hours then pulling a baseline insulin, feed the hay and repeat an insulin about 90 minutes post-introducing the hay. And this will tell you if the hay is inducing an insulin spike in your specific horse. NSC and hay can be further lowered by soaking, preferably in warm water for about 16 minutes prior to feeding. We don't typically recommend prolong soaking more than three hours and definitely not overnight as this can lead to increased likelihood of mold growing. Dr. Schmitt,

13:14Sheila, if you asked if supplements can help a horse with the idea, if so, how can she tell if the supplement is high quality? This is such a great question, and I have certainly tried a few supplements for Roy over the years as myself. are actually some supplements that have shown modest improvement in glucose and insulin dynamics and horses. There's a couple of them contain resveratrol or blends of antioxidants and polyphenols or plant-based metabolic compounds typically found in red grape skins or berries. So there's some evidence that resveratrol or supplements that contain resveratrol could be helpful. There's also been some recent work looking at the mineral chromium. It has been shown to enhance the action of insulin and one study at least in horses supplemented with chromium did show that they were able to kind of mitigate the increase in glucose.

14:31It's a possibility, but still there's a lot we don't know about chromium and we don't even have a recommended daily requirement for chromium. So it's still kind of an unknown there. And most recently, actually, there was an ingredient with a name that I will not try to pronounce, but it's abbreviated as one DNJ. It's a naturally occurring alkaloid commonly found in mulberry leaves. So you'll probably hear about supplements that advertise using mulberry leaves. There's one particular supplement or sorry, the compound will help to limit carbohydrate breakdown and therefore limit the ability to absorb the sugars from carbohydrates. So it's kind of a unique mechanism of action there where it can potentially block sugar absorption. And this one study found that if it's given an hour before feeding twice a day, there was some attenuation of the insulin response after a meal.

15:43So potential for that to be helpful as well. When it comes to assessing quality, I usually look for either a bet recommendation or evidence of research in horses and metabolic courses specifically and that research is limited so far. So there's not that many of them that have kind of checked that box for me, but there's at least an interest in this and there's definitely ongoing work in this. So there could be more ingredients and more supplements in the future, but Dr. Lowns, do you know of one that I've missed? No, you've hit all the ones I would have mentioned. Yeah, like I said, they're just at this point, still kind of a limitation there of just not a lot of work has been done on that topic.

16:46Thank you. Dr. Lowns, but he and Illinois asked what a veterinarian might consider an SGL T2 inhibitor for a very overweight ID and PP ID horse. Hi, Becky, so this these SGL T2 inhibitors are pretty hot topic in the veterinary world at the moment, and we've actually been doing some research in them ourselves. I tend to base my decisions in these cases on what the insulin is doing and if there is active clinical laminatus. I usually classify horses as mildly moderately or severely distracted, I consider severely distracted animals to be ones with those kind of three figure insulin. So 100 micro international units per mil or above. And these animals are the ones that are high risk of having a laminate episode if not already experiencing one. And so I, these are the ones I would tend to reach for the SGL T2 inhibitors on because I want to get that insulin down fast and get information under control in order to buy myself time to implement diet exercise and management changes and address exacerbating factors such as ways for uncontrolled PP ID before we have a laminate crisis on our hands.

17:58Ultimately, to me, SGL T2 inhibitors are rescue drugs. So in horses or ponies where the dysregulation is mild or even moderate. Usually there's enough time in my experience to try implementing diet and management changes first before jumping to pharmaceuticals. I think it's important to remember with these drugs that they're there to complement the traditional approach to management, not replace it. This is particularly true. I feel with the SGL T2 inhibitors, which control insulin and do it very well, but don't actually seem to improve overall metabolic health outside of maybe some weight loss side effects, which is why we can see insulin rapidly increase following discontinuing these drugs if exacerbating factors such as the way diet management, etc. I have not been addressed. Dr. Schmidt, Jennifer wants to know how to handle a mare in late gestation who also has metabolic problems.

18:59Yeah, this is a great question to Jennifer and number one, I'll have to say the best thing to do is to work with your vet and to have a plan. Either before she reaches late gestation or hopefully before she reaches falling, but as with any horses with metabolic problems, it's going to be best to maintain a low NSC forage based diet, have controlled energy intake. I'm trying to minimize any hyperinsolemia, provide appropriate exercise to if it's safe for the pregnancy, even if it's just walking. And then definitely monitor body condition, very regular to regularly, you definitely want to avoid excessive weight gain. I also think that your vet and you can work together to come up with a plan to monitor specific metabolic parameters and that will give you the information you need to adjust the diet safely as she goes through her pregnancy.

20:08And then if the mare is managed with any medications, this is particularly important for PP ID, it is important to work with your vet to have a plan for those specific medications. For example, purgolide treatment can affect lactation and so you'll want to again plan ahead and talk to your vet about the best approach for managing the PP ID and the treatment plan in that late gestation kind of following timeline. I'd also like to throw in there that some of these insulin regulating drugs are not advised to use during a pregnancy, as she altitude inhibitors have been associated with fetal abnormalities and humans. And pilot later on has also been associated with the late maturation of species and humans. Yeah, and those drugs not being fully investigated and FDA approved at this point, we just don't have all that information at this point. So it is, yeah, that's a great point is to be very careful with all of those.

21:20Dr. Lounds, but in our live audience says her mayor became overweight due to a number of reasons and the blood work showed an increase in insulin and glucose. But once she lost the weight, the values were normal is her mayor still considered to have insulin dysregulation. Yes, I would say she's got at this stage what we would refer to as well controlled insulin dysregulation and likely in her case, her obesity was the main exacerbating or driving factor in her insulin dysregulation, but I would still I wouldn't count her safe at this stage because obviously she's got the little predisposition there, not every course that becomes obese actually develops insulin dysregulation. So I would consider her a well controlled insulin dysregulated or metabolic course. Thank you. And Dr. Lounds norm from Ontario as if you can explain the risks associated with allowing metabolic forces on pasture.

22:24So high norm, fantastic question. The main problem with grass pasture is that it is very hard to predict and control one, how much is being consumed by the horse and to how much NSC there is in the pasture. So studies looking at consumption have in the average like 500 kilogram or 1100 pound horse will typically consume one to 1.4 pounds and grass per hour, which if you've got a horse on pasture 24 seven at the upper end would be nearly 1.7 times maintenance requirement. Hence why some horses got fat on grass pasture. Muzzling can restrict this intake, but the amount of decrease we see varies from 30 to 80% decrease depending on the study. This variation can make managing weight well out on pasture very difficult. The NSC is another problem depending on the type of grass and the season. It can be extraordinarily high NSC reported up to 40% NSC, which is not ideal when we're trying to keep our NSC of our diet below 10%.

23:30NSC and grass is also extraordinarily variable influenced by season growth stage rainfall and even time of day, meaning that grass that was safe one week may not be safe the next for your horse. We're in sugar than some of the common cool season grass haze that we think of. So it still needs to be proven that it's low in sugar and I still would test it and make sure that the NSC concentration is low, but that is ultimately the one benefit that we keep going back to alpha hay for so that it can be lower in sugar than the cool season grass haze.

24:47Still comes with some risks. It definitely is tends to be higher in calories and protein, which can contribute to weight gain. So if you've got, you know, that easy keeper metabolic horse. Sometimes you just have to offer them such a small amount of alpha hay that they're still not exactly satisfied. And the high protein itself may occasionally stimulate insulin in some individuals. So you still want to monitor that insulin need be a response with an alpha based diet as well. Potentially, you know, beneficial, but it's still very important to test your hay and work with your veterinarian or a nutritionist on formulating a well balanced diet. Dr. Lounds Leslie in California asked what the best weight management strategies are for horses with metabolic problems.

25:48Dr. Lounds Leslie, a very pertinent question. So when dealing with overweight horses, stringent calorie restriction really is going to be your best bet. We typically like to start with feeding forage at about one and a half to two percent ideal body weight per day. So when I say ideal body weight, I mean, that's the way I would like the horse to be rather than what the way it currently is. The first way to do this is to actually weigh out your hay and a hay net for each feeding and this can be done with a handheld luggage scale. We typically give this about four to six weeks to see some movement in body weight. Before getting a little impatient, if weight isn't budging, you can drop as low as 1% ideal body weight in stubborn cases, but I really wouldn't recommend going below that because then you can start dealing with problems like gastric ulcers. If you're not going to not forage in the diet, I'm soaking hay to remove water soluble carbohydrates can also decrease the calories of the hay, so that can be another great tool in your kit.

26:51If you've got one of these stubborn cases, again, as discussed in the answer to norms question, restricting forage appropriately can be difficult and horses on pasture because it's hard to gauge exactly how much they are getting. If you have access to a dry lot, that's going to be very helpful in appropriate weight management. Otherwise, there may be some trial and error to getting the balance with forage correct. Another big thing is if feeding a ration balancer, you do actually want to check for this low NSC because not all ration balancers are created equally. You can usually do this quickly yourself by adding the sugar and starch percentages on the back of the bag if they're there. If they're not there, you can check the feed website or mad burn has a lot of nutritional information on the common feeds available. Increasing exercise where possible is also helpful not only weight loss, but even just improving metabolic health. If dire restriction and exercise alone are not working, then you could also discuss the addition of leverferoxin sodium with your veterinarian.

27:56This is a synthetic thyroid hormone, the purpose of which is to increase metabolism to drive weight loss, but it must be used in conjunction with dietary restriction or else it will just result in the horse eating more and not losing weight. If you've got the opposite problem, so one of these so called skinny metabolic courses, which can often happen when you've got concurrent ppid and metabolic syndrome. Then you want to focus on a high fat for quality protein diet to increase calorie intake in a safer manner than these high carbohydrate diets. The question is June and Pennsylvania wants to know what health problems are common and the worst is with metabolic problems besides limititis. Yeah, so laminitis is definitely the number one concern, but besides laminitis, horses with insulin dysregulation can of course be in a hyperinsulinia state or high insulin high blood insulin concentration.

29:03At this point, it's sort of considered to be a pro inflammatory state so they could be at risk of sort of any condition that involves inflammation, although that's not a whole lot of specific correlations so far. With ppid, there is quite a long list of potential secondary health problems or core mobilities, including things like tendon and ligament laxity or even tendon and ligament injuries, infertility, exercise intolerance and altered mentation, which typically looks like lethargy. And have some random things like chronic infections and recurrent corneal ulcers as well, so definitely ppid is the is the disease that oftentimes comes along with additional health problems.

30:08Dr. Lowns, Rosanne and Iowa has a 14 year old pony that is limited and will grass ever be safe for this mayor again, and could you tell us why or why not. Hi, Rosanne, unfortunately I cannot speak directly to your case, as I don't know all the particulars. I think the main thing is that there will always be risks associated with grass when it comes to metabolic horses, though that risk can be very variable from horse to horse. There are some patients where obesity and uncontrolled ppid have been the main driving factors in their insulin dysregulation, and one of those things were under control. They could be managed on limited grass turn out with a nozzle. But then I've also had others that even with everything else under control still can tolerate any grass turn out without getting sore again. So again, as discussed in the answer to norms question, the NSE and grass can be very variable, which means that just because a horse appears well managed on pasture doesn't mean they will continue to be as season and weather conditions change.

31:11This means the safest place for these animals really is in the dry lot of possible. So I do realize that isn't possible for everyone. If you don't have a dry lot available, turn out should be restricted to early morning when the NSE and the grass is at the lowest. And keep in mind in temperate climates where there's seasonal change early spring and late fall are going to be high risk areas as the grass is storing an SC with a slow growth rate. And periods of drought are also going to be high risk for the same reason. So Dr. Schmitt, Sarah Pennsylvania wants to know how she can balance palliability with safe feed options for a key metabolic force. Hi Sarah, this is such a great question such a tricky question because picking this can be such an individual thing and certainly make it quite a challenge to feed some horses anything at all.

32:13But you will want to stick with low NSC, a diet and then that palliability might be something where you find a nutrient balanced balancer or ration balancer that your horse prefers there's several on the market, I would just again, as we've noted before, look, make sure you're looking at the label and making sure that it is truly low. Truly low NSC, but some horses just have a preference for one ration balancer over another something that I've done myself to is try to mix in some safe fiber so low NSC, hey pellets soaked things like beet pulp without molasses sometimes horses prefer that also some tips like gradually reintroducing. Or introducing new feeds and then just monitoring their acceptance of the feed as best as you can and making the changes as needed, but this is certainly very tricky some horses are just, you know, turn up their nose at anything that doesn't contain a bunch of molasses so.

33:33And Dr. Lowns, do you have any tips or tricks for these picky eaters. I wish now your answer was fantastic. Yeah, it's just the it's just a tough thing to deal with the horse that's got a limited menu options and being picky on top of it. For sure, Dr. Schmidt Raven in our live audience says she's had a horses that have had appetite suppression with the introduction of purgolide, do you have any tips for avoiding this and getting them eating again. Yeah, that's a well reported adverse or side effect of purgolides anorexia or appetite suppression so. The label will describe cutting the dose in half for like two to three weeks and then gradually reintroducing the needed dose some veterinarians as well will start their horses that they're treating on a lower dose and they know is necessary and then gradually build up to.

34:44A dose that the targeted dose essentially purgolide should also be titrated to affect as well so anytime you're making a dose adjustment it's best to make those adjustments as small as possible and then as gradual as possible as well. Dr. Lowns, Terry and our live audience would like to see what you think of using tepe or tepe pellets to help a metabolic horse lose weight. Yeah, so tepe is one of those and tepe is one of those grasses that does trend a little lower typically on an SC. However, again, just because it trends lower doesn't mean every single batch is actually going to be low NSC so it's still worth getting a proper high analysis done if you're using the hay if you or if you're getting it as bagged to have again those normally an analysis on the bag that you can check out and just ensure that it is low NSC but it can be a good option for these metabolic courses.

36:02Dr. Lowns, Judy and Canada asked if there's any link between EMS and the media. Hi Judy, so I found this question very interesting because I hadn't really thought about there being a link between EMS and anemia before so I did go on a little dig through literature for you. And what I find was one author that said they had observed anemia in horses with metabolic syndrome that had liver damage secondary to hepatic lipidosis. So in those cases, the anemia is more likely related to that liver damage than the metabolic syndrome itself and I couldn't really find any other potential links between metabolic syndrome and anemia thanks for the question. Dr. Schmidt, Don and Texas wants to know how to develop a diet for a horse with ID. Hi Don, this is a great question. It's a complex question too short question but pretty complex so I think the steps that I would keep in mind is think about your forage first and again you want to feed a lab tested low NSC hay limit pasture intake.

37:19So control turnout times muzzle use dry lots are great for getting horses outside without all that exposure to lush green pasture definitely restrict grains and sugary feeds a little completely eliminate anything that's a high starch feed and then you still want to include balanced nutrients so providing vitamin and mineral balancers. And making sure that they are getting a balanced diet without the excess of calories is very important. And then you always need to monitor these horses and monitor them especially after a diet adjustment to make sure that you're adjusting the caloric intake to achieve that target weight and body condition score that you're looking for. So it is a little bit of extra work but it's never typically a set the set the diet and stay on it for the rest of their life it's usually adjustments made throughout.

38:27So I would I would say best thing to do is to work with your veterinarian equine nutritionists are very helpful as well and just you know customize that diet plan and then make a make a plan for re evaluations and adjustments has needed. Dr. Lounds we've talked a bit about treatment and management but Rebecca in North Carolina asked if there are any ways to prevent a horse from developing PP ID or yes. Hi Rebecca million dollar question i'll start with PP ID the simple answer right now is unfortunately now there's a lot of research currently ongoing looking into risk factors and pathogenesis for this disease. One day might lead to a different answer to that question but right now the answer is now unfortunately. For equine metabolic syndrome keeping weight under control and keeping your horse fit and active is going to go a long way into keeping equine metabolic syndrome insulin dysregulation at bay.

39:30Even just 15 minutes of light exercise five days a week has been shown to improve insulin dynamics and other connecting concentrations over a six week period. And this is important because out of the neck then has been suggested to have a protective effect against the development of ID on laminatus and pennies and research out of the UK. It's also worth considering the low and a seed diet can be beneficial and animals without metabolic issues currently as well and focusing on providing calories through good quality protein and fats instead of in active horses. I think though it's also worth keeping in mind that even fit active horses can develop some low degree of metabolic issues and those can start to rear their heads if an injury occurs on the horse ends up on stall rest. So another important thing is going to be regular screening in at risk courses to identify and address a problem before it progresses to laminatus.

40:32Ideally, this would be performed by doing oral sugar tests once or twice a year, but that's often not feasible due to the time it takes to perform that test. So an alternative is to do a single blood draw for either resting or pro-sprandial insulin when I say pro-sprandial insulin, I mean the blood is drawn two hours after a grain meal is given and this kind of works as a poor man's meal challenge. The problem with this obviously is that single that insulin displays a lot of biological variations so single insulins can be unreliable and you can't always take a normal insulin for granted when you're just doing a baseline insulin. So together and this we typically also run out of connect and then left in this part of our screening process. These are both fat hormones out of connect and is typically considered a good fat hormone. With insulin sanitizing and anti inflammatory properties and is much more stable than insulin under a number of different circumstances.

41:35Lectin is associated with adiposity or fat body fat percentage. So low adipanectin as I discussed has been associated. Adipanectin is thought to be protective of against ID laminatus and low adipanectin has been associated with both increased likelihood and risk for ID laminatus. And has also has weak associations with ID by itself, but we are preparing research for publication, showing that the ratio of leptin to adipanectin, which has been frequently used in human medicine is a better marker for both presence of insulin dysregulation and laminatus and either adipanectin or leptin alignment forces as well. So this can just kind of improve the quality of our single strong blood test. So a little bit when we can't do the dynamic testing. Dr. Schmitt, period Utah wants to know what causes of forces insulin levels to spike and how long it usually takes for them to return to normal. Is any spike in insulin considered normal?

42:42So the cause of insulin spikes is really eating usually carbohydrates, which linked especially to non structural carbohydrates or NSCs and some links to high protein diets as well. We're thinking about sugars and starches though, so hay and pasture and concentrate. So after a horse eats these things, the glucose surge and their blood occurs and that triggers the insulin release stress and external factors can also alter insulin response as well. And with insulin dysregulated horses, they just happen to produce a larger insulin spike in response to the same meal that a normal horse might receive. But regarding your timing in normal horses, insulin rises after eating and then it generally returns to baseline approximately two hours after a carbohydrate meal in insulin dysregulated horses that insulin can remain elevated for much higher level and also much longer levels and that's going to be based on individual.

44:08And then the last question is any spike in insulin considered normal? Yeah, basically any insulin response after eating is normal. It's just those excessively high peaks or excessively long peaks that we're looking for and that's how we base our diagnoses on insulin dysregulation. And they're like even the normal peaks. So when we're talking about a high peak, if you are lab are cut off for normal resting is 20 and post neural sugar test is up, it only goes up to 30. So that's when we challenge them, we still expect them to be less than 30 if you're using Cornell's lab, I believe they're resting is about 30 and they're cut off for post neural sugar test is 45 so these still aren't massive peaks. If you're going up to 67 the 80 gossip normal. Yeah, more like a small rolling hill versus a mountain.

45:15Dr. Lowns, Carol from our live audience would like to know if experiencing a traumatic event can cause an upswing in a horse's cortisol raising the insulin level and even leading to a limited episode. Normally, not because to induce laminitis, it needs to kind of be. As Dr. Smith said in that last, it's not just a once off peak is about the sustained peak we're seeing after. So it's not going to be okay, we went up and we came down in a matter of hours, it's going to be we went up and we stayed there for 24 48 hours and normally a stress hyper insulin is going to stay up like that for that long. Dr. Should Holly from our live audience wants to know insulin dysregulation affects glycogen levels and muscle tissue and how it might she has a horse with generalized body pain and thus far muscle biopsy revealed depleted glycogen and blood work indicates insulin dysregulation.

46:33That is a great question depleted glycogen and muscle biopsies is. And Dr. Lowns, you know if there's a correlation there, I haven't heard of one myself. No, I'm not familiar with one either, I was saying more likely there's two different disease processes. Yeah, that's what I was just going to thinking as you you probably found two issues at the same time. Thank you. Dr. Lowns, Linda asks if DSLD could be related to metabolic problems. Hi, Linda. So it has been suggested that horses with PP ID are more susceptible to degenerative tendon and ligament injuries, either due to reduction in tensile strength or delayed healing. And there has been one paper suggesting a link between PP ID and DSLD, but unfortunately the literature is still a little bit lacking in this area.

47:39Dr. Schmidt, Melissa in our live audience says her eight year old mini was recently diagnosed with ID and PP ID. She just started the mayor on percolide and the metabolic supplement and the mayor has mild laminitis with an insulin of 200. So should she consider giving an SGLT to inhibitor? Well, I would definitely talk to your vet about the plan and especially when the plan is to re evaluate that insulin level. We definitely want that insulin level to come down 200 is out of my comfort zone for sure. But there may be. We have to give it some time and especially if we've adjusted the diet. You know, that could take weeks to get that sometime. So I think it's a consideration for sure, but I would definitely continue to work with your veterinarian and make sure that you're building in regular re checks re evaluations to assess that insulin level and monitor the decrease of that insulin level.

49:01Dr. Schmidt Deborah in Vermont wants to know generally how percolide works to benefit horses with PP ID. Sure. So going back to the first question, just a little review of what PP ID is, it's essentially a progressive age related degenerative disease, which affects neurons in the brain that release dopamine. So essentially, PP ID horses aren't releasing enough dopamine and therefore they lose the inhibitory breaking action. So to speak of dopamine on the parser media or on the pituitary gland of part of the pituitary gland. So they end up with this excessive overproduction of hormones, essentially. So percolide is a dopamine agonist or basically a dopamine receptor stimulant so it can hopefully replace that missing inhibitory dopamine signal from the hypothalamus or from the brain and reduce excess of hormone production.

50:17And it has been shown to reduce the clinical signs of PP ID as well as improve the results of endocrine testing or basically reduce the ACTH levels that we test for to make the diagnosis of PP ID. So essentially, it's just kind of replacing that dopamine action that those horses have lost with the generation. Dr. Lounds pays in from our live audience would like to know if a horse is known to have a history of metabolic issues. So that impact decision to breathe that horse. Yeah. So I think it definitely needs to be a consideration when you're choosing to breed that horse. I personally don't think it needs to rule the horse out completely, but I do think you need to keep in mind that mayors naturally see a decrease in insulin sensitivity peripherally during the third trimester as they're kind of chanting glucose to the ground fetus.

51:31And then can get some hyperinsulinemia, even in normal metabolic, which are just typically normal metabolic animals in that third trimester. And obviously, if you have a merit that is already prone to metabolic disease, she's more likely to have issues in that third trimester and could be at risk of gestational laminatus as discussed before in the question about feeding your metabolic food mayor. I was calm down to managing the feeding in that time period. A lot of these food mayor agrains tend to be quite high and see so finding one that is lower and see if she even needs a grain supplement in that third trimester. I'm a year she's falling out of the quality. Hey, forage diet with a ration balancer may be enough. And I would monitor her regularly throughout the pregnancy monitor insulin status and just keep an eye and make sure she looks comfortable isn't getting put sore any signs of laminatus.

52:43And it's also worth mentioning that mayors with metabolic syndrome can be a little bit harder to get in full because they can frequently have reproductive issues as well. And Joy and Oregon asked how long she should soak her metabolic forces pay to remove enough sugar and make it safer for him to consume. Yeah, that's a great question. Very practical question and I find there's quite a lot of information out there. So essentially soaking hay in water can reduce water soluble carbohydrates and help, you know, lower that overall carbohydrate concentration. I think currently the best recommendation it comes from the equine endocrinology group and they say to soak it for at least 60 minutes in cold water, especially if the hay is above a 10% NSC concentration.

53:47Now there have been studies that have shown that warmer water can have a similar effect in a shorter amount of time. So for example, 22 degrees Celsius or 72 degrees Fahrenheit ish soaking hay for 30 minutes can decrease the water soluble carbohydrate concentration by like 23 to 30 ish percent. That's pretty good in a 30 minute time period, but the water does have to be warm and, you know, you need kind of a lot of water to soak hay. So it could be a tricky to get that much water warmed up to 72 degrees Fahrenheit. The other thing with soaking hay, which was mentioned before too, is that it can make the hay kind of it key for lack of a better word. And so in warm weather, especially we want to sort of limit the soaking to maybe one to two hours.

54:50Definitely not overnight. Also excessive soaking will you'll lose the minerals and trace elements. So to simplify my answer, I usually go with a cold water soak and I aim for like one to two hours. How about you, Dr. Lounds, what's your general recommendation for that? Yeah, we we generally recommend sucking for an hour to 90 minutes. If you can do warm water, great. If you can't cold water works. Dr. Lounds, this will be our last question of the night and it's from candy and Ohio who wants to know if horses who have found it in the past can ever be comfortable barefoot and do these horses benefit from corrective chewing. Good question. So the main thing is we try to address from a biomechanical point of view is going to be the strain put on the in these laminate courses is going to be the strain, but on the lamella from the action of the deep digital flexor tendon on the coffin bone, which is what's kind of responsible for causing these rotational changes, we see on radiographs and then we also want to ensure there's enough cushion protecting the coffin bone from the concussive forces of the hope against ground.

56:07As when you get rotation and or sinking, we do lose some of that soul death and the national and that natural cushion of the soul. So yes, the best way to do that is going to be through corrective trimming and chewing. We typically reduce the strain from the deep digital flexor tendon by using breakover, this can be done by bringing back the toe using a bevel shoe and or a final wedge. Well, also implementing the rotational trimming pads and impression material can be used to provide more cushion in cases with decreased soul depth. If you want to avoid putting on shoes, you could consider a softer either cloud boots, which have a wedge bevel and padding built into them and are especially designed for management of laminate courses. If the rotational trimming is successful and soul depth can be improved, it may be possible for a horse to become comfortable for it again, but there's no guarantees.

57:07A lot also depends on the severity of the changes on radiographs, so this definitely going to be something you need to work with your veterinarian and your failure in tandem. And the other big part of the process is going to be making sure that insulin stays well regulated so that no further damage occurs to lmla while you're trying to address these biomechanical aspects. So all the time we have for tonight, but thank you both for joining me. Thank you very much. Yeah, thank you and thank you to the audience for all the great questions. Yes, definitely, thank you for these great questions and thank you to Decker for sponsoring this event. I really thank you to everyone who listened tonight. If you're listening to us after the live event as a podcast episode, please rate, review, subscribe and recommend asked the horse live to a friend.

58:07Until next time from everyone at the horse, have a great night.