Commentary: Changing Tides in IR Interpretation

One veterinarian describes options for determining insulin sensitivity in horses.
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In 1999, I was told, “everyone knows blood insulin and glucose are too variable to be of any use.” However insulin resistance (IR) and equine metabolic syndrome (EMS) have been the focus of much research for the past 10 years and blood insulin and glucose levels do have their purposes when appropriately used and interpreted.

A widespread perception exists that any elevation above “normal” in plasma insulin (hyperinsulinemia) indicates EMS and a significant risk of laminitis. However, diagnosis is not quite that simple.

There are indeed a number of factors that influence fasting glucose and insulin responses to dextrose or sugar challenges and tissue sensitivity to the actions of insulin. These need to be taken into consideration when evaluating an IR/EMS suspect. We now know that not all obese horses are IR, nor are truly IR horses, ponies, or donkeys at high risk of laminitis always obese. Stress and acute pain can also induce IR.

Hyperinsulinemic responses to sugar challenges and mild fasting hyperinsulinemia are normal in horses adapted to high starch/sugar feeds. This is an adaptation that allows rapid return to normal blood glucose levels after ingestion of high glycemic index feeds and does not pose a health risk to the horse. The return to baseline insulin concentrations is actually faster than in horses not accustomed to ingestion of grain-based concentrates, so previous rations need to be taken into consideration

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